The acute vestibular dysfunction in emergency neurology

2021 ◽  
Vol LIII (1) ◽  
pp. 28-33
Author(s):  
Aleksandr Yu. Kazancev ◽  
Eduard Z. Yakupov
Keyword(s):  
Emergency Room ◽  
Benign Paroxysmal Positional Vertigo ◽  
Vestibular Disorders ◽  
Clinical Hospital ◽  
Hunt Syndrome ◽  
Positional Vertigo ◽  
Diagnostic Center ◽  
Life Threatening ◽  
Vestibular Pathology ◽  
Paroxysmal Positional Vertigo

The aim of this study is to research the structure of acute vestibular disorders at the stage of the emergency room and to determine the frequency of occurrence of life-threatening conditions. Material and methods. It was made the analysis of acute vestibular disorders at the stage of emergency room of the Neurology department of Clinical Hospital No. 7, City Clinical Hospital No. 18 and stroke center of Interregional Clinical Diagnostic Center in Kazan, Tatarstan Republic, Russian Federation, for the period 20162020. The diagnosis of vestibular disorders was established on the basis of clinical data. There were additional instrumental researches made in doubtful cases. Statistical data processing was made using Microsoft Excel 10.0 program. Results. The study included 106 patients in total with reliably established pathology of the peripheral or central vestibular system. The peripheral or functional nature of vestibular disfunctions were identified in 84% patients. 57% patients had benign paroxysmal positional vertigo. 42% of these patients had repeated benign paroxysmal positional vertigo attack. Vestibular neuronitis and Ramsey Hunt syndrome were detected in 15% patients. Acute cerebrovascular origin was diagnosed in 10% patients (10 ischemic strokes and 1 transient ischemic attack). 1 patient had an ArnoldChiari malformation with the development of occlusive hydrocephalus. So, 12 patients had a life-threatening cause of vestibular pathology, among them only 2 patients had isolated vestibular symptoms. Vestibular migraine was diagnosed in another 5% patients. Conclusions. Life-threatening causes of vestibular pathology account for 11% of all cases. Focal neurological symptoms are the main red flags of systemic vertigo. Benign paroxysmal positional vertigo is detected in 57% of cases of vertigo in the emergency room.

Epley’s manoeuvre: treatment of choice for benign paroxysmal positional vertigo

2000 ◽  
Vol 114 (11) ◽  
pp. 844-847 ◽  
Author(s):  
Najam-Ul-Hasnain Khan F.C.P.S. ◽  
Mohammad Mujeeb
Keyword(s):  
Prospective Study ◽  
Benign Paroxysmal Positional Vertigo ◽  
Vestibular Disorders ◽  
Positional Vertigo ◽  
Epley’S Manoeuvre ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vestibular disorders. In this prospective study 21 patients with BPPV were treated by Epley’s manoeuvre. All patients had an immediate improvement in their symptoms. Recurrence was noted in three patients who required further treatment sessions with resultant improvement in all. However, one patient who originally had suffered from Me´nie`re’s disease involving the same ear for more than 14 years developed another recurrence which was treated successfully by further application of Epley’s manoeuvre. This study supports the usefulness of Epley’s manoeuvre for the treatment of BPPV.

scholarly journals Clinical and diagnostic approach to patient with vertigo and dizziness

2020 ◽  
pp. 15-20
Author(s):  
A. L. Guseva ◽  
S. A. Makarov ◽  
G. M. Dyukova ◽  
V. L. Golubev
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Diagnostic Algorithm ◽  
Signs And Symptoms ◽  
Vestibular Neuritis ◽  
Subjective Feeling ◽  
Vestibular Disorders ◽  
Bilateral Vestibulopathy ◽  
Positional Vertigo ◽  
Difficult Challenge ◽  
Paroxysmal Positional Vertigo

Diagnosis of vertigo and dizziness is a difficult challenge in various fields of medicine practice. In the article the diagnostic algorithm for the patient with dizziness and vertigo is presented. The main signs and symptoms (vertigo, nonspecific dizziness, disequilibrium, and presyncope), which are included in the subjective feeling of dizziness are analyzed. Possible diseases, accompanied with these symptoms, their clinical and instrumental evaluation are discussed. Special aspects of the complaints in peripheral vestibular disorders (benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, bilateral; vestibulopathy, etc.), central vestibular disorders (stroke, etc.), functional dizziness are overviewed and main principals of their treatment are presented.

scholarly journals 302 Vestibular Assessment and Rehabilitation within a Day Hospital Falls Assessment Service: Is it Necessary and is it Feasible?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Micheal McDonnell ◽  
Fiona McGrath ◽  
Tom O'Malley
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Age Groups ◽  
Significant Risk ◽  
Hospital Setting ◽  
Significant Risk Factor ◽  
Vestibular Rehabilitation ◽  
Day Hospital ◽  
Vestibular Disorders ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Abstract Background Benign Paroxysmal Positional Vertigo (BPPV) and other vestibular disorders are very common and often missed in older populations and are a significant risk factor and cause of falls. Vestibular rehabilitation is increasingly recognised as an effective intervention for the management of vestibular dysfunction in all age groups. This review aimed to explore the prevalence of vestibular disorders in the cohort attending an integrated day hospital falls assessment service and the feasibility of delivering vestibular rehabilitation interventions as part of this service. Methods We retrospectively reviewed the charts of all the patients who attended a new ambulatory day hospital between Nov 2018 and April 2019. Inclusion criteria included a recent history of falls and aged over 75. All patients had received a comprehensive geriatric assessment which included screening for vestibular symptoms and on-site assessment (if indicated) by a physiotherapist with expertise in vestibular rehabilitation. Results 40 patients (33 women, 7 men) with a mean age of 82 were seen in this period. All had suffered recent falls with 10 having suffered a fracture. 5 patients (12%) tested positive for Benign Paroxysmal Positional Vertigo and 2 others (5%) had evidence of both peripheral and central vestibular impairment. Vestibular rehabilitation interventions, including particle repositioning manoeuvres were delivered within the day hospital setting with review appointments offered to all patients. Conclusion This review highlights the high prevalence of vestibular disorders, especially BPPV (12%) in older fallers. It supports the feasibility of delivering vestibular assessments and rehabilitation as a component of the physiotherapy input within a day hospital falls service.

scholarly journals Burden of vertigo at home: Risks for patients with vertigo

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092913
Author(s):  
Yuri Kimura ◽  
Atsunobu Tsunoda ◽  
Kumiko Tanaka ◽  
Takashi Anzai ◽  
Katsuhisa Ikeda ◽  
...  
Keyword(s):  
Questionnaire Survey ◽  
Benign Paroxysmal Positional Vertigo ◽  
Ménière’S Disease ◽  
Living Room ◽  
Vestibular Disorders ◽  
Positional Vertigo ◽  
Significant Difference ◽  
Vestibular Vertigo ◽  
Paroxysmal Positional Vertigo ◽  
At Home

Objective We aimed to clarify the burden of vertigo in patients’ homes. Methods This was a questionnaire survey among patients with vestibular vertigo. Four main questions were prepared. Q1: Where did you first notice vertigo? Q2: Where have you had the most difficulty with vertigo in your home? Q3: Where do you have difficulty at present? Q4: What household equipment have you used as a countermeasure to prevent further problems with vertigo? Results Sixty patients completed the questionnaire. Benign paroxysmal positional vertigo (BPPV) was most common among respondents, followed by Ménière’s disease. Q1: Most patients with BPPV first noticed vertigo in the bedroom; patients with other diseases first noticed vertigo in the living room. Q2: Both groups previously had the most difficulty with vertigo in the same locations as in Q1; these differences were significant between Q1 and Q2. Q3: Both groups had the most difficulty on stairs. Q4: Handrails were the most often used equipment for vertigo in both groups. There was no significant difference between Q3 and Q4. Conclusion Our data revealed that the locations of risks differ among patients with vestibular disorders. Handrails were considered the most important equipment to prevent problems with vertigo.

Vestibular autorotation testing in patients with benign paroxysmal positional vertigo

2000 ◽  
Vol 122 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Peter Belafsky ◽  
Gerard Gianoli ◽  
James Soileau ◽  
David Moore ◽  
Sheri Davidowitz
Keyword(s):  
Gold Standard ◽  
Benign Paroxysmal Positional Vertigo ◽  
Vestibular Disorders ◽  
Tertiary Referral ◽  
Perilymphatic Fistula ◽  
Tertiary Referral Center ◽  
Phase Lead ◽  
Vestibular Hypofunction ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

OBJECTIVES: The current gold standard for diagnosis of benign paroxysmal positional vertigo (BPPV) is the Dix-Hallpike maneuver. However, because of fatigability, the Dix-Hallpike is often falsely normal. The objective of this study was to evaluate the utility of vestibular autorotation testing in the diagnosis of BPPV. METHODS: The charts of 210 patients at a tertiary referral center for vertiginous disorders were reviewed. All patients underwent clinical evaluation, Dix-Hallpike testing, audiometry, electronystag-mography, and vestibular autorotation testing. The vestibular autorotation results of patients with BPPV were compared with the findings in patients with non-BPPV vestibular disorders. The sensitivity and specificity of vestibular autorotation testing in diagnosing BPPV were calculated. RESULTS: Ninety-one patients (42.9%) had BPPV, 76 patients (36.2%) had vertigo of uncertain cause, 28 (13.3%) had unilateral vestibular hypofunction, 9 patients (4.3%) had Meniere's disease, and 2 patients (1.0%) had perilymphatic fistula. Patients with BPPV were 3.32 times more likely to have a normal horizontal gain (95% CI = 1.54–7.19). A normal horizontal gain is 85% sensitive but only 36% specific for BPPV. Patients with BPPV were 1.9 times more likely to have vertical phase lead (95% CI = 0.953.93). Patients with BPPV were 2.20 times more likely to have both normal horizontal gain and vertical phase lead (95% CI = 1.03–4.69) The sensitivity of the combination of normal horizontal gain and vertical phase lead on vestibular autorotation testing is 87% specific but only 25% sensitive in the diagnosis of BPPV. CONCLUSION: A normal horizontal gain or vertical phase lead on vestibular autorotation testing in a vertiginous patient is suggestive of but not exclusive to a diagnosis of BPPV. The combination of a normal horizontal gain and vertical phase lead on vestibular autorotation testing is highly suggestive of the diagnosis of BPPV. Adjuvant use of these parameters in vestibular autorotation testing may prove to be helpful in the diagnosis of BPPV.

scholarly journals Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046510
Author(s):  
Cristina García-Muñoz ◽  
María-Dolores Cortés-Vega ◽  
Juan Carlos Hernández-Rodríguez ◽  
Rocio Palomo-Carrión ◽  
Rocío Martín-Valero ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomised Controlled Trial ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Controlled Trial ◽  
Vestibular Disorders ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Randomised Controlled ◽  
Paroxysmal Positional Vertigo

IntroductionVestibular disorders in multiple sclerosis (MS) could have central or peripheral origin. Although the central aetiology is the most expected in MS, peripheral damage is also significant in this disease. The most prevalent effect of vestibular peripheral damage is benign paroxysmal positional vertigo (BPPV). Impairments of the posterior semicircular canals represent 60%–90% of cases of BPPV. The standard gold treatment for this syndrome is the Epley manoeuvre (EM), the effectiveness of which has been poorly studied in patients with MS. Only one retrospective research study and a case study have reported encouraging results for EM with regard to resolution of posterior semicircular canal BPPV. The aim of this future randomised controlled trial (RCT) is to assess the effectiveness of EM for BPPV in participants with MS compared with a sham manoeuvre.Methods and analysisThe current protocol describes an RCT with two-arm, parallel-group design. Randomisation, concealed allocation and double-blinding will be conducted to reduce possible bias. Participants and evaluators will be blinded to group allocation. At least 80 participants who meet all eligibility criteria will be recruited. Participants will have the EM or sham manoeuvre performed within the experimental or control group, respectively. The primary outcome of the study is changes in the Dix Hallpike test. The secondary outcome will be changes in self-perceived scales: Dizziness Handicap Inventory and Vestibular Disorders Activities of Daily Living Scale. The sample will be evaluated at baseline, immediately after the intervention and 48 hours postintervention.Ethics and disseminationThe study was approved by the Andalusian Review Board and Ethics Committee of Virgen Macarena-Virgen del Rocio Hospitals (ID 0107-N-20, 23 July 2020). The results of the research will be disseminated by the investigators to peer-reviewed journals.Trial registration numberNCT04578262.

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