scholarly journals Comparative analysis of the data obtained in computerized posturography and videonystagmography for patients with peripheral vestibular deficit

2018 ◽  
Vol 8 (32) ◽  
pp. 225-231
Author(s):  
Gabriela Musat ◽  
Alina Anghel ◽  
Lucia Radu ◽  
Roxana Decusara
Keyword(s):  
Final Diagnosis ◽  
Common Denominator ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Equilibrium System ◽  
Vestibular Diseases ◽  
Normal Limits ◽  
Number Of Patients ◽  
Computerized Posturography ◽  
Caloric Tests

Abstract BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations. OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders. MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months. RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity. CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.

Dizziness, migrainous vertigo and psychiatric disorders

2009 ◽  
Vol 124 (3) ◽  
pp. 285-290 ◽  
Author(s):  
R Teggi ◽  
D Caldirola ◽  
B Colombo ◽  
G Perna ◽  
G Comi ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Depressive Disorders ◽  
Final Diagnosis ◽  
University Hospital ◽  
Pathophysiological Mechanism ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Dizziness Handicap Inventory ◽  
Panic Disorders ◽  
Migrainous Vertigo

AbstractObjectives:This study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.Study design:Retrospective study.Setting:Out-patients in a university hospital.Materials and methods:Fifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.Results:Dizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).Conclusions:Our data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.

scholarly journals Transient neonatal pseudohypoparathyroidism

2007 ◽  
Vol 135 (9-10) ◽  
pp. 566-568
Author(s):  
Maja Jesic ◽  
Milos Jesic ◽  
Silvija Sajic ◽  
Svjetlana Maglajlic ◽  
Mirjana Tomanovic ◽  
...  
Keyword(s):  
Serum Level ◽  
Elevated Serum ◽  
Serum Levels ◽  
Final Diagnosis ◽  
High Serum ◽  
Oral Calcium ◽  
Elevated Serum Level ◽  
Normal Limits ◽  
Number Of Patients ◽  
Withdrawal Of Therapy

Introduction Pseudohypoparathyroidism (PHP) is a heterogeneous group of diseases characterized by end organ unresponsiveness to parathormone (PTH), due to receptor or postreceptor defects. The characteristic biochemical disturbances include hypocalcaemia, hyperphosphataemia and high serum parathormone levels. Case outlineWe present a 17-day old male baby who was brought to our hospital because of seizures. He was found to have hypocalcaemia, hyperphosphataemia and an elevated serum level of parathyroid hormone. The diagnosis of PHP was based on the elevated serum level of PTH during hypocalcaemia and persistence of normocalcaemia after administering alphacalcidiol with oral calcium. After 4 months of therapy, with tapering of the oral calcium doses, the treatment was discontinued. During the following six months without therapy, the infant did not have seizures and the serum levels of calcium and phosphorus were normal, so we established the final diagnosis of transient neonatal pseudohypoparathyroidism. Conclusion At the time when the newborn was diagnosed to have PHP, there was no indication whether it was of a permanent or transient form. A considerably lower number of patients have a transitory form of PHP, which is then confirmed in the infant period by a gradual reduction and withdrawal of therapy, with sustaining serum calcium and PTH within normal limits.

Clinical Significance of Lung Uptake in Liver Scanning

1986 ◽  
Vol 25 (01) ◽  
pp. 15-18 ◽  
Author(s):  
M. Luostarinen ◽  
M Vorne ◽  
T. Lantto
Keyword(s):  
Clinical Significance ◽  
Final Diagnosis ◽  
Reticuloendothelial System ◽  
Liver Imaging ◽  
Lung Uptake ◽  
Benign Diseases ◽  
Number Of Patients ◽  
Liver Image ◽  
Liver Scanning ◽  
Stimulation Of

Summary 99mTc tin colloid accumulated in the lungs in 102 patients during liver imaging both in malignant and benign diseases. The percentage of neoplastic diseases increased when the lung uptake became greater and only patients with malignant final diagnosis had marked lung uptake. Abnormal liver image was seen only in 23%, which disagrees highly with some earlier findings on a rather small number of patients. The cause of increased lung uptake was suggested to be the activation of the reticuloendothelial system (RES) by disease. The activation of the RES was stronger in malignant than in benign diseases. Some type of regional stimulation of the RES was suggested as being due to the location of the disease and both malignant and benign diseases of the chest region stimulated the pulmonary part of the RES more than other parts of the RES.

scholarly journals Risk factors and disposition in development of the nervous system infections

2009 ◽  
Vol 62 (9-10) ◽  
pp. 461-467
Author(s):  
Ljiljana Nesic ◽  
Predrag Canovic ◽  
Zeljko Mijailovic ◽  
Jelena Djokovic
Keyword(s):  
Risk Factors ◽  
Nervous System ◽  
Virus Infection ◽  
Lupus Erythematosus ◽  
Bacterial Infections ◽  
Heart Diseases ◽  
Final Diagnosis ◽  
Medical Documentation ◽  
Virus Infections ◽  
Number Of Patients

Introduction. Although well protected, brain is not resistant to infection agents. Acute infections of our nervous system appear more often in children and in persons who have medical history data about previous disorders, especially disorders of the nervous system. It is difficult to list possible risk factors which can be responsible for the appearance of infections of CNS and the resulting conditions. It is often difficult or impossible to determine what previous neural damage was (trauma, anoxic damages etc.) from those appearing during infections of CNS. All-inclusive anamnestic research reduces the possibility of approximate judgments. Material and methods. The research was based on the retrospective analysis of medical documentation of 275 patients. All patients were divided into three groups according to the final diagnosis. The first group consisted of 125 patients who were treated for acute virus encephalitis, the second group consisted of 125 patients who were treated for acute bacterial meningoencephalitis and the third group consisted of 25 patients who were treated for cerebritis. Discussion. In our studies sample, the youngest patient was 3 years old and the oldest was 87 years old. The highest number of patients with virus infection of the CNS was in the group under 25 years of age (45.6%). The highest number of patients with bacterial infections of the CNS and cerebritis was in the group of patients over 45 years of age (64%, 37%). Conclusion. Risk factors were more present in bacterial infections of the nervous system and cerebrit thanin virus infection of CNS. In virus infections of the CNS, 28% of patients had some risk factor, most often-chronic ethylism, diabetes mellitus and acquired heart diseases. In bacterial infections of the CNS, 64% of patients had some predisposed factor. The most frequent factor of risk in these patients were chronic otitis (21.6%) and craniotrauma (14.4%). In cerebritis, risk factors were present in 76% of patients and they were: sepsis (20%), chronic otitis (12%) and systemic lupus erythematosus (8%).

scholarly journals Impact of COVID-19 Pandemic on the Incidence, Prehospital Evaluation, and Presentation of Ischemic Stroke at a Nonurban Comprehensive Stroke Center

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Cesar Velasco ◽  
Brandon Wattai ◽  
Scott Buchle ◽  
Alicia Richardson ◽  
Varun Padmanaban ◽  
...  
Keyword(s):  
Urban Areas ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Medical Attention ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Community Transmission ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction. Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on nonurban areas with minimal community transmission is less well understood. Methods. Using a prospectively maintained prehospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results. In January, February, March, and April 2019, 10, 11, 17, and 19 patients, respectively, were transported in comparison to 19, 14, 10, and 8 during the same months in 2020. From January through April 2019, there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020, constituting significantly different trend-line slopes (3.30; 95% CI 0.48–6.12 versus -3.70; 95% CI -5.76–-1.64, p = 0.001 ). Patient demographics, comorbidities, and symptom severity were mostly similar over the two time periods, and the number of patients with a final diagnosis of stroke was also similar. However, the median interval from EMS dispatch to ED arrival for patients with a final diagnosis of stroke was significantly longer in January to April 2020 ( 50 ± 11.7   min ) compared to the same time period in 2019 ( 42 ± 8.2   min , p = 0.01 ). Discussion/Conclusion. Our data indicate a decrease in patient transport volumes and longer intervals to EMS activation for suspected stroke care. These results suggest that even in a nonurban location without widespread community transmission, patients may be delaying or avoiding care for severe illnesses such as stroke. Clinicians and public health officials should not ignore the potential impact of pandemic-like illnesses even in areas of relatively low disease prevalence.

Persistent Postural-Perceptual Dizziness

2020 ◽  
Vol 40 (01) ◽  
pp. 130-137 ◽  
Author(s):  
Jeffrey P. Staab
Keyword(s):  
Diagnostic Testing ◽  
Multimodality Treatment ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Ongoing Research ◽  
Sufficient Detail ◽  
Treatment Plans ◽  
Physical Examinations ◽  
Vestibular Symptoms

AbstractPersistent postural-perceptual dizziness (PPPD) was defined for the International Classification of Vestibular Disorders in 2017. It is a chronic vestibular disorder that manifests with waxing and waning symptoms of dizziness, unsteadiness, or nonspinning vertigo that last for 3 months or more and are exacerbated by upright posture, active or passive motion of self, and exposure to environments with complex or moving visual stimuli. Triggers of PPPD include a wide variety of conditions that may cause vestibular symptoms or disrupt balance functioning, including neuro-otologic and other medical conditions and psychological distress. The diagnosis is made by identifying key symptoms in patients' histories and conducting physical examinations and diagnostic testing of sufficient detail to establish PPPD as opposed to other illnesses. Ongoing research is providing insights into the pathophysiological mechanisms underlying PPPD and support for multimodality treatment plans incorporating specially adapted vestibular rehabilitation, serotonergic medications, and cognitive-behavior therapy.

scholarly journals P057: Impact of a clinical pathway for the treatment of acute asthma in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S84-S85
Author(s):  
F. Messier ◽  
J. Deshaies ◽  
G. Breault
Keyword(s):  
Emergency Department ◽  
Clinical Pathway ◽  
Acute Asthma ◽  
Final Diagnosis ◽  
Beta Agonist ◽  
Triage Nurse ◽  
Respiratory Therapist ◽  
Time To Treatment ◽  
Admission Rates ◽  
Number Of Patients

Introduction: In Canada, acute asthma is a common cause of emergency department (ED) attendance and its treatment is affected by ED overcrowding and increasing wait times. Literature suggests that a clinical pathway (CP) for the treatment of acute asthma can increase the use of medical therapy, reduce hospital admission rates and decrease associated costs. However, only few have looked at the effect on ED length of stay (ED LOS) when such a CP is initiated by triage nurse/respiratory therapist among adults. In this optic, an asthma CP was launched on Feb. 2016 at Centre Hospitalier Universitaire de Sherbrooke (QC) and included medical directives allowing triage nurse and respiratory therapist initiation of treatment. Methods: The objectives are to determine the effect of an ED nurse/respiratory therapist-initiated asthma CP on (1) ED LOS, (2) time-to-treatment (beta-agonist, corticosteroids), time-to-MD and other secondary outcomes. This was a retrospective before-after study. Adults presenting to the ED before and after CP implementation with a final diagnosis of asthma or asthma exacerbation were eligible. The groups A (before implementation) and B (after implementation) were compared for ED LOS. Three subgroups of 50 patients were generated and compared for outcomes: A1 (before implementation), B1 (after implementation without CP) and B2 (after implementation with CP). All five groups were controlled for triage level and sex. Results: In total, 1086 patients were included; 543 before implementation (Mar. 2011 – Feb. 2016) and 543 after (Feb. 2016 – Jun. 2019), of whom 14% (N = 77) were treated by CP. The average ED LOS was similar (10.36h vs 10.65h; (p = 0,31)) in group A and in group B. In groups A1, B1 and B2, the median ED LOS were respectively 6.00, 6.84, 4.80; these differences were not statistically significant. The average time-to-treatment for beta-agonist in A1, B1 and B2 was respectively 148, 180 and 50 mins; the differences between B2 and A1 and between B2 and B1 were both statistically significant (p < 0,05). Conclusion: Although this study indicates a low compliance to the CP, it shows that time-to-treatment can be reduced. It didn't demonstrate any statistically significant decrease in ED LOS, most likely due to low number of patients and non-normal distribution, but the 1.2h shorter could be a major advantage if it proves true. Further studies are essential to understand facilitators and alleviate the barriers in anticipation of a multi-centric implementation.

scholarly journals Genetic spectrum of Brazilian suspected Bartter Syndrome Patients

2020 ◽  
Author(s):  
Ana Carola Hebbia Lobo Messa ◽  
Juliana Caires de Oliveira Achili Ferreira ◽  
Fernanda Fonseca ◽  
Andreia Rangel-Santos ◽  
Maria Helena Vaisbich
Keyword(s):  
Pediatric Nephrology ◽  
Early Period ◽  
Final Diagnosis ◽  
Bartter Syndrome ◽  
Clinical Findings ◽  
Number Of Patients ◽  
Study Results ◽  
Significant Difference ◽  
Type 3 ◽  
Brazilian Cohort

Abstract Background This paper’s goal is to show the genetic study results of suspected Bartter syndrome (BS) patients followed in a pediatric nephrology reference center in Sao Paulo/Brazil, verify a possible genotype-phenotype correlation and compare the genetic results with those from other regions of the globe. Results This descriptive study included 22 patients (21 families) with clinical diagnosis of BS. Pathogenic variants in BS-related genes were detected in 19/22 patients. No BS-related genes were detected in three patients (one case of Congenital Chloride Diarrhea and two siblings with clinical Antenal BS that, in fact, had Gitelman Syndrome). We observed that 16/19 BS-confirmed patients had CLCNKB mutations (BS type 3) with a large phenotypical diversity. Among them, the deletion of the entire gene (del 1–20) was the most frequent variant detected. Interestingly, we observed that patients with homozygous or heterozygous del 1–20 presented earlier manifestations than patients with other CLCNKB mutations. They presented no other clinical significant difference. Conclusion This study demonstrates the importance of an appropriate investigation of clinically suspected BS patients to rule out pseudo-BS. This data also confirms the difficult to differentiate these patients based just on clinical findings, similar to what has been reported in other studies. There were patients with clinical Antenatal BS in whom the genetic analysis confirmed the final diagnosis of GS or BS type 3. Among BS cases, BS type 3 was the most frequent in this Brazilian cohort and del 1–20 was the most frequently variant detected. In addition, BS type 3 patients with homozygous or heterozygous del 1–20 had earlier manifestations than patients with other CLCNKB mutations. Brazilian community has a particular characteristic miscegenation as well as different origins such as Europeans, Africans and Asians and comparing our results with those from other regions we can suppose the genetic background of this Brazilian cohort is related to African and Portuguese inheritance, probably originated in the early period of immigration (colonization and slavery period). Limitations: low number of patients from a single center. However, as a rare disease all data can contribute to the improvement for diagnosis and treatment.

scholarly journals FUNCTIONAL DIZZINESS IN THE LIGHT OF THE NEWLY-ESTABLISHED ENTITY – PERSISTENT POSTURAL-PERCEPTUAL DIZZINESS

2019 ◽  
Vol 141 (7-8) ◽  
pp. 196-204
Keyword(s):  
The Body ◽  
Automatic Thoughts ◽  
Diagnostic Process ◽  
Wide Field ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Visual Objects ◽  
Field Of Vision ◽  
Cognitive Behavioural ◽  
Postural System

Functional dizziness is noted for its frequency and is the second most common cause of dizziness in the general population, most prevalent in the age group of 30–50 years. The classic diagnostic process is aimed at finding a medical or surgical diagnosis, and in case it is not found, it is said to be caused by a “psychogenic” disease. In recent decades, using a new, integrative way of thinking, there has been a discovery of functional vestibular disorders. They have always been overcome by acute or back vestibular disease due to poor readout of the postural system. The reason for this lies in a close connection to the brain of nerve projections responsible for controlling motion and position of the body in space with those responsible for danger and fear. The Nomenclature and Classification Committee of Barany’s Vestibular Disorders recently established diagnostic criteria for persistent postural-perceptive dizziness (PPPD). This is the most common functional vestibular disorder, which includes the previously established: persistent postural dizziness, visual and chronic subjective dizziness. The dominant symptom of PPPD is non-rotatory dizziness that lasts for at least three months continuously and is always associated with the condition of the body. The hypersensitivity to moving stimuli occurs, including the movements of large visual objects or complex visual stimuli in a wide field of vision and the difficulty of performing precision visual actions. For mild and moderate interferences it is advisable to conduct vestibular rehabilitation, as most patients have provocative factors related to vision and movement. Individually tailored exercises are used to reduce susceptibility to provocative movements, and conditioning exercises are very useful for repairing disturbed body posture. Pharmacotherapeutic treatment with selective serotonin or serotonin and norepinephrine reuptake inhibitors is also indicated. Good results are achieved by the use of cognitive-behavioural psychotherapy, changing of negative automatic thoughts, refocusing attention, re-allocation, systematic and gradual exposure or exposure at once, biofeedback etc. The prognosis of the disease is better in patients without comorbidity, while in those with comorbidity it is significantly worse.

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