Vestibular vertigo in emergency neurology

2021 ◽  
Vol 26 (4) ◽  
pp. 50-59
Author(s):  
A. A. Kulesh ◽  
D. A. Dyomin ◽  
A. L. Guseva ◽  
O. I. Vinogradov ◽  
V. A. Parfyonov
Keyword(s):  
Clinical Signs ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Vertebrobasilar System ◽  
Acute Vestibular Syndrome ◽  
Vestibular Vertigo ◽  
Vestibular Neuronitis ◽  
Emergency Neurology

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

scholarly journals Acute Vestibular Syndrome in Cerebellar Infarction: A Case Report

2021 ◽  
Vol 8 (9) ◽  
pp. 29-35
Author(s):  
Diayanti Tenti Lestari ◽  
Hanik Badriyah Hidayati
Keyword(s):  
Neurological Status ◽  
Rapid Onset ◽  
Great Sensitivity ◽  
Head Impulse Test ◽  
Symptomatic Therapy ◽  
Cerebellar Infarction ◽  
Head Impulse ◽  
Antiplatelet Medication ◽  
Acute Vestibular Syndrome ◽  
Skew Deviation

Introduction: Acute vestibular syndrome (AVS) is characterized by rapid onset of vertigo, nausea and vomiting, and gait unsteadiness in association with head motion intolerance and nystagmus, lasting days to weeks. Although the majority of AVS patients have acute peripheral vestibulopathy, some may also have brainstem or cerebellar strokes. Cerebellar infarctions sometimes only cause vertigo. The Head Impulse Test, skew deviation, and nystagmus testing provide for great sensitivity and specificity in distinguishing between peripheral vestibular impairment and stroke. Case: A 41-year-old male patient suffered from acute-onset vertigo and dizziness about 5 hours before admission, which started when he started doing his morning routine. Patients also feel gait unsteadiness and almost fall to the left side. There was no weakness in extremities, skew face or slurred speech. Patient's neurological status showed the cerebellar examination was positive left dysmetria, left dysdiadochokinesia, the Romberg test open eye fell to the left, normal Head Impulse Test (HIT), with horizontal bidirectional nystagmus and negative skew deviation test. Cerebellum infarction was discovered using computed tomography imaging. After passing through the acute stroke period, patients are offered symptomatic therapy in the form of betahistine, antiplatelet medication, and vestibular rehabilitation planning. On the tenth day after the onset, the patient's symptoms began to improve. Conclusion: Proper diagnosis of acute vestibular syndrome will guide the necessary tests. The HINTS oculomotor test at the bedside can detect acute vestibular stroke. Keywords: acute vestibular syndrome, vertigo, cerebellum, HINTS

Recent advances in head impulse test findings in central vestibular disorders

Neurology ◽  
2018 ◽  
Vol 90 (13) ◽  
pp. 602-612 ◽  
Author(s):  
Jeong-Yoon Choi ◽  
Hyo-Jung Kim ◽  
Ji-Soo Kim
Keyword(s):  
Vestibular Nucleus ◽  
Head Rotation ◽  
Medial Longitudinal Fasciculus ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Corrective Saccades ◽  
Cerebellar Lesions ◽  
Horizontal Head

The head impulse test (HIT) is used to evaluate the vestibulo-ocular reflex (VOR) during a high-velocity head rotation. Corrective catch-up saccades that occur during or after the HITs usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal clinical (bedside) HITs should prompt a search for a central lesion. However, recent quantitative studies that evaluated HITs using magnetic search coils or video-based techniques have demonstrated that specific patterns of HIT abnormalities are associated with central vestibular disorders. While normal clinical HITs are typical of central lesions, discrepancies have been observed between clinical and quantitative HITs. The horizontal head impulse VOR gains can be significantly reduced unilaterally or bilaterally (positive HITs) in lesions involving the vestibular nucleus, nucleus prepositus hypoglossi, or flocculus. In diffuse cerebellar lesions, the VOR gain during horizontal head impulses may increase (hyperactive) with corrective saccades directed the opposite way. The presence of cross-coupled vertical corrective saccades during horizontal HITs is also suggestive of diffuse cerebellar lesions. Lesions involving the vestibular nucleus, medial longitudinal fasciculus, and cerebellum may show decreased or increased gains of the VOR during vertical HITs. Defining the differences in patterns observed during abnormal HITs may help practitioners localize the responsible lesions in both central and peripheral vestibulopathy.

scholarly journals Diagnostic significance of clinical and para-clinical signs of community-acquired pneumonia in children

2020 ◽  
Vol 24 (2) ◽  
pp. 244-249
Author(s):  
V.Yu. Pasik
Keyword(s):  
Young Children ◽  
Sensitivity And Specificity ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
The Body ◽  
Diagnostic Methods ◽  
Statistical Hypothesis ◽  
Diagnostic Significance ◽  
Operational Characteristics ◽  
Gallbladder Dyskinesia

Annotation. Respiratory diseases are relevant in pediatric practice, which is associated with its widespread and frequent complications, especially in young children. The aim of the study was to assess the diagnostic value of clinical symptoms, laboratory and ultra-sonographic parameters in pneumonia in children of the first 3 years of life. A retrospective study of medical records of 218 children who were hospitalized in the department for young children diagnosed with pneumonia for the period from 2016 to 2018. The average age of children was 11.67±9.97 months and it was within the range from 1 month to 3 years. The ration of boys and girls was practically identical (51.8% and 48.2% accordingly). The first group included children aged under one year (the average age is 4.57±0.84 months; n=88). The second group included children aged from 1 to 3 years (the average age is 18.2±4.25 months; n=130). To characterize the information content of clinical and laboratory symptoms the study has used objective parameters defined as the operational characteristics of tests. The most important operational characteristics of diagnostic methods included: sensitivity (Se, sensitivity) and specificity (Sp, specificity). To check the statistical hypothesis on differences of absolute and relative frequencies, fractions, and ratios in two independent samples, the criteria of хі-square (χ2) was used. While detailing an anamnesis, the disease was more often related to untimely treatment and outpatient care. Various data were obtained on the absolute and relative risk, as well as the sensitivity and specificity of the localization of pneumonia depending on age. Therefore, the incidence of bilateral pneumonia was considered an indicator of risk. On admission to hospital, the body temperature of patients was 38.2±0.66°С. Most of the complaints were on the unproductive or productive cough. Besides, in some cases, shortness of breath and runny nose were mentioned. Thus, in young children with pneumonia, a diagnostically significant clinical symptom is a bilateral lung impression (82.6%), compared with right-handed (15.1%) and left-handed (2.3%), which is significantly more common in children under 1-th year of life compared with patients 1–3 years; laboratory features are probably higher levels of liver-specific enzymes – ALT and AST in children under 1 year; ultrasonographic indicators associated with the presence of pneumonia in young children include increased liver size, gallbladder deformity, the presence of sediment in the gallbladder, dyskinesia of the biliary tract, thickening of the gallbladder wall; children under 1 year of age have a risk of liver enlargement and biliary dyskinesia.

scholarly journals Coxitis in early axial spondyloarthritis

2019 ◽  
Vol 13 (4) ◽  
pp. 41-47 ◽  
Author(s):  
E. M. Agafonova ◽  
T. V. Dubinina ◽  
D. G. Rumyantseva ◽  
A. B. Demina ◽  
A. V. Smirnov ◽  
...  
Keyword(s):  
Disease Activity ◽  
Hip Joint ◽  
Joint Pain ◽  
Rating Scale ◽  
Axial Spondyloarthritis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Diagnostic Methods ◽  
Joint Movement ◽  
Joint Injury

In Russia, coxitis is one of the most common extra-axial manifestations of ankylosing spondylitis (AS). However, many issues regarding its early diagnosis remain unresolved.Objective: to compare the clinical manifestations of coxitis with the data from an instrumental examination of CoRSAR cohort (Cohort of Early Axial Spondyloarthritis) patients.Patients and methods. Examinations were made in 175 patients (mean age, 28.2±5.7 years) diagnosed as having axial spondyloarthritis (axSpA) with inflammatory back pain lasting up to 5 years, which occurred at the age of ≤45 years. There was non-radiographic axSpA (nraxSpA) in 69 patients and AS in 106 patients. 87% of patients were HLA-B27-positive. The median disease duration was 23.8 [1–60] months; BASDAI was 3.3±1.94. Regardless of complaints, all the patients underwent hip X-ray and ultrasound studies and 54 more patients had magnetic resonance imaging (MRI).Results and discussion. The clinical signs of coxitis were present in 95 (54%) patients, of them 60% were diagnosed with AS and 40% had nraxSpA. According to the numerical pain rating scale (NPRS), the median hip joint pain was 4 [3; 7]. Limited joint movement was observed in 6 (3.4%) patients. The level of hip joint pain correlated with BASDAI (r=0.53) and ASDAS (r=0.30). The ultrasound signs of coxitis were detected in 42 (24%) patients; of them 26 (62%) had the clinical manifestations of hip joint injury, and such changes were absent in 16 patients. The patients with ultrasound signs of coxitis were noted to have a higher disease activity; peripheral arthritis and enthesitis were more common. According to MRI, coxitis was diagnosed in 39 (72%) of the 54 examinees, while the disease was asymptomatic in 10%.Conclusion. Different diagnostic methods used in patients with early axSpA could reveal coxitis in 33% of cases. The patients with coxitis show higher laboratory disease activity than those without hip joint injury. It is necessary to include MRI and ultrasound in the mandatory examination of patients with axSpA.

scholarly journals Trypanosome infections in naturally infected horses and donkeys of three active sleeping sickness foci in the south of Chad

2020 ◽  
Author(s):  
Joël Vourchakbé ◽  
Arnol Auvaker Tiofack ◽  
Mbida Mpoame ◽  
Gustave Simo
Keyword(s):  
Capillary Tube ◽  
Control Strategies ◽  
Clinical Signs ◽  
Sleeping Sickness ◽  
Diagnostic Methods ◽  
Trypanosome Species ◽  
Blood Samples ◽  
Potential Reservoir ◽  
Objective Being

Abstract Background Equine trypanosomiases are complex infectious diseases with overlapping clinical signs defined by their mode of transmission. Despite their economic impacts, these diseases have been neglected by the scientific community, the veterinary authorities and regulatory organizations. To fill the observed knowledge gap, we undertook the identification of different trypanosome species and subspecies naturally infecting horses and donkeys within the Chadian sleeping sickness focus. The end objective, being to investigate the potential role of these domestic animals as reservoirs of the human infective Trypanosoma brucei gambienseMethod Blood samples were collected from 155 donkeys and 131 horses in three human African trypanosomiasis (HAT) foci of Chad. Rapid diagnostic test (RDT) and capillary tube centrifugation (CTC) test were used to search for trypanosome infections. DNA was extracted from each blood sample and different trypanosome species and subspecies were identified with molecular tools.Results From 286 blood samples collected, 54 (18.9%) and 36 (12.6%) were respectively positive for RDT and CTC. PCR revealed 144 (50.3%) animals with trypanosome infections. The kappa Cohen coefficients used to evaluate the concordance between the diagnostic methods were low; ranging from 0.087±0.0473 to 0.48 ± 0.0698. Trypanosomes of the subgenus Trypanozoon were the most prevalent (29.4%), followed by T. congolense forest (11.5%), T. congolense savannah (4.9%) and T. vivax (4.5%). Two donkeys and one horse from the Maro HAT focus were found with T. b. gambiense infections. Between animal species and HAT foci, no significant differences were observed in the infection rates of different trypanosomes. Conclusion This study revealed several trypanosome species and sub species in donkeys and horses, highlighting the existence of AAT in HAT foci of Chad. The identification of T. b. gambiense in donkeys and horses suggests considering these animals as potential reservoir for HAT in Chad. The presence of both human-infective and human non infective trypanosomes species highlights the need for developing joined control strategies for HAT and AAT.

scholarly journals 084 Separating stroke from vestibular neuritis by vestibular function test parameters

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.1-A27
Author(s):  
Zeljka Calic ◽  
Benjamin Nham ◽  
Rachel Taylor ◽  
Allison Young ◽  
Craig Anderson ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Vestibular Function ◽  
Vestibular Neuritis ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Saccade Amplitude ◽  
Vestibular Tests ◽  
Acute Vestibular Syndrome ◽  
Significant Difference ◽  
Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

scholarly journals Subacute ruminal acidosis in dairy cows - physiological background, risk factors and diagnostic methods

2020 ◽  
Vol 51 (1) ◽  
pp. 5-17
Author(s):  
Levente Kovács ◽  
Otto Szenci ◽  
Walter Baumgartner ◽  
Mátyás Hejel ◽  
László Rózsa
Keyword(s):  
Risk Factors ◽  
Dairy Cows ◽  
Continuous Measurement ◽  
Clinical Signs ◽  
The United States ◽  
Diagnostic Methods ◽  
Subacute Ruminal Acidosis ◽  
Field Techniques ◽  
Ruminal Ph ◽  
Ruminal Acidosis

According to the latest studies, the prevalence of subacute ruminal acidosis (SARA) is around 20% in early and mid- lactation dairy cows, generating annual losses in the United States of approximately USD 500 million to 1 billion. The diagnosis of SARA is still difficult due to lack of pathognomonic clues and the delayed appearance of certain clinical signs. Therefore, SARA remains neglected or even unrecognized in many dairy herds. SARA is characterized by daily episodes of low ruminal pH, when the pH remains in the range of 5.2 to 6 for a prolonged period due to the accumulation of short-chain fatty acids and insufficient rumen buffering. The causes of SARA are related to high-grain diets, such as feeding excessive amounts of non-structural carbohydrates and highly fermentable forages, and insufficient dietary coarse fibre. SARA is associated with the inflammation of several organs and tissues in dairy cows, and its main long-term health and economic consequences are the fluctuation of feed intake, reduced fibre digestion, depression of milk yield and milk fat content, gastrointestinal damage, diarrhoea, laminitis, liver abscesses, and lameness. The aim of this review is to summarize the information available on the physiological aspects, risk factors, prevalence and possible indicators of SARA in dairy cattle. Basedon the existing literature, rumenocentesis and the use of an oral stomach tube are reliable field techniques to detect SARA. Nowadays, improved field techniques allowing the continuous measurement of reticuloruminal pH are also available for better diagnosis of SARA. Wireless indwelling pH probes may become important tools for the continuous measurement of ruminal pH in the coming years.

Diagnose und Differenzialdiagnose von peripheren und zentralen Schwindelsyndromen

2019 ◽  
Vol 144 (12) ◽  
pp. 821-829 ◽  
Author(s):  
Michael Strupp ◽  
Katharina Feil ◽  
Andreas Zwergal
Keyword(s):  
Laboratory Tests ◽  
Time Course ◽  
Head Impulse Test ◽  
Ocular Motor ◽  
Vestibular Disorders ◽  
Patient History ◽  
Caloric Irrigation ◽  
Head Impulse ◽  
Accompanying Symptoms ◽  
Romberg Test

AbstractThe diagnosis of the various peripheral and central vestibular disorders is mainly based on the patient history (time course, type of symptoms, modulating factors, and accompanying symptoms) and a systematic clinical examination of the vestibular, ocular motor, and cerebellar systems (examination for nystagmus, head impulse test, positional maneuvers, Romberg test and examination for central ocular motor signs). The two most important laboratory tests are the “video-head impulse test” and caloric irrigation. Fortunately, the diagnosis of vestibular disorders has become easier and more precise as a result of the very clinically oriented diagnostic criteria of the Bárány Society (www.jvr-web.org/ICVD.html).

scholarly journals Plants that cause photosensitivity in ruminants in Brazil

2016 ◽  
Vol 37 (4) ◽  
pp. 2009 ◽  
Author(s):  
Sheila Nogueira Ribeiro Knupp ◽  
Leonardo Sidney Knupp ◽  
Franklin Riet-Correa ◽  
Ricardo Barbosa Lucena
Keyword(s):  
Pyrrolizidine Alkaloids ◽  
Clinical Signs ◽  
Mechanisms Of Action ◽  
Diagnostic Methods ◽  
Future Research ◽  
Steroidal Saponins ◽  
Poisonous Plants ◽  
Toxic Compounds ◽  
Toxic Compound ◽  
Ammi Majus

This study aimed to review the mechanisms of action, clinical signs, pathology, and toxic compounds of plants that cause photosensitivity in ruminants. In addition, we sought to clarify the diagnostic methods and prophylaxis of photosensitivity-induced plants. Photosensitizing plants constitute an important group of poisonous plants in Brazil and there are at least seventeen species distributed in nine genera. Some of these plants have well known toxic compounds; in others, the substance responsible for the disease is unknown. In general, the photosensitivity can be classified as primary or secondary. Among the plants causing primary photosensitivity in Brazil, Ammi majus contains furocoumarins, while the compound in Froelichia humboldtiana remains uncertain. The known toxic compounds causing secondary photosensitivity include pyrrolizidine alkaloids, furans sesquiterpenes, triterpenes, and steroidal saponins. In other plants causing secondary photosensitization, including Stryphnodendron spp. and Enterolobium spp., the toxic compound is still unknown. Future research should be conducted in order to determine the various mechanisms of action of each toxic compound to assist the diagnosis of photosensitivity, to develop less toxic or non-toxic cultivars, or even to find new ways of preventing photosensitization.

scholarly journals Variations in the detection of anti-PEDV antibodies in serum samples using three diagnostic tests – short communication

2018 ◽  
Vol 66 (2) ◽  
pp. 337-342 ◽  
Author(s):  
Jan Plut ◽  
Ivan Toplak ◽  
Marina Štukelj
Keyword(s):  
Clinical Signs ◽  
Elisa Test ◽  
Diagnostic Methods ◽  
P Value ◽  
Serum Samples ◽  
Blocking Elisa ◽  
Test Kit ◽  
Two Samples ◽  
Antibody Tests ◽  
Higher Sensitivity

Over the last few years several porcine epidemic diarrhoea (PED) outbreaks have been discovered in Europe including the first PED case in Slovenia in January 2015. The aim of this study was to determine when PED virus (PEDV) infection started in Slovenia. Serum samples collected between 2012 and 2016 were tested. Three hundred and seventy-five serum samples were collected from 132 Slovenian small, one-site pig farms. Samples were tested for PEDV antibodies utilising three different serological methods: commercially-available indirect ELISA, in-house blocking ELISA test and Immunoperoxidase Monolayer Assay (IPMA) test. One hundred and seventy (45.33%) tested samples were found positive by the commercially-available ELISA test kit, and 10 (5.68%) of these 170 samples found positive were positive by the in-house blocking ELISA. Only these 10 samples were collected from a farm where clinical signs of PED infection had been observed and PEDV was confirmed by RT-PCR methodology; the other 160 samples were collected randomly. Thirty-two samples with the highest S/P value obtained with the commercial ELISA were all negative with IPMA. Reasons for the high variance in the results obtained remain unclear; more research is required to ensure higher sensitivity and specificity in terms of PEDV antibody tests and other PED diagnostic methods.

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