scholarly journals Post-concussive Dizziness: A Review and Clinical Approach to the Patient

2022 ◽  
Vol 12 ◽  
Author(s):  
Gerard J. Gianoli
Keyword(s):  
Endolymphatic Hydrops ◽  
Vestibular Function ◽  
Central Component ◽  
Clinical Approach ◽  
Vestibular Disorders ◽  
Temporal Bone Fracture ◽  
Diagnostic Categories ◽  
The Past ◽  
Symptom Frequency ◽  
Paroxysmal Positional Vertigo

Dizziness is a frequent complaint after head trauma. Among patients who suffer a concussion (mild traumatic brain injury or mTBI), dizziness is second only to headache in symptom frequency. The differential diagnosis of post-concussive dizziness (PCD) can be divided into non-vestibular, central vestibular and peripheral vestibular causes with growing recognition that patients frequently exhibit both central and peripheral findings on vestibular testing. Symptoms that traditionally have been ascribed to central vestibular dysfunction may be due to peripheral dysfunction. Further, our ability to test peripheral vestibular function has improved and has allowed us to identify peripheral disorders that in the past would have remained unnoticed. The importance of the identification of the peripheral component in PCD lies in our ability to remedy the peripheral vestibular component to a much greater extent than the central component. Unfortunately, many patients are not adequately evaluated for vestibular disorders until long after the onset of their symptoms. Among the diagnoses seen as causes for PCD are (1) Central vestibular disorders, (2) Benign Paroxysmal Positional Vertigo (BPPV), (3) Labyrinthine dehiscence/perilymph fistula syndrome, (4) labyrinthine concussion, (5) secondary endolymphatic hydrops, (6) Temporal bone fracture, and (7) Malingering (particularly when litigation is pending). These diagnoses are not mutually exclusive and PCD patients frequently exhibit a combination of these disorders. A review of the literature and a general approach to the patient with post-concussive dizziness will be detailed as well as a review of the above-mentioned diagnostic categories.

scholarly journals Proceedings of the GDR Vertige 2019 annual meeting devoted to endolymphatic hydrops

2021 ◽  
pp. 1-3
Author(s):  
Christian Chabbert ◽  
Anne Charpiot
Keyword(s):  
Annual Meeting ◽  
Research Group ◽  
Endolymphatic Hydrops ◽  
Clinical Manifestations ◽  
Vestibular Function ◽  
Therapeutic Strategies ◽  
Vestibular Disorders ◽  
Special Issue ◽  
Clinical Imaging ◽  
New Methods

The GDR Vertige is a federative research group gathering the different components of the French neuro-otology community. The annual meeting of the GDR Vertige is an opportunity for interactive exchanges between scientists, clinicians and industrialists, on basic issues related to vestibular function, as well as translational questions regarding the management of vestibular disorders. For its fifth edition, the annual meeting of the GDR Vertige, which took place in September 2019 in Marseille (France), was devoted to one of the most peculiar phenomena of neuro-otology: endolymphatic hydrops. For two days, international scientists and clinicians presented the most recent advances regarding the biophysical correlates of endolymphatic hydrops, the genetic and endocrine tableaux that favor its manifestation, new methods of clinical imaging, and current and upcoming therapeutic strategies to overcome the associated clinical manifestations. This special issue of the Journal of Vestibular Research aims at providing the proceedings of this meeting.

Neuroanatomical Correlates of Vestibular Function

1980 ◽  
Vol 89 (1) ◽  
pp. 2-5 ◽  
Author(s):  
Richard R. Gacek
Keyword(s):  
Spinal Cord ◽  
Motor Neurons ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Disorders ◽  
The Past ◽  
Minor Degree ◽  
A Minor ◽  
Neuroanatomical Data ◽  
Utricular Function

Neuroanatomical data revealed by new neuroanatomical techniques over the past decade, have clarified the central connections of the peripheral vestibular sense organs. A knowledge of this information is important in the clinical evaluation of vestibular disorders. The reflex connections of the semicircular canals serve vestibulocerebellar, vestibulo-ocular, commissural, and vestibulospinal pathways. The central connections of the utricular macula are primarily in a descending direction to the motor neurons of the entire length of the spinal cord. These form the basis for vestibulospinal reflexes which are characteristically associated with utricular function. Additional central connections provide the basis for vestibulo-ocular responses to utricular activity. Finally, the saccule has reflex connections both to the upper spinal cord to a minor degree and to extraocular nuclei that serve vertical and oblique eye movements. The minor vestibular group Y nucleus provides a commissural reflex connection for the saccule.

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 Vestibular implants studied in animal models: clinical and scientific implications

2016 ◽  
Vol 116 (6) ◽  
pp. 2777-2788 ◽  
Author(s):  
Richard F. Lewis
Keyword(s):  
Animal Models ◽  
Vestibular System ◽  
Animal Studies ◽  
Vestibular Function ◽  
Clinical Problem ◽  
Head Motion ◽  
The Past ◽  
New Treatment ◽  
Vestibular Damage ◽  
The Brain

Damage to the peripheral vestibular system can result in debilitating postural, perceptual, and visual symptoms. A potential new treatment for this clinical problem is to replace some aspects of peripheral vestibular function with an implant that senses head motion and provides this information to the brain by stimulating branches of the vestibular nerve. In this review I consider animal studies performed at our institution over the past 15 years, which have helped elucidate how the brain processes information provided by a vestibular (semicircular canal) implant and how this information could be used to improve the problems experienced by patients with peripheral vestibular damage.

Relevance of Otopathological Findings in the Treatment of Dizzy Patients

1984 ◽  
Vol 93 (4_suppl) ◽  
pp. 12-16 ◽  
Author(s):  
Pierre B. Montandon ◽  
Rudolf Häusler
Keyword(s):  
Retrospective Study ◽  
Endolymphatic Hydrops ◽  
Vestibular Neuritis ◽  
Common Symptom ◽  
Vestibular Disorders ◽  
Histopathological Changes ◽  
The Brain

Dizziness is a common symptom in disorders of the brain and the ear. In a retrospective study of 1,000 cases, dizziness is attributed to a peripheral disorder in 25%, to a CNS disorder in 46%, and to undetermined causes in 29% of the cases. Peripheral disorders can be defined in terms of histopathological changes; the most frequent is cupulolithiasis, followed by endolymphatic hydrops and vestibular neuritis. These vestibular disorders are reviewed and discussed in connection with accepted facts and current hypotheses.

Effect of Transverse Temporal Bone Fracture on the Fluid Compartment of the Inner Ear

1979 ◽  
Vol 88 (6) ◽  
pp. 741-748 ◽  
Author(s):  
Syed S. Rizvi ◽  
Kevin P. Gibbin
Keyword(s):  
Hair Cells ◽  
Endolymphatic Hydrops ◽  
Membranous Labyrinth ◽  
Temporal Bone Fracture ◽  
Complete Obstruction ◽  
Vestibular Hair Cells ◽  
Vestibular Aqueduct ◽  
Fluid Compartment ◽  
Temporal Bones ◽  
Transverse Fractures

Five temporal bones exhibiting transverse fractures were studied with a view to determining whether such fractures could lead to symptomatic endolymphatic hydrops. Four out of the five temporal bones showed the fracture line traversing the vestibular aqueduct. Two of these four showed complete obstruction of the endolymphatic duct. One of these had an intact membranous labyrinth and severe endolymphatic hydrops. The other had ruptures of the membranous labyrinth and no hydrops. Three ears exhibited partial preservation of auditory and vestibular hair cells and neurons. These findings are consistent with the concept that a transverse fracture may produce endolymphatic hydrops by obstructing the vestibular aqueduct while preserving enough audiovestibular epithelium and neurons to present as symptomatic Menière's disease.

scholarly journals Biomarkers Related to Endothelial Dysfunction and Vascular Cognitive Impairment: A Systematic Review

2020 ◽  
pp. 1-10
Author(s):  
Rui Kleber Martins-Filho ◽  
Maria Clara Zotin ◽  
Guilherme Rodrigues ◽  
Octavio Pontes-Neto
Keyword(s):  
Cognitive Impairment ◽  
Endothelial Dysfunction ◽  
Selection Criteria ◽  
Data Extraction ◽  
Neurovascular Unit ◽  
Vascular Cognitive Impairment ◽  
Original Research ◽  
Clinical Approach ◽  
Qualitative Synthesis ◽  
The Past

<b><i>Introduction:</i></b> The damage in the endothelium and the neurovascular unit appears to play a key role in the pathogenesis of vascular cognitive impairment (VCI). Although there have been many advances in understanding the physiopathology of this disease, several questions remain unanswered. The association with other degenerative diseases and the heterogeneity of its clinical spectrum establish a diagnostic problem, compromising a better comprehension of the pathology and halting the development of effective treatments. The investigation of biomarkers is an important movement to the development of novel explicative models and treatment targets involved in VCI. <b><i>Methods:</i></b> We searched MEDLINE considering the original research based on VCI biomarkers in the past 20 years, following prespecified selection criteria, data extraction, and qualitative synthesis. <b><i>Results:</i></b> We reviewed 42 articles: 16 investigated plasma markers, 17 analyzed neuropathological markers, 4 studied CSF markers, 4 evaluated neuroimaging markers (ultrasound and MRI), and 1 used peripheral Doppler perfusion imaging. <b><i>Conclusions:</i></b> The biomarkers in these studies suggest an intrinsic relationship between endothelial dysfunction and VCI. Nonetheless, there is still a need for identification of a distinctive set of markers that can integrate the clinical approach of VCI, improve diagnostic accuracy, and support the discovery of alternative therapies.

Systematic review of the outcome of anxiety and depressive disorders

1998 ◽  
Vol 173 (S34) ◽  
pp. 35-41 ◽  
Author(s):  
J. Emmanuel ◽  
S. Simmonds ◽  
P. Tyrer
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Clinical Outcome ◽  
Anxiety Disorders ◽  
Strong Evidence ◽  
Depressive Disorders ◽  
Medline Search ◽  
Diagnostic Categories ◽  
The Past ◽  
Standard Procedures

Background Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the clinical outcome of greater diagnostic categories. We therefore compared the outcome of all studies which compared the outcome of specific anxiety and depressive disorders using the standard procedures of systematic review.Method A Medline search was carried out of all studies comparing the outcome of anxiety and depressive disorders or mixed anxiety-depressive disorders in which information was available separately for each disorder.Results Eight studies satisfied the search criteria (all involving a period of observation of two years or greater); only one of these included randomisation of treatment and comparison between specific anxiety disorder outcome. There was a somewhat better outcome in patients with depressive disorders compared with anxiety ones, and strong evidence that both anxiety and depressive disorders singly had better outcomes than comorbid mixed disorders.Conclusion Comorbid anxiety-depressive disorders have a poor outcome compared with single anxiety and depressive disorders, and there is some evidence that anxiety disorders have a worse outcome than depressive ones.

scholarly journals Vestibular Disorders after Stapedial Surgery in Patients with Otosclerosis

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Ditza de Vilhena ◽  
Inês Gambôa ◽  
Delfim Duarte ◽  
Gustavo Lopes
Keyword(s):  
Hearing Loss ◽  
Informed Consent ◽  
Observational Study ◽  
Postoperative Period ◽  
Prospective Observational Study ◽  
Vestibular Function ◽  
Vestibular Disorders ◽  
Dizziness Handicap Inventory

Introduction and Objectives. Vertigo is a described complication of stapedial surgery. Many studies have been conducted to assess the improvement of hearing loss, but there are few studies that assess vestibular function after stapedial surgery. The aim of this study was to evaluate the presence and characterize the vertigo after stapedial surgery.Methods. We conducted a prospective observational study. Patients undergoing stapedial surgery in our hospital between October 2013 and December 2014 were invited to participate. The vertigo was assessed before and 4 months after surgery, using the Dizziness Handicap Inventory.Results. We included 140 patients in the study. 12 patients (8.6%) reported vertigo before surgery, and all of them denied vertigo after surgery. 36 patients (25.7%) reported vertigo four months after surgery, and none of them had vertigo before surgery. Postoperative total scores in patients with vertigo ranged between 2 and 18 points.Conclusion. The study shows that vestibular disorders may remain after the immediate postoperative period and reinforces the need for clarification of the patient in the informed consent act.

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