scholarly journals History Taking in Non-Acute Vestibular Symptoms: A Four-Step Approach

2021 ◽  
Vol 10 (24) ◽  
pp. 5726
Author(s):  
Raymond van de Berg ◽  
Herman Kingma
Keyword(s):  
Time Course ◽  
Systematic Approach ◽  
Diagnostic Process ◽  
History Taking ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Process Systems ◽  
Co Morbidity ◽  
Vestibular Symptoms ◽  
Accompanying Symptoms

History taking is crucial in the diagnostic process for vestibular disorders. To facilitate the process, systems such as TiTrATE, SO STONED, and DISCOHAT have been used to describe the different paradigms; together, they address the most important aspects of history taking, viz. time course, triggers, and accompanying symptoms. However, multiple (vestibular) disorders may co-occur in the same patient. This complicates history taking, since the time course, triggers, and accompanying symptoms can vary, depending on the disorder. History taking can, therefore, be improved by addressing the important aspects of each co-occurring vestibular disorder separately. The aim of this document is to describe a four-step approach for improving history taking in patients with non-acute vestibular symptoms, by guiding the clinician and the patient through the history taking process. It involves a systematic approach that explicitly identifies all co-occurring vestibular disorders in the same patient, and which addresses each of these vestibular disorders separately. The four steps are: (1) describing any attack(s) of vertigo and/or dizziness; (2) describing any chronic vestibular symptoms; (3) screening for functional, psychological, and psychiatric co-morbidity; (4) establishing a comprehensive diagnosis, including all possible co-occurring (vestibular) disorders. In addition, pearls and pitfalls will be discussed separately for each step.

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.

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 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.

scholarly journals Introducing the DizzyQuest: an app-based diary for vestibular disorders

2020 ◽  
Vol 267 (S1) ◽  
pp. 3-14
Author(s):  
E. C. Martin ◽  
C. Leue ◽  
P. Delespaul ◽  
F. Peeters ◽  
A. M. L. Janssen ◽  
...  
Keyword(s):  
Daily Life ◽  
Ecological Validity ◽  
Response Rates ◽  
Future Research ◽  
Recall Bias ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Loss To Follow Up ◽  
Vestibular Symptoms ◽  
Attack Data

Abstract Background Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research. Methods Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders. Results Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p < 0.001). The attack-questionnaire was used 159 times. A variety of neuro-otological symptoms and different disease profiles were demonstrated between patients and subgroups of patients with different vestibular disorders. Conclusion The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population.

Clinical approach to the diagnosis of skin disease

2010 ◽  
pp. 4586-4592
Author(s):  
Vanessa Venning
Keyword(s):  
Skin Disease ◽  
Diagnostic Process ◽  
Clinical Approach ◽  
History Taking ◽  
Medical Specialities ◽  
The Impact ◽  
Careful History

As in most medical specialities, the diagnosis of skin disease relies on careful history taking, and a thorough examination, supported in some cases by appropriate investigation. Astute physicians will also be aware that management outcomes are improved by taking account of the impact of skin disease on patients’ lives, whether through discomfort, disfigurement, or disability. This section, however, is chiefly concerned with aspects of history taking and examination that inform the diagnostic process....

History and Examination of the Spine

2018 ◽  
Author(s):  
Maggie Henjum ◽  
Jodi Young
Keyword(s):  
Systematic Approach ◽  
Treatment Plan ◽  
Current Evidence ◽  
Evidence Based ◽  
Strength Testing ◽  
Objective Data ◽  
History Taking ◽  
Thoracic And Lumbar Spine ◽  
Assessment And Treatment ◽  
A Current

An efficient model for history-taking and physical examination of the spine using a current evidence-based approach provides the foundation for a targeted assessment and treatment plan. Taking a history and examining the cervical, thoracic, and lumbar spine may be complex, especially if the clinician does not use a systematic approach for collecting subjective and objective data. Included in this chapter are best evidence strategies for observing a patient’s posture and movement patterns, assessing active and passive range of motion, and performing neurologic testing, strength testing, special tests, and palpation. Special attention is given to test clusters and examination items with strong psychometric properties that provide efficient and accurate examination results. By incorporating these strategies into the history and examination, the examiner should be able to rule in or out particular diagnoses that will direct overall management of the patient’s symptoms.

scholarly journals Representation of Body Orientation in Vestibular-Defective Patients Before and After Unilateral Vestibular Loss

2021 ◽  
Vol 15 ◽  
Author(s):  
Liliane Borel ◽  
Jacques Honoré ◽  
Mathilde Bachelard-Serra ◽  
Jean-Pierre Lavieille ◽  
Arnaud Saj
Keyword(s):  
Time Course ◽  
Recovery Period ◽  
Body Representation ◽  
Acute Stage ◽  
Point Of View ◽  
Spatial Neglect ◽  
Body Orientation ◽  
Vestibular Disorder ◽  
Vestibular Loss ◽  
Before And After

Introduction: The unilateral vestibular syndrome results in postural, oculomotor, perceptive, and cognitive symptoms. This study was designed to investigate the role of vestibular signals in body orientation representation, which remains poorly considered in vestibular patients.Methods: The subjective straight ahead (SSA) was investigated using a method disentangling translation and rotation components of error. Participants were required to align a rod with their body midline in the horizontal plane. Patients with right vestibular neurotomy (RVN; n =8) or left vestibular neurotomy (LVN; n = 13) or vestibular schwannoma resection were compared with 12 healthy controls. Patients were tested the day before surgery and during the recovery period, 7 days and 2 months after the surgery.Results: Before and after unilateral vestibular neurotomy, i.e., in the chronic phases, patients showed a rightward translation bias of their SSA, without rotation bias, whatever the side of the vestibular loss. However, the data show that the lower the translation error before neurotomy, the greater its increase 2 months after a total unilateral vestibular loss, therefore leading to a rightward translation of similar amplitude in the two groups of patients. In the early phase after surgery, SSA moved toward the operated side both in translation and in rotation, as typically found for biases occurring after unilateral vestibular loss, such as the subjective visual vertical (SVV) bias.Discussion and Conclusion: This study gives the first description of the immediate consequences and of the recovery time course of body orientation representation after a complete unilateral vestibular loss. The overall evolution differed according to the side of the lesion with more extensive changes over time before and after left vestibular loss. It is noteworthy that representational disturbances of self-orientation were highly unusual in the chronic stage after vestibular loss and similar to those reported after hemispheric lesions causing spatial neglect, while classical ipsilesional biases were reported in the acute stage. This study strongly supports the notion that the vestibular system plays a major role in body representation processes and more broadly in spatial cognition. From a clinical point of view, SSA appeared to be a reliable indicator for the presence of a vestibular disorder.

scholarly journals Approach to hypercalcemia

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophy Mo
Keyword(s):  
Differential Diagnosis ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Physical Examination ◽  
Clinical Setting ◽  
Systematic Approach ◽  
History Taking ◽  
Laboratory Investigations ◽  
Main Components

Hypercalcemia is a presentation commonly encountered in the clinical setting. Due to its vast differential diagnosis, a systematic approach is necessary when approaching patients with hypercalcemia. This article presents a simple, yet thorough approach to help clinicians determine the etiology of their patient's hypercalcemia. The main components of history taking, physical examination, and laboratory investigations for patients with hypercalcemia are highlighted. Emphasis is put on the importance of determining whether the hypercalcemia is associated with elevated or inappropriately normal parathyroid hormone (PTH) or not. The main etiologies of PTH-dependent hypercalcemia and PTH-independent hypercalcemia are explored. Primary hyperparathyroidism and hypercalcemia secondary to malignancy are highlighted as together, they make up 90% of hypercalcemia cases. A presentation of the management principles of hypercalcemia is also provided.

scholarly journals Regulation of the Development Process Systems of Information and Telemetry Support for the Development of Launch Vehicles

2021 ◽  
Vol 8 (2) ◽  
pp. 43-50
Author(s):  
V. L. Vorontsov ◽  
◽  
I. A. Davidov ◽  
Keyword(s):  
Development Process ◽  
Systematic Approach ◽  
Past Research ◽  
Launch Vehicles ◽  
Process Systems ◽  
Organizational Issues ◽  
Ballistic Missiles ◽  
Software And Hardware ◽  
Intercontinental Ballistic Missiles ◽  
Launching Site

It is shown that the most prominent shortcomings of the existing general sectoral scientific and technical policy for the development of means of information and telemetry support (ITS) of development of launch vehicles are manifested in the absence of a systemic and dominance of subjective and fragmentary approaches, as a result of which the software and hardware (SW&HW) of the telemetric complex (TC) of a space launching site are redundant, but not invariant to the current ITS problems. At the same time, the loss of information during launches of spacecraft (SC) and intercontinental ballistic missiles (ICBMs) due to the influence of harmful factors of a different nature are comparable to the losses experienced during the 60s–70s of the 20th century. Under these conditions, a systematic approach is relevant and, accordingly, the regulation of the development process of domestic systems for information and telemetric support for the development of launch vehicles (ITSDLV). The main regulatory tools are the official concept of development of ITSDLV and the corresponding system of telemetry standards. The scientific and methodological foundations of their construction, based on the results of past research, are presented. The features of the solution of current and future organizational issues for the maintenance and development of the aforementioned concept and system of standards by the forces of the proposed working group are shown.

scholarly journals Time course of neuropathological events in hyperhomocysteinemic amyloid depositing mice reveals early neuroinflammatory changes that precede amyloid changes and cerebrovascular events

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Erica M. Weekman ◽  
Tiffany L. Sudduth ◽  
Brittani R. Price ◽  
Abigail E. Woolums ◽  
Danielle Hawthorne ◽  
...  
Keyword(s):  
Gene Expression ◽  
Mouse Model ◽  
Time Course ◽  
Control Diet ◽  
Interleukin 1 ◽  
Amyloid Deposition ◽  
Wild Type ◽  
Necrosis Factor Alpha ◽  
Co Morbidity ◽  
In The Wild

Abstract Background Vascular contributions to cognitive impairment and dementia (VCID) are the second leading cause of dementia behind only Alzheimer’s disease (AD); however, VCID is commonly found as a co-morbidity with sporadic AD. We have previously established a mouse model of VCID by inducing hyperhomocysteinemia in both wild-type and amyloid depositing mice. While we have shown the time course of neuropathological events in the wild-type mice with hyperhomocysteinemia, the effect of amyloid deposition on this time course remains unknown; therefore, in this study, we determined the time course of neuropathological changes in our mouse model of hyperhomocysteinemia-induced VCID in amyloid depositing mice. Methods APP/PS1 mice were placed on either a diet deficient in folate and vitamins B6 and B12 and enriched in methionine to induce hyperhomocysteinemia or a control diet for 2, 6, 10, 14, or 18 weeks. Immunohistochemistry and gene expression analysis were used to determine neuroinflammatory changes. Microhemorrhages and amyloid deposition were analyzed using histology and, finally, behavior was assessed using the 2-day radial arm water maze. Results Neuroinflammation, specifically a pro-inflammatory phenotype, was the first pathological change to occur. Specifically, we see a significant increase in gene expression of tumor necrosis factor alpha, interleukin 1 beta, interleukin 6, and interleukin 12a by 6 weeks. This was followed by cognitive deficits starting at 10 weeks. Finally, there is a significant increase in the number of microhemorrhages at 14 weeks on diet as well as redistribution of amyloid from the parenchyma to the vasculature. Conclusions The time course of these pathologies points to neuroinflammation as the initial, key player in homocysteine-induced VCID co-morbid with amyloid deposition and provides a possible therapeutic target and time points.

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