RESUMO
Objective:To explore the correlation between the parameters of suppression head impulse paradigmï¼SHIMPï¼ and changes in dizziness handicap inventoryï¼DHIï¼ scores. Additionally, to evaluate the degree of vertigo and prognosis of patients with acute vestibular neuritis through SHIMP parameters. Methods:Thirty-three patients with acute vestibular neuritis were enrolled for DHI evaluation, vHIT and SHIMP. A secondary DHI score were evaluated after after two weeks, once patients no longer exhibited spontaneous nystagmus. The decrease in the second DHI score was used as the efficacy indexï¼EIï¼. All patients were divided into significantly effective group, effective group and ineffective group based on EI. Differences of the VOR gain values of SHIMP and the anti-compensatory saccade were compared among the three groups. Results:There were 13 cases in the significant effective group, 11 cases in the effective group, and 9 cases in the ineffective group. â The mean gain of the horizontal semicircular canal in the significant effective group, the effective group, and the ineffective group wasï¼0.50±0.11ï¼, ï¼0.44±0.12ï¼, andï¼0.34±0.08ï¼, respectively. The difference between the significant effective group and the ineffective group was statistically significantï¼P<0.01ï¼. The gain of horizontal semicircular canal was positively correlated with EIï¼r=0.538 5, P<0.01ï¼ ãâ¡The occurrence rate of the anti-compensatory saccade in the significant effective group, the effective group, and the ineffective group wasï¼51.23±19.59ï¼, ï¼33.64±17.68ï¼, andï¼13.78±11.81ï¼, respectively. Pairwise comparisons between each group showed statistical significanceï¼P<0.05ï¼. The occurrence rate of anti-compensatory saccade was positively correlated with EIï¼r=0.658 2, P<0.01ï¼. Conclusion:The horizontal semicircular canal gain and the occurrence rate of the anti-compensatory saccade in SHIMP for patients with acute vestibular neuritis were closely correlated with decrease in DHI score.
Assuntos
Teste do Impulso da Cabeça , Neuronite Vestibular , Humanos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Teste do Impulso da Cabeça/métodos , Feminino , Masculino , Tontura , Doença Aguda , Vertigem , Pessoa de Meia-Idade , Prognóstico , Adulto , Canais Semicirculares/fisiopatologiaRESUMO
INTRODUCTION: Recently, end-point nystagmus, traditionally observed in an upright position, has been identified in the Dix-Hallpike position among healthy subjects, suggesting a physiological origin.However, its characteristics in individuals with vestibular hypofunction remain unexplored. OBJECTIVE: To elucidate the impact of vestibular hypofunction on the characteristics of positional end-point nystagmus. METHODS: Thirty-one patients diagnosed with acute unilateral vestibulopathy according to Bárány Society criteria were selected. A video head impulse test was conducted in all participants, followed by McClure and Dix-Hallpike maneuvers with and without gaze fixation, and with the initial position of the eye in the straight-ahead position or in the horizontal end-point position. Nystagmus direction, sense, latency, slow-phase velocity, and duration were recorded. The relationship between these characteristics and video head impulse test values was analyzed. RESULTS: Positional end-point nystagmus was observed in 92.6% of subjects with vestibular hypofunction, significantly more than in healthy individuals. Nystagmus direction varied depending on the performed positional test and on the vestibulo-ocular reflex gains. Gaze occlusion and the initial horizontal end-point position increased its frequency. CONCLUSION: Vestibular hypofunction influences the manifestation of positional end-point nystagmus. Recognizing this nystagmus can aid in resolving diagnostic uncertainties and preventing the misdiagnosis of benign paroxysmal positional vertigo in subjects with acute unilateral vestibulopathy.
Assuntos
Teste do Impulso da Cabeça , Nistagmo Patológico , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/fisiopatologia , Adulto , Teste do Impulso da Cabeça/métodos , Nistagmo Fisiológico/fisiologia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/fisiopatologia , Idoso de 80 Anos ou mais , Testes de Função Vestibular/métodos , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/complicações , Reflexo Vestíbulo-Ocular/fisiologiaRESUMO
OBJECTIVE: Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN. METHODS: We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared. RESULTS: Overall, the inter-rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head-impulse tests (p = 0.036), increased interaural difference in ocular vestibular-evoked myogenic potentials (p = 0.001), and a longer onset-to-MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement. INTERPRETATION: Robust gadolinium enhancement was observed on 4-hour-delayed 3D-FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN.
Assuntos
Imageamento por Ressonância Magnética , Neuronite Vestibular , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Imageamento por Ressonância Magnética/normas , Neuronite Vestibular/diagnóstico por imagem , Neuronite Vestibular/fisiopatologia , Idoso , Adulto , Imageamento Tridimensional , Estudos Prospectivos , Compostos Organometálicos , MegluminaRESUMO
Vestibular neuritis occupies the third place in terms of prevalence in the structure of peripheral vestibulopathies, therefore, the choice of optimal diagnostic and differential diagnostic tactics at different stages of the disease is an urgent task. OBJECTIVE: To optimize the diagnostic algorithm for vestibular neuritis based on an assessment of the sensitivity of clinical methods for studying vestibular function in the recovery period of the disease. MATERIAL AND METHODS: A comprehensive assessment of the sensitivity of clinical methods for the study of vestibular function in the acute (up to 14 days: at the time of initial treatment, on the 7th and 14th day) and subacute (up to 3 months: on the 28th and 90th day) periods of the disease in 52 patients with upper vestibular neuritis was carried out. RESULTS: The timing of the processes of restoration of vestibular function after a transferred vestibular neuritis is individual: after 14 days, restoration of vestibular function was recorded in 52% (n=27) patients, after 1 month - in 62% (n=32), after 3 months - in 71% (n=37) patients with upper vestibular neuritis. Statocoordination, statokinetic, oculomotor tests under visual control have the highest sensitivity in the acute period of vestibular neuritis, within up to 7 days from the onset of symptoms. In the subacute period of vestibular neuritis, the study of spontaneous nystagmus and nystagmus in the head shaking test retains high sensitivity only when using special tools (Frenzel goggles or videonystagmography). A decrease in the sensitivity of the head rotation test and the dynamic visual acuity test in the subacute period of vestibular neuritis is associated with the processes of central compensation and the formation of a latent saccade. CONCLUSION: The sensitivity of clinical tests in patients with vestibular neuritis depends on the timing of the examination.
Assuntos
Testes de Função Vestibular , Neuronite Vestibular , Humanos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/complicações , Testes de Função Vestibular/métodos , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Vestíbulo do Labirinto/fisiopatologia , Diagnóstico Diferencial , Recuperação de Função FisiológicaRESUMO
BACKGROUND: Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) can result in prolonged dizziness. OBJECTIVES: This study aimed to compare the video head impulse test (vHIT) of patients with SHLV and VN. METHODS: Fifteen patients with SHLV and 21 patients with VN who visited the Vertigo/Dizziness Center of our hospital between December 2016 and February 2023 were included. vHIT was performed at the time of admission, and the VOR gain and catch up saccade (CUS) in the three types of semicircular canals (SCCs) were analyzed. RESULTS: Pathologic vHIT results were observed most frequently in the posterior SCC (73%), followed by lateral (53%) and anterior (13%) SCCs in the SHLV group. In contrast, pathologic vHIT results were observed most frequently in the lateral SCC (100%), followed by the anterior (43%) and posterior SCC (24%) SCCs in the VN group. Pathological vHIT results in the lateral and posterior SCC showed significant differences between the two groups, but for anterior SCC, no significant differences were found. CONCLUSIONS AND SIGNIFICANCE: Comparison of the two vHIT results revealed differences in the SCC dysfunction patterns. This may be due to the different pathophysiological mechanisms of the two vestibular disorders, which may result in prolonged vertigo.
Assuntos
Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Canais Semicirculares , Vertigem , Neuronite Vestibular , Humanos , Teste do Impulso da Cabeça/métodos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/complicações , Masculino , Pessoa de Meia-Idade , Feminino , Vertigem/fisiopatologia , Vertigem/diagnóstico , Vertigem/etiologia , Canais Semicirculares/fisiopatologia , Perda Auditiva Súbita/fisiopatologia , Perda Auditiva Súbita/diagnóstico , Adulto , Idoso , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Gravação em Vídeo , Estudos Retrospectivos , Doença CrônicaRESUMO
OBJECTIVES: Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders. DESIGN: All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders. RESULTS: There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported. CONCLUSIONS: Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders.
Assuntos
Vertigem Posicional Paroxística Benigna , Tontura , Doença de Meniere , Transtornos de Enxaqueca , Doenças Vestibulares , Neuronite Vestibular , Humanos , Tontura/epidemiologia , Tontura/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Vestibulares/complicações , Doenças Vestibulares/epidemiologia , Doenças Vestibulares/diagnóstico , Adulto , Estudos Retrospectivos , Idoso , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Doença de Meniere/epidemiologia , Doença de Meniere/fisiopatologia , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/complicações , Neuronite Vestibular/complicações , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/epidemiologia , Vertigem Posicional Paroxística Benigna/epidemiologia , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/fisiopatologia , Deiscência do Canal Semicircular/complicações , Deiscência do Canal Semicircular/epidemiologia , Deiscência do Canal Semicircular/fisiopatologia , Vertigem/epidemiologia , Vertigem/fisiopatologia , Adulto Jovem , Testes de Função Vestibular , Probabilidade , Autorrelato , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Studying otolith functions after unilateral vestibular neuritis using ocular vestibular-evoked myogenic potentials and subjective visual vertical tests could give different results. METHOD: A total of 39 patients underwent a vestibular assessment that included the Dizziness Handicap Inventory and horizontal and vertical semicircular canal function testing with video head impulse testing, ocular vestibular-evoked myogenic potential testing, cervical vestibular-evoked myogenic potentials and subjective visual vertical testing. RESULTS: All patients showed a significant alteration (asymmetry ratio more than 40 per cent) for ocular vestibular-evoked myogenic potentials as well as for subjective visual vertical testing (more than -2° to more than +2°) during the acute phase, whereas after 72 hours from the acute vertigo attack normal values (asymmetry ratio less than 40 per cent) were found in 6 out of 39 patients for ocular vestibular-evoked myogenic potentials and 36 out of 39 for the subjective visual vertical (less than -2° to less than +2°). CONCLUSION: Ocular vestibular-evoked myogenic potentials are the most suitable test to evaluate otolith functions in patients with unilateral vestibular neuritis in the acute and sub-acute phase.
Assuntos
Recuperação de Função Fisiológica , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Neuronite Vestibular/fisiopatologia , Adulto , Idoso , Progressão da Doença , Feminino , Teste do Impulso da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Although symptoms of unilateral vestibular neuritis (uVN) resolve spontaneously within several weeks, recovery of gait function has unclearness in gait parameter changes and mediolateral stability improvements. In addition, prospective longitudinal studies on gait parameters after uVN are lacking. This study was conducted to reveal longitudinal change of gait function after acute uVN and to help the precise rehabilitation planning. Twenty three participants with uVN and 20 controls were included. 3D gait analyses were conducted three times after uVN onset at monthly intervals. From the gait analysis data, spatio-temporal parameters, inclination angle (IA) representing the relationship between center of mass (CoM) and center of pressure (CoP) in the frontal plane, and IA variability were obtained. Time effects on gait metrics were tested. Walking speed of participants with uVN improved significantly between the 1st and 3rd tests, but they were not significantly different to that of control, even in the 1st test. The step width of participants with uVN was significantly larger than that of control in the 1st test and improved significantly in the 2nd test. Variability of IA in affected side was significantly larger than that in controls in the 1st test and improved significantly in the 3rd test compared to the 1st test. Improvement of overall gait function and mediolateral stability during gait continued after acute stage of uVN (two months from onset in this study). Rehabilitation intervention should be continued after the acute stage of uVN to enhance appropriate adaptation in gait.
Assuntos
Marcha/fisiologia , Equilíbrio Postural , Nervo Vestibular/fisiopatologia , Neuronite Vestibular/fisiopatologia , Velocidade de Caminhada , Adaptação Fisiológica , Adulto , Idoso , Feminino , Lateralidade Funcional , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Percepção , Estudos Prospectivos , Reprodutibilidade dos Testes , CaminhadaRESUMO
BACKGROUND: Due to their anti-inflammatory action, corticosteroids are the reference treatment for brain injuries and many inflammatory diseases. However, the benefits of acute corticotherapy are now being questioned, particularly in the case of acute peripheral vestibulopathies (APV), characterized by a vestibular syndrome composed of sustained spinning vertigo, spontaneous ocular nystagmus and oscillopsia, perceptual-cognitive, posturo-locomotor, and vegetative disorders. We assessed the effectiveness of acute corticotherapy, and the functional role of acute inflammation observed after sudden unilateral vestibular loss. METHODS: We used the rodent model of unilateral vestibular neurectomy, mimicking the syndrome observed in patients with APV. We treated the animals during the acute phase of the vestibular syndrome, either with placebo or methylprednisolone, an anti-inflammatory corticosteroid. At the cellular level, impacts of methylprednisolone on endogenous plasticity mechanisms were assessed through analysis of cell proliferation and survival, glial reactions, neuron's membrane excitability, and stress marker. At the behavioral level, vestibular and posturo-locomotor functions' recovery were assessed with appropriate qualitative and quantitative evaluations. RESULTS: We observed that acute treatment with methylprednisolone significantly decreases glial reactions, cell proliferation and survival. In addition, stress and excitability markers were significantly impacted by the treatment. Besides, vestibular syndrome's intensity was enhanced, and vestibular compensation delayed under acute methylprednisolone treatment. CONCLUSIONS: We show here, for the first time, that acute anti-inflammatory treatment alters the expression of the adaptive plasticity mechanisms in the deafferented vestibular nuclei and generates enhanced and prolonged vestibular and postural deficits. These results strongly suggest a beneficial role for acute endogenous neuroinflammation in vestibular compensation. They open the way to a change in dogma for the treatment and therapeutic management of vestibular patients.
Assuntos
Anti-Inflamatórios/uso terapêutico , Metilprednisolona/uso terapêutico , Plasticidade Neuronal/efeitos dos fármacos , Recuperação de Função Fisiológica/efeitos dos fármacos , Neuronite Vestibular/tratamento farmacológico , Núcleos Vestibulares/efeitos dos fármacos , Animais , Anti-Inflamatórios/farmacologia , Metilprednisolona/farmacologia , Atividade Motora/efeitos dos fármacos , Plasticidade Neuronal/fisiologia , Equilíbrio Postural/efeitos dos fármacos , Ratos , Ratos Long-Evans , Recuperação de Função Fisiológica/fisiologia , Neuronite Vestibular/fisiopatologia , Núcleos Vestibulares/fisiopatologiaRESUMO
OBJECTIVE: Failure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem; however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown. METHODS: Patients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the emergency department between 2015 and 2020. All patients received neuroimaging, which served as a reference standard. We recorded fixation suppression with video-oculography (VOG) for forward, right, and left gaze. The ocular fixation index (OFI) and the spontaneous nystagmus slow velocity reduction was calculated. RESULTS: We screened 1,646 patients reporting dizziness in the emergency department and tested for spontaneous nystagmus in 148 patients with AVS. We analyzed 56 patients with a diagnosed acute unilateral vestibulopathy (vestibular neuritis) and 28 patients with a confirmed stroke. There was a complete nystagmus fixation suppression in 49.5% of patients with AVS, in 40% of patients with vestibular neuritis, and in 62.5% of patients with vestibular strokes. OFI scores had no predictive value for detecting strokes; however, a nystagmus reduction of less than 2 °/s showed a high accuracy of 76.9% (confidence interval 0.59-0.89) with a sensitivity of 62.2% and specificity of 84.8% in detecting strokes. CONCLUSIONS: The presence of fixation suppression does not rule out a central lesion. The magnitude of suppression was lower compared to patients with vestibular neuritis. The nystagmus suppression test predicts vestibular strokes accurately provided that eye movements are recorded with VOG. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with an AVS, decreased fixation suppression recorded with VOG occurred more often in stroke (76.9%) than in vestibular neuritis (37.8%).
Assuntos
Tontura/fisiopatologia , Nistagmo Patológico/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Tontura/diagnóstico por imagem , Feminino , Fixação Ocular , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/diagnóstico por imagem , Doenças Vestibulares/fisiopatologia , Neuronite Vestibular/fisiopatologia , Adulto JovemRESUMO
OBJECTIVE: The association between sudden sensorineural hearing loss (SSNHL) and radiological findings of the vertebrobasilar artery is not well-known and little research has been done. We hypothesized that the radiological features of the vertebrobasilar artery contribute to the incidence and prognosis of SSNHL. METHODS: We retrospectively enrolled patients diagnosed with unilateral SSNHL (SSNHL group) and those with acute vestibular neuritis (AVN; control group) in our hospital. All patients underwent magnetic resonance imaging and computed tomography. We measured the following parameters on the radiological images: basilar artery diameter, direction and distance of basilar artery deviation, direction and distance of vertebral artery deviation, and incidence of vertebral artery obstruction. Pure tone audiometry (PTA) was performed in all patients. Follow up PTA between 1 week and 1 month after treatment was performed in the SSNHL group. RESULTS: A total of 244 SSNHL patients and 62 AVN patients were included in the analysis. Age, body mass index, and basilar artery diameter were found to be significantly associated with SSNHL. In the SSNHL group, patients were divided into three subgroups based on the consistency between the basilar artery deviation site and disease site. No significant difference was noted in initial PTA, final PTA, PTA recovery, and symptom improvement among the three groups. In case of the basilar artery, when the deviation and disease sites were in the opposite direction and the basilar artery diameter was >3.5 mm, diameter of basilar artery was positively correlated with PTA recovery. CONCLUSIONS: The strength of this study is that radiological evaluation of the vertebrobasilar artery was performed. Further research on the association between SSNHL and radiological features of the vertebrobasilar artery should be conducted to emphasize the importance of vascular assessment in SSNHL.
Assuntos
Artéria Basilar/diagnóstico por imagem , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Súbita/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Aciclovir/uso terapêutico , Adulto , Idoso , Variação Anatômica , Antivirais , Audiometria de Tons Puros , Bloqueio Nervoso Autônomo , Estudos de Casos e Controles , Angiografia Cerebral , Feminino , Ginkgo biloba , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/fisiopatologia , Perda Auditiva Súbita/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Extratos Vegetais , Substitutos do Plasma/uso terapêutico , Prognóstico , Estudos Retrospectivos , Gânglio Estrelado , Tomografia Computadorizada por Raios X , Insuficiência Vertebrobasilar/diagnóstico por imagem , Neuronite Vestibular/diagnóstico por imagem , Neuronite Vestibular/fisiopatologiaRESUMO
OBJECTIVES: In the present report, we aimed to investigate the impact of the coronavirus disease (COVID-19) pandemic on vertigo/dizziness outpatient cancellations in Japan. METHODS: We examined 265 vertigo/dizziness outpatients at the ear, nose, and throat department of the Nara Medical University between March 01, 2020, and May 31, 2020, during the COVID-19 pandemic in Japan. We also focused on 478 vertigo/dizziness outpatients between March 01, 2019, and May 31, 2019, before the COVID-19 pandemic, to compare the number of cancellations between these 2 periods. The reasons for cancellation and noncancellation were investigated using telephone multiple-choice questionnaires (telMCQs), particularly for patients with benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD). RESULTS: There were many cancellations for medical examinations during the 2020 study period. The total number of vertigo/dizziness outpatients decreased by 44.6% in the 2020 period compared to the same period in 2019. The percent reduction in clinic attendance from 2019 to 2020 (ie, [2019-2020]/2019) for patients with BPPV was higher than that for patients with MD. Compared to the other vertigo-associated conditions, patients with MD exhibited a lower percent reduction in clinic attendance. According to the results of the telMCQs, 75.0% of BPPV cases and 88.2% of MD cases cancelled their appointment and gave up visiting hospitals due to fear of COVID-19 infection, even if they had moderate to severe symptoms. On the contrary, 25.0% and 80.0% patients with BPPV and MD, respectively, did not cancel their appointment; they should not have visited the hospital but stayed at home because they had slight symptoms. CONCLUSIONS: These findings suggest that advanced forms should be prepared for medical care, such as remote medicine. These forms should not only be for the disease itself but also for the mental distress caused by persistent symptoms.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Agendamento de Consultas , Vertigem Posicional Paroxística Benigna/fisiopatologia , Doença de Meniere/fisiopatologia , Assistência ao Convalescente , Vertigem Posicional Paroxística Benigna/terapia , COVID-19 , Atenção à Saúde , Gerenciamento Clínico , Tontura/fisiopatologia , Tontura/terapia , Medo , Humanos , Japão , Doença de Meniere/terapia , Otolaringologia , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Inquéritos e Questionários , Telemedicina , Vertigem/fisiopatologia , Vertigem/terapia , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/terapiaRESUMO
OBJECTIVE: Posturography (PG) shows various patterns corresponding to a patient's equilibrium condition; however, PG is not useful for the differential diagnosis of peripheral vestibular diseases (PVDs). The aim of this study was to identify parameters of PG that can distinguish between PVDs. METHODS: The differences in PG parameters between PVDs were evaluated retrospectively. Two hundred and two patients with Ménière's disease (MD), 154 patients with benign paroxysmal positional vertigo (BPPV), 20 patients with sudden sensorineural hearing loss with vertigo (SSNHLwV), and 31 patients with vestibular neuritis (VN) underwent PG during the non-acute phase of vertigo, from January 2010 to March 2017. RESULTS: The velocity of body oscillation of BPPV patients with eyes open and closed were significantly faster than those of MD patients with eyes open (p < 0.001) and closed (p = 0.033). The velocity of body oscillation of VN patients with eyes open was significantly faster than that of MD patients with eyes open (p = 0.0083). There were no significant differences among the other PG parameters between PVDs. Although there were significant differences among the velocity with eyes open and closed between males and females (eye open: p = 0.0009, eye close: p < 0.0001), there was no significant difference in the ratio of males to females among PVDs (p = 0.1834). Therefore, the ratio did not influence the difference in velocity among PVDs. Patient age correlated with the velocity with eyes open (p < 0.001) and with eyes closed (p < 0.001). Post-hoc analysis revealed significant differences in patient age, and comparisons of MD and BPPV, MD and SSNHLwV, BPPV and VN, and VN and SSNHLwV. Therefore, we performed multiple regression analysis to determine whether the significant differences in the velocity of body oscillation among PVDs were caused by the difference in age distribution between PVD groups, rather than by differences in the PVDs themselves. There were correlations between age and the velocity of body oscillation with eyes open (p < 0.001) and with eyes closed (p < 0.001). There also were correlations between MD or VN and the velocity of body oscillation with eyes open (p = 0.0194). CONCLUSION: There were significant differences in the velocity of body oscillation with eyes open between MD and VN patients. The difference between MD and VN was significant regardless of the age distribution. To distinguish between MD and VN, the velocity of body oscillation with eyes open is a useful PG index.
Assuntos
Vertigem Posicional Paroxística Benigna/fisiopatologia , Perda Auditiva Súbita/fisiopatologia , Doença de Meniere/fisiopatologia , Equilíbrio Postural/fisiologia , Neuronite Vestibular/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Vertigem/fisiopatologia , Neuronite Vestibular/diagnóstico , Adulto JovemRESUMO
OBJECTIVE: To test the hypothesis that patterns of semicircular canal (SCC) and otolith impairment in unilateral vestibular loss depend on the underlying disorders, we analyzed peripheral-vestibular function of all 5 vestibular sensors. METHODS: For this retrospective case series, we screened the hospital video-head-impulse test database (n = 4,983) for patients with unilaterally impaired SCC function who also received ocular vestibular-evoked myogenic potentials and cervical vestibular-evoked myogenic potentials (n = 302). Frequency of impairment of vestibular end organs (horizontal/anterior/posterior SCC, utriculus/sacculus) was analyzed with hierarchical cluster analysis and correlated with the underlying etiology. RESULTS: Acute vestibular neuropathy (AVN) (37.4%, 113 of 302), vestibular schwannoma (18.2%, 55 of 302), and acute cochleovestibular neuropathy (6.6%, 20 of 302) were most frequent. Horizontal SCC impairment (87.4%, 264 of 302) was more frequent (p < 0.001) than posterior (47.4%, 143 of 302) and anterior (37.8%, 114 of 302) SCC impairment. Utricular damage (58%, 175 of 302) was noted more often (p = 0.003) than saccular impairment (32%, 98 of 302). On average, 2.6 (95% confidence interval 2.48-2.78) vestibular sensors were deficient, with higher numbers (p ≤ 0.017) for acute cochleovestibular neuropathy and vestibular schwannoma than for AVN, Menière disease, and episodic vestibular syndrome. In hierarchical cluster analysis, early mergers (posterior SCC/sacculus; anterior SCC/utriculus) pointed to closer pathophysiologic association of these sensors, whereas the late merger of the horizontal canal indicated a more distinct state. CONCLUSIONS: While the extent and pattern of vestibular impairment critically depended on the underlying disorder, more limited damage in AVN and Menière disease was noted, emphasizing the individual range of loss of function and the value of vestibular mapping. Likely, both the anatomic properties of the different vestibular end organs and their vulnerability to external factors contribute to the relative sparing of the vertical canals and the sacculus.
Assuntos
Doença de Meniere/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Testes de Função Vestibular/métodos , Doenças do Nervo Vestibulococlear/fisiopatologia , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Masculino , Doença de Meniere/patologia , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia , Estudos Retrospectivos , Canais Semicirculares/patologia , Canais Semicirculares/fisiopatologia , Neuronite Vestibular/patologia , Neuronite Vestibular/fisiopatologia , Doenças do Nervo Vestibulococlear/patologiaRESUMO
OBJECTIVE: To separate vestibular neuritis (VN) from posteriorcirculation stroke (PCS) using quantitative tests of canal and otolith function. METHODS: Video Head-Impulse tests (vHIT) were used to assess all three semicircular canal pairs; vestibulo-ocular reflex (VOR) gain and saccade metrics were examined. Cervical and ocular-Vestibular-Evoked Myogenic Potentials (c- and oVEMP) and Subjective Visual Horizontal (SVH) were used to assess otolith function. RESULTS: For controls (n = 40), PCS (n = 22), and VN (n = 22), mean horizontal-canal VOR-gains were 0.96 ± 0.1, 0.85 ± 0.3 and 0.40 ± 0.2, refixation-saccade prevalence was 71.9 ± 41, 90.7 ± 57, 209.2 ± 62 per 100 impulses and cumulative-saccade amplitudes were 0.9 ± 0.4°, 2.4 ± 2.2°, 8.0 ± 3.5°. Abnormality-rates for cVEMP, oVEMP and SVH were 38%, 9%, 72% for PCS, and 43%, 50%, 91% for VN. A gain ≤0.68, refixation-saccade prevalence of ≥135% and cumulative-saccade amplitudes ≥5.3° separated VN from PCS with sensitivities of 95.5%, 95.5%, and 81.8%, and specificities of 68.2%, 86.4% and 95.5%. VOR-gain and saccade prevalence when combined, separated VN from PCS with a sensitivity and specificity of 90.9%. Abnormal oVEMP asymmetry-ratios were of low sensitivity (50%) but high specificity (90.9%) for separating VN from PCS. CONCLUSION: vHIT provided the best separation of VN from PCS. VOR-gain, refixation-saccade prevalence and amplitude were effective discriminators of VN from PCS. SIGNIFICANCE: vHIT and oVEMP could assist early identification of the aetiology of Acute Vestibular Syndrome in the Emergency Room.
Assuntos
Teste do Impulso da Cabeça/métodos , Acidente Vascular Cerebral/diagnóstico , Neuronite Vestibular/diagnóstico , Diagnóstico Diferencial , Teste do Impulso da Cabeça/normas , Humanos , Membrana dos Otólitos/fisiopatologia , Reflexo Vestíbulo-Ocular , Sensibilidade e Especificidade , Acidente Vascular Cerebral/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares , Neuronite Vestibular/fisiopatologiaRESUMO
Ataxia, causing imbalance, dizziness and falls, is a leading cause of neurological disability. We have recently identified a biallelic intronic AAGGG repeat expansion in replication factor complex subunit 1 (RFC1) as the cause of cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) and a major cause of late onset ataxia. Here we describe the full spectrum of the disease phenotype in our first 100 genetically confirmed carriers of biallelic repeat expansions in RFC1 and identify the sensory neuropathy as a common feature in all cases to date. All patients were Caucasian and half were sporadic. Patients typically reported progressive unsteadiness starting in the sixth decade. A dry spasmodic cough was also frequently associated and often preceded by decades the onset of walking difficulty. Sensory symptoms, oscillopsia, dysautonomia and dysarthria were also variably associated. The disease seems to follow a pattern of spatial progression from the early involvement of sensory neurons, to the later appearance of vestibular and cerebellar dysfunction. Half of the patients needed walking aids after 10 years of disease duration and a quarter were wheelchair dependent after 15 years. Overall, two-thirds of cases had full CANVAS. Sensory neuropathy was the only manifestation in 15 patients. Sixteen patients additionally showed cerebellar involvement, and six showed vestibular involvement. The disease is very likely to be underdiagnosed. Repeat expansion in RFC1 should be considered in all cases of sensory ataxic neuropathy, particularly, but not only, if cerebellar dysfunction, vestibular involvement and cough coexist.
Assuntos
Ataxia/fisiopatologia , Ataxia Cerebelar/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Neuronite Vestibular/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Ataxia/complicações , Cerebelo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico/efeitos adversos , Doenças do Sistema Nervoso Periférico/complicações , Reflexo Anormal/fisiologia , Transtornos de Sensação/etiologia , Transtornos de Sensação/fisiopatologia , Síndrome , Neuronite Vestibular/complicaçõesAssuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Nistagmo Patológico/fisiopatologia , Neuronite Vestibular/diagnóstico , Idoso , Antieméticos/uso terapêutico , Vertigem Posicional Paroxística Benigna/fisiopatologia , Dimenidrinato/uso terapêutico , Teste do Impulso da Cabeça , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Posicionamento do Paciente/métodos , Neuronite Vestibular/tratamento farmacológico , Neuronite Vestibular/fisiopatologiaRESUMO
OBJECTIVE: To compare the results of suppression head impulse paradigm (SHIMP) and head impulse paradigm (HIMP) in acute vestibular neuritis (AVN). STUDY DESIGN: Retrospective study. SETTING: Tertiary otology clinic. PATIENTS AND INTERVENTIONS: We tested 21 patients with AVN with the HIMP, SHIMP, and caloric tests, and we analyzed the relationships between the tests' results. MAIN OUTCOME MEASURES: For this study, we adopted vestibulo-ocular reflex (VOR) gains in the SHIMP and HIMP, peak saccade velocity (PSV) of SHIMP which is another indicator of residual vestibular function, and canal paresis of caloric test. RESULTS: VOR gains showed significant correlation (Râ=â0.926, pâ<â0.001) between the SHIMP and HIMP, but VOR gains were slightly lower in the SHIMP than in the HIMP (mean difference 0.07â±â0.09, pâ<â0.001). The difference between the HIMP and SHIMP gains was slightly larger on the affected side (0.10â±â0.09) than on the healthy side (0.03â±â0.09). The PSV of SHIMP had significant correlation with HIMP gain and canal paresis. Sixteen of 21 patients showed 100% ipsilesional caloric canal paresis, and eight (50%) of them showed no anti-compensatory saccade (direction toward head rotation) in the SHIMP. However, they showed not extremely low VOR gain but variable VOR gain. CONCLUSION: The new parameters of SHIMP might be used as complement for evaluating vestibular function in AVN. However, the clinical impact of the saccades of SHIMP in AVN has not been revealed clearly yet. This question should be investigated in further studies.
Assuntos
Teste do Impulso da Cabeça/métodos , Neuronite Vestibular/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reflexo Vestíbulo-Ocular/fisiologia , Estudos Retrospectivos , Neuronite Vestibular/fisiopatologiaRESUMO
OBJECTIVE: Our aim was to elucidate relationships between results from the caloric test (c-test), video Head Impulse Test (vHIT) and inner ear gadolinium-enhanced MRI (ieMRI) in patients with endolymphatic hydrops (EH), especially patients with Ménière's disease (MD). METHODS: We managed 1789 successive patients at the Vertigo/Dizziness Center in Nara Medical University from May 2014 to December 2018. After providing informed consent for vertigo/dizziness examinations, 281 patients were hospitalized to check their inner ear function for proper diagnosis and treatment. Then 76 participants underwent the c-test, vHIT and ieMRI. Among these 76 cases, 20 were diagnosed with MD (20/76; 26.3%) and 56 were non-MD (56/76; 73.7%) according to the 2015 diagnostic guideline of the International Classification of Vestibular Disorders. The MD group included 15 unilateral and 5 bilateral cases. The non-MD group included 22 benign paroxysmal positional vertigo, 10 vestibular neuritis, 8 sudden deafness with vertigo, 6 orthostatic dysregulation, 4 vestibular neuropathy and 6 others. Results in these examinations in the side of an active lesioned inner ear were representative in each peripheral case. RESULTS: Twenty-nine of the 76 patients (38.1%) showed discrepant results between the c-test (outside of normal range) and vHIT (within normal range). Twenty-two of 76 patients (28.9%) had a positive EH sign on ieMRI. The c-test/vHIT discrepancy percentage in MD (14/20; 70.0%) was significantly higher than that in non-MD (15/56; 26.8%) (p=0.00179). The positive EH sign in ieMRI percentage in MD (15/20; 75.0%) was significantly higher than that in non-MD (7/56; 12.5%) (p=0.0015). There was a significant positive relationship between the c-test/vHIT discrepancy and the positive EH sign (p=0.00058) in all 76 cases combined. However, there was no significant relationship between c-test/vHIT discrepancy and positive EH sign (p=0.13) in the 20 MD cases. Considering the 15 unilateral and 5 bilateral MD cases, the c-test/vHIT discrepancy was observed in 14 of the 25 affected ears. Positive signs of vestibular EH herniation into the cupula in the lateral semicircular canal was seen in 14 of the 25 MD ears. There was significant relationship between the c-test/vHIT discrepancy and EH herniation (p=0.0012) in MD ears. CONCLUSION: The present results suggest that patients with MD could have inner ear EH significantly more often than those with non-MD. In cases with MD, a positive EH sign on ieMRI did not always indicate a c-test/vHIT discrepancy; both findings may occur due to herniation of vestibular EH adjacent to the lateral semicircular canal.