RESUMEN
PURPOSE OF REVIEW: We performed a narrative review of the recent findings in epidemiology, clinical presentation, mechanisms and treatment of vestibular migraine. RECENT FINDINGS: Vestibular migraine is an underdiagnosed condition that has a high prevalence among general, headache and neuro-otology clinics. Vestibular migraine has a bimodal presentation probably associated with a hormonal component in women. These patients could have a complex clinical phenotype including concomitant autonomic, inflammatory or connective tissue conditions that have a higher prevalence of psychological symptoms, which may mistakenly lead to a diagnosis of a functional neurological disorder. A high proportion of patients with postural perceptual persistent dizziness have a migraine phenotype. Independently of the clinical presentation and past medical history, patients with the vestibular migraine phenotype can respond to regular migraine preventive treatments, including those targeting the calcitonin gene-related peptide pathways. SUMMARY: Vestibular migraine is an underdiagnosed migraine phenotype that shares the pathophysiological mechanisms of migraine, with growing interest in recent years. A thorough anamnesis is essential to increase sensitivity in patients with unknown cause of dizziness and migraine treatment should be considered (see supplemental video-abstract).
Asunto(s)
Mareo , Trastornos Migrañosos , Humanos , Mareo/diagnóstico , Mareo/fisiopatología , Mareo/epidemiología , Mareo/terapia , Mareo/etiología , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/fisiopatología , Trastornos Migrañosos/terapia , Vértigo/diagnóstico , Vértigo/fisiopatología , Vértigo/terapia , Vértigo/epidemiología , Vértigo/etiología , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/epidemiología , Enfermedades Vestibulares/terapia , Enfermedades Vestibulares/fisiopatologíaRESUMEN
OBJECTIVES: Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC). METHODS: Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests. RESULTS: The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke. CONCLUSIONS: Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.
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Lupus Eritematoso Sistémico , Arteritis de Takayasu , Acúfeno , Vértigo , Humanos , Arteritis de Takayasu/epidemiología , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/diagnóstico , Femenino , Masculino , Adulto , Estudios Transversales , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/diagnóstico , Prevalencia , Persona de Mediana Edad , Acúfeno/etiología , Acúfeno/epidemiología , Acúfeno/diagnóstico , Encuestas y Cuestionarios , Estudios de Casos y Controles , Vértigo/etiología , Vértigo/epidemiología , Vértigo/fisiopatología , Factores de Riesgo , Pérdida Auditiva/epidemiología , Pérdida Auditiva/etiología , Pérdida Auditiva/diagnóstico , Adulto Joven , Modelos Logísticos , Centros de Atención Terciaria , Audición , Audiometría , Oportunidad RelativaRESUMEN
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.
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Vértigo Posicional Paroxístico Benigno , Mareo , Enfermedad de Meniere , Trastornos Migrañosos , Enfermedades Vestibulares , Neuronitis Vestibular , Humanos , Mareo/epidemiología , Mareo/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Enfermedades Vestibulares/complicaciones , Enfermedades Vestibulares/epidemiología , Enfermedades Vestibulares/diagnóstico , Adulto , Estudios Retrospectivos , Anciano , Enfermedad de Meniere/complicaciones , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/epidemiología , Enfermedad de Meniere/fisiopatología , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/complicaciones , Neuronitis Vestibular/complicaciones , Neuronitis Vestibular/diagnóstico , Neuronitis Vestibular/fisiopatología , Neuronitis Vestibular/epidemiología , Vértigo Posicional Paroxístico Benigno/epidemiología , Vértigo Posicional Paroxístico Benigno/diagnóstico , Vértigo Posicional Paroxístico Benigno/fisiopatología , Dehiscencia del Canal Semicircular/complicaciones , Dehiscencia del Canal Semicircular/epidemiología , Dehiscencia del Canal Semicircular/fisiopatología , Vértigo/epidemiología , Vértigo/fisiopatología , Adulto Joven , Pruebas de Función Vestibular , Probabilidad , Autoinforme , Anciano de 80 o más AñosRESUMEN
PURPOSE OF REVIEW: To provide an update on comorbidity of vestibular symptoms and migraine. RECENT FINDINGS: Multisensory processing and integration is a key concept for understanding mixed presentation of migraine and vestibular symptoms. Here, we discuss how vestibular migraine should be distinguished from a secondary migraine phenomenon in which migraine symptoms may coincide with or triggered by another vestibular disorder. We also have some updates on the diagnostic criteria of vestibular migraine, its pathophysiology, and common approaches used for its treatment. As a common clinical presentation of migraine and vestibular symptoms, vestibular migraine should be distinguished from a secondary migraine phenomenon, in which migraine symptoms may be triggered by or coincide with another vestibular disorder. Recent experimental evidence suggests vestibular symptoms in vestibular migraine are linked to multisensory mechanisms that control body motion and orientation in space.
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Comorbilidad , Trastornos Migrañosos , Vértigo , Humanos , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/fisiopatología , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/terapia , Vértigo/epidemiología , Vértigo/fisiopatología , Vértigo/diagnóstico , Vértigo/terapiaRESUMEN
PURPOSE: To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS: Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.
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Trastornos Migrañosos , Vértigo , Enfermedades Vestibulares , Humanos , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/fisiopatología , Trastornos Migrañosos/complicaciones , Vértigo/diagnóstico , Vértigo/fisiopatología , Vértigo/etiología , Vértigo/terapia , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/fisiopatología , Enfermedades Vestibulares/complicaciones , Enfermedades Vestibulares/terapia , Mareo/fisiopatología , Mareo/diagnóstico , Mareo/etiología , Mareo/terapiaRESUMEN
INTRODUCTION: Persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM) share symptoms of visual vertigo and motion sickness that can be confusing for clinicians to distinguish. We compare the severity of these symptoms and dynamic subjective visual vertical (dSVV) in these two common vestibular conditions. METHOD: Twenty-nine patients with PPPD, 37 with VM, and 29 controls were surveyed for subjective symptoms using the visual vertigo analogue scale (VVAS) and motion sickness susceptibility questionnaire during childhood (MSA) and the past 10 years (MSB). dSVV is a measure of visual dependence measures perception of verticality against a rotating background (5 deg./s). RESULTS: VVAS revealed contextual differences for dizziness between those with PPPD and VM. Ratings of visual vertigo were most severe in PPPD, less in VM, and mild in controls (VVAS PPPD 27.1, VM 11.2, control 4.6, p < 0.001). MSA was more severe in VM than in PPPD or control (12.8 vs 7.6 vs 8.5, p = 0.01). MSB was more severe in VM than controls (MSB score 12.9 VS 8.1 p = 0.009) but was not different than PPPD (MSB score 10.0, p = 0.10). dSVV alignment was similar among the three groups (p = 0.83). Both VM and PPPD groups had greater simulator sickness than controls after completing the dSVV. CONCLUSIONS: Patients with PPPD report more visual vertigo than those with VM, but a history of motion sickness as a child is more common in VM. Additionally, the environmental context that induces visual vertigo is different between PPPD and VM.
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Mareo , Trastornos Migrañosos , Mareo por Movimiento , Vértigo , Humanos , Mareo por Movimiento/fisiopatología , Mareo por Movimiento/complicaciones , Vértigo/diagnóstico , Vértigo/fisiopatología , Femenino , Mareo/etiología , Mareo/diagnóstico , Mareo/fisiopatología , Masculino , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/fisiopatología , Trastornos Migrañosos/diagnóstico , Adulto , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
BACKGROUND: Short-term personalized vestibular rehabilitation (ST-PVR) can establish stable vestibular compensation. However, there is a lack of a clear definition for clinical indicators that can dynamically reflect the progress of vestibular rehabilitation (VR). OBJECTIVE: To explore the clinical indicators suitable for evaluating the effectiveness of ST-PVR in treating benign recurrent vertigo (BRV). METHODS: In total, 50 patients diagnosed with BRV were enrolled. All patients received the ST-PVR treatment program. At 2 and 4 weeks after rehabilitation, subjective scales, including the visual analogue scale (VAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence scale (ABC) and generalized anxiety disorder (GAD-7) were assessed. Objective vestibular function tests were performed. VR grading was determined. RESULTS: At 2 weeks after rehabilitation, significant enhancements were observed in VAS, DHI, ABC, GAD-7, UW, vHIT results, and VR grading scores (p < 0.05). The sensory organization test (SOT) results demonstrated statistically significant improvements at 2 weeks and 4 weeks after rehabilitation (p < 0.05). CONCLUSION AND SIGNIFICANCE: Both subjective scales and partial examination results in objective assessment can serve as indicators to dynamically monitor the compensatory process of vestibular function in patients with BRV. The VR efficacy grading score, which incorporates the above indicators, allows for quantification of the changes that occur during the vestibular rehabilitation process.
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Vértigo , Pruebas de Función Vestibular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Vértigo/rehabilitación , Vértigo/fisiopatología , Pruebas de Función Vestibular/métodos , Resultado del Tratamiento , Anciano , Recurrencia , Equilibrio Postural/fisiologíaRESUMEN
BACKGROUND: Although the diagnostic criteria of vestibular migraine (VM) have already been defined, various clinical manifestations of VM and the lack of pathognomonic biomarker result in high rate of misdiagnosis and mismanagement. A timely and accurate diagnosis tool for the evaluation of VM is highly needed. OBJECTIVE: The current study aims to investigate the potential feasibility of cervical vestibular evoked myogenic potential (cVEMP) and vestibular autorotation test (VAT) as a diagnosis tool for VM. METHODS: A total of 211 subjects were recruited into the current study with all subjects meeting the inclusion and exclusion criteria. The subjects were divided into 3 groups: healthy control group, general migraine group and VM group. Test of cVEMP and VAT was conducted in all the groups, and the generated data were statistically compared. RESULTS: Compared with the other two groups, cVEMP P13-N23 amplitudes of VM patients showed a significant decline. Mean latency values of the VM group had no significant difference in comparison with other groups. Asymmetry ratios showed increased level in VM patients compared to the control groups, without significant difference. VAT results showed that all the horizontal gain, horizontal phase, vertical gain and vertical phase differ from the other two groups to varying degrees at higher frequency. CONCLUSION: cVEMP and VAT have potential usage in the assessment of VM and can serve as powerful tool in diagnosis of VM.
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Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/fisiopatología , Vértigo/diagnóstico , Vértigo/fisiopatología , Potenciales Vestibulares Miogénicos Evocados , Pruebas de Función Vestibular , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Vértigo/complicacionesRESUMEN
BACKGROUND AND PURPOSE: The recognition of clinical features of transient vestibular symptoms (TVSs) preceding posterior circulation stroke (PCOS) would be informative to discriminate dizziness/vertigo due to vertebrobasilar transient ischemic attack from the acute transient vestibular syndrome. We sought to determine the prevalence and characteristics of TVSs preceding PCOS. METHODS: We performed a prospective multicenter observational study that had recruited 447 patients with PCOS from referral-based 4 university hospitals in Korea. We investigated the timing, pattern, frequency, duration, and accompanying neurological symptoms of TVSs during the 3 months preceding PCOS. RESULTS: The prevalence of TVSs preceding PCOS was 12% (55/447) during the previous 3 months. The TVSs preceding PCOS occurred within 1 week (33%), between 1 week and 1 month (16%), or between 1 and 3 months (51%). The TVSs were mostly dizziness/vertigo with (36%) or without (60%) imbalance, while the remaining 4% had an isolated imbalance. The dizziness/vertigo was spinning in 38% and was aggravated during head position in 45%. The duration of TVSs was mostly a few seconds (55%) or minutes (38%). Approximately 72% of the patients with PCOS had TVSs 1 to 5 times, while 16% had >10 times. Accompanying neurological symptoms, including headache, tinnitus, limb weakness, sensory change, dysarthria, visual field defect, and diplopia, were reported in 11%. CONCLUSIONS: Preceding TVSs can occur in 12% of PCOS during the previous 3 months. Isolated dizziness/vertigo of unknown cause needs to be considered as a vertebrobasilar transient ischemic attack symptom, especially in patients with vascular risk factors. The characteristics of isolated vestibular symptom in vertebrobasilar transient ischemic attacks is highly variable and atypical compared with other transient ischemic symptoms.
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Mareo/diagnóstico , Ataque Isquémico Transitorio/diagnóstico , Accidente Cerebrovascular/diagnóstico , Vértigo/diagnóstico , Sistema Vestibular , Adulto , Anciano , Anciano de 80 o más Años , Mareo/etiología , Mareo/fisiopatología , Femenino , Humanos , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Vértigo/etiología , Vértigo/fisiopatología , Sistema Vestibular/fisiopatología , Adulto JovenRESUMEN
OBJECTIVES: The efficacy of intratympanic steroid (ITS) injection for intractable Meniere's disease has been reported; however, its differences in responsiveness are not fully understood. This study investigated the clinical characteristics of patients who responded to ITS injection treatment. METHODS: This retrospective study included 32 patients with Meniere's disease who were unable to control frequent vertigo attacks despite conservative treatment for at least 3 months. They received an intratympanic injection of dexamethasone (3.3 mg/mL) in the affected side at least three times. We measured hearing threshold, subjective symptom scores, cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP), and performed glycerol and bithermal caloric tests. RESULTS: Satisfactory control of vertigo for 1 year after the first round of injection was found in 18 patients (56.3%; the response group). However, the injections failed to control vertigo in the other 14 patients (43.8%; the non-response group), and they were then treated with middle ear micropressure therapy. The response group showed improvement in low-frequency hearing, whereas hearing acuity did not change in the non-response group. Significantly reduced amplitude of cVEMP on the affected side was found in 62.5% of patients in the response group; however, no patients in the non-response group showed reduced amplitude of cVEMP. CONCLUSIONS: ITS injection significantly improved the subjective symptoms for intractable Meniere's disease; however, the long-term effects were heterogeneous. Our results suggest that reduced amplitude in cVEMP is associated with the effectiveness of ITS injection treatment.
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Dexametasona/administración & dosificación , Enfermedad de Meniere/complicaciones , Vértigo/tratamiento farmacológico , Vértigo/etiología , Adulto , Anciano , Anciano de 80 o más Años , Pruebas Calóricas/métodos , Femenino , Humanos , Inyección Intratimpánica , Masculino , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/fisiopatología , Persona de Mediana Edad , Resultado del Tratamiento , Vértigo/diagnóstico , Vértigo/fisiopatología , Potenciales Vestibulares Miogénicos EvocadosRESUMEN
PURPOSE: This study aims to assess the effect of age in vestibulo-ocular reflex (VOR) gain measured by Video Head Impulse Test (VHIT) and to present normative data of VOR gain, median gain at 40, 60, 80 and 0-100 ms, and gain asymmetry according to decades of life in healthy subjects. MATERIAL AND METHODS: A total of 132 subjects with no previous history of vestibular disorders were enrolled to assess VOR gain by employing VHIT. The test was performed in the X-axis evaluating both horizontal semicircular canals (HSC). The same right-handed operator performed the test in all subjects. RESULTS: The mean VOR gain was higher in the right ear (0.99 ± 0.09) compared to the left ear (0.97 ± 0.08) (p = 0.001). Median gain at 60 ms was 0.92 ± 0.12 in the right HSC and 0.93 ± 0.10 for the left HSC, without significant difference (p = 0.94). A significant decrease of VOR gain occurred with increasing age in the right ear (r = -0.21, p = 0.01). Median gain at 60 ms decreased significantly as age increased in both HSC (right r = -0.17, p = 0.04; left r = -0.23, p = 0.006). No significant differences in VOR gain values were observed when the sample was stratified by age according to the analysis of variance. CONCLUSIONS: A slight but significant decrease in VOR function was observed as age increased for gain and median gain at 60 ms. Larger studies, including patients with central and peripheral vestibular disorders, are needed to assess the clinical implication of this effect when evaluating patients with vestibular disorders.
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Envejecimiento/fisiología , Prueba de Impulso Cefálico/métodos , Voluntarios Sanos , Reflejo Vestibuloocular/fisiología , Movimientos Sacádicos/fisiología , Grabación en Video , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Mareo/diagnóstico , Mareo/etiología , Mareo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vértigo/diagnóstico , Vértigo/fisiopatología , Enfermedades Vestibulares/complicaciones , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/fisiopatología , Adulto JovenRESUMEN
PURPOSE: Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS: 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS: Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS: VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.
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Accidentes de Tránsito , Electronistagmografía/métodos , Movimientos Oculares , Náusea/diagnóstico , Náusea/etiología , Vértigo/diagnóstico , Vértigo/etiología , Grabación en Video/métodos , Lesiones por Latigazo Cervical/complicaciones , Lesiones por Latigazo Cervical/fisiopatología , Adolescente , Adulto , Anciano , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/fisiopatología , Vértigo/fisiopatología , Adulto JovenRESUMEN
The aim of research is to unveil the mechanisms of the beneficial effects of XYD on PCIV in a rabbit model. 40 New Zealand white rabbits were randomly divided into 5 groups,including normal control group (NC), model control group (MC), low-dose of XYD group (LXYD), high-dose of XYD group (HXYD) and Yang-Xue-Qin-Nao group (YXQN). PCIV rabbit model was established by feeding high-fat diet companied with paravertebral sclerotherapy and rotation exercise. The general observation, step-down test, rheoencephalogram, blood tests, histopathological detection and the plasma concentration of the effective component of XYD were investigated. After pharmacological intervening, the step-down time, REG, PL, IPL, blood viscosity, the levels of blood lipids, CRGP were significantly improved. Moreover, the vertebral artery showed the reduced stenosis of arterial lumen and less proliferation of fibrous tissue in the arterial wall in the LXYD, HXYD and YXQN group. Based on the LC-MS detection, the blood concentrations of puerarin in the LXYD and HXYD group were significantly increased after pharmacological intervening. XYD could ameliorate the symptoms of vertigo, Qi-deficiency and blood stasis in PCIV rabbits via effectively regulating the levels of blood lipids and vasoactive substances, decreasing blood viscosity, increasing CBF and protecting vestibular function.
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Conducta Animal/efectos de los fármacos , Medicamentos Herbarios Chinos/farmacología , Potenciales Evocados Auditivos del Tronco Encefálico/efectos de los fármacos , Arteria Vertebral/efectos de los fármacos , Insuficiencia Vertebrobasilar/fisiopatología , Vértigo/fisiopatología , Núcleos Vestibulares/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Hemorreología , Metabolismo de los Lípidos/efectos de los fármacos , Medicina Tradicional China , Conejos , Arteria Vertebral/patología , Arteria Vertebral/ultraestructura , Núcleos Vestibulares/patología , Núcleos Vestibulares/ultraestructuraRESUMEN
PURPOSE OF REVIEW: To present evidence of a functional interrelation between the vestibular and the anxiety systems based on a complex reciprocally organized network. The review focuses on the differential effects of various vestibular disorders, on psychiatric comorbidity, and on anxiety related to vertigo. RECENT FINDINGS: Episodic vertigo syndromes such as vestibular migraine, vestibular paroxysmia, and Menière's disease are associated with a significant increase of psychiatric comorbidity, in particular anxiety/phobic disorders and depression. Chronic unilateral and bilateral vestibulopathy (BVP) do not exhibit a higher than normal psychiatric comorbidity. Anxiety related to the vertigo symptoms is also increased in episodic structural vestibular disorders but not in patients with chronic unilateral or bilateral loss of vestibular function. The lack of vertigo-related anxiety in BVP is a novel finding. Several studies have revealed special features related to anxiety in patients suffering from BVP: despite objectively impaired postural balance with frequent falls, they usually do not complain about fear of falling; they do not report an increased susceptibility to fear of heights; they do not have an increased psychiatric comorbidity; and they do not report increased anxiety related to the perceived vertigo. Subtle or moderate vestibular stimulation (by galvanic currents or use of a swing) may have beneficial effects on stress or mood state in healthy adults, and promote sleep in humans and rodents. The intimate structural and functional linkage of the vestibular and anxiety systems includes numerous nuclei, provincial and connector hubs, the thalamocortical network, and the cerebellum with many neural transmitter systems. SUMMARY: The different involvement of emotional processes and anxiety - to the extent of 'excess anxiety' or 'less anxiety' - in structural vestibular disorders may be due to the specific dysfunction and whether the system activity is excited or diminished. Both psychiatric comorbidity and vertigo-related anxiety are maximal with excitation and minimal with loss of peripheral vestibular function.
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Ansiedad/psicología , Mareo/psicología , Miedo/psicología , Vértigo/psicología , Enfermedades Vestibulares/psicología , Accidentes por Caídas , Ansiedad/fisiopatología , Mareo/fisiopatología , Miedo/fisiología , Humanos , Vértigo/fisiopatología , Enfermedades Vestibulares/fisiopatología , Vestíbulo del Laberinto/fisiopatologíaRESUMEN
Vestibular migraine (VM), also known as migrainous vertigo or migraine-associated vertigo, is characterized by recurrent vestibular attacks often accompanied by migraine headaches and other migraine symptoms. It is one of the most common presenting complaints to physicians in primary care, otolaryngology, and neurology. Epidemiologic data suggest that VM may affect 1 to 3% of the general population and 10 to 30% of patients seeking treatment for dizziness. Attacks typically last minutes to hours and range from spontaneous and positional vertigo to extreme sensitivity to self and surround motion. As with headaches, nausea, and vomiting, phonophobia and photophobia are common accompanying symptoms. The clinical spectrum of VM and its underlying pathophysiological mechanisms are just being identified, with much debate about the causal relationship of vestibular symptoms and headache, no evidence-based guidelines for clinical management, limited characterization of its disease burden, and little information about its negative impact on health-related quality of life.
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Trastornos Migrañosos , Vértigo , Humanos , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/etiología , Trastornos Migrañosos/fisiopatología , Vértigo/diagnóstico , Vértigo/etiología , Vértigo/fisiopatologíaRESUMEN
Cerebellar dizziness and vertigo account for approximately 10% of diagnoses in a tertiary dizziness center. This term summarizes a large group of disorders with chronic (degenerative, hereditary, acquired cerebellar ataxias), recurrent (episodic ataxias), or acute (stroke, inflammation) presentations. Key to the diagnosis is a comprehensive examination of central ocular motor and vestibular function. Patients with cerebellar dizziness and vertigo usually show a pattern of deficits in smooth pursuit, gaze-holding, saccade accuracy, or fixation-suppression of the vestibulo-ocular reflex. Central fixation nystagmus (e.g., downbeat nystagmus), gaze-evoked nystagmus, central positional nystagmus, or head-shaking nystagmus with cross-coupling (i.e., horizontal head shaking causing inappropriate vertical nystagmus) occurs frequently. Overlap syndromes with peripheral vestibular disorders, such as cerebellar ataxia, neuropathy, and vestibular areflexia, exist rarely. Posturography and gait analysis can contribute to diagnostic differentiation, estimation of the risk of falls, as well as quantification of progression and treatment effects. Patients with cerebellar dizziness and vertigo should receive multimodal treatment, including balance training, occupational therapy, and medication.
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Enfermedades Cerebelosas , Mareo , Vértigo , Enfermedades Cerebelosas/diagnóstico , Enfermedades Cerebelosas/etiología , Enfermedades Cerebelosas/fisiopatología , Enfermedades Cerebelosas/terapia , Mareo/diagnóstico , Mareo/etiología , Mareo/fisiopatología , Mareo/terapia , Humanos , Vértigo/diagnóstico , Vértigo/etiología , Vértigo/fisiopatología , Vértigo/terapiaRESUMEN
Environmental circumstances that result in ambiguity or conflict with the patterns of sensory stimulation may adversely affect the vestibular system. The effect of this conflict in sensory information may be dizziness, a sense of imbalance, nausea, and motion sickness sometimes even to seemingly minor daily head movement activities. In some, it is not only exposure to motion but also the observation of objects in motion around them such as in supermarket aisles or other places with visual commotion; this can lead to dizziness, nausea, or a feeling of motion sickness that is referred to as visual vertigo. All people with normal vestibular function can be made to experience motion sickness, although individual susceptibility varies widely and is at least partially heritable. Motorists learn to interpret sensory stimuli in the context of the car stabilized by its suspension and guided by steering. A type of motorist's disorientation occurs in some individuals who develop a heightened awareness of perceptions of motion in the automobile that makes them feel as though they may be rolling over on corners and as though they are veering on open highways or in streaming traffic. This article discusses the putative mechanisms, consequences and approach to managing patients with visual vertigo, motion sickness, and motorist's disorientation syndrome in the context of chronic dizziness and motion sensitivity.
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Conducción de Automóvil , Confusión , Mareo , Mareo por Movimiento , Vértigo , Confusión/etiología , Confusión/fisiopatología , Confusión/terapia , Mareo/etiología , Mareo/fisiopatología , Mareo/terapia , Humanos , Mareo por Movimiento/etiología , Mareo por Movimiento/fisiopatología , Mareo por Movimiento/terapia , Vértigo/etiología , Vértigo/fisiopatología , Vértigo/terapiaRESUMEN
Mal de debarquement syndrome (MdDS) is a disorder of persistent vertigo characterized by a feeling of oscillation such as rocking, bobbing, or swaying. It is triggered by passive motion, typically by exposure to water, air, or land transportation. This syndrome affects middle-aged individuals who are predominantly women. MdDS presents as a balance disorder that carries significant risk of morbidity due to both the direct effects of balance impairment and associated symptoms of fatigue, cognitive slowing, and visual motion intolerance. The Barany Society will be publishing criteria for diagnosing persistent MdDS. In addition, more insight has been gained into the pathophysiology of MdDS, with current hypotheses pointing to a cerebral and cerebellar basis. Treatments have expanded beyond medication trials, and now include the use of noninvasive brain stimulation and readaptation of the vestibulo-ocular reflex.
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Disfunción Cognitiva , Fatiga , Mareo por Movimiento , Enfermedad Relacionada con los Viajes , Vértigo , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/terapia , Fatiga/diagnóstico , Fatiga/etiología , Fatiga/fisiopatología , Fatiga/terapia , Humanos , Mareo por Movimiento/diagnóstico , Mareo por Movimiento/etiología , Mareo por Movimiento/fisiopatología , Mareo por Movimiento/terapia , Síndrome , Vértigo/diagnóstico , Vértigo/etiología , Vértigo/fisiopatología , Vértigo/terapiaRESUMEN
Brain metastasis is a rare and generally late manifestation of an advanced-stage, high-grade serous ovarian carcinoma. Nowadays, the improved control of intra-abdominal disease by surgery and platinum-based chemotherapy results in a longer survival, allowing distant metastasis to implant and grow in the brain parenchyma. Herein, we describe a unique case of a cerebellar metastasis from clear cell ovarian carcinoma that initially presented as a FIGO Stage IC cancer. Surprisingly, 6 mo after surgery, the patient was in good condition with complete disappearance of symptoms and no evidence of recurrence. This relatively good biologic behavior may be explained by the presence of a PIK3CA-activating mutation in exon 9 which as previously reported in the literature, may be associated with better prognosis. To the best of our knowledge, this is the first reported case of cerebellar metastasis from ovarian clear cell carcinoma. In the presence of neurological symptoms, both clinicians and pathologists must be aware of this rare possibility, to assure correct patient management and effective therapeutic options. Generally, the prognosis of epithelial ovarian cancer patients with brain metastases is poor. PIK3CA mutations could be a good prognostic indicator in clear cell carcinomas.
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Adenocarcinoma de Células Claras/secundario , Neoplasias Cerebelosas/secundario , Fosfatidilinositol 3-Quinasa Clase I/genética , Neoplasias Ováricas/patología , Adenocarcinoma de Células Claras/diagnóstico por imagen , Adenocarcinoma de Células Claras/genética , Biomarcadores de Tumor/genética , Neoplasias Cerebelosas/diagnóstico por imagen , Neoplasias Cerebelosas/genética , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Mutación , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/genética , Vértigo/fisiopatologíaRESUMEN
OBJECTIVE: To determine whether patients with vestibular migraine are more likely to suffer from an occipital headache than patients with migraine without vestibular symptoms. BACKGROUND: Vestibular migraine is an underdiagnosed disorder in which migraine is associated with vestibular symptoms. Anatomical evidence and symptomatology hint at the involvement of brain structures in the posterior fossa (back of the head location). We hypothesized that vestibular migraine patients are more likely than migraineurs without vestibular symptoms to experience headaches located in the back of the head, that is, occipital headaches. METHODS: A retrospective cross-sectional study was conducted at the University of Iowa Hospital and Clinics. Chart analysis of 169 patients was performed. The primary outcome was the location of the headache in vestibular migraine patients and migraineurs without vestibular symptoms. The secondary outcomes included the association of vestibular migraine with gender, age at onset of headache, age at onset of vestibular symptoms (such as vertigo, head motion-induced dizziness), aura, motion sickness, other associated symptoms, family history of headaches, and family history of motion sickness. RESULTS: In vestibular migraine group, 45/103 (44%) had occipital location for their headaches vs 12/66 (18%) in migraine patients without vestibular symptoms, for an odd's ratio of 3.5 (95% CI = 1.7-7.2, P < .001). Additionally, the age at onset of headache was greater in the vestibular migraine group (28 ± 12 vs 18 ± 9 years, P < .001) and motion sickness was more common (41/98 (42%) in the vestibular migraine group, 1/64 (2%) in the migraine without vestibular symptoms group, P < .001). CONCLUSIONS: This study suggests that patients with vestibular migraine are more likely to have occipital headaches than patients with migraine without vestibular symptoms. Our data support the initiation of a prospective study to determine whether a patient presenting with occipital headaches, with late onset of age of headache, and with a history of motion sickness is at an increased risk for the possible development of vestibular migraine.