Effectiveness of neck-specific exercises with and without internet-based support on dizziness/unsteadiness in chronic whiplash-associated disorders: Secondary analyses of a randomised controlled trial.

AIM: To investigate the effectiveness in individuals with chronic whiplash-associated disorders (WADs) of neck-specific exercise (NSE) supervised by a physiotherapist twice a week for 12 weeks versus neck-specific exercise with internet support and four physiotherapy visits (NSEIT) regarding dizziness, unsteadiness and balance, and to investigate the differences between WAD grades. METHOD: This is a secondary analysis of a prospective randomised multicentre study (RCT) with concealed allocation (ClinicalTrials.gov Protocol ID: NCT03022812). The outcomes were dizziness measured on the Dizziness Handicap Inventory (DHI); dizziness at rest and during activity and unsteadiness using visual analogue scales; and standing on one leg with eyes closed (SOLEC). Participants (n = 140) were randomised to NSE or NSEIT. Measurements were obtained at baseline, and at three- and 15-month follow-ups by assessor-blinded investigators. RESULTS: There were no significant differences between NSEIT and NSE in any of the outcomes (p>0.38). Both NSEIT and NSE improved over time (p<0.02; effect size (ES) = 0.74-1.01) in DHI score and dizziness during activity. There was a significant group-by-time interaction effect in dizziness (at rest: p = 0.035; ES: 0.66; and during activity: p = 0.016; ES: 1.24) between WAD grades. Individuals with WAD grade 3 had dizziness/unsteadiness to a greater extent and improved in all outcomes over time (p<0.04) compared to those with WAD grade 2, except for SOLEC. CONCLUSIONS: There were no significant group differences between NSEIT and NSE. Both groups decreased in terms of self-reported dizziness (DHI, dizziness during activity), with medium to large effect size. Those with WAD grade 3 have dizziness/unsteadiness to a greater extent than those with WAD grade 2. Despite improvements, many participants still reported dizziness at 15-month follow-up, and additional balance training and/or vestibular exercise may be investigated for potential additional effect.

Persistent Postural Perceptual Dizziness In The Neurology Clinic.

Aim: To determine the proportion of referrals to a General Neurology New Patient Clinic which meet the diagnostic criteria of Persistent Postural Perceptual Dizziness (PPPD) and to gauge patient-perceived response to treatment. Methods: Referral letters, n=1315, to a General Neurology New Patient Clinic from 2021-2023 were screened for terms 'dizziness', 'vertigo', 'unsteadiness' and 'vestibular'. A chart review was performed to establish study outcomes. Results: 202 (15.4%) patients were referred with 'dizziness', 'vertigo' or 'unsteadiness', 22 (11%) of which fulfilled the diagnostic criteria. Venlafaxine was offered in 10 (45.5%) patients and conferred ≥50% benefit in 8 (80%). Vestibular physiotherapy improved symptoms by ≥25% in all 7 (100%) patients with access to the intervention. Cognitive behavioural therapy and effective communication of the diagnosis alleviated symptoms by 50% in 3 (14%) patients respectively. Discussion: PPPD is increasingly recognised in patients with chronic vestibular symptoms and can cause significant functional morbidity. Venlafaxine may independently improve symptoms1.

Constant Dizziness Versus Episodic Vertigo in Ménière's Disease: Health-Related Quality of Life, Cognitive Dissonance, and Postural Problems.

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.

Basilar Artery Tortuosity Increases the Risk of Persistent Dizziness and Unsteadiness After Posterior Circulation Infarction.

BACKGROUND AND PURPOSE: Basilar artery (BA) tortuosity is closely associated with posterior circulation infarction (PCI) and dizziness/unsteadiness. This study aims to determine the relationship between BA tortuosity and the outcome of dizziness and unsteadiness in PCI patients. METHOD: This study prospectively recruited PCI patients presenting with dizziness and unsteadiness. BA tortuosity was diagnosed based on Smoker's criteria. The BA tortuosity index (BATI) was measured from magnetic resonance angiography (MRA) images. Posterior circulation was divided into proximal (medulla oblongata and posterior inferior cerebellar), middle, and distal territories. Symptoms, risk of falls, and quality of life were followed up in 3 months after stroke. Logistic regression was used to identify possible factors associated with the persistence of dizziness and unsteadiness. RESULTS: Among 182 PCI patients presenting with dizziness and unsteadiness, 97 (53.3%) had BA tortuosity, including 19 (10.4%) with moderate-to-severe BA tortuosity. At the 3-month follow-up, 58 (31.9%) patients continued to experience dizziness and unsteadiness, with significantly decreased quality of life and a high risk of falls. Binary logistic regression analysis identified moderate-to-severe BA tortuosity (OR, 4.474; 95% CI, 1.591-12.579; p = 0.004) and lesions involving the proximal posterior circulation territory (OR, 2.146; 95% CI, 1.097-4.199; p = 0.026) as risk factors for persistent dizziness and unsteadiness after PCI, while thrombolysis (OR, 0.280; 95% CI, 0.079-0.992; p = 0.049) as a protective factor. BATI (OR, 1.072; 95% CI, 1.028-1.119; p = 0.001) was also independently associated with dizziness and unsteadiness after PCI. CONCLUSION: Prominent BA tortuosity increases the risk of persistent dizziness and unsteadiness after PCI, leading to a high risk of falls and decreased quality of life. This warrants more attention in clinical practice.

[Dizziness and hearing loss in healthcare workers with COVID-19]. / Les vertiges et la perte auditive chez le personnel de santé atteint de COVID-19.

Coronavirus disease 2019 (COVID-19) affects the respiratory system. Studying the clinical characteristics of this infection has revealed its tropism to the nervous system, which is responsible for neurological and sensory damage, in particular, dizziness and hearing loss. To determine the frequency and characteristics of the neurological impairment represented by dizziness and hearing loss in healthcare professionals (HCP) with COVID-19. Cross-sectional descriptive study conducted among HCP at Charles Nicolle Hospital (CNH) in Tunis affected by COVID-19 during the period from September 2020 to December 2020. Data collection was carried out by regular telephone follow-up of COVID-19 symptoms in these HCPs during the period of sanitary isolation. A total of 482 HCPs with COVID-19 were collected. The average age of the population was 41 ± 10 years, of which 111 were men (23%) and 371 were women (77%). The main neurological manifestations were: headache (71.2%), anosmia (60%), dizziness (21.8%), and hearing loss (1.5%). Patients with vertigo were significantly older (P=0.035), female (P=0.003), obese (P=0.014), suffering from more comorbidities (P=0.004), and having greater professional seniority (P=0.009). Dizziness was significantly associated with fever (P=0.001), abdominal pain (P=0.001), and desaturation (P=0.039). Neurological symptoms including dizziness and hearing loss may be the only sign with which a case of COVID-19 could be recognized. Raising awareness of such a presentation of COVID-19 patients is crucial during this pandemic period to prevent infectious spread, especially in hospitals.

Potential determinants of early discontinuation of Etonogestrel implant: a cohort prospective study.

OBJECTIVE: To assess the frequency of early discontinuation of Implanon as a method of contraception. METHODS: The cohort prospective study was conducted at the Obstetrics and Gynaecology Department, Al-Yarmouk Teaching Hospital, Baghdad, Iraq from January 2017 to January 2021, after approval from the ethics review committee of the College of Medicine, Al-Mustansiriyha University, Bghadad, Iraq, and comprised women of childbearing age seeking long-acting contraception. The participants received Implanon, an etonorgestril implant, under local anaesthesia, and were followed up for 12 months for possible side effects. Data was analysed using SPSS 26. RESULTS: There were 115 women with mean age 29.8±6 years (range: 15-44 years) and mean body mass index 27±4.9 kg/m2. Early discontinuation of the plant was done by 32(27.8%) subjects, and the overall incidence of early Implanon removal per 1,000 women per month was 14.47 (95% confidence interval: 10.24-20.47). Lower body mass index, dizziness and insertion-site side effects were the potential determinants of early discontinuation (p<0.05). CONCLUSIONS: More than a quarter of the sample opted for early Implanon discontinuation. Low body mass index, dizziness and insertion-site side effects were potential determinants of early removal.

Pattern of fall and its determinants among elderly patients attending the general outpatient clinic of a tertiary hospital in northern Nigeria: a cross-sectional study.

Introduction: falls in the elderly are a neglected health problem in many societies, particularly in the developing world. Many health and social service providers are unprepared to prevent and manage falls and related injuries as they lack sufficient knowledge to identify their predisposing factors. For this reason, this study aims to identify the pattern of falls and its determinants among the elderly in northern Nigeria. Methods: a cross-sectional study was conducted among 300 elderly patients, selected by systematic random sampling. An interviewer-administered questionnaire was used. Data was analyzed using SPSS version 20. Variables were summarised using percentages and measures of central tendency/dispersion. The chi-square test was used in assessing the significance of associations between categorical variables. A p-value of <0.05 was considered statistically significant. Binary logistic regression analysis was conducted to identify determinants of falls. Results: the prevalence of falls and fall injuries was 41.4% and 25.4% respectively. The commonest pattern of fall injuries was swellings and pain (31.1%). Tripping was the commonest 60 (49.2%) cause of fall. Age (p<0.026, AOR=4.424, CI=1.192-16.424), presence of dizziness (p<0.015, AOR=0.334, CI=0.138-0.810), use of shoes with uneven (P<0.021, AOR=0.337, CI=0.133-0.851)/slippery soles (p<0.038, AOR=0.392 CI=0.162-0.948), having slippery mats (P<0.001, AOR=0.086, CI=0.039-0.192), wires/cords exposed (p=0.005, AOR=0.306 CI=0.132-0.705) on the pathways were the determinants. Conclusion: the high prevalence of falls and fall injuries signifies its importance in health care. This implies that physicians should be proactive in asking, assessing, and assisting the elderly to provide targeted interventions to potentially prevent falls.

Postural Orthostatic Tachycardia Syndrome (POTS) as a Cause of Dizziness - Expanding the Etiological Spectrum.

BACKGROUND AND OBJECTIVES: Dizziness is a frequent complaint encountered in neurology clinics. Dizziness can be spontaneous or triggered, which includes orthostatic dizziness. Orthostatic dizziness can be acute (reflex/vasovagal syncope), chronic (orthostatic hypotension (OH), or postural orthostatic tachycardia syndrome (POTS). Since dizziness has numerous causes, these patients undergo extensive investigations before a diagnosis is made. Here, we describe five patients who presented with dizziness and were diagnosed to have POTS on evaluation. MATERIALS AND METHODS: We conducted a retrospective study of patients who presented to the Department of Neurology from August 2020 to November 2021 with the complaint of dizziness and were diagnosed with POTS. The clinical history, neurological examination, treatment response, routine blood investigations, magnetic resonance imaging (MRI) brain, and autonomic function tests (AFTs) of the patients were reviewed from patients' clinical records. Patients with dizziness and with diagnosis other than POTS were excluded from the study. RESULTS: Among the five patients, males were predominant with a male to female ratio of 3:2. All the patients were in their early fourth decade with a mean age of 35.4 years. The presenting symptom was dizziness, and the key associated symptoms were anxiety and headache. Due to the orthostatic nature of symptoms and absence of orthostatic fall in blood pressure (BP), a detailed AFT was carried out, leading to the diagnosis of POTS. Patients were assessed at 3-6 months after treatment and there was a moderate response in one and no response in the remaining four patients. CONCLUSION: POTS should be considered a possible etiology when patients present with orthostatic dizziness in the absence of orthostatic fall in BP. Anxiety and headache may be associated with this type of dizziness.

[Diagnosing and treating acute and chronic dizziness : new approach in 2024]. / Prise en charge des vertiges aigus et chroniques : nouveautés 2024.

Diagnosing and treating acute and chronic dizziness is challenging for general physicians with multiple potential etiologies and difficulties in diagnosis. A new classification of dizziness is meant to facilitate diagnosis and treatment, based on the trigger and the timing of dizziness, rather than the quality. The latter is not consi-dered as a reliable information anymore for diagnosis. New studies show the absence of superiority of certain treatments compared to placebo, such as corticotherapy in vestibular neuritis or benzodia-zepine for symptomatic treatment. New consensus has been set regarding chronic dizziness, such as persistent perceptual postural dizziness (PPPD) and cervical dizziness, that might be useful for the general physician.

La prise en charge des vertiges aigus et chroniques reste un défi en médecine de premier recours, étant donné les étiologies multi­ples et une orientation diagnostique difficile. Afin de faci­liter celle-ci, une nouvelle classification des vertiges est proposée, basée sur la présence ou l'absence d'un trigger ou déclencheur, et de leur timing ou temporalité. La qualité des vertiges n'est plus considérée comme fiable pour poser le diag­nostic. De nouvelles études démontrent l'absence de supériorité de la corticothérapie dans la vestibulopathie unilatérale aiguë, comparée au placebo, de même pour les benzodiazépines dans le traitement symptomatique des vertiges. Dernièrement, des consensus ont été établis concernant des vertiges chroniques, utiles en médecine de premier recours : les vertiges posturaux perceptuels persistants et les cervicaux.

Effectiveness of vestibular rehabilitation therapy and yoga in the management of chronic peripheral vertigo: A randomized controlled trial.

Background: The purpose of the study was to compare the effectiveness of yoga as a form of Vestibular Rehabilitation (VR) to standard VR for managing patients with symptoms such as dizziness, disequilibrium and gait instability. Methods: 150 participants based on 18-point difference in the DHI score were randomly assigned to group 1- Yoga, group 2- VR and group 3- control group using block randomization. The intervention was provided for 12 weeks. The participants were assessed for Dizziness Handicap Inventory (DHI) at baseline, 4 th, 8 th and 12 th week. Results: The mean DHI for group 1(41.12±7.13) group 2 (42.96±10.54) group 3 (50.84±10.78), p<0.001 decreased significantly in group 1 and 2 when compared to baseline. There was no statistically significant difference in overall Dizziness Handicap Inventory (DHI) scores between the Yoga and Physiotherapy groups after one month; however, both groups resulted in a significant decrease in scores when compared to the control group. Similarly, by the end of the second and third months, there was no significant distinction between the Yoga and Physiotherapy groups, even though both had a considerable decrease in DHI scores when compared to the control group. Furthermore, an examination of the functional, emotional, and physical components of DHI demonstrated persistent trends of significant improvement in both the Yoga and Physiotherapy groups as compared to the control group over a three-month period. Conclusions: In addition to VR, Yoga and medications administered concurrently can provide effective therapeutic effects. Yoga has an advantage over VR since it offers a customized cure for giddiness in addition to symptom relief. Yoga might be a great alternative to the conventional VR because along with enhancing overall body relaxation, it is affordable and is easy to learn.

Concurrent abnormalities in galvanic cervical and ocular vestibular-evoked myogenic potentials as a predictive marker for prolonged dizziness in vestibular neuritis.

BACKGROUND: Despite the growing use of cervical (cVEMP) and ocular (oVEMP) VEMP tests, their effectiveness in predicting chronic dizziness in vestibular neuritis (VN) patients remains unclear. Our research examines the link between long-lasting dizziness and inner ear assessments, encompassing VEMPs induced by air-conducted sound (ACS), bone-conducted vibration (BCV), and galvanic vestibular stimulation (GVS). OBJECTIVES: This study explores prognostic markers by examining the relationship between the persistence of dizziness symptoms and various inner ear test findings in VN patients. MATERIAL AND METHODS: A retrospective cohort of 60 unilateral VN patients underwent comprehensive audiovestibular tests, including pure tone audiometry, cVEMP and oVEMP induced by ACS, BCV, GVS, and caloric tests. Patient subgroups were established based on dizziness duration: short-term (<3 months) and long-term (≥3 months). RESULTS: No substantial correlation existed between the dizziness duration and the outcomes of any particular single inner ear test. However, patients exhibiting concurrent abnormal GVS-cVEMP and GVS-oVEMP were more likely to experience prolonged dizziness, indicating more extensive vestibular system involvement. CONCLUSIONS: Concurrent abnormalities in GVS-cVEMP and GVS-oVEMP may indicate a higher chance of long-term dizziness in VN. SIGNIFICANCE: This study identifies concurrent abnormalities in GVS-cVEMP and GVS-VEMP as a potential prognostic marker for prolonged dizziness in VN.

Association between dizziness and future falls and fall-related injuries in older adults: a systematic review and meta-analysis.

BACKGROUND: Dizziness is common in older adults, especially in those attending falls services. Yet, the extent to which dizziness is associated with future falls has not been reviewed. This systematic review and meta-analysis assessed the association between dizziness and future falls and related injuries in older adults. METHODS: EMBASE, CINAHL Plus, SCOPUS and PsycINFO databases were searched from inception to 5 February 2024. The review was registered on PROSPERO (registration ID: CRD42022371839). Meta-analyses were conducted for the associations of dizziness with future falls (including recurrent and injurious falls). Three meta-analyses were performed on different outcomes: any-type falls (≥1 falls), recurrent falls (≥2 falls) and injurious falls. RESULTS: Twenty-nine articles were included in the systematic review (N = 103 306 participants). In a meta-analysis of 14 articles (N = 46 795 participants), dizziness was associated with significantly higher odds of any-type future falls (OR = 1.63, 95% CI = 1.44-1.84). In another meta-analysis involving seven articles (N = 5630 participants), individuals with dizziness also had significantly higher odds of future recurrent falls (OR = 1.98, 95% CI = 1.62-2.42). For both meta-analyses, significant overall associations were observed even when adjusted for important confounding variables. In contrast, a meta-analysis (three articles, N = 46 631 participants) revealed a lack of significant association between dizziness and future injurious falls (OR = 1.12, 95% CI = 0.87-1.45). CONCLUSIONS: Dizziness is an independent predictor of future falls in older adults. These findings emphasise the importance of recognising dizziness as a risk factor for falls and implementing appropriate interventions.

Approach to Acute Dizziness/Vertigo in the Emergency Department: Selected Controversies Regarding Specialty Consultation.

Acute dizziness and vertigo are common emergency department presentations (≈4% of annual visits) and sometimes, a life-threatening diagnosis like stroke is missed. Recent literature reviews the challenges in evaluation of these symptoms and offers guidelines for diagnostic approaches. Strong evidence indicates that when well-trained providers perform a high-quality bedside neurovestibular examination, accurate diagnosis of peripheral vestibular disorders and stroke increases. However, it is less clear who can and should be performing these assessments on a routine basis. This article offers a focused debate for and against routine specialty consultation for patients with acute dizziness or vertigo in the emergency department as well as a potential path forward utilizing new portable technologies to quantify eye movements.

Dizziness and vertigo sick leave before and after insurance restrictions - a descriptive Swedish nationwide register linkage study.

BACKGROUND: Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific "R" diagnoses. METHODS: Through Swedish nationwide registers we identified individuals aged 16-64 years who during the years 2005-2018 were sickness absent > 14 consecutive days - minimum register threshold - due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. RESULTS: We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005-2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21-61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). CONCLUSIONS: The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.

Risk factors for imaging abnormalities in patients with dizziness complaints: an algorithm for ordering brain imaging.

AIM: The diagnostic detection of abnormal findings with head imaging is low for dizziness. This study aimed to investigate the risk factors associated with abnormal computed tomography (CT) or magnetic resonance imaging (MRI) findings for patients with dizziness. MATERIALS AND METHODS: Medical records of patients who had CT or MRI examinations for dizziness complaints between January 1, 2019, and December 31, 2020, were retrospectively reviewed. Imaging outcomes were grouped as normal or abnormal findings. Risk factors, including demographics, dizziness pattern, symptoms, comorbidities, and medical history were assessed. A Chi-square automatic interaction detection decision tree model was used to classify abnormal imaging findings based on risk factors identified through multivariable analyses. RESULTS: A total of 2,342 scans were examined. Detection of abnormal findings was 4.8% (n = 96), including acute cerebral infarction (n = 33), acute cranial hemorrhage (n = 15), cancer/tumor-like lesions (n = 27), and inner ear abnormalities (n = 21). The risk factor most indicative of abnormal findings were loss of consciousness and neurologic deficit (Odds Ratio 55.57, p < 0.001). The likelihood of abnormality indicating acute brain lesions was 44.4% for patients with loss of consciousness and neurologic deficits. Loss of consciousness and neurologic deficits, hearing loss, nausea/vomiting, and comorbid malignancy distinguished abnormal findings from negative imaging findings (AUC 0.729; 95%CI 0.672-0.785; p < 0.001). Patients with unspecific dizziness complaints were less likely to have abnormal imaging findings. CONCLUSION: These findings highlighted the significance of specific risk factors in recognizing individuals with dizziness complaints who may have abnormal imaging findings indicative of serious diseases. Further studies are warranted to verify the findings.

Causal effect of cerebral small vessel disease on unexplained dizziness: A Mendelian randomization study.

BACKGROUND: Previous cohort studies have suggested an association between cerebral small vessel disease (cSVD) and "unexplained dizziness". The causality of this link remains uncertain, but it would be of significant clinical importance, considering the substantial number of patients presenting with unexplained dizziness is large. We aimed to investigate the causal effect of cSVD-related phenotypes on unexplained dizziness using a Mendelian randomization approach. METHODS: Genetic instruments for each cSVD-related phenotype - white matter hyperintensity (WMH) volume, lacunar stroke (LS), perivascular spaces (PVS), and cerebral microbleeds (CMBs) - as well as unexplained dizziness were identified through large-scale genome-wide association studies. We conducted 2-sample Mendelian randomization analyses. The random-effects inverse-variance weighted (IVW) method was chosen for the primary analysis. For sensitivity analyses, we employed the weighted-median, MR-Egger, MR pleiotropy residual sum and outlier (MR-PRESSO), and leave-one-out analysis methods were implemented for the sensitivity analyses. RESULTS: We successfully identified a significant causal effect of WMH volume on unexplained dizziness (odds ratio [95% CI], 1.12 [1.01-1.23]). However, we were unable to detect any significant causal effects of the other cSVD-related phenotypes on unexplained dizziness, with odds ratios [95% CI] of 1.03 [0.98-1.09] for LS, 0.75 [0.55-1.02] for white matter PVS, 1.02 [0.68-1.52] for basal ganglia PVS, 0.80 [0.43-1.51] for hippocampal PVS, 0.95 [0.90-1.00] for lobar CMBs, and 0.97 [0.92-1.01] for mixed CMBs respectively. The results from the sensitivity analyses were generally consistent with those of the primary analyses. CONCLUSIONS: This MR study supports a causal relationship between WMH, a phenotype associated with cSVD, and the risk of unexplained dizziness, but does not support such a relationship between other cSVD-related phenotypes and unexplained dizziness. These findings require further validation through randomized controlled trials, larger cohort studies, and MR studies based on more extensive GWASs.

The Role of the Cervical Spine in Dizziness.

The neck can be implicated in dizziness via several, separate, discreet mechanisms. Proprioceptive cervicogenic dizziness (CGD) is the most common and reflects the cervical spine's important role, along with visual and vestibular input, for sensorimotor control. Impaired cervical proprioception can lead to symptoms such as dizziness, unsteadiness, visual disturbances, and altered sensorimotor control, and treatment directed toward cervical musculoskeletal and sensorimotor control is efficacious to improve this in individuals with cervical musculoskeletal disorders. Despite this, CGD is difficult to diagnose. Many people present with both neck pain and dizziness, and often the onset of both follows head and neck trauma, but neither necessarily implicate the neck as the cause of dizziness. Further, people often present with mixed forms of dizziness. Thus, rather than diagnosing CGD, it might be more important to consider the potential for the neck to have no (nil, co-morbid cervical condition) or some (minor, major, or compensatory) role in dizziness. Determining the precise role of the cervical spine role in dizziness requires a skilled interview and examination for cervical musculoskeletal and related sensorimotor impairments and relevant testing of other potential causes. A combination and cluster of test outcomes in addition to comparing responses to specific tests when the cervical afferents are stimulated and not stimulated will be important. Considering the role of the neck in dizziness will allow a balanced approach in assessment and management to allow timely, effective intervention to be provided to the large number of individuals presenting with neck pain and dizziness (Supplemental Digital Content, available at: http://links.lww.com/JNPT/A484 ).

Evaluation of Semicircular Canal Function in Relapsing Polychondritis Patients With Dizziness and Sensorineural Hearing Loss Using Video Head Impulse Test.

OBJECTIVE: To evaluate semicircular canal function using video head impulse test (vHIT) in relapsing polychondritis (RP) patients presenting with dizziness and sensorineural hearing loss. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Three patients with RP underwent vHIT and hearing tests. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: The gain in vestibulo-ocular reflex (VOR) and the presence of catch-up saccade were examined, and the correlation between semicircular canal dysfunction and hearing loss was investigated. RESULTS: Of the six ears, five exhibited semicircular canal dysfunction. Among these, one ear showed dysfunction in two semicircular canals, while the remaining four ears demonstrated dysfunction in all three semicircular canals. Sensorineural hearing loss, ranging from moderate to profound, was detected by pure-tone audiometry in all six ears. Furthermore, a significant correlation was observed between VOR gain in the horizontal semicircular canal (HSC) and hearing level. CONCLUSIONS: This study demonstrated semicircular canal dysfunction in RP patients presenting with dizziness and hearing loss using vHIT. Moreover, a significant correlation was found between HSC dysfunction and the severity of hearing loss. While inner ear involvement is a key clinical symptom included in the diagnostic criteria for RP, there have been few reports evaluating vestibular dysfunction, and this is the first report on the evaluation of several cases using vHIT. Accurate assessment of vestibular function by vHIT may facilitate early diagnosis and intervention in RP, potentially improving patient outcomes.

Bilateral vestibulopathy - Loss of vestibular function and experience of emotions.

OBJECTIVE: The vestibular system is closely connected to emotion-processing neuronal circuits. Patients with bilateral vestibulopathy (BVP), a chronic loss of vestibular function, show remarkably lower rates of psychiatric comorbidities and vertigo-related anxiety (VRA) than those with episodic vertigo/dizziness (v/d). This study aimed to evaluate whether patients with BVP differ from those with episodic v/d in terms of VRA, general anxiety, and cognitions about body and health. METHODS: This cross-sectional study involved a subsample of 202 patients with episodic v/d (i.e., vestibular migraine, vestibular paroxysmia, or Menière's disease) and 43 patients with BVP. All patients underwent standardised neurological/neurotological examinations, structured clinical interviews (SCID-I), and self-report questionnaires, such as the Vertigo Handicap Questionnaire (VHQ), Beck Anxiety Inventory (BAI), Trait Anxiety from the State-Trait-Anxiety Inventory (STAI-T), and Cognitions About Body and Health questionnaire (CABAH). Non-parametric tests were used for analysis. Due to multiple testing, the significance level was set at p ≤ .008. RESULTS: Patients with episodic v/d exhibited higher VRA levels than those with BVP. However, this difference was not statistically significant (p = .04; r = 0.15, small effect). Additionally, patients with BVP reported more catastrophizing cognitions (p < .001; r = 0.25, small effect) and bodily weakness (p = .003; r = 0.22, small effect) compared to those with episodic v/d. There were no differences in general anxiety levels (BAI and STAI-T) between patients with v/d and those with BVP. CONCLUSION: Patients with episodic v/d and BVP differed in their appraisal (cognition). The difference in VRA (subjective feeling) was not statistically significant. These preliminary results are discussed using a component approach to emotions.