Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 796
Filtrar
1.
Artigo em Russo | MEDLINE | ID: mdl-32678559

RESUMO

Vestibular vertigo is most often caused by benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, vestibular migraine or stroke. Features, diagnosis and treatment of vestibular vertigo in patients with these diseases are discussed. The authors analyze common diagnostic errors based on the data of 700 outpatients (205 men and 495 women, aged 25-88 years, mean age 55 years). It is noted that the cause of vertigo is often misdiagnosed with vertebral-basilar insufficiency, discirculatory encephalopathy, cervical spine pathology; at the same time, BPPV, Meniere's disease, vestibular neuritis or vestibular migraine is diagnosed less often. This fact reflects the lack of awareness of physicians about these diseases. BPPV, Meniere's disease and migraine are effectively treated and therefore their diagnosis and adequate treatment are of great importance.


Assuntos
Vertigem , Adulto , Idoso , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna , Feminino , Humanos , Masculino , Doença de Meniere , Pessoa de Meia-Idade , Transtornos de Enxaqueca , Insuficiência Vertebrobasilar , Neuronite Vestibular
3.
Otolaryngol Head Neck Surg ; 162(3): 283-289, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32013711

RESUMO

OBJECTIVE: Cardiovascular risk factors have been associated with benign paroxysmal positional vertigo (BPPV), possibly causing degeneration of the utricular epithelium and subepithelium, but supportive evidence is mixed. This is the first study to examine the association between cardiovascular risk factors and BPPV as they present in the community practice of comprehensive otolaryngology-head and neck surgery. STUDY DESIGN: Cross-sectional case-matched case-control series. SETTING: A community practice of otolaryngology-head and neck surgery with 3 clinical offices and a socioeconomically diverse patient population. SUBJECTS AND METHODS: Clinical data were collected retrospectively from the electronic health records of a continuous 4-year series of 628 patients with BPPV and age- and sex-matched controls. RESULTS: There were no statistically significant associations found between BPPV and diabetes, hypertension, dyslipidemia, or body mass index in the study population in pairwise comparisons or multivariable modeling. CONCLUSION: This study suggests that BPPV as encountered in a community ear, nose, and throat practice is not generally associated with cardiovascular risk factors. The possibility that these or other cardiovascular risk factors may be causative in some cases cannot be excluded, though most cases of BPPV appear to be caused primarily by shedding of otoconia from the utricle that is idiopathic or at least in part by unconfirmed noncardiovascular factors.


Assuntos
Vertigem Posicional Paroxística Benigna/epidemiologia , Vertigem Posicional Paroxística Benigna/etiologia , Doenças Cardiovasculares/complicações , Otolaringologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
4.
Harefuah ; 159(1): 103-106, 2020 Feb.
Artigo em Hebraico | MEDLINE | ID: mdl-32048489

RESUMO

OBJECTIVES: To characterize a subgroup of patients that were diagnosed with benign paroxysmal positional vertigo of the posterior semicircular canal pBPPV, with findings of geotropic-torsional nystagmus on the roll rest (RT) that intensified on the Dix-Hallpike exam (DH). METHODS: The study population consisted of patients with the diagnosis of pBPPV. First, the roll test (RT) and then the DH test were performed. Characteristics were compared between group 1 - patients with a negative RT and positive DH (in keeping with pBPPV), and group 2- patients with a torsional-geotropic nystagmus on the RT, that intensified on DH. Patients from both groups were treated with the Epley maneuver. If the nystagmus continued, further Epley maneuvers were performed until it subsided. Patients continued follow-up visits until they were asymptomatic and the exam was normal. RESULTS: Ninety-one consecutive patients were diagnosed with pBPPV. Sixty nine patients belonged to group 1 and 22 to group 2. The average age was just under 60 and the percentage of males was 22 in group 1 and 45 in group 2, which was significantly different. Additional significant differences included: 1. Symptom duration, in days, until diagnosis (43.2 in group 1 and 22.3 in group 2). 2. The fraction of patients requiring only one Epley maneuver in the first treatment session was 77.4% in group 1 and 23.4% in group 2. CONCLUSIONS: The appearance of a torsional-geotropic nystagmus during RT is most probably due to pBPPV, with a more severe clinical presentation, requiring more Epley maneuvers than in patients with a negative RT. These patients had increased symptoms and were diagnosed earlier. However, the response to treatment was similar in both groups. It is most important to differentiate these patients in group 2 from patients with BPPV arising from the horizontal semicircular canal, which has different clinical features and is treated differently.


Assuntos
Vertigem Posicional Paroxística Benigna , Canais Semicirculares , Humanos , Masculino , Posicionamento do Paciente
5.
Orv Hetil ; 161(6): 208-213, 2020 Feb.
Artigo em Húngaro | MEDLINE | ID: mdl-32008350

RESUMO

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. The most important symptom is vertigo, which is triggered by changes in head position and sometimes is accompanied by vegetative symptoms. Furthermore, etiology may be subcategorized into idiopathic and secondary (connected to other vestibular disorder, like Ménière's disease, vestibular neuritis, or vestibular migraine). Aim: To identify such parameter of ultrasound-computer-craniocorpography (US-COMP-CCG), which could be useful in the differentiation of idiopathic and secondary BPPV. Material and method: 135 patients suffering from BPPV and 140 normal vestibular functioning patients were examined with UC-COMP-CCG. Statistical analysis was completed by using IBM SPSS V24 software. Results: 109 patients suffered from idiopathic BPPV (i-BPPV), and 26 patients from secondary BPPV (s-BPPV). Parameters indicating the imbalance were observed in both the standing test and the stepping test. Respectively, remarkable results were given in the forehead covering and the self-spin parameter. Conclusion: By applying and examining both study groups with US-COMP-CCG, we were able to use modern diagnostics and thus have an objective evaluation based on their properties. The objective results from the US-COMP-CCG parameters show the deterioration of the vestibular system as well as the change in values, based on the cause of BPPV in secondary cases. Orv Hetil. 2020; 161(6): 208-213.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/etiologia , Diagnóstico Diferencial , Humanos
6.
Artigo em Chinês | MEDLINE | ID: mdl-32086905

RESUMO

Objective:To investigate the clinical characteristics and therapeutic effect of benign paroxysm positional vertigo(BPPV) secondary to middle ear surgery. Method:A total of 1 126 patients who underwent tympanoplasty or radical mastoidectomy due to chronic suppurative otitis media and middle ear cholesteatoma in our hospital from January 2014 to December 2018 were collected. Clinical data of BPPV within 1 month after surgery were collected, The incidence, incidence side, involved semicircular canal, onset time, age of onset, and duration of operation of secondary BPPV after middle ear surgery were analyzed. All patients with secondary BPPV were treated by manual reduction, and the efficacy was evaluated 1 day, 1 week, and 1 month after reduction. Result:2.13% (24 cases) of patients had secondary BPPV after operation, among which 2 cases were parietal incidence. 18 cases were involved in posterior semicircular canals and 6 cases were horizontal semicircular canals. The onset time was 1-12 days after the operation, with an average of (3.29±2.44) days. The mean age of onset was (51.62±10.15) years old, and there was no statistically significant difference between the age of patients without BPPV after middle ear surgery (P>0.05). The average operating time was (97.29±14.78) minutes, showing no statistically significant difference compared with patients in the group without BPPV (P>0.05). Fourteen cases (58.3%) were cured and 10 cases were improved after 1 day evaluation. Evaluated 1 week after treatment, 19 cases (79.17%) were cured and 5 cases were improved. Evaluated 1 month after treatment, all patients were cured without recurrence. Conclusion:BPPV secondary to middle ear surgery often appears 3 days after surgery, and the posterior semicircular canal of the operative ear is most commonly involved. Age and operation duration have no significant influence on the incidence of BPPV, and satisfactory therapeutic effect can be obtained through manipulative reduction.


Assuntos
Vertigem Posicional Paroxística Benigna/etiologia , Orelha Média/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Canais Semicirculares/patologia
7.
J Clin Neurosci ; 72: 26-30, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31948878

RESUMO

The aim of this study was to evaluate clinical and neurophysiological characteristics of Persistent postural-perceptual dizziness (PPPD) in a tertiary vertigo clinic. This was a cross-sectional study that included consecutive patients examined in the Vertigo clinic of the University Hospital Center Zagreb, Croatia. The following data were extracted from the electronic hospital records: age, sex, the duration of symptoms, initial trigger event, results of the caloric testing, video head impulse test (vHIT) for all six semicircular canals and ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP). During the study period 147 consecutive patients with dizziness were examined and 28 (19%) were diagnosed with PPPD, 68% of them were women and the mean age was 59.5 ± 15 years. The median duration of symptoms was 23 months. The most common initial event was vestibular neuritis in 39.3% of patients, followed by benign paroxysmal positional vertigo in 10.7% of patients. Caloric testing was performed in 25 patients. It revealed six cases of unilateral canal paresis. vHIT was performed in 24 patients. There were 13 pathological responses with three cases of lateral canal dysfunction, two cases of posterior, one case of anterior and seven cases of multiple canals affection. VEMP was performed in 23 patients. There were five isolated oVEMP pathologies, one isolated cVEMP pathology and 11 findings of a combined oVEMP and cVEMP pathology. This study provides clinical and neurophysiological data on PPPD and indicates the utility of complete neurophysiological assessment of vestibular function in this group of patients.


Assuntos
Tontura/diagnóstico , Tontura/fisiopatologia , Adulto , Idoso , Vertigem Posicional Paroxística Benigna/diagnóstico , Testes Calóricos , Estudos Transversais , Feminino , Teste do Impulso da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Canais Semicirculares/patologia , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Neuronite Vestibular/diagnóstico , Vestíbulo do Labirinto
8.
Neurology ; 94(9): e942-e949, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-31888973

RESUMO

OBJECTIVES: To develop a simple questionnaire for self-diagnosis of benign paroxysmal positional vertigo (BPPV). METHODS: We developed a questionnaire that consisted of 6 questions, the first 3 to diagnose BPPV and the next 3 to determine the involved canal and type of BPPV. From 2016 to 2017, 578 patients with dizziness completed the questionnaire before the positional tests, a gold standard for diagnosis of BPPV, at the Dizziness Clinic of Seoul National University Bundang Hospital. RESULTS: Of the 578 patients, 200 were screened to have BPPV and 378 were screened to have dizziness/vertigo due to disorders other than BPPV. Of the 200 patients with a questionnaire-based diagnosis of BPPV, 160 (80%) were confirmed to have BPPV with positional tests. Of the 378 patients with a questionnaire-based diagnosis of non-BPPV, 24 (6.3%) were found to have BPPV with positional tests. Thus, the sensitivity, specificity, and precision of the questionnaires for the diagnosis of BPPV were 87.0%, 89.8%, and 80.0% (121 of 161, 95% confidence interval 74.5%-85.5%). Of the 200 patients with a questionnaire-based diagnosis of BPPV, 30 failed to respond to the questions 4 through 6 to determine the involved canal and type of BPPV. The questionnaire and positional tests showed the same results for the subtype and affected side of BPPV in 121 patients (121 of 170, 71.2%). CONCLUSION: The accuracy of questionnaire-based diagnosis of BPPV is acceptable. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that, in patients with dizziness, a questionnaire can diagnose BPPV with a sensitivity of 87.0% and a specificity of 89.8%.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Tontura/diagnóstico , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Sensibilidade e Especificidade , Adulto Jovem
9.
Otolaryngol Head Neck Surg ; 162(1): 40-49, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610734

RESUMO

OBJECTIVES: A last resort for therapy for intractable benign paroxysmal positional vertigo (BPPV) is mechanical occlusion of the posterior semicircular canal. The aim of this review was to assess the effect of posterior canal occlusion for intractable posterior canal BPPV on vertigo and to determine the risk of loss of auditory or vestibular function. DATA SOURCES: A systematic literature search according to the PRISMA statement was performed on PubMed, the Cochrane Library, Embase, Web of Science, and CINAHL. The last search was conducted in June 2018. REVIEW METHODS: Cohort studies with original data and case reports describing >5 cases were included if they analyzed the effect of posterior semicircular canal obliteration in adults with intractable posterior BPPV on vertigo. Two authors screened titles and abstracts for eligibility. The first author screened full texts and analyzed the data. RESULTS: Eight retrospective studies met the eligibility criteria. The quality of all individual studies was rated fair. Canal occlusion was performed on 196 patients. All studies reported complete resolution of BPPV in all patients (100%). Among postoperatively tested patients, total loss of auditory function and vestibular function was reported in 2 of 190 (1%) and 9 of 68 (13%), respectively. CONCLUSION: Posterior semicircular canal plugging resulted in 100% resolution of BPPV in patients with intractable BPPV in all studies. However, the strength of evidence was weak. Potential serious complications, such as deafness and loss of vestibular function, should be taken into account.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Qualidade de Vida , Canais Semicirculares/fisiopatologia , Vertigem Posicional Paroxística Benigna/reabilitação , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Países Baixos , Cuidados Pós-Operatórios/métodos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
10.
HNO ; 68(3): 191-198, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31555852

RESUMO

Vertigo and dizziness in advanced age are common complaints in daily clinical practice. The otorhinolaryngologist holds a central position in the differential diagnostic clarification. Age-related disorders (e.g. benign positional vertigo, presbyvestibulopathy, otholith functional disorders) arise due to a physiological, individually distinct and objectively detectable reduction in the sensitivity of sensory and extrasensory elements of the vestibular system. They may reach pathological significance if these dysfunctions affect the physical and emotional well-being (e.g. gait disturbances and falls with subsequent morbidity). Disorders accompanying aging (e.g. neurological, cardiovascular or psychiatric) can occur simultaneously with age-related changes in sensory function. The identification, especially with respect to the risk of falling in older people and the development of individual therapeutic strategies is an interdisciplinary task. Besides a causative therapy, strength, coordination and balance training contribute to the treatment of equilibrium disorders and falls from the perspective of evidence-based medicine.


Assuntos
Vertigem Posicional Paroxística Benigna , Tontura , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/etiologia , Tontura/diagnóstico , Tontura/etiologia , Medicina Baseada em Evidências , Humanos , Exame Físico
11.
Braz J Otorhinolaryngol ; 86(1): 83-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30482521

RESUMO

INTRODUCTION: Subjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus. OBJECTIVE: To study the characteristics of subjects with subjective benign paroxysmal positional vertigo. METHODS: Prospective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables. RESULTS: 259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p=0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher. CONCLUSIONS: Subjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.


Assuntos
Vertigem Posicional Paroxística Benigna/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Osteoporose/fisiopatologia , Adolescente , Adulto , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/tratamento farmacológico , beta-Histina/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Nistagmo Fisiológico/fisiologia , Osteoporose/complicações , Modalidades de Fisioterapia , Postura/fisiologia , Estudos Prospectivos , Sulpirida/uso terapêutico , Adulto Jovem
12.
Ann Otol Rhinol Laryngol ; 129(5): 434-440, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31810393

RESUMO

OBJECTIVES: The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver. METHODS: In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0. RESULTS: In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD (P = .05). CONCLUSION: The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.


Assuntos
Vertigem Posicional Paroxística Benigna/complicações , beta-Histina/uso terapêutico , Dimenidrinato/uso terapêutico , Tontura/tratamento farmacológico , Adolescente , Adulto , Idoso , Vertigem Posicional Paroxística Benigna/tratamento farmacológico , Vertigem Posicional Paroxística Benigna/fisiopatologia , Tontura/etiologia , Método Duplo-Cego , Feminino , Seguimentos , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Vasodilatadores/uso terapêutico , Adulto Jovem
13.
Am J Otolaryngol ; 41(1): 102313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31732302

RESUMO

Although the etiology of benign paroxysmal positional vertigo (BPPV) is idiopathic in most cases, the association of osteoporosis or vitamin D deficiency with BPPV has attracted much interest recently. While it is generally accepted that osteoporosis or vitamin D deficiency is related to the occurrence and/or recurrence of BPPV, the difference in serum vitamin D level and bone mineral density (BMD) among different subtypes of BPPV has not been investigated. We aimed to compare T-score of BMD score and serum 25-hydroxyvitamin D level among idiopathic BPPV patients with a different subtype. This study included 117 consecutive patients with idiopathic BPPV (26 men and 91 women; mean age, 55 ±â€¯11 years; age range, 25 to 78 years) who underwent blood sampling for serum 25-hydroxyvitamin D level measurement and bone mineral densitometry of the anterior-posterior lumbar spine and femur between April 2018 and February 2019. Among 117 patients, 49 were diagnosed with posterior semicircular canal (PSCC) BPPV, 24 were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, and 44 were diagnosed with LSCC cupulolithiasis. The mean T-score of BMD was -1.5 ±â€¯0.9 in PSCC BPPV, -1.5 ±â€¯1.3 in LSCC canalolithiasis, and -1.5 ±â€¯1.1 in LSCC cupulolithiasis, which was not significantly different (p = 0.998, One-way ANOVA test). The mean level of 25-hydroxyvitamin D was 22.5 ±â€¯10.6 ng/ml in PSCC BPPV, 26.8 ±â€¯16.0 ng/ml in LSCC canalolithiasis, and 25.4 ±â€¯9.6 ng/ml in LSCC cupulolithiasis, which was not significantly different (p = 0.262, One-way ANOVA test). The proportion of osteoporosis/osteopenia or vitamin D deficiency/insufficiency did not show significant difference among idiopathic BPPV patients with different subtypes, and findings of this study indicate that either serum level of vitamin D or T-score of BMD is not a distinguishable characteristic among different subtypes of BPPV.


Assuntos
Vertigem Posicional Paroxística Benigna/epidemiologia , Densidade Óssea , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Absorciometria de Fóton , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Vitamina D/sangue
14.
Ann Emerg Med ; 75(4): 459-470, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31866170

RESUMO

STUDY OBJECTIVE: We evaluated a strategy to increase use of the test (Dix-Hallpike's test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for benign paroxysmal positional vertigo in emergency department (ED) dizziness visits. METHODS: We conducted a stepped-wedge randomized trial in 6 EDs. The population was visits with dizziness as a principal reason for the visit. The intervention included educational sessions and decision aid materials. Outcomes were DHT or CRM documentation (primary), head computed tomography (CT) use, length of stay, admission, and 90-day stroke events. The analysis was multilevel logistic regression with intervention, month, and hospital as fixed effects and provider as a random effect. We assessed fidelity with monitoring intervention use and semistructured interviews. RESULTS: We identified 7,635 dizziness visits during 18 months. The DHT or CRM was documented in 1.5% of control visits (45/3,077; 95% confidence interval 1% to 1.9%) and 3.5% of intervention visits (159/4,558; 95% confidence interval 3% to 4%; difference 2%, 95% confidence interval 1.3% to 2.7%). Head CT use was lower in intervention visits compared with control visits (44.0% [1,352/3,077] versus 36.9% [1,682/4,558]). No differences were observed in admission or 90-day subsequent stroke risk. In fidelity evaluations, providers who used the materials typically reported positive clinical experiences but provider engagement was low at facilities without an emergency medicine residency program. CONCLUSION: These findings provide evidence that an implementation strategy of a benign paroxysmal positional vertigo-focused approach to ED dizziness visits can be successful and safe in promoting evidence-based care. Absolute rates of DHT and CRM use, however, were still low, which relates in part to our broad inclusion criteria for dizziness visits.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Serviço Hospitalar de Emergência , Prática Clínica Baseada em Evidências , Posicionamento do Paciente , Adulto , Vertigem Posicional Paroxística Benigna/diagnóstico por imagem , Tontura/etiologia , Tontura/terapia , Feminino , Fidelidade a Diretrizes , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/epidemiologia
15.
J Laryngol Otol ; 134(1): 86-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31843038

RESUMO

BACKGROUND: Periodic alternating nystagmus is a rare condition characterised by spontaneous horizontal nystagmus that periodically reverses direction, indicating an alteration of the velocity storage mechanism. Windmill nystagmus is a peculiar and rare variant of periodic alternating horizontal nystagmus with a superimposed periodic alternating vertical nystagmus. It is generally observed in blind patients. CASE REPORT: This paper presents the unique case of a normally sighted patient with a windmill nystagmus triggered by an episode of benign paroxysmal positional vertigo due to bilateral posterior canalolithiasis. Videonystagmography revealed an anticlockwise up-beating nystagmus followed by a clockwise down-beating nystagmus with a cycle lasting 2 minutes, followed by a brief burst of horizontal left-beating nystagmus. CONCLUSION: This case report represents the first observation of a new type of windmill nystagmus, probably provoked by a malfunction of the velocity storage mechanism, gaze-stabilisation and short-adaptation networks, with a loss of cerebellar inhibition.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Nistagmo Patológico/diagnóstico , Canais Semicirculares/fisiopatologia , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna/fisiopatologia , Feminino , Humanos , Nistagmo Patológico/fisiopatologia , Testes de Função Vestibular , Gravação em Vídeo
16.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(9. Vyp. 2): 85-89, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825395

RESUMO

The development of peripheral vestibular disorders are often thought to be associated with vascular mechanisms, taking into account terminal type of inner ear blood supply and other predisposing factors. A number of studies indicates a high frequency of vascular risk factors in the patients with vestibular neuronitis and benign paroxysmal positional vertigo (BPPV). According to other results, migraine is widely spread among patients with Meniere's disease and BPPV. However currently there is no evidence for casual relationship between vascular factors and development of peripheral vestibulopathy. The only exclusion is labyrinthine infarction, which develops as a result of posterior circulation disorder. More research is needed in this area.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Neuronite Vestibular , Vertigem Posicional Paroxística Benigna/etiologia , Humanos , Doença de Meniere/etiologia , Transtornos de Enxaqueca/etiologia , Fatores de Risco , Neuronite Vestibular/etiologia
17.
J Int Adv Otol ; 15(3): 420-424, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846923

RESUMO

OBJECTIVES: This study aimed to evaluate the efficacy of the repositioning maneuver on quality of life in elderly patients with dizziness and/or vertigo. MATERIALS AND METHODS: This controlled, prospective randomized clinical trial was conducted in elderly patients aged 65 years and above with a positive history of benign paroxysmal positional vertigo (BPPV), presence of vertigo, and no observable nystagmus during the Dix-Hallpike test, so-called Subjective BPPV (S-BPPV). Individuals were evaluated by visual analog scale (VAS) and dizziness handicap inventory (DHI). Groups were defined as treatment (treated with Epley maneuver bilaterally) or no treatment control (no treatment modality or canalith repositioning maneuver). Ten days after the first assessment, all patients were reassessed using VAS and DHI. RESULTS: A total of 50 patients were randomized into two groups: 25 to the treatment group, and 25 to the control group. No significant differences were observed for baseline VAS and total DHI scores between the groups (p=0.636, p=0.846, respectively). On the other hand, after the reassessment, VAS and total DHI scores were both significantly reduced in the treatment group (p<0.001, p<0.001, respectively), but no reduction in either score was found in the control group (p=0.216, p=0.731, respectively). CONCLUSION: This study showed that elderly patients with S-BPPV benefit from the Epley maneuver, in particular global and disease-specific quality of life.


Assuntos
Vertigem Posicional Paroxística Benigna/terapia , Posicionamento do Paciente/métodos , Modalidades de Fisioterapia/psicologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/psicologia , Tontura/diagnóstico , Tontura/etiologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Escala Visual Analógica
20.
Isr Med Assoc J ; 21(11): 716-718, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713357

RESUMO

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It is assumed that sleep is involved in the pathogenesis of BPPV, and that habitual head-lying side during sleep correlates with the affected side in the posterior semicircular canal BPPV. OBJECTIVES: To investigate the relationship between the preferred sleeping position and the affected semicircular canal in patients with BPPV. METHODS: We performed a retrospective data review of patients seeking help for vertigo/dizziness who had undergone clinical evaluation including a Dix-Hallpike test. Patients diagnosed with posterior canal BPPV (p-BPPV) were asked to define their preferred lying side (right, left, supine, or variable) during the night sleep. Affected semicircular canal (right posterior or left posterior) was registered along with demographic data. RESULTS: In all, 237 patients were diagnosed with p-BPPV. Patients with horizontal semicircular canal BPPV (n=11) were excluded. Patient mean age was 57 years (range 14-87). There were 150 patients with right p-BPPV and 87 patients with left p-BPPV. Among the patients, 122 (52%) habitually slept on the right side. Of those, 102 (84%) were diagnosed with right p-BPPV (P = 0.0006), while 82 patients (34%) habitually slept on the left side. Fifty-three (65%) were diagnosed with left p-BPPV (P < 0.0001). There were no differences in right vs. left p-BPPV in the 33 patients (14%) who expressed no preference concerning their sleeping positions. CONCLUSIONS: Our study highlights the etiology of BPPV and showed that changing sleep position habits might be helpful in preventing recurrent BPPV.


Assuntos
Vertigem Posicional Paroxística Benigna/fisiopatologia , Movimentos da Cabeça , Postura , Canais Semicirculares/fisiopatologia , Sono , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hábitos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA