Asunto(s)
Enfermedades Autoinmunes , Enfermedad de Meniere , Humanos , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/inmunología , Masculino , Diagnóstico Diferencial , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Femenino , Persona de Mediana Edad , Adulto , Oído Interno/inmunología , Audiometría de Tonos Puros , Anciano , Enfermedades del Laberinto/inmunología , Enfermedades del Laberinto/diagnóstico , Prueba de Impulso CefálicoRESUMEN
Despite of the symptoms of vertigo have been known since thousands of years, it was evident by the research of the pioneer scientists of the 19th century (Flourens, Ménière, Breuer and others) that dizziness can also be attributed to inner ear disfunctions. The discovery of the vestibulo-ocular reflex was an important milestone (Endre Hogyes, 1884). The vestibulo-ocular reflex stabilizes images on the retina by rotating the eyes at the same speed but in the opposite direction of head motion. The milestone discovery of Hogyes by stimulating individual labyrinth receptors and recording the activity of eye muscles were verified by János Szentágothai in 1950. Low-frequency lesions of the angular vestibulo-ocular reflex can be investigated by caloric test (Robert Bárány,1906), high-frequency lesions by head impulse test (Gabor Michael Halmagyi and Ian Stewart Curthoys, 1988).
Asunto(s)
Otoneurología/historia , Reflejo Vestibuloocular , Vértigo , Prueba de Impulso Cefálico , Historia del Siglo XIX , Historia del Siglo XX , Humanos , HungríaRESUMEN
INTRODUCTION AND AIM: To diagnose acute vestibular syndrome (AVS) in a prospective study by a new bedside test (providing 1A evidence) based on oculomotor analysis and assessment of hearing loss. To assess the frequency of central and peripheral causes of acute vestibular syndrome in the emergency room. To establish the diagnostic accuracy of acute cranial computed tomography as compared to oculomotor analysis done by video oculography goggles and audiometry. METHOD: Between 1st March 2016 and 1st March 2017 we documented 125 patients (62 women, 63 men, average age 53 years) in the emergency room of the Petz Aladár County Teaching Hospital using the above bedside and instrumental testing. Diagnosis was verified by cranial magnetic resonance imaging. RESULTS: According to the results of the instrumental examination in AVS in 67% we found a peripheral cause and in 33% a central pathology. In 62% isolated posterior circulation stroke manifested itself by isolated vertigo without additional focal signs and the acute cranial computed tomography showed negative results in 96%. The instrumental examination increased diagnostic accuracy by making the diagnosis of isolated inferior semicircular canal vestibular neuritis possible. CONCLUSIONS: The new bedside oculomotor test is suitable for the diagnosis of posterior circulation stroke manifesting with isolated vertigo in early cases, when the routine neuroradiologic methods have a lower sensitivity or are not available. Orv Hetil. 2017; 158(51): 2029-2040.
Asunto(s)
Servicio de Urgencia en Hospital , Medidas del Movimiento Ocular , Potenciales Vestibulares Miogénicos Evocados , Neuronitis Vestibular/diagnóstico , Adulto , Femenino , Humanos , Hungría , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Estudios RetrospectivosRESUMEN
According to international statistics, the first examination of 25% of patients with vertigo is carried out in Emergency Departments. The most important task of the examining physician is to diagnose life threatening pathologic processes. One of the most difficult otoneurological diagnostic challange in Emergency Departments is to differentiate between dangerous posterior scale stroke presenting with isolated vertigo and the benign vestibular neuritis.These two disorders can be safely differentiated using fast, non-invasive, evidence based bedside tests which have been introduced in the past few years. 35% of stroke cases mimicking vestibular neuritis (pseudoneuritis) are misdiagnosed at the Emergency Department, and 40% of these cases develop complications. During the first 48 hours, sensitivity for stroke of the new test that is based on the malfunction of the oculomotor system is better than the diffusion-weighted cranial magnetic resonance imaging. Using special test glasses each component of the new test can be made objective and repeatable.
Asunto(s)
Enfermedades del Sistema Nervioso Central/diagnóstico , Técnicas de Diagnóstico Neurológico , Técnicas de Diagnóstico Otológico , Servicio de Urgencia en Hospital , Enfermedades del Laberinto/diagnóstico , Pruebas en el Punto de Atención , Vértigo/etiología , Neuronitis Vestibular/diagnóstico , Enfermedades del Sistema Nervioso Central/complicaciones , Diagnóstico Diferencial , Errores Diagnósticos , Imagen de Difusión por Resonancia Magnética , Encefalitis/complicaciones , Encefalitis/diagnóstico , Humanos , Enfermedades del Laberinto/complicaciones , Laberintitis/complicaciones , Laberintitis/diagnóstico , Mastoiditis/complicaciones , Mastoiditis/diagnóstico , Síndrome de Miller Fisher/complicaciones , Síndrome de Miller Fisher/diagnóstico , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico , Sensibilidad y Especificidad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Vértigo/clasificación , Vértigo/fisiopatología , Pruebas de Función Vestibular , Neuronitis Vestibular/complicaciones , Encefalopatía de Wernicke/complicaciones , Encefalopatía de Wernicke/diagnósticoRESUMEN
The primary aim of the present study was to investigate the relationship between the subjective sensation of nasal airflow resistance, the rhinoscopic findings and the objective measures of nasal obstruction in patients followed up after septoplasty. A further goal was to determine which of the above modalities is most suitable for assessment of the severity of nasal obstruction and which best indicates the need for surgery. 86 patients who had previously undergone septoplastic surgery were recruited. Objective and subjective measures of nasal obstruction were recorded by using active anterior rhinomanometry, rhinoscopy and a visual analogue scale. The Spearman rank order correlation model revealed a significant correlation between the VAS score and the airway resistance of the more obstructed nasal cavity (r = 0.24); furthermore, between the VAS score and rhinoscopic findings (r = 0.35). By applying the generalized linear model, we also found significant relation between the VAS score and the rhinomanometric data, and between the rhinoscopic findings and the airway resistance of the more obstructed nasal cavity (p = 0.02). The correlation between the subjective sensation of nasal airflow resistance, the rhinoscopic findings, and the rhinomanometric data proved to be significant, but weak even in the group of patients that underwent septoplasty. Every postoperative complaint should therefore be evaluated carefully. Rhinomanometry is an appropriate diagnostic tool with which to determine the measure of obstruction caused by nasal pathological factors. It is suitable for making objective the patients' complaints. Rhinoscopy, beyond the assessment of the degree of obstruction, is capable of analysis of its cause. The decision as to the need for surgery should be based on rhinoscopy, or nasal endoscopy, and can be supported by pathologically elevated resistance of the more obstructed nasal cavity.
Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Cavidad Nasal/fisiopatología , Obstrucción Nasal/diagnóstico , Tabique Nasal/cirugía , Rinomanometría , Sensación , Adulto , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Nasal/etiología , Obstrucción Nasal/fisiopatología , Tabique Nasal/patología , Valor Predictivo de las Pruebas , Rinoplastia , Resultado del Tratamiento , Adulto JovenRESUMEN
Analytical results are reported for the determination of inorganic species in water and sediments sampled in the Aso river ecosystem. The species determined are Cd, Co, Cr, Cu, Fe, Mn, Ni, Zn, Hg, F-, NO3-, SO4--, Na, K, Ca, Mg, NH4+ in water, and Cd, Co, Cr, Cu, Fe, Mn, Ni, Zn, Hg in sediments. For all the elements, in addition to detection limits, precision and accuracy are given: the former, expressed as relative standard deviation (Sr), and the latter, expressed as relative error (e), were good, being in all cases lower than 6%.