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1.
Health Qual Life Outcomes ; 19(1): 231, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600557

RESUMO

BACKGROUND: Dizziness is a common complaint among older adults and may affect quality of life in a negative way. The aim of this study was to assess health-related quality of life (HRQL), sense of coherence (SOC), self-rated health (SRH) and comorbidity in relation to dizziness, among older persons from an urban population. METHODS: The study is part of the Gothenburg H70 Birth Cohort Studies (H70). A cross-sectional population-based sample including 662 79-years-olds (404 women, 258 men, 62% response rate) were surveyed with questions regarding dizziness, imbalance, comorbidities and general health. HRQL was assessed using the 36-item Short Form-36 Health Survey (SF-36) and SOC with the 13-items questionnaire Sense of Coherence (SOC-13). RESULTS: Half of the participants reported problems with dizziness (54%). Dizziness was negatively associated with HRQL, including after adjusting for comorbidities, especially in the physical domains of SF-36. Having dizziness was also associated with poorer SRH, tiredness and comorbidity among both men and women. SOC (mean total score), however, did not differ between dizzy and non-dizzy participants. CONCLUSIONS: Dizziness was negatively associated with HRQL, also after adjusting for comorbidities. Identification and treatment of dizziness, when possible, are important because reduction of dizziness symptoms may potentially help to enhance overall well-being in this age group.


Assuntos
Tontura , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Tontura/epidemiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários , População Urbana
2.
Physiother Res Int ; 26(4): e1923, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34585499

RESUMO

BACKGROUND AND PURPOSE: Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life. METHODS: The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3 months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70 years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS). RESULTS: The sample consisted of 503 patients, 60.2% were women, the median age was 50 years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS. DISCUSSIONS: Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.


Assuntos
Tontura , Qualidade de Vida , Estudos Transversais , Tontura/diagnóstico , Tontura/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Cervicalgia/epidemiologia , Vertigem/diagnóstico , Vertigem/epidemiologia
3.
Artigo em Chinês | MEDLINE | ID: mdl-34304471

RESUMO

Objective:To assess the status of anxiety and depression among patients with different type of vertigo and dizziness, and to figure out the possible reason. Methods:The data of the patients with vertigo from November 2017 to June 2020 were reviewed, and their status of anxiety and depression were assessed using self-rating anxiety scale(SAS) and self-rating depression scale(SDS). Results:A total of 559 patients with vertigo were enrolled, including 94 cases for vestibular migraine (VM), 86 cases for Meniere disease (MD), 78 cases for benign paroxysmal positional vertigo (BPPV), 77 cases for sudden hearing loss(SHL) with vertigo, 74 cases for no definite diagnosis, 58 cases for vestibular neuritis (VN), 57 cases for benign recurrent vertigo (BRV) and 35 cases for persistent postural-perceptual dizziness (PPPD).The incidence of anxiety is 43.11%(no definite diagnosis=64.86%, VM=63.83%, MD=55.81%, PPPD=48.57%, BRV=47.37%), and the incidence of depression is 11.27% (no definite diagnosis=25.68%, PPPD=17.14%, VM=14.89%, BRV=14.04%, MD=12.79%). Kruskal-Wallis test was used to analyze SAS and SDS scores of patients with vertigo. The results showed that there were significant differences in each group. All patients were divided into 3 groups according to the duration of vertigo. The anxiety incidence of >2 years group was highest(58.56%), and the second one was 2 months to 2 years group(54.75%). There was no statistically significant difference between 2 groups by χ²test(P>0.05). But both of them were significantly higher than the <2 months group(17.30%). The depression incidence of >2 years group was highest(32.43%), the second one was 2 months to 2 years group(10.27%), and the lowest one was <2 months group(0%). χ² test(P<0.01) showed statistically significant differences among these three groups. Conclusion:Anxiety is more common among patients with vertigo than depression, and the patients who suffer from VM,MD,PPPD or BRV have significantly higher rates of psychiatric comorbidity.


Assuntos
Tontura , Neuronite Vestibular , Ansiedade/epidemiologia , Vertigem Posicional Paroxística Benigna/epidemiologia , Depressão/epidemiologia , Tontura/epidemiologia , Humanos
4.
Eur J Neurol ; 28(9): 3177-3181, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34115915

RESUMO

BACKGROUND AND PURPOSE: In posterior circulation stroke, vertigo can be a presenting feature. However, whether isolated hemispheric strokes present with vertigo is less clear, despite a few single case reports in the literature. Here, (a) the prevalence of vertigo/dizziness in acute stroke is explored and (b) the cortical distribution of the lesions in relation to both the known vestibular cortex and the evolution of the symptoms, are considered. METHODS: Structured interviews were conducted in 173 consecutive unselected patients admitted to the hyperacute stroke unit at the University College London Hospitals. The interview was used to evaluate whether the patient was suffering from dizziness and/or vertigo before the onset of the stroke and at the time of the stroke (acute dizziness/vertigo), and the nature of these symptoms. RESULTS: In all, 53 patients had cortical infarcts, of which 21 patients reported acute dizziness. Out of these 21, five patients reported rotational vertigo. Seventeen of the total 53 patients had lesions in known vestibular cortical areas distributed within the insular and parietal opercular cortices. CONCLUSIONS: The prevalence of vertigo in acute cortical strokes was 9%, with no single locus of lesion overlap. There is growing evidence supporting a lateralized vestibular cortex, with speculation that cortical strokes affecting the right hemisphere are more likely to cause vestibular symptoms than left hemispheric strokes. A trend was observed for this association, with the right hemisphere affected in four of five patients who reported spinning vertigo at the onset of the stroke.


Assuntos
Tontura , Acidente Vascular Cerebral , Tontura/epidemiologia , Tontura/etiologia , Humanos , Prevalência , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Lobo Temporal , Vertigem/epidemiologia
5.
Artigo em Russo | MEDLINE | ID: mdl-34184487

RESUMO

OBJECTIVE: To identify risk factors for functional vertigo (FV) in patients with benign paroxysmal positional vertigo (BPPV) based on the analysis of emotional and personality disorders at the time of the occurrence of BPPV and to develop a method for predicting its development. MATERIAL AND METHODS: The study included 93 people, 81 women (87.1%), with benign paroxysmal positional vertigo (BPPV), aged 18 to 65 years, mean age 50 [41.5; 59]). After successful treatment with repositioning maneuvers, patients were re-examined 1 month later. Fifty-three patients underwent a semi-structured interview to identify a history of panic attacks (PA) using DSM-5 diagnostic criteria. After successful BPPV treatment, patients completed the following scales and questionnaires: Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short form (VSS-SF), Numeric analog scale of fear (from 0 to 10), Depersonalization-Derealization Inventory (DDI), PHQ-9, GAD-7, PHQ-15, Holmes-Rahe Stress Inventory, Anxiety Sensitivity Index (ASI). RESULTS: The cohort was divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=76) of complaints for dizziness 1 month after BPPV. The frequency of PA history in group 1 was higher than in group 2 (80 vs 29.3%). Patients from group 1 had higher rates in all scales: DHI (57 vs 49, p=0.048), subscale DHI-E (18 vs 12, p=0.006), and subscale A VSS-SF (9 vs 5, p=0.03); DDI (18 vs 11, p=0.01), GAD-7 (13 vs 4), p=0.0002), Numeric analog scale of fear (10 vs 5, p<0.00005), ASI (55.5 vs 36.5, p<0.005). We developed a predictive method for diagnosis FD after BPPV, which sensitivity is 78.9% (95% CI 67.80-86.94) and specificity 94.12% (95% CI 71.31-99.85). CONCLUSION: The likelihood of developing FV after BPPV can be predicted using the proposed predictive method. Early screening for FV can be used to prevent persistent postural-perceptual dizziness.


Assuntos
Vertigem Posicional Paroxística Benigna , Tontura , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/epidemiologia , Estudos de Coortes , Tontura/diagnóstico , Tontura/epidemiologia , Tontura/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente , Inquéritos e Questionários
6.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064850

RESUMO

Background and Objectives: Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood-BPV). We aimed to provide the possible etiological background of vertigo and dizziness in Slovenian children. Materials and Methods: A retrospective case series of pediatric vertigo and dizziness children referred to the tertiary pediatric otorhinolaryngology center from 2015 to 2020. Children received a complete audiological and vestibular workup and were referred to pediatric specialists depending on the clinical presentation. Results: Of 257 children (42% male, 58% female) aged 1-17 years (M = 10.9, SD = 4.3 years) in 19.1% vertigo and dizziness were classified as central, in 12.4% as a peripheral vestibular, in 10.9% as a hemodynamic, in 5.8% as a psychological and none as visual by pediatric neurologists, otorhinolaryngologists, cardiologists, psychologists or ophthalmologists, respectively. 40.8% (20) children with central vertigo had BPV (7.8% of all children) and 8.2% (4) migrainous vertigo. In 43.6% (112 children), the etiology remained unclassified. Conclusions: After a thorough multidisciplinary workup, the etiology of vertigo and dizziness was unraveled in the majority of children referred to our tertiary otorhinolaryngology center. The most common cause was central; however, in a considerable number, the etiology remained unclassified. The latter could be attributed to the self-limiting nature of vertigo spells. Hence, a child presenting with dizziness and vertigo requires a multidisciplinary approach, in which referral to a neurologist is, in most cases, essential.


Assuntos
Tontura , Transtornos de Enxaqueca , Criança , Tontura/epidemiologia , Tontura/etiologia , Família , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Estudos Retrospectivos , Vertigem/diagnóstico , Vertigem/epidemiologia , Vertigem/etiologia
7.
Am J Emerg Med ; 48: 218-223, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33975134

RESUMO

INTRODUCTION: Cannabidiol (CBD) has become a popular supplement in consumer products in recent years, resulting in part from normalization of the cultivation of low THC cannabis in 2018. However, the actual content of CBD-labeled products is frequently uncertain, as oversight of such products is minimal. To date, there is little pragmatic knowledge regarding exposures to products labeled as containing CBD. METHODS: Cases reported to Poison Control Centers from April 1, 2019 and March 31, 2020, the first year in which CBD was identified uniquely as a substance in the National Poison Data System, were analyzed for demographic, temporal, and clinical trends. RESULTS: Poison Control Centers handled 1581 cases exposures to CBD-containing products between April 1, 2019 and March 31, 2020. There was a significant trend of over 5 additional cases related to this substance per month (linear regression coefficient = 5.2, 95% CI: 1.52-8.98). Patients under age 13 years made up 44.0% of reported exposures. Mild CNS depression (10.3%), tachycardia (5.7%), dizziness/vertigo (5.3%), vomiting (4.9%), nausea (4.5%), and agitation (4.4%) were the most frequently reported symptoms. 13% of cases were coded as having "moderate" or "severe" medical outcomes. There were no fatalities. CONCLUSIONS: Cases reported to Poison Control Centers regarding exposures to CBD-labeled products have been increasing, representing an emerging trend of interest to Poison Control Center professionals, clinicians, and public health officials. Further monitoring of this trend is recommended.


Assuntos
Anticonvulsivantes/envenenamento , Canabidiol/envenenamento , Síndromes Neurotóxicas/epidemiologia , Centros de Controle de Intoxicações , Adolescente , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Canabidiol/efeitos adversos , Criança , Pré-Escolar , Bases de Dados Factuais , Tontura/induzido quimicamente , Tontura/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/epidemiologia , Síndromes Neurotóxicas/etiologia , Taquicardia/induzido quimicamente , Taquicardia/epidemiologia , Estados Unidos/epidemiologia , Vertigem/induzido quimicamente , Vertigem/epidemiologia , Vômito/induzido quimicamente , Vômito/epidemiologia , Adulto Jovem
8.
Int J Pediatr Otorhinolaryngol ; 146: 110761, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34000496

RESUMO

INTRODUCTION: Pediatric dizziness is an uncommon complaint presenting to the Otolaryngology clinic. While the term dizziness may be used to describe any altered sensation of orientation to the environment which includes presyncope, light-headedness and ataxia, vertigo refers to a false sensation of motion of self or surroundings. Although a variety of etiologies are known to cause dizziness and vertigo, evaluation of this symptom becomes challenging in children who are unable to clearly explain what they experience, the provoking factors, associated symptoms and the duration of attacks. Vestibular tests are also difficult to conduct in the pediatric age group leading to apathy from the clinician. OBJECTIVES: To ascertain the prevalence of pediatric vertigo in children under 18 years of age, presenting to the Otolaryngology Clinic of a tertiary care hospital, and to describe the clinical profile, investigations and diagnosis in these children. METHODS: A prospective cross-sectional, descriptive clinical study was undertaken from January 1, 2018 to April 30, 2019. All children below the age of 18 years presenting to our department with primary complaints of dizziness were included in the study. After a thorough history and physical examination, screening methods and diagnostic tests were conducted to make a diagnosis. Referrals were sought from other specialties when necessary. RESULTS: The number of children visiting the Department for various ENT ailments during the study period was 10,950. Among these 89 children presented with a primary complaint of dizziness. Their ages ranged from 3 to 18 years; mean age was 11.42 years (SD 3.45). A diagnosis was made in all except two children. The most common cause of dizziness in the age group less than 6 years was benign paroxysmal vertigo of childhood (BPVC) and in the older children was migraine associated vertigo, which was also the commonest overall diagnosis made (28.1%). This was followed by circulation related dizziness like orthostatic hypotension and vasovagal syncope (15.7%). CONCLUSIONS: The prevalence of pediatric dizziness in children presenting to the Otolaryngology clinic was 0.8%. The diagnosis of pediatric vertigo may be challenging, but careful history and examination along with guided investigations and referrals results in correct diagnosis in almost all patients.


Assuntos
Tontura , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Tontura/diagnóstico , Tontura/epidemiologia , Tontura/etiologia , Humanos , Prevalência , Estudos Prospectivos , Centros de Atenção Terciária
9.
J Am Acad Audiol ; 32(3): 186-194, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34030194

RESUMO

BACKGROUND: Balance dysfunction is a complex, disabling health condition that can present with multiple phenotypes and etiologies. Data regarding prevalence, characterization of dizziness, or associated factors is limited, especially in an African American population. PURPOSE: The aim of the study is to characterize balance dysfunction presentation and prevalence in an African American cohort, and balance dysfunction relationship to cardiometabolic factors. RESEARCH DESIGN: The study design is descriptive, cross sectional analysis. STUDY SAMPLE: The study sample consist of N = 1,314, participants in the Jackson Heart Study (JHS). DATA COLLECTION AND ANALYSIS: JHS participants were presented an initial Hearing health screening questionnaire (N = 1,314). Of these, 317 participants reported dizziness and completed a follow-up Dizziness History Questionnaire. Descriptive analysis was used to compare differences in the cohorts' social-demographic characteristics and cardiometabolic variables to the 997 participants who did not report dizziness on the initial screening questionnaire. Based on questionnaire responses, participants were grouped into dizziness profiles (orthostatic, migraine, and vestibular) to further examine differences in cardiometabolic markers as related to different profiles of dizziness. Logistical regression models were adjusted for age, sex, education, reported noise exposure, and hearing sensitivity. RESULTS: Participants that reported any dizziness were slightly older and predominantly women. Other significant complaints in the dizzy versus nondizzy cohort included hearing loss, tinnitus, and a history of noise exposure (p < 0.001). Participants that reported any dizziness had significantly higher prevalence of hypertension, blood pressure medication use, and higher body mass index (BMI). Individuals with symptoms alluding to an orthostatic or migraine etiology had significant differences in prevalence of hypertension, blood pressure medication use, and BMI (p < 0.001). Alternatively, cardiometabolic variables were not significantly related to the report of dizziness symptoms consistent with vestibular profiles. CONCLUSION: Dizziness among African Americans is comparable to the general population with regards to age and sex distribution, accordingly to previously published estimates. Participants with dizziness symptoms appear to have significant differences in BMI and blood pressure regulation, especially with associated orthostatic or migraine type profiles; this relationship does not appear to be conserved in participants who present with vestibular etiology symptoms.


Assuntos
Afro-Americanos , Doenças Cardiovasculares , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Tontura/epidemiologia , Tontura/etiologia , Feminino , Humanos , Estudos Longitudinais
10.
Pediatr Cardiol ; 42(4): 723-726, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33856495

RESUMO

Virtual reality (VR) is a relatively new technology that allows an individual to experience a virtual world. This new immersive video type may be of particular usefulness in procedure-based healthcare settings. We hypothesized that VR echocardiography was non-inferior to live demonstration. Our aim was to assess the usefulness of a VR echocardiographic approach in teaching echocardiography to pediatric trainees compared to live demonstration. This was a single center, cross-sectional observational design. We used a Garmin VIRB® 360 and a head-mount display to record live echocardiography exams in a pediatric population. An Oculus Go™ was used to view the 360° immersive/VR videos. Trainees responded to a written questionnaire afterwards. Fifteen trainees participated in the study, each of whom had previously seen echocardiography through live demonstration teaching. Eleven respondents had previous hands-on echocardiography experience. All 15 participants confirmed that VR echocardiography is a useful teaching tool with 87% (n = 13) rating it as good or very good on a 5-point Likert scale. When asked to compare VR to live demonstration, 67% (n = 10) rated VR echocardiography as the same or better than live demonstration. One of the participants reported a side effect, namely mild and self-resolving dizziness. VR echocardiography is a safe, inexpensive and practical way for trainees to learn echocardiography. The addition of VR echocardiography to the arsenal of teaching tools may enrich the learning experience for trainees.


Assuntos
Ecocardiografia/métodos , Educação Médica/métodos , Realidade Virtual , Estudos Transversais , Tontura/epidemiologia , Feminino , Humanos , Masculino , Pediatria/educação , Inquéritos e Questionários
11.
Sci Rep ; 11(1): 6114, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731825

RESUMO

Diagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.


Assuntos
Tontura , Serviço Hospitalar de Emergência , Acidente Vascular Cerebral , Idoso , Tontura/complicações , Tontura/diagnóstico por imagem , Tontura/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
12.
BMC Emerg Med ; 21(1): 38, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33765940

RESUMO

BACKGROUND: Dizziness is a relatively common symptom among patients who call for the emergency medical services (EMS). AIM: To identify factors of importance for the early identification of a time-sensitive condition behind the symptom of dizziness among patients assessed by the EMS. METHODS: All patients assessed by the EMS and triaged using Rapid Emergency Triage and Treatment (RETTS) for adults code 11 (=dizziness) in the 660,000 inhabitants in the Municipality of Gothenburg, Sweden, in 2016, were considered for inclusion. The patients were divided into two groups according to the final diagnosis (a time-sensitive condition, yes or no). RESULTS: There were 1536 patients who fulfilled the inclusion criteria, of which 96 (6.2%) had a time-sensitive condition. The majority of these had a stroke/transitory ischaemic attack (TIA). Eight predictors of a time-sensitive condition were identified. Three were associated with a reduced risk: 1) the dizziness was of a rotatory type, 2) the dizziness had a sudden onset and 3) increasing body temperature. Five were associated with an increased risk: 1) sudden onset of headache, 2) a history of head trauma, 3) symptoms of nausea or vomiting, 4) on treatment with anticoagulants and 5) increasing systolic blood pressure. CONCLUSION: Among 1536 patients who were triaged by the EMS for dizziness, 6.2% had a time-sensitive condition. On the arrival of the EMS, eight factors were associated with the risk of having a time-sensitive condition. All these factors were linked to the type of symptoms or to clinical findings on the arrival of the EMS or to the recent clinical history.


Assuntos
Tontura , Serviços Médicos de Emergência , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Fatores de Tempo , Adulto , Tontura/diagnóstico , Tontura/epidemiologia , Tontura/etiologia , Humanos , Ataque Isquêmico Transitório/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Suécia , Triagem
13.
J Am Acad Dermatol ; 84(6): 1644-1651, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33639244

RESUMO

BACKGROUND: The major concern regarding the use of low-dose oral minoxidil (LDOM) for the treatment of hair loss is the potential risk of systemic adverse effects. OBJECTIVE: To describe the safety of LDOM for the treatment of hair loss in a large cohort of patients. METHODS: Retrospective multicenter study of patients treated with LDOM for at least 3 months for any type of alopecia. RESULTS: A total of 1404 patients (943 women [67.2%] and 461 men [32.8%]) with a mean age of 43 years (range 8-86) were included. The dose of LDOM was titrated in 1065 patients, allowing the analysis of 2469 different cases. The most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 14 patients (0.5%). Systemic adverse effects included lightheadedness (1.7%), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%), leading to drug discontinuation in 29 patients (1.2%). No life-threatening adverse effects were observed. LIMITATIONS: Retrospective design and lack of a control group. CONCLUSION: LDOM has a good safety profile as a treatment for hair loss. Systemic adverse effects were infrequent and only 1.7% of patients discontinued treatment owing to adverse effects.


Assuntos
Alopecia/tratamento farmacológico , Minoxidil/efeitos adversos , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Tontura/induzido quimicamente , Tontura/epidemiologia , Edema/induzido quimicamente , Edema/epidemiologia , Feminino , Cefaleia/induzido quimicamente , Cefaleia/epidemiologia , Humanos , Hipertricose/induzido quimicamente , Hipertricose/epidemiologia , Masculino , Pessoa de Meia-Idade , Minoxidil/administração & dosagem , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Taquicardia/induzido quimicamente , Taquicardia/epidemiologia , Adulto Jovem
14.
J Neurol ; 268(7): 2523-2532, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33544219

RESUMO

The study aimed to identify the predictors of response to selective serotonin reuptake inhibitors (SSRIs) for 12 weeks in patients with persistent postural-perceptual dizziness (PPPD). Short-term treatment responses were studied in 197 outpatients [127 (64.5%) women, mean age ± SD = 51.7 ± 15.9] diagnosed with PPPD. Clinical and self-rated assessments were analyzed at the baseline and at the end of pharmacotherapy for 12 weeks. Multivariable logistic regression analysis was used to determine the following variables as the potential predictors of treatment response as measured by scoring in clinical global impression-improvement scale (CGI-I) scores: age, sex, comorbidity, baseline CGI-S score, Beck Depression Inventory-II score, State-Trait Anxiety Inventory score, Dizziness Handicap Inventory score at the baseline, and prescribed doses of antidepressants or benzodiazepines. The overall response rate to pharmacotherapy was 65.0% (128/197). Female sex and greater disease severity at the baseline (higher CGI-S score) were associated with a better response to the pharmacotherapy. Subgroup analyses by sex identified younger age and lower anxiety as the indicators for better outcomes in men, and absence of comorbidities in women. During the initial assessment, the severity of PPPD was associated with depressive symptoms and subjective functional handicap due to dizziness. The response to pharmacotherapy is favorable in PPPD. Sex, age and initial disease severity are the predictors of the response to SSRIs in patients with PPPD.


Assuntos
Tontura , Equilíbrio Postural , Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Comorbidade , Tontura/tratamento farmacológico , Tontura/epidemiologia , Feminino , Humanos , Masculino , Vertigem
15.
Otol Neurotol ; 42(6): 883-889, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33606474

RESUMO

OBJECTIVE: Cognitive symptoms in patients with vestibular disorders are far from rare, but identification of patients at risk for cognitive impairment remains poor. The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome questionnaire for dizzy patients with several questions that address cognitive function. However, the relationship between subjective cognitive symptomatology in patients with vestibular disorders and performance on DHI is poorly characterized. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care vestibular clinic. SUBJECTS: Individuals with diagnoses of vestibular migraine (VM), Menière's disease (MD), and concomitant vestibular migraine and Menière's disease (VMMD) presenting to clinic between January 2007 and December 2019. RESULTS: Of 761 subjects, 365 had VM, 311 had MD, and 85 had VMMD. Symptoms of brain fog and chronic fatigue occurred more frequently in the VM and VMMD groups compared with the MD group (χ2 (df = 2, n = 761) = 67.8, 20.9, respectively, p < 0.0001). DHI scores were significantly higher in patients with VM and VMMD compared with those with MD (F[2,758] = 63.5, p < 0.001). A DHI score ≥ 13 suggested that the patient suffered from brain fog (sensitivity = 47.4%, specificity = 72.3%), whereas a score ≥ 15 indicated that the patient complained of chronic fatigue (sensitivity = 81.5%, specificity = 57.7%). CONCLUSION: Our results indicate a high prevalence of interictal cognitive symptoms in patients with episodic vestibular disorders. The DHI cannot be reliably used to differentiate between vestibular disorders nor detect cognitive impairment in these patient populations. Alternative methods must be used to identify vestibulopathic patients with cognitive symptoms to initiate strategies for prevention and treatment.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Cognição , Tontura/diagnóstico , Tontura/epidemiologia , Humanos , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Estudos Retrospectivos
16.
Ann Otol Rhinol Laryngol ; 130(9): 990-995, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33467884

RESUMO

OBJECTIVES: Subjective symptoms of dizziness in older adults are affected not only by objective data such as postural balance, but also by complex psychological factors. Published data analyzing how simultaneous evaluations of both objective and subjective assessments of balance can predict fall risk remain lacking. This study examined how fall risk can be predicted based on both objective data for balance and hearing and subjective symptoms of dizziness among older adults visiting otolaryngology clinics. METHODS: Medical charts of 76 patients ≥65 years old with dizziness/vertigo who visited the otolaryngology clinic were reviewed. Objective data were evaluated by postural balance (posturographic data with eyes open and closed, and one-leg standing test), spontaneous nystagmus, and mean hearing levels. Subjective handicap associated with dizziness/vertigo was assessed using the Dizziness Handicap Inventory (DHI). Subjective mental status of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Information on history (cardiovascular diseases) and fall accidents within the preceding year was collected using an in-house interview sheet. RESULTS: Objective data on postural balance did not correlate with subjective symptoms on DHI or HADS (P > .05, Pearson's correlation coefficient). Adjusted logistic regression modeling with the outcome of incident falls revealed that poor postural balance significantly predicted fall risk (P < .05; 4.9 [1.4-16.8] per 10-cm2 increment). Nystagmus tended to be associated with fall risk. In contrast, DHI score did not predict fall risk (P = .43; 1.0 [0.9-1.03]). Receiver operating characteristic analysis proposed a cut-off for postural sway with eyes closed >6.1 cm2 as optimal to predict falls in patients with nystagmus (AUC, 0.74; 95% confidence interval, 0.48-0.997). CONCLUSION: Poor postural balance is associated with increased fall risk after adjusting for subjective symptoms in older adults at otolaryngology clinics. Conversely, the self-perceived dizziness handicap of DHI score is an insufficient tool to evaluate their fall risk.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Ansiedade/epidemiologia , Depressão/epidemiologia , Tontura/epidemiologia , Equilíbrio Postural , Transtornos das Sensações/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Autoavaliação Diagnóstica , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Otolaringologia , Medição de Risco , Transtornos das Sensações/fisiopatologia
17.
J Gen Intern Med ; 36(10): 3064-3070, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33501533

RESUMO

BACKGROUND: Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China. OBJECTIVE: To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction. DESIGN: Retrospective before-after study. PARTICIPANTS: Sample of 29,793 patients with vertigo/dizziness as primary complaint. MEASURES: Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China. KEY RESULTS: The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001). CONCLUSIONS AND RELEVANCE: Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.


Assuntos
Vertigem Posicional Paroxística Benigna , Tontura , China/epidemiologia , Estudos Controlados Antes e Depois , Tontura/diagnóstico , Tontura/epidemiologia , Tontura/terapia , Humanos , Estudos Retrospectivos , Centros de Atenção Terciária
18.
Acta Neurochir (Wien) ; 163(3): 753-758, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33511461

RESUMO

BACKGROUND: Intracranial arachnoid cysts are extra-axial benign lesions mainly found in the middle cerebral fossa. Rare case series report various cranial nerve dysfunctions associated with cerebellopontine angle (CPA) cysts and there is no consensus with regard to their surgical management; some reports claiming that subjective improvement in adults with intracranial arachnoid cysts cannot justify surgical treatment. METHODS: This retrospective study included all 12 consecutive adult patients treated by microsurgical fenestration for symptomatic CPA arachnoid cysts between 2010 and 2019 and using a retrosigmoid approach. Demographic, clinical, surgical, and radiological data were collected from medical files. RESULTS: The main symptoms were audiovestibular in 9 patients (75%) complaining of dizziness and 6 patients (50%) with hearing loss. In addition, 3 patients (25%) reported tinnitus, 3 patients (25%) presented vasovagal syncope, and 1 patient (8.3%) reported facial pain. Surgery improved 5 patients (83%) with pre-operative hearing loss, 7 patients (78%) reporting dizziness, and all patients with vasovagal syncope. All of the patients recovered from at least one symptom. No recurrence was observed with a mean follow-up of 5.5 years. CONCLUSION: Although most arachnoid cysts are asymptomatic, the CPA location may lead to cranial nerve impairments. Microsurgical fenestration seems to be a simple, safe, and effective technique.


Assuntos
Cistos Aracnóideos/cirurgia , Ângulo Cerebelopontino/patologia , Tontura/epidemiologia , Perda Auditiva/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Zumbido/epidemiologia , Vertigem/epidemiologia , Adulto , Ângulo Cerebelopontino/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos
19.
Laryngoscope ; 131(4): E1308-E1314, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32809223

RESUMO

OBJECTIVES: To examine the relative prevalence of individual diagnoses in children and adolescents presenting with dizziness and/or imbalance, and to assess the proportion of patients assigned multiple contributing diagnoses. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively reviewed our internal database of all patients seen at our pediatric vestibular program between January 2012 and March 2019 to determine the incidence of common diagnoses and groups of diagnoses for patients ages 21 or younger. RESULTS: One thousand twenty-one patients were included with a mean age of 12.5 ± 4.9 years (range: 9 months-21 years). Of this total, 624 patients were female and 397 were male. Common diagnoses included vestibular migraine (VM; 35.0%), benign paroxysmal positional vertigo (BPPV; 21.6%), primary dysautonomia (15.7%), anxiety disorder (13.5%), and persistent postural perceptual dizziness (PPPD; 11.2%). A high proportion of patients (44.4%) received multiple contributing diagnoses. VM was frequently diagnosed with BPPV or PPPD, and 22 patients were diagnosed with all three concurrently. CONCLUSION: The causes of dizziness and imbalance in the pediatric population are diverse, and many patients have multiple diagnoses that are often interrelated. It is important that providers recognize that the causes of vestibular symptoms in children and adolescents may be multifactorial and may span across multiple specialties. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1308-E1314, 2021.


Assuntos
Tontura/etiologia , Equilíbrio Postural/fisiologia , Vestíbulo do Labirinto/fisiopatologia , Adolescente , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/epidemiologia , Criança , Tontura/diagnóstico , Tontura/epidemiologia , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Síndrome Pós-Concussão/complicações , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/epidemiologia , Prevalência , Disautonomias Primárias/complicações , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/epidemiologia , Estudos Retrospectivos
20.
Eur Arch Otorhinolaryngol ; 278(10): 3725-3730, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33095432

RESUMO

PURPOSE: Tinnitus and equilibrium disorders such as dizziness and vertigo have been reported by patients with COVID-19; however, they have been rarely investigated. The aim of this study was to study the prevalence of subjective tinnitus and dizziness in a sample of COVID-19 patients using an online 10-item close-ended questionnaire. METHODS: A multicentric study that included 15 Italian hospitals in different regions was conducted using an online 10-item close-ended questionnaire developed to identify the presence of tinnitus and balance disorders in patients with COVID-19 between May 5 and June 10, 2020. The questionnaire was administered to 185 patients in a period of > 30 - < 60 days after diagnosis of COVID-19; responses were recorded in an online Excel spreadsheet. The questionnaire was composed of three sections: (1) demographic information; (2) presence and characteristics of tinnitus and dizziness after COVID-19 diagnosis; (3) possible association with migraine. RESULTS: Thirty-four patients (18.4%) reported equilibrium disorders after COVID-19 diagnosis. Of these, 32 patients reported dizziness (94.1%) and 2 (5.9%) reported acute vertigo attacks. Forty-three patients (23.2%) reported tinnitus; 14 (7.6%) reported both tinnitus and equilibrium disorders. CONCLUSION: This study suggests that the presence of subjective otoneurological symptoms such as tinnitus and balance disorders can affect COVID-19 patients; further studies are necessary to investigate the prevalence and pathophysiological mechanisms underlying these subjective symptoms in COVID-19 patients.


Assuntos
COVID-19 , Zumbido , Teste para COVID-19 , Tontura/epidemiologia , Tontura/etiologia , Humanos , SARS-CoV-2 , Zumbido/epidemiologia , Vertigem/diagnóstico , Vertigem/epidemiologia
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