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1.
Orv Hetil ; 161(5): 177-182, 2020 Feb.
Artigo em Húngaro | MEDLINE | ID: mdl-31984774

RESUMO

Introduction: Tenotomy of the tendon of the stapedius and tensor tympani (TT) muscles is a minimal-invasive surgical therapeutic procedure in Ménière's disease (MD). It has been assumed that the TT medializes the stapes into the oval window, resulting in changes in perilymphatic pressures of the inner ear. By cutting the tendons of both middle ear muscles, they affect the pressure dynamics by not augmenting this pressure even further. Aim: The immediate and long-term investigation of the effect of middle ear muscle tenotomy on the quality of life of patients suffering from Ménière's disease, measured by the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (THI). Method: A follow-up study of 22 patients with definite, unilateral Ménière's disease had undergone tenotomy under general or local anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients. Statistical analysis: The statistical analysis was completed by using the IBM SPSS V24 software. Since the parameters did not show normal distribution, non-parametric test (Mann-Whitney U test) was used. The significance level was specified as p<0.05. Results: A statistically significant reduction of DHI scores was noted in all patients. The tinnitus significantly reduced and all of the patients mentioned improved symptoms of MD. Conclusion: Although the follow-up period is short, and the pathomechanism (decrease of stapes medialization in the oval window) is not exactly clear, tenotomy seems to be a successful promising surgical treatment method with a high reduction of dizziness handicap score in conservative therapy-resistant Ménière's disease. Orv Hetil. 2020; 161(5): 177-182.


Assuntos
Doença de Meniere/cirurgia , Qualidade de Vida/psicologia , Estapédio/cirurgia , Tenotomia/métodos , Tensor de Tímpano/cirurgia , Seguimentos , Humanos , Doença de Meniere/complicações , Doença de Meniere/psicologia , Resultado do Tratamento , Vertigem/etiologia
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(9. Vyp. 2): 5-9, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825383

RESUMO

Persistent postural perceptual dizziness (PPPD) is a common cause of complaints to dizziness and unitability among patients of all-ages. The disease is characterized by a permanent feeling of non-rotatory dizziness or unsteadiness that at first can be caused by an acute vestibular dizziness, somatic disturbance that causes sudden unsteadiness and loss of balance or, for example, by a panic attack. Despite the permanent feeling of unsteadiness and dizziness, a regular instrumental examination cannot reveal important changes that can explain personal feeling. The diagnosis can be made according to the diagnostic criteria developed by the International Barani Society. Treatment consists of psychotherapy, drug therapy and vestibular rehabilitation.


Assuntos
Tontura , Equilíbrio Postural , Doenças Vestibulares , Idoso , Humanos , Vertigem
4.
Artigo em Russo | MEDLINE | ID: mdl-31793549

RESUMO

The review of domestic and foreign literature was conducted to identify the current terminology, diagnostic criteria, mechanisms of ethiopathogenesis, and the methods of treatment of psychogenic vertigo. The article covers the questions of combined approach to treatment, including vestibular rehabilitation combined with cognitive behavioral therapy.


Assuntos
Tontura , Transtornos Psicofisiológicos , Vertigem , Terapia Cognitivo-Comportamental , Tontura/psicologia , Tontura/terapia , Humanos , Transtornos Psicofisiológicos/terapia , Vertigem/psicologia , Vertigem/terapia
5.
Orv Hetil ; 160(48): 1915-1920, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31760777

RESUMO

Introduction: Ménière's disease (MD) is a disorder that affects the inner ear, characterized by vertigo, tinnitus, hearing loss and vegetative symptoms. One of the main points of the management of the patients is the analysis of the vertigo diaries. Aim: To identify the typical characteristics of the symptoms and to highlight the importance of multidisciplinary approach. Material and method: 58 (12 male and 46 females, mean age 56.97 ± 10.45 SD) definite MD patients were enrolled in this investigation. The vertigo diaries filled out by the patients were analysed. The statistical analysis was performed using IBM SPSS V24 software. Since the parameters did not show normal distribution, non parametric test (Mann-Whitney U test) was used. Results: Based on the diaries, the most tormenting symptom is vertigo (mean power: 5.38 ± 2.06 SD), the second one is tinnitus (4.54 ± 2.81 SD), and last one is headache (2.77 ± 3.1 SD). Despite the frequent prevalence of associated headache, vestibular migraine could be ruled out in all of the cases. Another important outcome was that the attacks associated with headache were significantly stronger (p = 0.001). In the case of the vegetative symptoms, the association was even much stronger (p<0.01). According to the narrative analysis, the most frequent provocation factors of the attacks were the cold front and stress. Conclusion: Along with the treatment of vertigo, the management of the associated symptoms (headache, vegetative symptoms) is also of great importance. Monitoring the quality of life and psychiatric disorders suggests the importance of multidisciplinary approach. Orv Hetil. 2019; 160(48): 1915-1920.


Assuntos
Doença de Meniere/diagnóstico , Transtornos de Enxaqueca , Qualidade de Vida , Vertigem , Idoso , Feminino , Cefaleia , Perda Auditiva , Humanos , Masculino , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Zumbido
6.
BMC Neurol ; 19(1): 257, 2019 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-31656167

RESUMO

BACKGROUND: A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult it is associated with multiple pathological conditions including trigeminal neuralgia, ophthalmoplegia, hypopituitarism, intracavernous fistula, brain aneurysms and posterior circulation strokes. The latter may occur through steal phenomena or thrombosis in the anterior circulation. PTA associated vertebrobasilar hypoplasia has yet to be associated to TIA like events, however, in the reported case, that seems to be the case with reported vertigo being probably linked to vertebrobasilar insufficiency. CASE REPORT: We present a case of an 82-year-old man with sudden onset neurological deficits, including left hemiparesis with crural predominance, vertical nystagmus, right internuclear ophthalmoplegia, dysarthria and dysmetria on the left arm. CT angiography disclosed basilar artery hypoplasia in the proximal two thirds and a persistent trigeminal artery. He was diagnosed with acute ischemic stroke. He was submitted to rt-PA with partial reversion of deficits. CONCLUSION: The ischemic events related to PTA remain a rare cause of stroke with specific pathophysiological mechanisms and implications. They may occur through steal phenomena or thrombosis in the anterior circulation. Upon literature review, in the described case both mechanisms seem possible, however the transient episodes of vertigo could have been the first sign of vertebrobasilar insufficiency.


Assuntos
Acidente Vascular Cerebral/etiologia , Insuficiência Vertebrobasilar/congênito , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Ativadores de Plasminogênio/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologia , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/patologia , Vertigem/etiologia
7.
Laryngorhinootologie ; 98(10): 674-684, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31610595

RESUMO

This article critically discusses the current assessment guidelines valid since 2014 which must be applied to determine the driving aptitude of patients with dizziness and balance disorders (in the official document called "disorders of the sense of balance"). With all due respect for the meticulous work of the expert commission who established the guidelines - the likes of which are not known anywhere else - we consider their revision imperative. On the basis of our many years of experience in the German Center for Dizziness and Balance Disorders of the LMU Munich it is our opinion that these restrictions are too strict and the required dizziness-free intervals are too long.The guidelines now stipulate the following for drivers with a group 1 driving licence ("private"):1) Patients with Meniere's disease (attacks without prodromes) must have had no attacks for 2 years before it is possible to drive a car again.2) Patients with vestibular migraine without prodromes must not have had any attacks for 3 years.The following stipulations hold for drivers with a group 1 and group 2 driving licence ("professional driver"):3) Patients with bilateral vestibulopathy as a rule are considered to have a driving disability, likewise4) Patients with central vestibular forms of vertigo, e. g., oculomotor disorders like downbeat and upbeat nystagmus syndromes are also as a rule regarded as having a driving disability.5) Patients with functional (psychogenic) forms of dizziness (e. g., phobic postural vertigo) who have a group 1 driving licence are considered to have a driving disability if dizziness occurs while driving. Those with a group 2 driving licence are in general considered to have a driving disability. However, many patients with episodic or chronic dizziness have such minor symptoms that their driving fitness is not relevantly impaired or if they do have an attack, they are able to stop driving in a controlled manner. In contrast, the restrictions on other illnesses that are accompanied by attack-like disorders of cognition and consciousness like the epilepsies are less strict. Depending on the type of attack or its trigger, the attack-free interval for such patients with a group 1 driving licence amounts to 3 months up to 1 year, although they clearly are not fit to drive during an attack.


Assuntos
Vestibulopatia Bilateral , Doença de Meniere , Nistagmo Patológico , Vertigem , Tontura , Humanos
8.
Clin Drug Investig ; 39(11): 1045-1056, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31571128

RESUMO

BACKGROUND AND OBJECTIVE: Vertigo derived from peripheral vestibular disorders is quite frequently encountered in daily clinical practice and can be a severely disabling symptom associated with substantial impairment of health-related quality of life for the affected patients. Betahistine, a structural analogue of histamine and presumably the most widely prescribed anti-vertigo drug worldwide, has previously been shown to be an effective and safe treatment for these patients. The objective of the present study was to evaluate whether the fixed combination of cinnarizine and dimenhydrinate (Arlevert®) is non-inferior and thus a potentially useful alternative to betahistine dihydrochloride in the treatment of patients suffering from peripheral vestibular vertigo. METHODS: In this prospective, multicenter, double-blind, randomized, non-inferiority clinical trial, outpatients from 8 ENT clinics in Austria, Bulgaria, the Czech Republic and Russia were randomly assigned to receive three times daily one tablet of either the fixed combination cinnarizine 20 mg/dimenhydrinate 40 mg or betahistine dihydrochloride 16 mg for 4 weeks. Primary endpoint was the reduction of the mean vertigo score (MVS), a validated 12-item composite score defined as the mean of 6 vertigo symptoms (dystasia and walking unsteadiness, staggering, rotary sensation, tendency to fall, lift sensation, blackout) and 6 trigger factors for vertigo (change of position, bowing, getting up, driving by car/train, head movements, eye movement), after 4 weeks of therapy, as judged by the patient on a 5-point visual analogue scale (VAS). The non-inferiority margin was set to 0.3. Secondary outcomes included the patient's and investigator's judgment of global efficacy, the patient's rating of impairment of daily activities, and safety/tolerability of the treatments. RESULTS: Three hundred and six patients (mean age 53.5 years, approximately 60% female) were enrolled and randomized to the fixed combination cinnarizine/dimenhydrinate (n = 152) or betahistine (n = 154) groups; 297 patients completed the study and 294 (146 and 148, respectively) were valid for the per-protocol analysis, which was used for the non-inferiority analysis. Treatment with cinnarizine/dimenhydrinate led to a stronger reduction of the MVS [least squares mean (LSM)] after 4-week therapy (primary endpoint) in comparison to betahistine (0.395 vs 0.488; difference: - 0.093, 95% CI - 0.180; - 0.007, p = 0.035); since the upper limit of the two-sided 95% confidence interval was not only below the non-inferiority margin of 0.3, but also entirely below 0, superiority of the fixed combination could be demonstrated. The combination preparation was also more effective after 1 week of therapy and received more favorable patient's ratings on overall efficacy and impairment of daily activities. Both treatments were very well tolerated. Only 12 patients (3.92%) reported 13 non-serious adverse events; 2 cinnarizine/dimenhydrinate-treated patients discontinued the study prematurely due to adverse events as compared to 5 betahistine-treated patients. CONCLUSION: The fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg was found to be not only non-inferior, but superior to betahistine 16 mg in the improvement of peripheral vestibular vertigo. Furthermore, taking into account a good and slightly favorable safety profile, the present study provides evidence that the fixed-combination preparation is a potent and even superior alternative to betahistine in the treatment of vertigo related to peripheral vestibular disorders. STUDY REGISTRATION: EudraCT No. 2011-004025-27.


Assuntos
beta-Histina/uso terapêutico , Cinarizina/uso terapêutico , Dimenidrinato/uso terapêutico , Vertigem/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , beta-Histina/efeitos adversos , Cinarizina/efeitos adversos , Dimenidrinato/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
9.
Medicine (Baltimore) ; 98(38): e17194, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567966

RESUMO

BACKGROUND: This study will systematically investigate the efficacy and safety of methylprednisolone for treatment of persistent vertigo (PV). METHODS: All following electronic databases will be searched from inception to the June 30, 2019 without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database. All randomized controlled trials focusing on assessing the efficacy and safety of methylprednisolone for patients with PV will be fully considered for inclusion. Cochrane risk of bias tool will be used for assessing methodological quality, and RevMan 5.3 software (Cochrane Community, London, UK) will be utilized for statistical analysis. RESULTS: This study will assess the efficacy and safety of methylprednisolone for PV via assessing primary outcome of vertigo, and secondary outcomes of somatization, depression, anxiety, health-related quality of life, and adverse events. CONCLUSION: This study will provide a high-quality evidence to judge whether methylprednisolone is an effective and safety therapy for patients with PV. DISSEMINATION AND ETHICS: No individual data will be utilized in this study, thus, it does not need ethical approval. The results of this study will be published at peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138890.


Assuntos
Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Vertigem/tratamento farmacológico , Glucocorticoides/efeitos adversos , Humanos , Metilprednisolona/efeitos adversos , Resultado do Tratamento
10.
Ideggyogy Sz ; 72(9-10): 295-303, 2019 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31625696

RESUMO

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).


Assuntos
Neuro-Otologia/história , Reflexo Vestíbulo-Ocular , Vertigem , Teste do Impulso da Cabeça , História do Século XIX , História do Século XX , Humanos , Hungria
12.
Ann R Coll Surg Engl ; 101(8): 602-605, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31508988

RESUMO

INTRODUCTION: Menière's disease (MD) is an uncommon cause of sudden profound vertigo. A variety of medical and surgical treatments have been used to manage this condition. This study reviewed the outcomes of patients treated with grommet insertion and transtympanic steroid injection. METHODS: Patients diagnosed with MD between 2007 and 2017 were identified, and case notes and audiological data were retrieved for those managed by grommet (ventilation tube) insertion with and without transtympanic steroid injection. RESULTS: Thirty-three patients were identified as being diagnosed with MD. Grommet insertion resulted in cessation or improvement of attacks in 91% of cases. The mean follow-up duration was 33.8 months (median: 29 months). The mean hearing threshold across the low frequencies improved from 57.2dBHL to 49.4dBHL (p=0.031). Following the intervention, improved tinnitus was reported in 80% of cases. Twelve patients (36%) reported aural fullness prior to grommet insertion; all reported improved symptoms following the procedure. CONCLUSIONS: Early grommet insertion with transtympanic steroid injection, combined with customised vestibular physiotherapy, may provide an alternative first-line strategy for MD, preventing further true MD attacks. In some patients, it may significantly improve hearing thresholds.


Assuntos
Doença de Meniere/cirurgia , Ventilação da Orelha Média/métodos , Adulto , Idoso , Limiar Auditivo , Terapia Combinada , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Testes Auditivos , Humanos , Injeções , Masculino , Doença de Meniere/complicações , Doença de Meniere/tratamento farmacológico , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Zumbido/tratamento farmacológico , Zumbido/etiologia , Zumbido/cirurgia , Vertigem/tratamento farmacológico , Vertigem/etiologia , Vertigem/cirurgia
15.
Rev Saude Publica ; 53: 73, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553377

RESUMO

OBJECTIVE: To assess the effects of the lian gong practice as a rehabilitation strategy in primary health care on the quality of life and functional capacity of people with dizziness. METHODS: Randomized controlled clinical trial. Thirty-six people, who were complaining of dizziness or vertigo without the presence of central signs and were referred by the physician of primary health care participated in the study. The individuals were randomly allocated to the three experimental conditions: lian gong group (n = 11), vestibular rehabilitation group (n = 11) and control group (n = 14). The interventions were weekly, in group, with duration of 12 sessions. The participants were evaluated before and after the intervention regarding quality of life by the 36-Item Short Form Health Survey and the functional capacity by the Short Physical Performance Battery. RESULTS: The scores of all domains of the Short Form Health Survey increased after intervention in the lian gong group. This variation was higher than that observed in the control group for the domains functional capacity, limitation by physical aspects and general health status, and also higher than that found after the intervention in the Vestibular Rehabilitation Group regarding pain. No differences were found in the Short Physical Performance Battery. CONCLUSIONS: Based on the results presented, lian gong improves the quality of life of individuals with dizziness, without altering the functional capacity.


Assuntos
Tontura/reabilitação , Terapia por Exercício/métodos , Atenção Primária à Saúde/métodos , Qualidade de Vida , Vertigem/reabilitação , Idoso , Análise de Variância , Brasil , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Inquéritos e Questionários , Resultado do Tratamento , Vertigem/fisiopatologia
16.
Vestn Otorinolaringol ; 84(3): 61-64, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31486430

RESUMO

A case of perilymphatic fistula with the luxation of the stapes into vestibule was described, which was caused by a direct damage of the eardrum (the patient cleaned the right ear with a cotton swab and received a strong blow to the arm). The moment of injury was characterized by severe pain, a significant hearing loss, the appearance of tympanophonia and vertigo. Clinical examination revealed the eardrum rupture. After perforation healing the hearing did not improve, a high degree of mixed sensorineural hearing loss remained with a bone-air interval of up to 50 dB throughout the tone scale. CT of the temporal bones showed a pneumolabirinth and a change in the malleus position, which made it possible to suggest the presence of a perilymphatic fistula with the luxation of the stapes. The extent of damage was confirmed by surgery. The stapes was removed and the perilymphatic fistula was closed.


Assuntos
Fístula , Cirurgia do Estribo , Doenças Vestibulares , Vestíbulo do Labirinto , Humanos , Estribo , Vertigem
17.
BMC Neurol ; 19(1): 219, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481007

RESUMO

BACKGROUND: Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). METHOD: Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. RESULTS: Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8 ± 4.1° and 0.7 ± 1.0°, respectively. The abnormal rate of SVV deviations (> 2.3°) in CVD was significantly higher than VM (p < 0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 74.1%, specificity 91.7%, positive likelihood ratio (LR+) 8.9, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (92.6%) and specificity (88.9%) were optimized (LR+ (8.3), LR- (0.08)). CONCLUSION: The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus.


Assuntos
Tontura/etiologia , Transtornos de Enxaqueca/diagnóstico , Vertigem/diagnóstico , Doenças Vestibulares/diagnóstico , Adulto , Idoso , Tronco Encefálico/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/etiologia , Estudos Prospectivos , Sensibilidade e Especificidade
18.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46771

RESUMO

Um quadro aflitivo em que há tontura giratória, geralmente acompanhada de náusea e vômito. Em alguns casos, pressão ou barulho no ouvido, uma espécie de zumbido. Esses são os principais sinais de que a pessoa pode estar com labirintite, uma infecção no labirinto, o órgão responsável pelo equilíbrio, localizado dentro da orelha interna.


Assuntos
Labirintite , Viroses , Tontura , Vertigem
19.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414750

RESUMO

BACKGROUND: Vertigo and acute cerebral infarction (ACI) patients show similar symptoms such as dizziness and imbalance. This study was to investigate the diagnostic values of neutrophil counts and neutrophil to lymphocyte ratio (NLR) in distinguishing patients with ACI from those with vertigo. METHODS: This retrospective study was performed and data were gathered from medical records of patients with vertigo symptoms from the Department of Emergency and Neurology Clinics who were admitted to the Fourth Affiliated Hospital Zhejiang University School of Medicine between August 2017 and January 2019. Of the 173 patients with vertigo symptoms, 111 non-ACI vertigo patients (vertigo group) and 62 cases diagnosed with ACI (ACI group) were enrolled in this study. The neutrophil counts, lymphocyte counts, platelet counts, NLR, and PLT to lymphocyte ratio (PLR) within 24 hours after admission were compared between the two groups. Student's t-test of independent samples was adopted for the comparison of the mean between two groups. The neutrophil counts and NLR were evaluated by comparing the areas under the receiver operating characteristic curve (AUC) in distinguishing patients with ACI from those with vertigo. Comparison of AUC was performed using the Z-test. RESULTS: The neutrophil counts and NLR were significantly increased in the ACI group compared with the vertigo group (all p < 0.05), while there were no significant statistical differences of the lymphocyte counts, platelet counts, and PLR (all p > 0.05); moreover, AUC in distinguishing patients with ACI from those with vertigo was 0.647 (95% confidence interval (CI), 0.570 to 0.718) for neutrophil counts and 0.639 (95% CI, 0.562 to 0.710) for NLR, but there was no significant statistical difference (p > 0.05); finally, the cutoff values were 3.1 x 109/L in distinguishing patients with ACI from those with vertigo (specificity 41.44% and sensitivity 83.87%) for neutrophil counts and 2 (specificity 55.86% and sensitivity 67.74%) for NLR. CONCLUSIONS: As easy-to-obtain inflammatory biomarkers, both neutrophil counts and NLR could demonstrate diagnostic values in distinguishing between ACI and vertigo.


Assuntos
Infarto Cerebral/sangue , Linfócitos , Neutrófilos , Vertigem/sangue , Doença Aguda , Idoso , Biomarcadores/sangue , Infarto Cerebral/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Vertigem/diagnóstico
20.
J Clin Neurosci ; 69: 175-178, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31409547

RESUMO

INTRODUCTION: Vertigo is a common condition occurring in the general population and is usually self-limited. Reports studying vertigo in patients with brain metastasis (BM), are scarce. Therefore, the aim of this study was to analyze if the presence of vertigo in cancer patients is associated with the presence of BM. METHODS: This study was conducted in a cancer referral center, where patients with confirmed systemic cancer sent for a neuro-oncologic consultation from May 2012 to March 2018 were included for review. RESULTS: Of 3220 patients, 723 were diagnosed with BM, and 204 had vertigo. Of these patients, 22.5% of those who had vertigo were diagnosed to have BM and 6% of those with BM had vertigo as an initial symptom (odds ratio [OR] 0.9; p = 0.9). An additional symptom was present in 104 patients with vertigo. Bivariate regression analysis disclosed a higher risk of having BM in patients with vertigo accompanied by headache (OR18.6; p < 0.0001), ataxia (OR12.1; p < 0.0001), seizures (OR10.9; p = 0.04), visual symptoms (OR10.4; p < 0.0001), speech impairment (OR6.3; p = 0.01), altered mental status (OR7.4; p < 0.0001), and focal weakness (OR7.4; p = 0.001), or focal sensitive complaint (OR6.9; p = 0.003). Vertigo with headache or ataxia remained statistically significant after multivariate analysis. CONCLUSION: In this cohort, a higher risk of having BM was associated with the presence of vertigo coexistent with headache, ataxia, seizures, visual symptoms, speech impairment, altered mental status, focal weakness, or focal sensitive complaint. On the basis of these results, these accompanying symptoms must be considered as red flags in patients with systemic cancer.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Vertigem/etiologia , Adulto , Neoplasias Encefálicas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vertigem/diagnóstico
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