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1.
Zhongguo Zhen Jiu ; 40(2): 179-84, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32100505

RESUMO

OBJECTIVE: To observe the effects of fast-twisting long-retaining (FTLR) acupuncture therapy on apoptosis of vestibular nucleus and expression of Caspase-3, Bcl-2 and Bax in rats with vertigo induced by posterior circulation ischemia. METHODS: A total of 70 healthy SD rats were randomly divided into a sham operation group, a model group, a medication group, a regular acupuncture group and a FTLR acupuncture group, 14 rats in each group. The rats in the model group, medication group, regular acupuncture group and FTLR acupuncture group were intervented with surgical ligation of the right common carotid artery (CCA) and the right subclavian artery (SCA) to establish the model of vertigo induced by posterior circulation ischemia; in the sham operation group, the right CCA and the right SCA were separated without ligation. The rats in the medication group were treated with gavage of flunarizine hydrochloride suspension (10 mL/kg). "Baihui" (GV 20), "Shuaigu" (GB 8) and "Fengchi" (GB 20) were selected in the two acupuncture groups. The rats in the regular acupuncture group were treated with routine acupuncture and the needles were retained for 30 min, while the rats in the FTLR acupuncture group were treated with quick twist (200-300 times/min) for 1 min and the needles were retained for 60 min. The rats in the sham operation group and the model group received no intervention. All the intervention was provided once a day for 10 days. The decline rate of local blood flow in vestibular nucleus was observed; the apoptosis of vestibular nucleus was observed by TUNEL method; the expression of Caspase-3, Bcl-2 and Bax proteins were detected by immunohistochemistry. RESULTS: Compared with the sham operation group, the decline rate of local blood flow in the right vestibular nucleus was significantly increased in the model group (P<0.01), and the apoptosis index (AI) of vestibular nucleus was significantly increased (P<0.01). Compared with the model group, the decline rates of local blood flow in the right vestibular nucleus in the two acupuncture groups and medication group were significantly reduced (P<0.01), and the AIs of vestibular nucleus cells were significantly reduced (P<0.01). The decline rate of local blood flow in the right vestibular nucleus in the FTLR acupuncture group was lower than those in the medication group and the regular acupuncture group (P<0.01, P<0.05), and the AI of vestibular nucleus was lower than those in the regular acupuncture group and the medication group (P<0.05). Compared with the sham operation group, the expression of Bcl-2 in the vestibular nucleus was significantly decreased in the model group (P<0.01), and the expressions of Bax and Caspase-3 were significantly increased (P<0.01). Compared with the model group, the expressions of Bcl-2 in the vestibular nucleus were significantly increased in the two acupuncture groups and medication group (P<0.01), and the expressions of Bax and Caspase-3 were significantly reduced (P<0.01). The expression of Bcl-2 in the vestibular nucleus in the FTLR acupuncture group was higher than those in the regular acupuncture group and the medication group (P<0.05), and the expressions of Bax and Caspase-3 were lower than those in the regular acupuncture group and the medication group (P<0.05). CONCLUSION: The FTLR acupuncture therapy could effectively inhibit the apoptosis of vestibular nucleus in rats with vertigo induced by posterior circulation ischemia, and its mechanism may be related to improving the blood supply of vestibular nucleus and regulating the expressions of Caspase-3, Bcl-2 and Bax proteins.


Assuntos
Terapia por Acupuntura , Apoptose , Isquemia/complicações , Vertigem/terapia , Núcleo Vestibular Lateral/metabolismo , Animais , Caspase 3/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Ratos Sprague-Dawley , Vertigem/etiologia , Proteína X Associada a bcl-2/metabolismo
2.
J Altern Complement Med ; 26(1): 58-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31580705

RESUMO

Objectives: Large sample and high-quality evidence to evaluate the preliminary safety of the mobilizations and massage for cervical vertigo are not yet available. Thus, the present study aimed to investigate the comparative effectiveness and preliminary safety of Shi-style cervical mobilizations (SCM) compared with traditional massage (TM) in cervical vertigo patients. Design: A prospective, multicenter, open-label, randomized, controlled clinical trial with a 1:1 allocation ratio. Settings: Five academic medical centers. Subjects: A total of 360 adult patients with a diagnosis of cervical vertigo. Interventions: The patients were randomly allocated to either an SCM (n = 180) or TM (n = 180) group. The patients were treated during six sessions over 2 weeks. The primary outcome was the Dizziness Handicap Inventory (DHI) total scale score, and secondary outcomes included the DHI subscales, Chinese version of the Short-Form 36 Health Survey (CSF-36), and adverse events (AEs). Outcomes were assessed in the short term at 2 weeks, 1 month, and 3 months, and in the intermediate term at 6 months after randomization. Results: Significant changes were observed from the baseline in the DHI total scale and subscales at 2 weeks and 1, 3, and 6 months in both groups (all p < 0.05). However, the differences between the two groups were not significant (all p > 0.05). Furthermore, we noted significant changes from the baseline in SF-36 scores at 2 weeks in both groups (all p < 0.05), whereas CSF-36 scores were not significantly higher in the SCM group (all p > 0.05) compared with the TM group. No serious AEs were reported in either of the two groups. Conclusions: No differences in outcomes were detected between the SCM and TM groups in terms of treatment of cervicogenic dizziness. Efficacy trials are required to determine whether the improvement observed for each treatment was causally related to the interventions.


Assuntos
Massagem , Manipulações Musculoesqueléticas , Vertigem/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/fisiopatologia , Vertigem/fisiopatologia
3.
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
4.
Neurology ; 93(18): e1715-e1719, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31554650

RESUMO

OBJECTIVE: To report on the benefits of noninvasive vagus nerve stimulation (nVNS) on acute vestibular migraine (VM) treatment. METHODS: This was a retrospective chart review of patients with VM treated with nVNS in a single tertiary referral center between November 2017 and January 2019. Eighteen patients (16 women) were identified (mean age 45.7 [±14.8] years); 14 were treated for a VM attack and 4 for bothersome interictal dizziness consistent with persistent perceptual postural dizziness (PPPD). Patients graded the severity of vestibular symptoms and headache using an 11-point visual analog scale (VAS; 0 = no symptoms, 10 = worst ever symptoms) before and 15 minutes after nVNS. RESULTS: In those with acute VM, vertigo improved in 13/14 (complete resolution in 2, at least 50% improvement in 5). The mean vertigo intensity before nVNS was 5.2 (±1.6; median 6), and 3.1 (±2.2; median 3) following stimulation; mean reduction in vertigo intensity was 46.9% (±31.5; median 45%). Five experienced headache with the VM attack; all reported improvement following nVNS. Mean headache severity was 6 (±1.4; median 6) prior to treatment and 2.4 (±1.5; median 3) following nVNS; mean reduction in headache intensity was 63.3% (±21.7; median 50). All 4 treated with nVNS for interictal PPPD reported no benefit. CONCLUSION: Our study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute VM, and supports further randomized, sham-controlled studies into nVNS in VM. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with acute VM, nVNS rapidly relieves vertigo and headache.


Assuntos
Cefaleia/terapia , Transtornos de Enxaqueca/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação do Nervo Vago/métodos , Vertigem/terapia , Doença Aguda , Adulto , Idoso , Feminino , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Vertigem/fisiopatologia , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/terapia , Adulto Jovem
5.
Medicine (Baltimore) ; 98(34): e16906, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441871

RESUMO

RATIONALE: Brain abnormalities have frequently been reported in neuromyelitis optica spectrum disorders patients, but vertigo as an initial manifestation has rarely been described. PATIENT CONCERNS: A 64-year-old woman who initially presented with vertigo, then accompanied with other brainstem manifestations and spinal cord involvement. DIAGNOSES: MRI revealed medulla oblongata, cervical and thoracic spinal cord lesions. NMO-IgG antibody was seropositive. Taken her previous medical history and clinical manifestations into consideration, the patient was eventually diagnosed as neuromyelitis optica spectrum disorders. INTERVENTIONS: Before diagnosis, symptomatic treatment and acupuncture were adopted, whereas after diagnosis, steroid, intravenous immunoglobulin, and immunosuppressant were supplemented. OUTCOMES: Her dizziness, nausea and vomiting were gradually relieved by symptomatic treatment and acupuncture before the confirmed diagnosis and immunotherapy. After added treatment with steroid, immunosuppressant, especially intravenous immunoglobulin, diplopia and nystagmus disappeared, and superficial sensation was improving. She was fully recovered six months after admission. LESSONS: Vertigo as a rare prodrome of neuromyelitis optica spectrum disorders deserves attention. The symptoms and signs were improved by a combined treatment of steroid, immunosuppressant, acupuncture, and particularly intravenous immunoglobulin.


Assuntos
Neuromielite Óptica/diagnóstico , Vertigem/etiologia , Terapia por Acupuntura , Diplopia/etiologia , Diplopia/terapia , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Pessoa de Meia-Idade , Náusea/etiologia , Náusea/terapia , Neuromielite Óptica/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vertigem/terapia , Vômito/etiologia , Vômito/terapia
6.
Artigo em Chinês | MEDLINE | ID: mdl-31446715

RESUMO

Summary Vestibular disorders are a group of disorders that may result from damage to peripheral or central vestibular system, which seriously affect the patients' lives and work and even life-threatened. The causes of most vestibular disorders are still unclear, the auxiliary examination is not effective enough and the treatment is not individualized. It needs to improve the diagnosis and treatment efficiency of patients with vestibular disorders. Recent advance in artificial intelligence technology could provide novel promising strategies for the diagnosis and treatment of patients and assist clinical trials. Here we summarized the application of artificial intelligence technique in the field of vertigo, and look to the possible application in the future.


Assuntos
Inteligência Artificial , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/terapia , Diagnóstico por Computador , Humanos , Vertigem/diagnóstico , Vertigem/terapia
8.
J Int Adv Otol ; 15(1): 121-129, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31058601

RESUMO

OBJECTIVES: This study aimed to assess the clinical benefit of device therapy on controlling the symptoms of Meniere's disease (MD). MATERIALS AND METHODS: We searched PubMed, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang Data before January 13, 2018. We selected randomized controlled clinical trials, case-controlled studies, and cohort studies that dealt with outcomes of device therapy for the treatment of MD. RESULTS: Sixteen trials met our inclusion criteria. The use of device therapy resulted in improved vertigo control, which was described as a reduction in the number of vertigo days by month (weighted mean difference [WMD]: 3.15, 95% confidence interval [CI]: 2.00-4.31), in the number of vertigo episodes by month (WMD: 7.37, 95% CI: 2.40-12.35), and in the vertigo visual analog score (WMD: 41.51, 95% CI: 34.68-48.34). In addition, the overall complete vertigo control (class A) rate was 50% (95% CI: 37%-64%). The device therapy also reduced the number of sick days by month (WMD: 4.56, 95% CI: 2.15-6.97), and the functional level improved (WMD: 2.66, 95% CI: 2.15-3.17). The electrocochleographic parameters decreased. The device therapy proved beneficial for hearing changes (WMD: 3.19, 95% CI: 0.66-5.71). No publication bias was found in the funnel plot and the results of Egger's test. CONCLUSION: This study showed that the device therapy might reduce vertigo attacks and sick days in patients with MD. Additionally, the function level and hearing level may improve after the device therapy. In addition, the decrease in electrocochleographic parameters showed that inner ear electrophysiology improved after device therapy.


Assuntos
Audiometria de Resposta Evocada/instrumentação , Doença de Meniere/terapia , Tratamento Transtimpânico com Micropressão/métodos , Vertigem/terapia , Adulto , Idoso , Audiometria de Resposta Evocada/métodos , Estudos de Casos e Controles , Estudos Transversais , Orelha Interna/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Licença Médica/estatística & dados numéricos , Tratamento Transtimpânico com Micropressão/estatística & dados numéricos , Escala Visual Analógica
9.
J Int Adv Otol ; 15(1): 146-150, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31058604

RESUMO

OBJECTIVES: Despite increasing utilization of reposition devices in the management of benign paroxysmal positional vertigo (BPPV), knowledge on subjective outcomes is insufficient. The objective of the present study was to evaluate subjective vertigo complaints and vertigo-associated emotional distress during reposition chair management for refractory BPPV. MATERIALS AND METHODS: This was a prospective observational cohort study of subjective and objective data of 31 patients suffering from refractory BPPV representing failed conventional repositioning treatment. At the beginning of each visit, the patients filled out the Dizziness Handicap Inventory (DHI), the Visual Analog Scale (VAS), and the Hospital Anxiety and Depression Scale (HADS). Treatment and re-evaluation were repeated every 2 weeks until the patient was declared disease-free. RESULTS: Complete remission of BPPV required a mean of two treatments. Mean DHI score decreased from 45 points prior to first treatment to 22 points by finished treatment (p<0.001). Similarly, mean VAS score was reduced from 58 to 25 points (p<0.001), and HADS decreased from 8 to 5 points (p<0.001). Patients with cupulolithiasis reported worse vertigo complaints than those with canalolithiasis. All scores correlated positively. CONCLUSION: Patients with refractory BPPV improved significantly by reposition chair management according to all subjective outcomes. Thus, the reposition device could significantly reduce disease burden in the group of patients with BPPV who failed to respond to conventional management. The strong correlation between the scores suggests VAS as a useful tool for vertigo-related patient complaints.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Posicionamento do Paciente/instrumentação , Vertigem/terapia , Adulto , Idoso , Ansiedade/etiologia , Ansiedade/psicologia , Vertigem Posicional Paroxística Benigna/fisiopatologia , Estudos de Coortes , Tontura/fisiopatologia , Tontura/psicologia , Tontura/terapia , Feminino , Movimentos da Cabeça/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/complicações , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/fisiopatologia , Nistagmo Fisiológico , Posicionamento do Paciente/métodos , Modalidades de Fisioterapia , Estudos Prospectivos , Canais Semicirculares/patologia , Vertigem/complicações , Vertigem/fisiopatologia , Vertigem/psicologia , Escala Visual Analógica
10.
J Neurol ; 266(9): 2120-2128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31119449

RESUMO

OBJECTIVES: Vertigo is a common reason for primary care consultations, and its diagnosis and treatment consume considerable medical resources. However, limited information on the specific cost of vertigo is currently available. The aim of this study is to analyse the health care costs of vertigo and examine which individual characteristics would affect these costs. STUDY DESIGN: We used cross-sectional data from the German KORA ("Cooperative Health Research in the Augsburg Region") FF4 study in 2013. METHODS: Impact of personal characteristics and other factors was modelled using a two-part model. Information on health care utilisation was collected by self-report. RESULTS: We included 2277 participants with a mean age of 60.8 (SD = 12.4), 48.4% male. Moderate or severe vertigo was reported by 570 (25.0%) participants. People with vertigo spent 818 Euro more than people without vertigo in the last 12 months (2720.9 Euro to 1902.9 Euro, SD = 4873.3 and 5944.1, respectively). Consultation costs at primary care physicians accounted for the largest increase in total health care costs with 177.2 Euro (p < 0.01). After adjusting for covariates, the presence of vertigo increased both the probability of having any health care costs (OR = 1.6, 95% CI =[1.2;2.4]) and the amount of costs (exp(ß) = 1.3, 95% CI = [1.1;1.5]). The analysis of determinants of vertigo showed that private insurance and a medium level of education decreased the probability of any costs, while higher income increased it. CONCLUSIONS: The presence of vertigo and dizziness required considerable health care resources and created significantly more related costs in different health care sectors for both primary and pertinent secondary care.


Assuntos
Tontura/economia , Tontura/epidemiologia , Custos de Cuidados de Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Vertigem/economia , Vertigem/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Tontura/terapia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/tendências , Vertigem/terapia
11.
Adv Otorhinolaryngol ; 82: 119-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947176

RESUMO

This chapter is a brief overview of migraine associated vertigo (MAV), focusing on the points most relevant to the practicing clinician. We review the definition of MAV, theories regarding its underlying pathophysiology, clinical presentation, epidemiology, findings on physical examination and oto vestibular testing, differential diagnosis, management and prognosis.


Assuntos
Transtornos de Enxaqueca/complicações , Vertigem/etiologia , Diagnóstico Diferencial , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Transtornos de Enxaqueca/terapia , Exame Físico , Fatores de Risco , Vertigem/diagnóstico , Vertigem/fisiopatologia , Vertigem/terapia , Testes de Função Vestibular
12.
Medwave ; 19(3): e7610, 2019 Apr 08.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-30985738

RESUMO

INTRODUCTION: Ménière's disease is a disorder of the inner ear characterized by episodes of spontaneous vertigo, fluctuating hearing loss and tinnitus. Positive pressure therapy has been used to reduce the intensity and frequency of episodes, but it is not clear whether it is actually effective. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including 22 studies overall, of which five were randomized trials. We concluded positive pressure therapy probably leads to slightly worse hearing and makes little or no difference in the intensity of vertigo. In addition, we are uncertain whether positive pressure therapy improves functionality or decreases vertigo attacks as the certainty of the evidence has been assessed as very low.


Assuntos
Doença de Meniere/terapia , Bases de Dados Factuais , Perda Auditiva/etiologia , Perda Auditiva/terapia , Humanos , Doença de Meniere/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Zumbido/etiologia , Zumbido/terapia , Resultado do Tratamento , Vertigem/etiologia , Vertigem/terapia
13.
Zhonghua Nei Ke Za Zhi ; 58(2): 102-107, 2019 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-30704196

RESUMO

Vestibular migraine (VM) is a common disorder characterized by recurrent dizziness and/or vertigo, which involves a number of specialites and is easily misdiagnosed. The Stroke and Vertigo Association of Chinese Stroke Association and Vertigo Professional Committee of Neurology Branch of Chinese Physicians Association organized multi-disciplinary experts to discuss clinical issues of VM. The purpose of this consensus is to establish a standard framework for the diagnosis and management of VM in China.


Assuntos
Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Vertigem/diagnóstico , Vertigem/terapia , China , Consenso , Humanos
14.
J Int Adv Otol ; 15(1): 141-145, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30411707

RESUMO

OBJECTIVES: To evaluate short-term outcome for posterior canal benign paroxysmal positional vertigo (p-BPPV) after modified Epley's maneuver (mEM). MATERIALS AND METHODS: Patients who were diagnosed with p-BPPV between September 2017 and January 2018 in a tertiary care center were included. Patients were treated with mEM. Five follow-up points were set at one hour, two hours, one day, three days and one week. If Dix-Hallpike test (DH) was positive, mEM was performed and patient was scheduled for follow-up at the next follow-up point. If negative, the patient was accepted as completely resolved and scheduled for follow-up at one week. The proportion of completely resolved patients at each follow-up point, recurrence, lateral canal conversion rate and time were noted. A retrospective control group was created from patients treated for p-BPPV between April and August 2017. The outcome of the study and control groups were compared. RESULTS: There were 93 patients in study group. 63 (67.7%), 8 (8.6%), 3 (3.2%), 0 (0%) and 9 (9.7%) patients completely resolved at one-hour, two-hour, one-day, three-days and one-week follow-ups. 1.96±1.60 (1-5) mEMs were performed. Control group included 61 patients. At one-week follow-up a total of 83 (89.2%) patients in study group and 48 (78.7%) in control group were completely resolved(p=0.1043). In study group 5 (5.37%) of patients had lateral canal conversion within one day. 2(2.15%) had recurrence one day later after two-hour follow-up. The number of patients completely resolved at two-hour follow-up and before (76.34%) compared to the patients completely resolved at one-day follow-up and before (79.56%) were not significantly different (p=0.7235). CONCLUSION: Two-hour follow-up is equivalent to one-day follow-up of p-BPPV in terms of therapy outcome and adverse affects.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Canais Semicirculares/fisiopatologia , Vertigem/etiologia , Adulto , Idoso , Feminino , Seguimentos , Movimentos da Cabeça/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/métodos , Modalidades de Fisioterapia , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Vertigem/diagnóstico , Vertigem/fisiopatologia , Vertigem/terapia
16.
Emerg Med Clin North Am ; 37(1): 11-28, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454774

RESUMO

This article summarizes the systematic assessment of the dizzy patient who presents with peripheral vertigo. It demonstrates the steps and tests necessary using the Triage-Timing-Trigger-Test (Triage + TiTraTe) method to accurately diagnose the underlying most probable cause while ruling out life-threatening causes. Using video support and just-in-time infographics, it demonstrates the Dix-Hallpike, Semont, Epley, and HINTS maneuvers.


Assuntos
Vertigem/diagnóstico , Diagnóstico Diferencial , Emergências , Humanos , Posicionamento do Paciente , Vertigem/etiologia , Vertigem/terapia
17.
Psychol Psychother ; 92(1): 57-73, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29603590

RESUMO

OBJECTIVES: Functional vertigo and dizziness (VD) are frequent and severely distressing complaints that are often described as hard to treat. Our aim was to provide preliminary data on potential effects of multimodal psychosomatic inpatient therapy for patients with functional VD symptoms in reducing vertigo-related handicap and related psychopathology, and to evaluate the role of symptom burden and body-related locus of control in predicting vertigo-related handicap at follow-up. DESIGN: We conducted an uncontrolled clinical pilot trial. METHODS: We included data of n = 72 inpatients with functional VD as a primary symptom and various psychopathological and/or physical comorbidities admitted for multimodal psychosomatic inpatient treatment. Patients completed self-report questionnaires assessing vertigo-related handicap (VHQ), somatization (PHQ-15), depression (BDI-II), anxiety (BAI), health-related quality of life (HRQOL; SF-36), and body-related locus of control (KLC) at admission (T0), discharge (T1), and 6 months after discharge (T2). RESULTS: We observed medium effects for the change of vertigo-related handicap (T0-T1: g = -0.60, T0-T2: g = -0.67) and small effects for the change of somatization (T0-T1: g = -0.29, T0-T2: g = -0.24), mental HRQOL (T0-T1: g = 0.43, T0-T2: g = 0.49), and depression (T0-T1: g = -0.41, T0-T2: g = -0.28) from admission to discharge and admission to follow-up. Body-related locus of control did not predict vertigo-related handicap at follow-up. CONCLUSIONS: Findings provide preliminary evidence for the beneficial role of psychosomatic inpatient treatment for patients with functional VD symptoms. Potentially relevant predictors of outcome at follow-up are discussed. PRACTITIONER POINTS: The change of vertigo-related handicap and related variables through multimodal psychosomatic inpatient treatment was evaluated in a clinical pilot trial in patients with functional vertigo and dizziness. We observed medium effects for the change of vertigo-related handicap and small effects for the change of somatization, mental health-related quality of life, and depression. Internal body-related locus of control at admission did not predict vertigo-related handicap at follow-up.


Assuntos
Depressão/psicologia , Tontura/terapia , Pacientes Internados , Vertigem/terapia , Adulto , Idoso , Terapia Combinada , Depressão/terapia , Tontura/psicologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escalas de Graduação Psiquiátrica , Psicoterapia , Qualidade de Vida , Autorrelato , Vertigem/psicologia
19.
Medicina (B Aires) ; 78(6): 410-416, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30504108

RESUMO

Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.


Assuntos
Vertigem/diagnóstico , Vertigem/fisiopatologia , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/fisiopatologia , Vertigem Posicional Paroxística Benigna/terapia , Tontura/diagnóstico , Tontura/fisiopatologia , Tontura/terapia , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/fisiopatologia , Doença de Meniere/terapia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Transtornos de Enxaqueca/terapia , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/fisiopatologia , Nistagmo Patológico/terapia , Vertigem/terapia , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/terapia
20.
Medicine (Baltimore) ; 97(45): e13130, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407336

RESUMO

RATIONALE: Tendinitis of the longus colli muscle is an aseptic inflammatory process leading to acute posterior neck pain, neck stiffness, and dysphagia or odynophagia. We present a patient exhibiting an infrequent symptom, vertigo. This is the first description of the occurrence of vertigo symptoms caused by longus colli tendinitis. PATIENT CONCERNS: A 38-year-old man was diagnosed with vertigo, presenting with a 1-month history of dizziness, palpitations, and numbness in the hands. DIAGNOSIS: Longus colli tendinitis. The diagnosis was established using magnetic resonance imaging fat-suppression sequences. INTERVENTIONS: Treatment with corticosteroid injections and acupotomy. OUTCOMES: The symptoms relieved immediately after the treatment and complete resolution of the symptoms was observed after 1 week. LESSONS: Longus colli tendinitis with vertigo is an under-reported condition in the literature and physicians should be aware of its existence. A lack of familiarity with the anatomy of the prevertebral space and its variable radiographic appearance makes the diagnosis of longus colli tendinitis clinically difficult. Misdiagnosis of this condition may lead to unnecessary interventions in vertigo.


Assuntos
Músculos do Pescoço/patologia , Tendinopatia/diagnóstico , Vertigem/etiologia , Terapia por Acupuntura/métodos , Adulto , Diagnóstico Diferencial , Glucocorticoides/administração & dosagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Tendinopatia/complicações , Tendinopatia/terapia , Vertigem/terapia
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