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Vertigo emergency

J Löhler, D Eßer, B Wollenberg, L E Walther
No abstract text is available yet for this article.
November 30, 2018: HNO
Pablo Young, Melissa Castillo-Bustamante, Carlos J Almirón, Julio E Bruetman, Bárbara C Finn, María A Ricardo, Ana C Binetti
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...
2018: Medicina
Anne Mucha, Sheri Fedor, Danielle DeMarco
The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment...
2018: Handbook of Clinical Neurology
Manan U Shah, Seth Lotterman, Daniel Roberts, Marc Eisen
OBJECTIVES/HYPOTHESIS: Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix-Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests...
November 26, 2018: Laryngoscope
Ian Gerard Parker, Gunter Hartel, Jennifer Paratz, Nancy Low Choy, Ann Rahmann
OBJECTIVES: To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time. DATA SOURCES: Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016. STUDY SELECTION: Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics...
November 13, 2018: Otology & Neurotology
Do Kyeun Jeong, Sung-Kyun Hwang
We describe the case of a patient who had infarction of the posterior inferior cerebellar artery (PICA) after a chiropractic cervical manipulation. A 39-year-old man visited the emergency room with signs of cerebellar dysfunction, presenting with a 6-hour history of vertigo and imbalance. Two weeks ago, he was treated by a chiropractor for intermittent neck pain. At the time of admission, brain computed tomography, magnetic resonance imaging, and angiography revealed an acute infarction in the left PICA territory and occlusion of the extracranial vertebral artery (VA; V1/2 junction) as a result of the dissection of the VA...
October 2018: Korean Journal of Neurotrauma
Pavlina Sverak, Meredith E Adams, Stephen J Haines, Samuel C Levine, David Nascene, Katherine Sommer, Kathryn Dusenbery, Tina C Huang, Christopher Moertel
OBJECTIVE: Bevacizumab for hearing preservation in patients with neurofibromatosis type 2 (NF2) is an emerging practice. We set out to characterize the effectiveness and toxicity of bevacizumab in our patient group. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Seventeen consecutive patients with NF2 received bevacizumab treatment for vestibular schwannomas, including 2 patients treated to maintain cochlear implant performance...
October 30, 2018: Otolaryngology—Head and Neck Surgery
Tomislav Pavlović, Marina Milošević, Sanja Trtica, Hrvoje Budinčević
BACKGROUND: Vertigo is a common symptom and reason for admission to the emergency department (ED). AIM: This research aimed to determine the incidence of clinically significant findings on computed tomography (CT) in patients with vertigo without focal neurological abnormalities in the ED. MATERIAL AND METHODS: The results of the native CT scans in the ED were retrospectively analysed. Exclusion criteria included: focal neurological abnormalities, underlying malignancy, brain metastasis, previous brain operation, headache, fever, nausea, vomiting, head trauma, coagulopathy...
September 25, 2018: Open Access Macedonian Journal of Medical Sciences
Marcello Covino, Emanuele Gilardi, Alberto Manno, Benedetta Simeoni, Veronica Ojetti, Chiara Cordischi, Evelina Forte, Luigi Carbone, Simona Gaudino, Francesco Franceschi
INTRODUCTION: Well recognized guidelines are available for the use of cranial computed tomography (CCT) in traumatic patients, while no definitely accepted standards exists to for CCT in patients without history of head injury. The aim of this study is to propose an easy clinical score to stratify the need of CCT in emergency department (ED) patients with suspect non-traumatic intracranial pathology. METHODS: We retrospectively evaluated patients presenting to the ED for neurological deficit, postural instability, acute headache, altered mental status, seizures, confusion, dizziness, vertigo, syncope, and pre-syncope...
September 19, 2018: American Journal of Emergency Medicine
Melanie Lloyd, Alexandra Mackintosh, Catherine Grant, Fiona McManus, Anne-Maree Kelly, Harin Karunajeewa, Clarice Y Tang
AIM: To determine whether patients presenting to the emergency department (ED) with possible benign paroxysmal positional vertigo (BPPV) are managed in accordance with best practice guidelines, and whether physiotherapists are involved in their care. DESIGN: Retrospective observational study. PARTICIPANTS: Ninety-six consecutive patients presenting to one of three EDs with vertigo, dizziness or imbalance symptoms documented at triage. Individuals with a clear non-vestibular cause of symptoms were excluded...
October 17, 2018: Physiotherapy Theory and Practice
Stoyan Popkirov, Jon Stone, Dagny Holle-Lee
PURPOSE OF REVIEW: Persistent postural-perceptual dizziness (PPPD) is a newly defined disorder of functional dizziness that in the International Classification of Diseases in its 11th revision (ICD-11) supersedes phobic postural vertigo and chronic subjective dizziness. Despite efforts to unify the diagnosis of functional (somatoform) dizziness, patients will present with a variety of triggers, perpetuating factors, and comorbidities, requiring individualized treatment. This article will review different treatment strategies for this common functional neurological disorder and provide practical recommendations for tailored therapy...
October 13, 2018: Current Treatment Options in Neurology
Bassel Abou-Khalil, Pavel Klein, Aashit Shah, Philippe Ryvlin, Luigi M Specchio, Helena Gama, Francisco Rocha, David Blum, Todd Grinnell, Hailong Cheng, JungAh Jung
OBJECTIVE: To evaluate and compare the effects of concomitant lamotrigine (LTG) or carbamazepine (CBZ) on the incidence of treatment-emergent adverse events (TEAEs) in patients taking adjunctive eslicarbazepine acetate (ESL) for focal (partial-onset) seizures (FS). METHODS: These post-hoc analyses of data pooled from three randomized, double-blind, placebo-controlled studies of adjunctive ESL (BIA-2093-301, -302 and -304) included adults (≥16 years) with FS refractory to 1-3 antiepileptic drugs (AEDs)...
November 2018: Epilepsy Research
L Harenberg, H M Oßwald, H Jaschonek, S Nagel
BACKGROUND: The proportion of patients with neurological disorders as well as the absolute number of patients in German emergency departments is rising. OBJECTIVE: This article presents the results of a survey among patients with self-referral to a dedicated neurological emergency department (ED). We sought to find out if the individual evaluation of urgency for treatment was comparable for patients and physicians. METHODS: During a prospective trial to validate a new and specific neurological triage system over a time period of three months (October 2015 to January 2016), patients who presented themselves to the ED were handed a questionnaire and asked to provide information on the symptoms, including duration and the subjective urgency for evaluation by a physician (priority 1-4, 1 = emergency, 4 = elective)...
October 1, 2018: Der Nervenarzt
Paloma Del C Monroig-Bosque, Jonathan Balk, Francisco Segura, Eric Salazar, Christopher M Leveque, Tina S Ipe
Medication error is a preventable cause of morbidity and death in the inpatient population. We describe a patient with an antifungal overdose treated with therapeutic plasma exchange (TPE). The patient was diagnosed with cryptococcal meningitis and received an acute overdose of amphotericin B deoxycholate instead of the prescribed liposomal amphotericin B. Consequently, the patient developed clinical symptoms including tremors, hypertension, visual hallucinations, vertigo, fever, and acute renal failure. A series of four TPEs was emergently initiated, resulting in complete resolution of most symptoms...
September 18, 2018: Transfusion and Apheresis Science
Tanzer Korkmaz, Yusuf Ozgur Bicer, Erdinc Serin, Sinan Seyhan, Serap Koybasi Sanal
We aim to demonstrate possible autonomic dysfunction based on salivary α-amylase measurements during and after the vertigo attacks associated with Ménière disease (MD) and benign paroxysmal positional vertigo (BPPV). Patients admitted to the emergency room with a diagnosis of vertigo attacks caused by either MD (n = 15) or BPPV (n = 9) constituted the study groups. The control group (n = 10) consisted of volunteer patients admitted to the emergency department with minor soft-tissue trauma. The first saliva samples were obtained immediately during the attacks and the second and third samples were obtained on the third and fifteenth days of the attack, respectively...
September 2018: Ear, Nose, & Throat Journal
Alia Saberi, Seyed Hashem Pourshafie, Ehsan Kazemnejad-Leili, Shadman Nemati, Sara Sutohian, Sara Sayad-Fathi
BACKGROUND: Vertigo is a common annoying complaint needing emergent treatment. There are various treatment options for this condition with different outcomes and side effects. OBJECTIVES: Assessment and comparison of the effectiveness of Ondansetron and Promethazine in the treatment of acute peripheral vertigo. MATERIALS AND METHODS: This clinical trial was conducted in an academic hospital in the north of Iran in 2017. A total of 170 eligible patients were randomly allocated to groups A: received intramuscular (IM) promethazine; and B: received intravenous (IV) Ondansetron, using quadripartite blocks...
September 14, 2018: American Journal of Otolaryngology
Gilles Van Haesendonck, Vincent Van Rompaey, Annick Gilles, Vedat Topsakal, Paul Van de Heyning
OBJECTIVE: After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included...
December 2018: Otology & Neurotology
Eveline Pipolo Milan, Walicyranison Plinio Silva-Rocha, Jéssica Jacinto Salviano de Almeida, Tatiane Uetti Gomes Fernandes, André Luciano de Araújo Prudente, Matheus Firmino de Azevedo, Elaine Cristina Francisco, Analy Salles de Azevedo Melo, Arnaldo Lopes Colombo, Guilherme Maranhão Chaves
BACKGROUND: Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin. CASE PRESENTATION: Here we report the first clinical case of meningoencephalitis due to this species in a female previously healthy patient under corticosteroids and antibiotics therapy for several months...
September 18, 2018: BMC Infectious Diseases
G Conte, F M Lo Russo, S F Calloni, C Sina, S Barozzi, F Di Berardino, E Scola, G Palumbo, D Zanetti, F M Triulzi
Ménière's disease (MD) is a chronic condition characterised by fluctuating hearing loss, intermittent vertigo, tinnitus and aural fullness. Its anatomical and pathological counterpart is represented by endolymphatic hydrops (EH). Recent development and progress in magnetic resonance (MR) imaging techniques has enabled visualisation of EH in living human subjects using a 3 Tesla (T) scanner and gadolinium-based contrast-agent (GBCA) via intravenous (IV) or intra-tympanic (IT) administration. Data emerging from the literature about MR imaging of EH in MD patients are limited, and we therefore reviewed the most common MR imaging findings in the study of the endolymphatic space in both MD and non-MD patients...
August 2018: Acta Otorhinolaryngologica Italica
Toine Mercier, Griet Deslypere, Kristiaan Nackaerts
OBJECTIVES: Ramsay Hunt syndrome (RHS) is a rare complication of varicella zoster virus (VZV) reactivation with high morbidity, requiring swift and specific treatment. METHODS: We discuss the epidemiology, diagnosis and treatment of RHS using a case report of a cancer patient who presented with disseminated VZV reactivation, including RHS. RESULTS: A 68-year old man with stage IV lung adenocarcinoma, for which he received pemetrexed maintenance chemotherapy, presented to the emergency department with a progressive skin rash despite broad spectrum antibiotics, vertigo, and diminished hearing...
September 6, 2018: Acta Clinica Belgica
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