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Vertigo emergency

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...
September 24, 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
Kwang-Dong Choi, Ji-Soo Kim
Discriminating strokes in patients with acute dizziness/vertigo is challenging especially when other symptoms and signs of central nervous involvements are not evident. Despite the developments in imaging technology over the decades, a significant proportion of acute strokes may escape detection on imaging especially during the acute phase or when the lesions are small. Thus, small strokes causing isolated dizziness/vertigo would have a higher chance of misdiagnosis in the emergency department. Even though several diagnostic algorithms have been advanced for acute vascular vertigo, we still await more comprehensive and sophisticated ones that can also be applied to transient vestibular symptoms due to vascular compromise...
September 5, 2018: Journal of Neurology
Andrea Mike, T László Tamás
Dizziness is one of the most common causes of medical visits. Management of the dizzy patient may be challenging both for the general practitioner, in emergency departments, and special clinics, as behind a seemingly homogeneous clinical presentation several very different etiologies may occur. Research of the last two century enriched our knowledge about physiology and pathophysiology of the vestibular system. Much knowledge is now available about the labyrinth being able to sense head motions and gravity, processing of afferent vestibular stimuli, reflectory oculomotor and postural control, or recovery of the vestibular system...
July 30, 2018: Ideggyógyászati Szemle
Lian Zuo, Yiqiang Zhan, Feifeng Liu, Chen Chen, Luran Xu, Zeljka Calic, Dennis Cordato, Cecilia Cappelen-Smith, Yunfeng Hu, Gang Li
OBJECTIVE: To clarify the relationship of clinical factors with isolated vertigo or dizziness of cerebrovascular origin. METHODS: Clinical data of patients admitted in East Hospital from Jan. 2015 to Apr. 2016, whose complaint were acute vertigo or dizziness were retrospectively collected. All patients arrived at the emergency department within 24 hr of symptom onset, had no acute ischemic lesion first CT and NIHSS score of 0. Patients were divided into cerebral infarction group and noncerebral infarction group according to subsequent cerebral imaging results and clinical and laboratory factors related to cerebral infarction were analyzed...
September 2018: Brain and Behavior
Abhay Venkat, Cecilia Cappelen-Smith, Shabeel Askar, Peter R Thomas, Sonu Bhaskar, Amanda Tam, Alan J McDougall, Suzanne J Hodgkinson, Dennis J Cordato
BACKGROUND: Failure to recognise acute stroke may result in worse outcomes due to missed opportunity for acute stroke therapies. Our study examines factors associated with stroke misdiagnosis in patients admitted to a large comprehensive stroke centre. METHODS: Retrospective review comparing 156 consecutive stroke patients misdiagnosed in emergency department (ED) with 156 randomly selected stroke controls matched for age, gender, language spoken and stroke subtype for the period 2014-2016...
August 9, 2018: Neuroepidemiology
Davide Deriu
•The paper explores the ambivalent concept of vertigo and its significance for contemporary architecture.•It examines in particular the rise of elevated glass platforms through concepts of transparency, experience, and kinaesthesia.•Proposes that these emerging design features constitute a kind of 'sixth façade'.•Discusses this phenomenon as a spatial manifestation of the experience economy.•Concludes by highlighting the rise of 'architectures of vertigo' in relation to wider social imperatives.
August 2018: Emotion, Space and Society
Robert J Long, Reese A Charles
BACKGROUND: Otitis externa secondary to irritant or chemical exposure is well documented; however, specifically secondary to jet fuel exposure and its associated toxicology is not. Over 2 million military and civilian personnel per year are occupationally exposed to aviation fuels. CASE REPORT: An aircraft maintainer presented with noninfectious acute otitis externa secondary to external ear canal exposure to JP-5 jet fuel. Proper exposure guidelines were followed, but it was not realized that the external ear canal was involved...
July 1, 2018: Aerospace Medicine and Human Performance
L A Rodríguez de Antonio, I García Castañón, M J Aguilar-Amat Prior, I Puertas, I González Suárez, C Oreja Guevara
OBJECTIVES: To describe non-relapse-related emergency consultations of patients with multiple sclerosis (MS): causes, difficulties in the diagnosis, clinical characteristics, and treatments administered. METHODS: We performed a retrospective study of patients who attended a multiple sclerosis day hospital due to suspected relapse and received an alternative diagnosis, over a 2-year period. Demographic data, clinical characteristics, final diagnosis, and treatments administered were evaluated...
May 26, 2018: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Sung Eun Chung, Tae Hwan Yoon, Kyung Mi Lee, Hyug-Gi Kim, Bum Joon Kim
BACKGROUND: Cervical artery dissection is one of the most important causes of ischemic stroke in young age patients. However, multiple cervical artery dissection simultaneously involving the anterior and posterior circulation is uncommon. Here, we would like to report a case of a patient with bilateral vertebral artery (VA) and internal carotid artery dissection (ICA) after a use of systemic steroid due to peripheral facial palsy. CASE PRESENTATION: A 44-year-old man with hypertension visited emergency department due to recurrent vertigo...
May 28, 2018: BMC Neurology
I Mármol-Szombathy, E Domínguez-Durán, L Calero-Ramos, S Sánchez-Gómez
PURPOSE: To calculate the incidence of subsequent acute cerebrovascular syndrome in emergency department patients with vertigo or dizziness symptoms and to determine predictors of subsequent acute cerebrovascular syndrome in these patients. METHODS: Descriptive and retrospective hospital based-population study among emergency department patients with vertigo or dizziness symptoms in 1 year. One year follow-up since the medical visit was performed. Chi-square and Fisher tests were used for qualitative variables; Mann-Whitney U test for quantitative variables...
July 2018: European Archives of Oto-rhino-laryngology
Yanbin Wang, Yao Liu, Yu Wang, Yuchen Li, Pei Wu, Huaizhang Shi
Here, we report a case of a 64-year-old female with acute-onset vertigo, nausea, and vomiting. In an emergency imaging examination, the results of computed tomography (CT) and diffusion weighted imaging (DWI) were negative. However, on 1 day post-hospital admission, a small acute infarct in the posterolateral aspect of the left medulla was detected by DWI. Extra attention should be payed to the false-negative imaging results to avoid diagnosis and treatment delay.
September 2018: Neurological Sciences
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