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Vertigo AND stroke

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https://www.readbyqxmd.com/read/29163350/differential-diagnosis-of-vertigo-in-the-emergency-department-a-prospective-validation-study-of-the-standing-algorithm
#1
Simone Vanni, Rudi Pecci, Jonathan A Edlow, Peiman Nazerian, Rossana Santimone, Giuseppe Pepe, Marco Moretti, Andrea Pavellini, Cosimo Caviglioli, Claudia Casula, Sofia Bigiarini, Paolo Vannucchi, Stefano Grifoni
Objective: We investigated the reliability and accuracy of a bedside diagnostic algorithm for patients presenting with vertigo/unsteadiness to the emergency department. Methods: We enrolled consecutive adult patients presenting with vertigo/unsteadiness at a tertiary hospital. STANDING, the acronym for the four-step algorithm we have previously described, based on nystagmus observation and well-known diagnostic maneuvers includes (1) the discrimination between SponTAneous and positional nystagmus, (2) the evaluation of the Nystagmus Direction, (3) the head Impulse test, and (4) the evaluation of equilibrium (staNdinG)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29129037/eye-movement-abnormalities-in-middle-cerebellar-peduncle-strokes
#2
Sung-Hee Kim, Ji-Soo Kim
The middle cerebellar peduncle (MCP) is a major conduit for cortico-ponto-cerebellar fibers that convey information related to eye movements. This study aims to elucidate eye movement abnormalities that arise from lesions confined to the MCP. In 23 patients with acute strokes restricted to unilateral MCPs, we investigated the clinical features and ocular motor findings including spontaneous nystagmus, saccades, smooth pursuit, ocular tilt reaction, and head impulse tests. Bithermal caloric tests and audiometry were also performed...
November 11, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/29102540/sudden-hearing-loss-with-vertigo-portends-greater-stroke-risk-than-sudden-hearing-loss-or-vertigo-alone
#3
Tzu-Pu Chang, Zheyu Wang, Ariel A Winnick, Hsun-Yang Chuang, Victor C Urrutia, John P Carey, David E Newman-Toker
BACKGROUND: Because it is unknown whether sudden hearing loss (SHL) in acute vertigo is a "benign" sign (reflecting ear disease) or a "dangerous" sign (reflecting stroke), we sought to compare long-term stroke risk among patients with (1) "SHL with vertigo," (2) "SHL alone," and (3) "vertigo alone" using a large national health-care database. METHODS: Patients with first-incident SHL (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] 388...
November 1, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29089218/-how-to-manage-vertigo-in-adult
#4
Hella Vuong Chaney, Dominique Rohmer, Anne Charpiot
The interrogation and the clinical examination are critical in the research of vertigo etiology. In the context of vertigo, the vital emergencies are of neurological and vascular origins. It is therefore necessary to be able to identify them quickly and simply. Vertigo is a symptom to relieve and the cause is to be diagnosed. Careful questioning combined with neurological examination, nystagmus study, Halmagyi test and skew deviation search are more reliable than imaging in the first 48hours to detect a stroke...
October 28, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/29084063/central-vertigo
#5
Jeong-Yoon Choi, Seung-Han Lee, Ji-Soo Kim
PURPOSE OF REVIEW: This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. RECENT FINDINGS: Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome...
October 27, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29063076/restless-legs-syndrome-secondary-to-pontine-infarction-clinical-analysis-of-five-cases
#6
Hou-Zhen Tuo, Ze-Long Tian, Yi-Nong Cui, Xiao-Yang Ma, Chun-Ling Xu, Hong-Yan Bi, Li-Yan Zhang, Yong-Bo Zhang, Wei-Dong Le, William Ondo
OBJECTIVE: Pontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi-paralysis, hemi-sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS) are extremely rare. Herein, we reported five cases with RLS as a major manifestation of pontine infarction. METHODS: Five cases of pontine infarction related RLS were collected from July 2013 to February 2016...
September 2017: Chronic Dis Transl Med
https://www.readbyqxmd.com/read/29018076/protocol-for-a-prospective-interventional-trial-to-develop-a-diagnostic-index-test-for-stroke-as-a-cause-of-vertigo-dizziness-and-imbalance-in-the-emergency-room-emvert-study
#7
Ken Möhwald, Stanislavs Bardins, Hans-Helge Müller, Klaus Jahn, Andreas Zwergal
INTRODUCTION: Identifying stroke as a cause of acute vertigo, dizziness and imbalance in the emergency room is still a clinical challenge. Many patients are admitted to stroke units, but only a minority will have strokes. This imposes a heavy financial burden on the healthcare system. The aim of this study is to develop a diagnostic index test to identify patients with a high risk of having a stroke as the cause of acute vertigo and imbalance. METHODS AND ANALYSIS: Patients with acute onset of vertigo, dizziness, postural imbalance or double vision within the last 24 hours lasting for at least 10 min are eligible to be included in the study...
October 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28987310/spontaneous-subclavian-artery-dissection-causing-ischemia-of-the%C3%A2-medulla-oblongata-and-cerebellum
#8
Naoto Nagino, Hiraku Funakoshi, Takashi Shiga, Kuniyasu Saigusa
BACKGROUND: Spontaneous subclavian artery dissection is a rare etiology. Spontaneous artery dissection causing brain ischemia is rare in all ischemic strokes. However, in young to middle-aged patients with brain ischemia, spontaneous carotid or vertebral artery dissection causing ischemic stroke accounts for 10-25%. CASE REPORT: A 58-year-old man with a history of hypertension presented to the Emergency Department with a sudden onset of left-arm paresthesia and numbness followed by symptoms of vertigo and vomiting...
November 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28982784/clinical-and-imaging-characteristics-of-arteriopathy-subtypes-in-children-with-arterial-ischemic-stroke-results-of-the-vips-study
#9
M Wintermark, N K Hills, G A DeVeber, A J Barkovich, T J Bernard, N R Friedman, M T Mackay, A Kirton, G Zhu, C Leiva-Salinas, Q Hou, H J Fullerton
BACKGROUND AND PURPOSE: Childhood arteriopathies are rare but heterogenous, and difficult to diagnose and classify, especially by nonexperts. We quantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings. MATERIALS AND METHODS: The Vascular Effects of Infection in Pediatric Stroke (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (2010-2014)...
October 5, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28980578/-vestibular-vertigo-in-hemispheric-strokes
#10
M V Zamergrad, D V Artemev, O S Levin
The literature on cases of hemispheric stroke manifesting with acute vertigo is reviewed. The authors describe a 56-year-old patient with recurrent acute vestibular syndrome due to hemispheric ischemic stroke. Imaging study revealed ischemic stroke with lesions in a parietal-occipital region of the left hemisphere. Possible mechanisms of vestibular symptoms in hemispheric lesions are discussed.
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/28974371/predictors-of-false-negative-diffusion-weighted-mri-in-clinically-suspected-central-cause-of-vertigo
#11
Ebru Unal Akoglu, Haldun Akoglu, Tuba Cimilli Ozturk, Bahaeddin Onur, Serkan Emre Eroglu, Ozge Onur, Arzu Denizbasi
INTRODUCTION: Vertigo is classified as peripheral and central. Differentiation of stroke mimics is the most important diagnostic challenge. There is no clinical guidance for the indications of neuroimaging in isolated vertigo patients. The primary aim of this study is to test the diagnostic value of a DWI-MRI protocol to rule-out a central cause in patients with acute isolated vertigo in the ED. METHODS: We prospectively enrolled 144 patients who were presented with isolated vertigo to the ED...
September 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28906387/a-nearly-full-recovery-from-avm-hemorrhagic-stroke-17-years-after-insult-using-a-new-integrated-neurodevelopmental-approach-a-case-report
#12
Alberto J Friedmann
RATIONAL: With the prevalence of stroke increasing in the USA and the world along with increased survival and longevity due to medical advancements, it has become increasingly necessary to look at the chronic phase of stroke recovery. Previous paradigms of stroke treatment have proven ineffective when looking at 10, 15, or 20 years of survival post insult. PATIENT CONCERNS: The patient, being a young man just out of high school, was concerned with his overall morbidity...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28790096/paraneoplastic-cerebellar-degeneration-secondary-to-ovarian-carcinosarcoma-a-cerebellar-conundrum
#13
Julian David Birch, Arup Sen, Katherine Rowland, Tatyana Viner
We present a case of an elderly female patient who presented with a 6-month history of progressive slurred speech, vertigo, unsteadiness and falls. She underwent an extensive battery of neurological and cardiovascular investigations, none of which demonstrated a diagnostic cause for her symptoms. She was referred to the stroke and neurology teams and was started on treatment for presumed anxiety. As her symptoms continued to progress, she was referred to the falls service. Following a multidisciplinary team discussion, she was reviewed by the consultant geriatrician who felt this may be due to a malignancy so the consultant geriatrician arranged blood testsand CT scan of her chest, abdomen and pelvis...
August 7, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28771753/sleep-apnea-and-risk-of-vertigo-a-nationwide-population-based-cohort-study
#14
Ming-Shao Tsai, Li-Ang Lee, Yao-Te Tsai, Yao-Hsu Yang, Chia-Yen Liu, Meng-Hung Lin, Cheng-Ming Hsu, Chin-Kuo Chen, Hsueh-Yu Li
OBJECTIVE: To investigate the risk of vertigo in patients with sleep apnea. STUDY DESIGN: Retrospective cohort study. METHODS: This study used data from the National Health Insurance Research Database of Taiwan, a population-based database. A total of 5,025 patients who were newly diagnosed with sleep apnea between January 1, 1997, and December 31, 2012, were identified from the Longitudinal Health Insurance Database 2000, a nationally representative database of 1 million randomly selected patients...
August 3, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28759510/cerebellar-stroke-a-missed-diagnosis
#15
Diane C Berry, Amber Rafferty, Kathleen Tiu, Timothy F Platt-Mills
Cerebellar strokes account for less than 10% of all strokes but lead to significantly poor outcomes. Cerebellar strokes that are initially missed have a mortality rate of 40%, and half of the patients who survive have long-term deficits. The patient's history may provide clues that point to a cerebellar stroke. Signs and symptoms include vertigo, headache, vomiting and ataxia. It is important to note the presence of stroke risk factors, such as a history of strokes or transient ischemic attacks, diabetes mellitus, hypertension, hypercholesterolemia, advanced age, atrial fibrillation, and cigarette smoking...
July 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/28717428/awareness-toward-stroke-in-a-population-based-sample-of-iranian-adults
#16
Mozaffar Hosseininezhad, Hannan Ebrahimi, Seyed Mohammad Seyedsaadat, Babak Bakhshayesh, Motahareh Asadi, Amir Reza Ghayeghran
Background: Stroke is the leading cause of death and functional disability. While there have been major advances regarding the management of stroke, a significant proportion of people are still unaware of stroke-related symptoms and risk factors. This study was performed to assess the awareness of stroke's warning signs and risk factors among a sample of Iranian population. Methods: A total of 649 participants were randomly selected using systematic randomization from the list of telephone numbers obtained from the telephone directory...
January 5, 2017: Iranian Journal of Neurology
https://www.readbyqxmd.com/read/28696571/acute-evaluation-of-the-acute-vestibular-syndrome-differentiating-posterior-circulation-stroke-from-acute-peripheral-vestibulopathies
#17
REVIEW
Benjamin Kwok-Tung Tsang, Alex Siew-Kar Chen, Mark Paine
This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke presenting as an acute vestibular syndrome has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/ Nystagmus/Test-of-skew) examination battery, yields a higher sensitivity for diagnosis of posterior circulation stroke than even standard magnetic resonance imaging with diffusion weighted imaging...
July 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28687453/cerebellar-stroke-presenting-with-isolated-dizziness-brain-mri-in-136-patients
#18
Michael D Perloff, Nimesh S Patel, Carlos S Kase, Anuja U Oza, Barbara Voetsch, Jose R Romero
OBJECTIVE: To evaluate occurrence of cerebellar stroke in Emergency Department (ED) presentations of isolated dizziness (dizziness with a normal exam and negative neurological review of systems). METHODS: A 5-year retrospective study of ED patients presenting with a chief complaint of "dizziness or vertigo", without other symptoms or signs in narrative history or on exam to suggest a central nervous system lesion, and work-up included a brain MRI within 48h. Patients with symptoms commonly peripheral in etiology (nystagmus, tinnitus, gait instability, etc...
November 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28646330/-imaging-of-vessels-supplying-the-brain
#19
REVIEW
S M Schellong, N Abolmaali, B Voigts, C Stelzner
Nowadays, several technically validated modalities are available for imaging both the extracranial and intracranial segments of arteries supplying blood to the brain. In the acute stroke setting, computed tomography (CT) angiography is of utmost importance because it provides the key diagnostic criteria indicative for the use of catheter-based recanalization techniques. Ultrasound imaging of extracranial arteries is most suitable for detecting an underlying stenosis of the internal carotid artery (ICA) in patients with stroke, transient ischemic attacks (TIA), retinal vessel occlusion and amaurosis fugax...
August 2017: Der Internist
https://www.readbyqxmd.com/read/28617375/-persistent-postural-perceptual-dizziness
#20
R G Esin, I Kh Khairullin, E R Mukhametova, O R Esin
AIM: To study persistent postural perceptual dizziness (PPPD) in outpatients with benign paroxysmal positional vertigo (BPPV) and patients with presbiataxia (PAt). MATERIAL AND METHODS: Eighty-four patients with PPPD, including 14 with Meniere's disease (MD), 19 with BPPV, 17 with a history of ischemic stroke (IS) in the vertebrobasilar system and 34 with Pat, were examined. For the diagnosis of anxiety, the original 15-point questionnaire with the Likert Scale structure was used...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
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