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Vertigo AND stroke

Dao Pei Zhang, Gui Feng Lu, Jie Wen Zhang, Shu Ling Zhang, Qian Kun Ma, Suo Yin
BACKGROUND: We aimed in this study to investigate the prevalence of vertebral artery hypoplasia (VAH) in a population with isolated vertigo in association with stroke risk factors, to determine whether VAH is an independent risk factor for posterior circulation infarction (PCI). METHODS: We sequentially enrolled 245 patients with isolated vertigo with at least 1 vascular risk factor, who were divided into PCI and non-PCI groups, according to present signs of acute infarction on diffusion-weighted magnetic resonance imaging...
October 13, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
K-D Choi, H Lee, J-S Kim
Dizziness/vertigo and imbalance are the most common symptoms of vertebrobasilar ischemia. Even though dizziness/vertigo usually accompanies other neurologic symptoms and signs in cerebrovascular disorders, a diagnosis of isolated vascular vertigo is increasing markedly by virtue of recent developments in clinical neurotology and neuroimaging. It is important to differentiate isolated vertigo of a vascular cause from more benign disorders involving the inner ear, since therapeutic strategies and prognosis differ between these two conditions...
2016: Handbook of Clinical Neurology
A Bisdorff
History taking is an essential part in the diagnostic process of vestibular disorders. The approach to focus strongly on the quality of symptoms, like vertigo, dizziness, or unsteadiness, is not that useful as these symptoms often coexist and are all nonspecific, as each of them may arise from vestibular and nonvestibular diseases (like cardiovascular disease) and do not permit to distinguish potentially dangerous from benign causes. Instead, patients should be categorized if they have an acute, episodic, or chronic vestibular syndrome (AVS, EVS, or CVS) to narrow down the spectrum of differential diagnosis...
2016: Handbook of Clinical Neurology
Guangxin Duan, Jiaping Xu, Jijun Shi, Yongjun Cao
Bow hunter's syndrome (BHS), also known as rotational vertebral artery (VA) occlusion syndrome, is a rare yet treatable type of symptomatic vertebrobasilar insufficiency resulting from mechanical occlusion or stenosis of the VA during head and neck rotation or extension. The symptoms of BHS range from transient vertigo to posterior circulation stroke. The underlying pathology is dynamic stenosis or compression of the VA by abnormal bony structures with neck rotation or extension in many cases, such as osteophyte, disc herniation, cervical spondylosis, tendinous bands or tumors...
June 2016: Interventional Neurology
Haifeng Mao, Peiyi Lin, Junrong Mo, Yunmei Li, Xiaohui Chen, Timothy H Rainer, Huilin Jiang
BACKGROUND: Early identification of stroke is crucial to maximize early management benefits in emergency departments. This study aimed to develop and validate a new stroke recognition instrument for differentiating acute stroke from stroke mimics in an emergency setting. METHODS: A prospective observational cohort study among suspected stroke patients presenting to Emergency Department in the Second Affiliated Hospital of Guangzhou Medical University was conducted from May 2012 to March 2013...
September 8, 2016: BMC Neurology
Isabelle Beuchat, Patrik Michel, Philippe Maeder, Karin Diserens
UNLABELLED: A 53-year-old man developed significant mass effect secondary to an ischaemic stroke and was treated with decompressive craniectomy. During the first few days postsurgery he developed orthostatic vertigo with nausea. After a month, with increasing mobilisation and rehabilitation, he started reporting of severe abdominal pain. No aetiology could be found despite extensive local work up and the symptoms were resistant to any symptomatic treatment. Within days postcranioplasty there was a complete resolution of all the symptoms...
2016: BMJ Case Reports
Ryosuke Doijiri, Hisakazu Uno, Kotaro Miyashita, Masafumi Ihara, Kazuyuki Nagatsuka
BACKGROUND: The sudden development of vertigo or dizziness without focal neurological symptoms is generally attributable to vestibular diseases such as benign paroxysmal positional vertigo. Isolated vertigo or dizziness attack needs more attention than vestibular diseases. This retrospective study was performed to elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack. SUBJECTS AND METHODS: We enrolled 221 patients (men, 119; women, 102; mean age, 68...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
David E Newman-Toker, Charles C Della Santina, Ari M Blitz
Symptoms referable to disorders affecting the inner ear and vestibulocochlear nerve (eighth cranial nerve) include dizziness, vertigo, tinnitus, and hearing loss, in various combinations. Similar symptoms may occur with involvement of the central nervous system, principally the brainstem and cerebellum, to which the vestibular and auditory systems are connected. Imaging choices should be tailored to patient symptoms and the clinical context. Computed tomography (CT) should be used primarily to assess bony structures...
2016: Handbook of Clinical Neurology
H R Hixson, C Leiva-Salinas, S Sumer, J Patrie, W Xin, M Wintermark
BACKGROUND AND PURPOSE: Evaluation of posterior fossa ischemia on conventional CT is limited. The goal of our study was to determine if virtual monochromatic CT increases the diagnostic accuracy for the detection of posterior infarcts relative to standard CT while using diffusion-weighted MRI as a reference standard. METHODS: Thirty consecutive subjects who meet the following inclusion criteria were retrospectively enrolled: (1) symptoms of posterior fossa stroke (e...
October 2016: Journal of Neuroradiology. Journal de Neuroradiologie
Shi-Bing Wong, Wei-Chen Hung, Ming-Yuan Min
Tian ma (Gastrodia elata, GE) is an ancient Chinese herbal medicine that has been suggested to be effective as an anticonvulsant and analgesic, and to have sedative effects against vertigo, general paralysis, epilepsy and tetanus. The primary active ingredient isolated from GE is termed gastrodin, which is the glucoside of 4-hydroxybenzyl alcohol (4-HBA). Gastrodin can abolish hypoxia-, glutamate- and N-methyl-D-aspartate (NMDA) receptor-induced toxicity in primary culture of rat cortical neurons, and reduces seizure severity in seizure-sensitive gerbils...
June 30, 2016: Chinese Journal of Physiology
Roland Nau, Marija Djukic, Manfred Wappler
The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e...
June 2016: Der Nervenarzt
Mohammad Reza Najafi, Nafiseh Toghianifar, Morteza Abdar Esfahani, Mohammad Amin Najafi, Mohammad Javad Mollakouchakian
BACKGROUND: Vertebrobasilar dolichoectasia (VBD) is a rare vasculopathy. The etiology of this disease is unknown. Transient ischemic attacks (TIAs) of vertebrobasilar system refer to a transient (< 24 hours) lowering of blood flow in the posterior circulation of the brain. We present a case of dolichoectasia in the vertebrobasilar artery that presented with TIAs. CASE REPORT: A hypertensive 54-year-old man with true vertigo, nausea, imbalance, dysarthria, dysmetria, horizontal nystagmus, and gait ataxia was referred to Alzahra Hospital, Isfahan, Iran...
January 2016: ARYA Atherosclerosis
Véronique Quenardelle, Valérie Lauer-Ober, Ielyzaveta Zinchenko, Marc Bataillard, Olivier Rouyer, Rémy Beaujeux, Raoul Pop, Nicolas Meyer, Hervé Delplancq, Stéphane Kremer, Christian Marescaux, Bernard Gény, Valérie Wolff
BACKGROUND: Since the use of tissue plasminogen activator for acute ischemic stroke (IS), stroke care pathways have been developed for patients with suspicion of acute stroke. The aim of this prospective observational study was to analyze the stroke mimic (SM) characteristics in patients who were part of our stroke care pathway. METHODS: All consecutive patients admitted in the code stroke within a 1-year period were prospectively enrolled in this study. Patients with a sudden onset of neurological focal deficit in a time window less than 4H30 as indicated for intravenous thrombolysis, had been accepted in the pathway by a neurologist who was directly contactable by the prehospital emergency medical service 24 h per day...
2016: Cerebrovascular Diseases
Salomeh Keyhani, Eric M Cheng, Ayman Naseri, Ethan A Halm, Linda S Williams, Jason Johanning, Erin Madden, Soraya Rofagha, Alexandra Woodbridge, Ann Abraham, Rosa Ahn, Susan Saba, Elnaz Eilkhani, Paul Hebert, Dawn M Bravata
IMPORTANCE: National guidelines do not agree on the role of carotid screening in asymptomatic patients (ie, patients who have not had a stroke or transient ischemic attack). Recently, several physician organizations participating in the Choosing Wisely campaign have identified carotid imaging in selected asymptomatic populations as being of low value. However, the majority of patients who are evaluated for carotid stenosis and subsequently revascularized are asymptomatic. OBJECTIVE: To better understand why asymptomatic patients who undergo revascularization receive initial carotid imaging...
May 1, 2016: JAMA Internal Medicine
Y Ogawa, K Otsuka, A Hagiwara, T Inagaki, S Shimizu, N Nagai, U Konomi, S Itani, T Kondo, M Suzuki
OBJECTIVES: To determine the characteristics of acute phase nystagmus in patients with cerebellar lesions, and to identify a useful indicator for differentiating central lesions from peripheral lesions. METHODS: Acute phase nystagmus and the appearance of neurological symptoms were retrospectively investigated in 11 patients with cerebellar stroke. RESULTS: At the initial visit, there were no patients with vertical nystagmus, direction-changing gaze evoked nystagmus or pure rotatory nystagmus...
June 2016: Journal of Laryngology and Otology
Sung-Hee Kim, Ziyoda Abdulkhaevna Akbarkhodjaeva, Ileok Jung, Ji-Soo Kim
Studying eye movements and vestibular function would provide insights into brain networks that are vulnerable in mitochondrial disorders. We sought eye movement and vestibular abnormalities in three Korean patients with a mitochondrial A3243G point mutation. The patients suffered from vertigo and imbalance during the stroke-like and seizure episodes from lesions involving the posterior cerebral cortex, which were accompanied by bilateral saccadic hypermetria and horizontal gaze-evoked nystagmus. Furthermore, two patients showed bilateral impairments of the vestibulo-ocular reflex during head impulses for the horizontal and posterior canals on both sides in the absence of caloric paresis...
July 2016: Neurological Sciences
Paul G Mathew, Regina Krel, Bhuvin Buddhdev, Hossein Ansari, Shivang G Joshi, Warren D Spinner, Brad C Klein
BACKGROUND: Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this study was to demonstrate that triptans and DHE can be used for the abortive treatment of BM and HM without significant adverse ischemic vascular events. METHODS: A retrospective chart review of patients with BM features or HM who received acute abortive treatment with either triptans or DHE was conducted at 4 headache centers to assess the frequency of ischemic vascular events after administration...
April 8, 2016: Headache
Tzu-Pu Chang, Yueh-Wen Lin, Pi-Yu Sung, Hsun-Yang Chuang, Hsien-Yang Chung, Wen-Ling Liao
BACKGROUND: Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation...
2016: PloS One
Ting-yu Yi, Wen-huo Chen, Mei-fang Zhang, Yue-hong Chen, Ruo-wei Cai, Zong-zhong Wu, Yan-min Wu, Yan-chuan Shi, Bai-ling Chen, Ting-hui Guo, Chao-xin Wu, Miao-xiong Yang, Xue-jiao Chen
BACKGROUND: Vertebral-basilar artery stenosis is associated with posterior circulation infarction. So correct detection of vertebral basilar artery stenosis is very important. Studies concerning the sensitivity and specificity of 3-dimensional contrast enhanced MR angiography (3D-CE-MRA) in detecting vertebral basilar artery stenosis is generally lacking. METHODS: Retrospectively reviewed the imagines of consecutive one hundred and forty-nine Chinese patients with ischemic stroke or vertigo/dizziness who underwent 3D-CE-MRA and DSA...
April 15, 2016: Journal of the Neurological Sciences
J Venhovens, J Meulstee, W I M Verhagen
Almost 20 % of cerebral ischaemic strokes occur in the posterior circulation. Estimates are that 20 % of these patients present with isolated vertigo. In approximately one-sixth to one-third of these patients, this symptom is wrongly diagnosed to be peripheral vestibular in origin. As a result, these missed stroke patients are withheld from therapeutic and secondary prophylactic treatment, which may result in unnecessary morbidity and mortality. We therefore propose a diagnostic algorithm concerning the clinical differentiation of acute vestibular syndrome (AVS) patients based on a critical review of the available literature...
March 16, 2016: Journal of Neurology
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