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Vertigo AND stroke

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https://www.readbyqxmd.com/read/29317012/prehospital-identification-of-patients-with-a-final-hospital-diagnosis-of-stroke
#1
Elin Andersson, Linda Bohlin, Johan Herlitz, Annelie J Sundler, Zoltán Fekete, Magnus Andersson Hagiwara
Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29282702/treatment-of-dizziness-an-interdisciplinary-update
#2
Rainer Spiegel, Heiko Rust, Thomas Baumann, Hergen Friedrich, Raoul Sutter, Martina Göldlin, Christiane Rosin, René Müri, Georgios Mantokoudis, Roland Bingisser, Michael Strupp, Roger Kalla
This review provides an update on interdisciplinary treatment for dizziness. Dizziness can have various causes and the treatment offered should depend on the cause. After reading this article, the clinician will have an overview of current treatment recommendations. Recommendations are made for the most prevalent causes of dizziness including acute and chronic vestibular syndromes, vestibular neuritis, benign paroxysmal positional vertigo, endolymphatic hydrops and Menière's disease, vestibular paroxysmia and vestibular migraine, cardiac causes, transient ischaemic attacks and strokes, episodic ataxia type 2, persistent postural-perceptual dizziness, bilateral vestibulopathy, degenerative, autoimmune and neoplastic diseases, upbeat- and downbeat nystagmus...
December 28, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29276136/duplex-sonography-of-vertebral-arteries-for-evaluation-of-patients-with-acute-vertigo
#3
Peiman Nazerian, Sofia Bigiarini, Rudi Pecci, Lucia Taurino, Marco Moretti, Andrea Pavellini, Elisa Capretti, Stefano Grifoni, Simone Vanni
We evaluated the role of vertebral artery extracranial color-coded duplex sonography (VAECCS) in predicting vertebrobasilar stroke in consecutive patients presenting to the emergency department with vertigo of suspected ischemic origin. The final diagnosis was established by a panel of experts consisting of an emergency physician, a neurologist, and an otoneurologist. Vertebrobasilar stroke was diagnosed when an acute brain ischemic lesion congruent with symptoms was detected by neuroimaging during the index visit or a stroke was diagnosed within a 3-mo period after emergency department presentation...
December 21, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/29250967/-emergency-diagnosis-of-the-acute-vestibular-syndrome
#4
T László Tamás, Tibor Garai, István Király, Andrea Mike, Csaba Nagy, Ágnes Paukovics, Péter Schmidt, Ferenc Szatmári, Tamás Tompos, Árpád Vadvári, Ágnes Szirmai
INTRODUCTION AND AIM: To diagnose acute vestibular syndrome (AVS) in a prospective study by a new bedside test (providing 1A evidence) based on oculomotor analysis and assessment of hearing loss. To assess the frequency of central and peripheral causes of acute vestibular syndrome in the emergency room. To establish the diagnostic accuracy of acute cranial computed tomography as compared to oculomotor analysis done by video oculography goggles and audiometry. METHOD: Between 1st March 2016 and 1st March 2017 we documented 125 patients (62 women, 63 men, average age 53 years) in the emergency room of the Petz Aladár County Teaching Hospital using the above bedside and instrumental testing...
December 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/29234822/-acute-vestibular-syndrome-clinical-examination-outperforms-mri-in-the-detection-of-central-lesions
#5
REVIEW
F Thömke
A significant number of patients who seek medical treatment in an emergency department because of vertigo or dizziness, suffer from acute vestibular syndrome. This is characterized by sustained vertigo, horizontal or horizontal rotatory jerk nystagmus, and unsteady stance and gait. In the acute situation it is crucial to differentiate patients with a peripheral vestibular disorder from those with a central disease. A number of recent studies have shown that a structured clinical examination enables a reliable differential diagnosis of central or peripheral disorders...
December 12, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/29231438/-infraoccipital-needle-knife-for-cervical-vertigo
#6
Shaofang Li, Manhua Huang, Zhuopeng Lin, Xinze Chen, Dongna Lin, Peng Lu, Qu Lu
OBJECTIVE: To observe the clinical effect differences between infraoccipital needle-knife and massage for cervical vertigo. METHODS: A total of 366 patients with cervical vertigo were randomly assigned into a needle-knife group (186 cases) and a massage group (180 cases). With cases dropping excluded, 183 cases in the needle-knife group and 176 cases in the massage group were included. Needle-knife was used at Fengchi (GB 20), infraoccipital ashi point, etc. in the needle-knife group...
March 12, 2017: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
https://www.readbyqxmd.com/read/29208731/misleading-signs-in-acute-vertigo
#7
Sean Lance, Stuart Scott Mossman
The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma)...
December 5, 2017: Practical Neurology
https://www.readbyqxmd.com/read/29163350/differential-diagnosis-of-vertigo-in-the-emergency-department-a-prospective-validation-study-of-the-standing-algorithm
#8
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
#9
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
#10
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
#11
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
#12
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...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29063076/restless-legs-syndrome-secondary-to-pontine-infarction-clinical-analysis-of-five-cases
#13
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 Diseases and Translational Medicine
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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