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J Löhler, D Eßer, B Wollenberg, L E Walther
BACKGROUND: Dizziness and vertigo are some of the most common reasons for seeking medical help. Acute dizziness and vertigo require interdisciplinary cooperation. New diagnostic methods (the video head impulse test) and modern algorithms (HINTS: head impulse test/nystagmus [direction changing]/test-of-skew) are increasingly used in case of the acute vestibular syndrome in emergency care. METHODS: In a survey on the management and participation of the ENT specialist area, the authors interviewed 168 German ENT clinics during the spring of 2017 using an online survey...
March 2, 2018: HNO
Nathan H Kung, Gregory P Van Stavern, Daniel R Gold
The acute vestibular syndrome (AVS) is characterized by the rapid onset of vertigo, nausea/vomiting, nystagmus, unsteady gait, and head motion intolerance lasting more than 24 hours. We present 4 patients with AVS to illustrate the pearls and pitfalls of the Head Impulse, Nystagmus, Test of Skew (HINTS) examination.
January 9, 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
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
Benjamin K T Tsang, Alex S K 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 (PCS) presenting as an AVS 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 the diagnosis of PCS than even standard magnetic resonance imaging with diffusion-weighted imaging...
December 2017: Internal Medicine Journal
A Zwergal, K Möhwald, M Dieterich
Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests)...
June 2017: Der Nervenarzt
Herbert L Muncie, Susan M Sirmans, Ernest James
Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient's history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss suggests Meniere disease...
February 1, 2017: American Family Physician
Dayna Jaynstein
Dizziness and vertigo are common and difficult complaints encountered by providers. The differential diagnosis is large and varies from benign to life-threatening disorders. The true challenge becomes differentiating benign peripheral vertigo from central vertigo. The HINTS examination can help differentiate peripheral from central causes of dizziness and vertigo.
October 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
David E Newman-Toker, Ian S Curthoys, G Michael Halmagyi
Patients who present to the emergency department with symptoms of acute vertigo or dizziness are frequently misdiagnosed. Missed opportunities to promptly treat dangerous strokes can result in poor clinical outcomes. Inappropriate testing and incorrect treatments for those with benign peripheral vestibular disorders leads to patient harm and unnecessary costs. Over the past decade, novel bedside approaches to diagnose patients with the acute vestibular syndrome have been developed and refined. A battery of three bedside tests of ocular motor physiology known as "HINTS" (head impulse, nystagmus, test of skew) has been shown to identify acute strokes more accurately than even magnetic resonance imaging with diffusion-weighted imaging (MRI-DWI) when applied in the early acute period by eye-movement specialists...
October 2015: Seminars in Neurology
Natalia Mochalina, Ardavan Khoshnood, Mikael Karlberg, Eric Dryver
The majority of patients who present to the Emergency Department with vertigo suffer from benign conditions. However, a few percent of these patients have life-threatening conditions, such as a cerebellar stroke. The HINTS clinical decision rule (Head-Impulse test, Nystagmus, Test-of-Skew) allows the physician to identify patients with an acute vestibular syndrome of central origin. HINTS is more sensitive than early magnetic resonance imaging. There is no role for computed tomography in the evaluation of patients with isolated acute vestibular syndrome in the Emergency Department...
February 24, 2015: Läkartidningen
Ángel Batuecas-Caletrío, Raquel Yáñez-González, Carmen Sánchez-Blanco, Enrique González-Sánchez, José Benito, José Carlos Gómez, Santiago Santa Cruz-Ruiz
INTRODUCTION: One of the most important dilemmas concerning vertigo in emergency departments is its differential diagnosis. There are highly sensitive warning signs in the examination that can put us on the path towards finding ourselves before a case of central vertigo. AIM: To determine how effective the application of the HINTS protocol is in the diagnosis of cerebrovascular accidents that mimics peripheral vertigo. PATIENTS AND METHODS: We conducted a descriptive observation-based study on patients admitted to hospital with a diagnosis of acute vestibular syndrome in the emergency department...
October 16, 2014: Revista de Neurologia
Ali S Saber Tehrani, Jorge C Kattah, Georgios Mantokoudis, John H Pula, Deepak Nair, Ari Blitz, Sarah Ying, Daniel F Hanley, David S Zee, David E Newman-Toker
OBJECTIVE: Describe characteristics of small strokes causing acute vestibular syndrome (AVS). METHODS: Ambispective cross-sectional study of patients with AVS (acute vertigo or dizziness, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with at least one stroke risk factor from 1999 to 2011 at a single stroke referral center. Patients underwent nonquantitative HINTS "plus" examination (head impulse, nystagmus, test-of-skew plus hearing), neuroimaging to confirm diagnoses (97% by MRI), and repeat MRI in those with initially normal imaging but clinical signs of a central lesion...
July 8, 2014: Neurology
Brian Cohn
No abstract text is available yet for this article.
September 2014: Annals of Emergency Medicine
David E Newman-Toker, Kevin A Kerber, Yu-Hsiang Hsieh, John H Pula, Rodney Omron, Ali S Saber Tehrani, Georgios Mantokoudis, Daniel F Hanley, David S Zee, Jorge C Kattah
OBJECTIVES: Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2])...
October 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Matthias Unger
Ginkgo biloba leaf extracts (GLEs) are popular herbal remedies for the treatment of Alzheimer's dementia, tinnitus, vertigo and peripheral arterial disease. As GLEs are taken regularly by older people who are likely to also use multiple other drugs for the treatment of, e.g. hypertension, diabetes, rheumatism or heart failure, potential herb-drug interactions are of interest. Preclinical studies of high doses/concentrations of GLEs of varying quality and standardization hinted at both an inhibition and induction of metabolic enzymes and transporters...
August 2013: Drug Metabolism Reviews
Steven D Rauch
Meniere disease is one of the most fascinating and most vexing of all clinical conditions encountered by the otolaryngologist. Operationally speaking, a Meniere ear is a fragile ear. In fact, Meniere disease can and should be redefined as a degenerating inner ear that has impairment of one or more homeostatic systems, resulting in instability of hearing and balance function. This updated definition is a valuable guide to the clinical epidemiology and presentation of Meniere disease and to understanding the effects of conservative treatments...
October 2010: Otolaryngologic Clinics of North America
Nicholas J Wade
In the biography of his grandfather (Erasmus Darwin), Charles Darwin hinted that his father (Robert Darwin) had received parental assistance in conducting and writing his medical thesis (which concerned afterimages). The experiments also involved visual vertigo, and they were elaborated by the senior Darwin in his Zoonomia, published in 1794. Erasmus Darwin's interpretation was in terms of trying to pursue peripheral afterimages formed during rotation; it was at variance with one published two years earlier by William Charles Wells, who had investigated the visual consequences of body rotation when the body is subsequently still...
April 8, 2010: Journal of the History of the Neurosciences
Jorge C Kattah, Arun V Talkad, David Z Wang, Yu-Hsiang Hsieh, David E Newman-Toker
BACKGROUND AND PURPOSE: Acute vestibular syndrome (AVS) is often due to vestibular neuritis but can result from vertebrobasilar strokes. Misdiagnosis of posterior fossa infarcts in emergency care settings is frequent. Bedside oculomotor findings may reliably identify stroke in AVS, but prospective studies have been lacking. METHODS: The authors conducted a prospective, cross-sectional study at an academic hospital. Consecutive patients with AVS (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with >or=1 stroke risk factor underwent structured examination, including horizontal head impulse test of vestibulo-ocular reflex function, observation of nystagmus in different gaze positions, and prism cross-cover test of ocular alignment...
November 2009: Stroke; a Journal of Cerebral Circulation
Jan von Ohsen, Undine Ott, Hans Jörg Fricke, Gunter Wolf
BACKGROUND: Anemia is a phenomenon frequently observed after kidney transplantation and differential diagnosis is broad. CASE REPORT: A 39-year-old woman who had been transplanted a kidney of her father 11 months ago was admitted to the hospital because of severe and worsening anemia (hematocrit [Hct] 0.24). She was under a standard posttransplant immunosuppressive protocol consisting of tacrolimus, mycophenolate mofetil (MMF) and prednisolone. Kidney function was excellent (serum creatinine 118 micromol/l), clinical symptoms of anemia included vertigo, fatigue and low blood pressure...
July 15, 2006: Medizinische Klinik
Lawrence R Lustig, Jennifer Yeagle, John K Niparko, Lloyd B Minor
OBJECTIVE: To evaluate the indications and clinical outcomes (audiologic and vestibular) in patients with Ménière's syndrome who have undergone cochlear implantation. STUDY DESIGN: This is a retrospective review of patients at a large tertiary academic medical center. PATIENTS: Nine patients were included in the study with AAO-HNS criteria for diagnosis of Ménière's syndrome as well as bilateral severe to profound sensorineural hearing loss as an indication for undergoing cochlear implantation...
May 2003: Otology & Neurotology
S Kösling, F Bootz
This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci...
November 2001: European Journal of Radiology
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