Common Cause Of Vertigo Research Articles

Benign paroxysmal positional vertigo may be the most common cause of dizziness in emergency department

Benign paroxysmal positional vertigo may be the most common cause of dizziness in emergency department

Vertigo and Dizziness in the Elderly.

The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years. Balance disorders in the elderly constitute a major public health problem, and require an adequate diagnosis and management by trained physicians. In the elderly, common causes of vertigo may manifest differently, as patients tend to report less rotatory vertigo and more non-specific dizziness and instability than younger patients, making diagnosis more complex. In this mini review, age-related degenerative processes that affect balance are presented. Diagnostic and therapeutic approaches oriented to the specific impaired system, including visual, proprioceptive, and vestibular pathways, are proposed. In addition, presbystasis – the loss of vestibular and balance functions associated with aging – benign paroxysmal positional vertigo, and stroke (in acute syndromes) should always be considered.

Dizziness and Unstable Gait in Old Age

Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected persons, the factors leading to dizziness and gait impairment in old age are never identified, yet some of these factors can be specifically detected and treated. This review is based on publications (2005-2014) retrieved by a selective search in PubMed on the terms "aging," "dizziness," "elderly," "gait," "gait disorder," "geriatric," "locomotion," and "vertigo." Dizziness interferes with the everyday activities of 30% of persons over age 70 and is so severe that it constitutes a reason for consulting a physician. The more common causes of dizziness and unsteady gait in old age are sensory deficits, such as bilateral vestibular failure, polyneuropathy, and impaired visual acuity; benign paroxysmal positioning vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and fear of falling. Many elderly persons have multiple factors at the same time. Benign paroxysmal positioning vertigo can be effectively treated with specific physical maneuvers. Sedating drugs are indicated only for the treatment of acute rotatory vertigo and are not suitable for long-term use. Sarcopenia can be treated with physical training. If a specific cause can be identified, dizziness and gait unsteadiness in old age can often be successfully treated. The common causes can be revealed by systematic clinical examination. Controlled clinical trials on the efficacy of treatments for elderly persons are urgently needed.

Vestibular asymmetry predicts falls among elderly patients with multi-sensory dizziness

Background: Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. Multisensory deficits is the second most common cause of dizziness among elderly, with visual, vestibular and proprioceptive reduced function. Asymmetric vestibular function is overrepresented in elderly persons with hip fractures and wrist fractures and can be accessed for screening. Vestibular disorders are probably unrecognized as a cause to dizziness in the elderly. Given this, it is possible that elderly patients with multisensory dizziness also have asymmetric vestibular function to a high degree, which might indicate a higher risk of falls.

Rotational chair testing in patients with unilateral peripheral vestibular disorders

Abstract The aim of the study was to evaluate the rotational chair (RC) sinusoidal harmonic acceleration (SHA) test and the rotational velocity step (RVS) test in patients with unilateral peripheral vestibular disorders. This study was retrospective in nature. It was conducted in a clinical tertiary care vestibular function test center. A total of 119 patients (63 men and 56 women) with documented unilateral peripheral vestibular lesions were evaluated with bithermal binaural caloric and sinusoidal and step velocity RC tests. Clinical, caloric, and RC tests were carried out. The study group was selected by including patients with a clinical diagnosis suggestive of peripheral vestibular lesions and with documented unilateral caloric weakness matching the clinical diagnosis, and by excluding patients with a clinical diagnosis suggestive of a peripheral vestibular lesion but not documented by unilateral caloric weakness, as well as patients with incomplete tests or uninterpretable data (due to poor recordings or eye movement artifacts). Caloric testing was performed using an infrared video-oculographic system and a Brookler-Grams closed-loop irrigation unit with standard bithermal irrigations of 30 and 44°C for 45 s each in the following order: L30°C, R30°C, R44°C, and L44°C. The RC testing paradigms used in this study were the rotational SHA test and the RVS test. When patients were classified on the basis of etiology, the most common cause of dizziness in the study group was found to be Mιniθre’s disease (34.9%), followed by vestibular neuritis (31.1%). Seventy-two patients in the study group demonstrated right caloric weakness and 47 patients demonstrated left caloric weakness, whereas only 18 of 119 patients demonstrated directional preponderance. When the RC SHA test parameters (gain, phase, and symmetry) in the study group were compared with the manufacturer’s normal values, statistically significant difference was seen in vestibulo-ocular reflex (VOR) gain at low frequencies (0.01-0.08 Hz), in VOR phase at all frequencies, and in VOR symmetry at low frequencies (0.01-0.04 Hz). In summary, despite the encouraging results of the discriminating power of caloric testing, it should be emphasized that RC testing has its own unique capabilities, such as the following: (i) it is a physiologic stimulus whose frequency and amplitude can be varied precisely; (ii) the stimulus is unrelated to physical features of the external ear or temporal bone; (iii) it is useful in children who may not tolerate caloric testing; and (iv) it is very useful in assessing patients receiving vestibulotoxic drugs. Multiple stimuli of varying intensities can be applied to the vestibular system within a relatively short period of time.

Vertigo and dizziness in children.

Vertigo and dizziness occur with considerable frequency in childhood and adolescence. Most causes are benign and treatable. This review aims to make physicians more alert to the frequent causes of dizziness in the young. Epidemiological data confirm that migraine-related syndromes are the most common cause of vertigo in children. Vestibular migraine and benign paroxysmal vertigo have now been defined by the International Classification of Headache Disorders. About half of the adolescents with vertigo and dizziness show psychiatric comorbidity and somatization. Vestibular paroxysmia has been described as a new entity in children that can be treated with low doses of carbamazepine. To assess vestibular deficits, video head impulses (for the semicircular canals) and vestibular-evoked myogenic potentials (for the otoliths) are increasingly being used. Pediatricians and neuro-otologists should be aware of the full spectrum of causes of vertigo and dizziness in children and adolescents. Vestibular function can reliably be tested nowadays. Although treatment for the common migraine-related syndromes can be done in analogy to the treatment of migraine in general, specific approaches are required for somatoform vertigo, the most frequent diagnosis in adolescent girls.

Pancreatic Arteriovenous Malformation as an Unusual Cause of Chronic Gastrointestinal Bleeding in a Patient with Early Gastric Cancer: Multimodality Imaging Spectrum with Pathologic Correlation

Anemia is one of the most common causes of dizziness. Most chronic anemia is associated with gastrointestinal bleeding, such as peptic ulcers or cancer of various organs (1). Pancreatic arteriovenous malformation (AVM) is a rare cause of gastrointestinal bleeding (2). They are usually asymptomatic but may present with abdominal pain, portal hypertension in the absence of hepatopathy, or gastrointestinal bleeding. Although pancreatic AVM is rare, it should be considered in patients with anemia of unknown origin or those who failed therapy for more common causes of anemia. Even though previous studies have reported the imaging findings of pancreatic AVM including ultrasound, computed tomography, and magnetic resonance imaging, most Arteriovenous malformation (AVM) of the pancreas is extremely rare, although it may be increasingly diagnosed due to the widespread use of cross-sectional imaging of the abdomen. Early diagnosis of this disease is important to prevent delay of treatment and resulting fatal complications. We report a rare case of pancreatic AVM in a 48-year-old man who presented with severe chronic anemia and early gastric cancer, which made diagnosis challenging. Imaging findings, including ultrasound, computed tomography, and magnetic resonance imaging, are shown, as well as the pathologic features.

Benign Paroxysmal Positional Vertigo: Our Experience.

Benign paroxysmal positional vertigo (BPPV) is probably common cause of vertigo. A total of 205 cases reported to ENT OPD for vertigo. Of these 43 patients were found to suffer from BPPV and in our experience BPPV is common condition. BPPV was more common in age group of 4th and 7th decades. The youngest patient reported was 41years and the oldest patient was 78years with a mean of 56.5. In this group there were 16 females and 27 males. This is a retrospective case study of 205 cases presenting with vertigo. The modality of treatment was Epley's manoeuvre in cases diagnosed with BPPV. The age of patients ranged from 41 to 78years with mean of 56.5. The over all success rate was 96%. All cases were instructed to report recurrence and were followed for 1year.

Benign paroxysmal positional vertigo in outpatient practice: Diagnosis and treatment

Dizziness is one of the common reasons for visits to physicians of various specialties; the data of foreign investigations show that benign paroxysmal positional vertigo (BPPV) is most frequently encountered. Objective: to study the causes of dizziness, to analyze the frequency of BPPV and the efficiency of its treatment in outpatient practice. Patients and methods . The investigation enrolled 80 patients, including 55 (68.7%) women and 25 (31.3%) men, aged 18 to 75 years (mean age 53.8±12.8 years), who complained of dizziness and sought for medical advice in the Therapeutic-and-Diagnostic Unit, A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University. Results . The most common causes of dizziness in outpatient practice were BPPV (46.2%) and postural phobic vertigo (35%). The diagnosis of VPPV, if special positional testing (Dix-Hallpike and McClure-Pagnini tests) was carried out, was shown to create no significant difficulties. The diagnosis was not established in the majority (97.5%) of the patients; effective treatment was performed in one of the patients. Combined treatment, by performing the positional tests and using betaserc for 2 months, led to complete resolution of positional vertigo in most (97.3%) patients. Discussion. The findings indicate the efficiency of examining patients with complaints of dizziness, by using the special otoneurological tests to detect BPPV. The purposeful questioning of patients with BPPV can suspect this disease in the majority of cases. Our investigation shows the high efficiency of rehabilitation maneuvers for BPPV, which agrees well with the data of other authors. Physicians’ poor awareness of BPPV among physicians and the high efficiency of its treatment in outpatient practice are noted.

Benign Paroxysmal Positional Vertigo: An Integrated Perspective

Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50% of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition.

Current Views on Treatment of Vertigo and Dizziness

Based on the current literature treatment of vertigo and dizziness was summarized depending on its origin. Attention was drawn to the most common causes of vertigo and early differential diagnosis between central and peripheral vertigo. There are three main methods of treatment for vertigo: pharmacotherapy, rehabilitation and surgical treatment. Pharmacotherapy in the treatment of vertigo has its place mainly in the acute phase of attacks. Rehabilitation is one of the most important methods of vestibular compensation support, recommended in the vertigo treatment after the resolution of acute symptoms in most cases. Benign paroxysmal positional vertigo usually release after repositional maneuvers such as Epley maneuver. In some diagnoses, such as Meniere’s disease or migraine associated vertigo, appropriate diet can befavorable to preventing the attacks. Surgery is used in some cases where there is no improvement after pharmacotherapy and also in tumors, vascular and cervical spine lesions. In some patients with vertigo, treatment success depends on multidisciplinary cooperation: an otolaryngologist, a physiotherapist, an internist, a vascular surgeon, a neurosurgeon or a psychiatrist.

The Causes of Dizziness in Parkinson’s Disease

Patients with Parkinson’s disease complain dizziness frequently. Postural hypotension and postural instablity are suggested to be the reasons of dizziness in elderly people with Parkinson’s disease. The aim of this prospective surveillance study was to characterize the etiology of the dizziness in patients with PD. A total of 47 consecutive patients with idiopathic Parkinson’s disease were enrolled in the prospective surveillance study. Of the 47 patients, 32 (68.1%) had dizziness. All patients underwent neurological and otologic examination. Complete blood count, serum electrolytes, glucose, liver function tests, renal function tests and thyroid function tests, cranial computerized tomography, direct cervical region radiography and vertebral artery doppler ultrasonography were obtained from all patients. Patients were screened for blood pressure changes, drug use, cardiovascular diseases, hypertension and diabetes mellitus. The findings of loss of disk height, with subsequent loss of cervical lordosis were higher in patients with dizziness (p = 0.01). The results of this study show that cervical-vertebral degeneration may be a common cause of dizziness in Parkinson’s disease patients.

Benign paroxysmal positional vertigo

To review benign paroxysmal positional vertigo (BPPV) and some of the recent literature. As BPPV is such a common diagnosis, it is important to understand the disorder and treatment considerations. Although BPPV is typically an easy diagnosis to make, one must be aware of the differential diagnosis. An unusual entity, convergence spasm, is recently presented and discussed as an addition to the differential diagnosis. The recent literature confirms the efficacy of treatment of BPPV. Large studies of horizontal canal BPPV support the success of the barbeque roll and present the simple head shake as a possible treatment in the apogeotropic form. There is reported success with the less often discussed Gufoni (and its variations) maneuver. The presence of orthoptic nystagmus during treatment has positive predictive value for the success of the maneuver. Although uncommon, canal conversion is important to recognize during treatment as it can be readily treated. BPPV is a very common cause of dizziness and generally straightforward to identify and treat. Awareness of possible horizontal canal variants and nonvestibular differential diagnosis possibilities is important. Repositioning maneuvers of various types are typically successful and understanding the nuances is important in assuring successful outcomes.

Vestibular asymmetry predicts falls among elderly patients with multi- sensory dizziness

BackgroundDizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. While BPPV is the most common cause of dizziness among elderly, multisensory deficits is the second, with visual, vestibular and proprioceptive reduced function. Asymmetric vestibular function is overrepresented in elderly persons with hip fractures and wrist fractures and can be accessed for screening.The objective was to study if vestibular asymmetry, vibration sense, balances performance, postural sway in quiet stance and self-perceived handicap because of dizziness could predict falls among elderly, dizzy patients.MethodsIn this prospective study with one year observation period, 55 patients (41 women, 14 men), 65 to 90 years old (median 80, interquartile range 11) with multisensory dizziness were included.Vestibular function was screened with the headshake test and vibration sense was assessed using a tuning fork. Balance was assessed with four clinical measures and self-perceived dizziness handicap was assessed by the Dizziness Handicap Inventory. Postural sway was measured using a force plate.ResultsHeadshake test were pathologic in 24 patients, which substantially increased the risk of falls (OR 3.4). Thirteen of the 21 patients who had fallen (p = 0.03), and all 6 patients who sustained three falls or more (p = 0.04), had vestibular asymmetry. No other measure could predict the risk of falls (OR 0.55–1.71).ConclusionSigns of vestibular asymmetry among elderly with multisensory dizziness could predict falls. Hence, it seems important to address fall-prevention programs to such a group of patients. Simple bedside tests of vestibular asymmetry might be a possibility to screen for one risk factor for falls among elderly.

Persistent benign paroxysmal positional vertigo: our experience and proposal for an alternative treatment

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Despite the great efficacy of canalith repositioning procedures (CRPs), BPPV may persist (PBPPV). The aim of the study was to evaluate whether a prolonged and self-assessed temporal bone vibration (TBV) could change the outcome of PBPPV after 12 months of repeated treatments, in order to avoid further invasive and/or drug therapies. This evaluation was also conducted with respect to the entire BPPV population treated with CRPs. Seventy-two patients affected by PBPPV were enrolled in the study: 51 and 21 of them suffering from posterior semicircular canal (PSC) and lateral semicircular canal (LSC), respectively. PBPPV patients underwent a twice-a-day self-assessed TBV, using a common low-intensity massaging cushion. Patients were re-tested 1 week later and they were considered free from disease as the results of the positioning tests continued to be negative after 1 month. 70.6 % of PSC PBPPV and 61.9 % of LSC PBPPV patients had positive and statistically significant (P < 0.01) outcomes not biased by "age" and "gender" variables. The recurrence rate of BPPV (RBPPV) was also studied in the BPPV and PBPPV groups after a 12/24-month follow-up and any statistically significant result was found in multiple regression analysis between nuisance variables and RBPPV patients previously treated by CRPs or TBV. The present study suggests that the self-assessed and prolonged TBV could be an alternative treatment in patients affected by PBPPV otherwise addressed to undergo more invasive procedures and pharmacological treatment that are not completely side effects free.

Treatment of Objective and Subjective Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in adults and is a result of otolithic particles or debris that become free floating within a semicircular canal or adhere to the cupula. Characteristics of BPPV include brief episodes of latent onset vertigo that occur with changes in head position, transient rotary nystagmus beating toward the dependent ear, and reversed nystagmus upon sitting up. Both the vertigo and nystagmus fatigue quickly while maintaining the same head position. The BPPV may be classified as objective or subjective. Objective BPPV presents all the aforementioned symptoms whereas subjective BPPV presents all the symptoms without nystagmus. The accepted method of treatment for objective BPPV is canalith repositioning maneuvers (CRM); however, CRM are not traditionally used as the method of treatment for cases of subjective BPPV. The purpose of the study was to determine if the subjective report of dizziness using the Dizziness Handicap Inventory (DHI) was different in patients with objective and subjective BPPV and to determine if the two groups showed similar improvements in perceived dizziness handicap following CRM treatment. The present study utilized a retrospective, repeated measures design. Sixty-three adults with BPPV that were given the DHI both before and after CRM treatment. Pre and post DHI results were analyzed for participants with objective versus subjective BPPV. A five-question DHI subscale was also analyzed between the groups. A significant difference was noted between initial and posttreatment DHI scores for patients in both the subjective and objective groups when using the full-scale and subscale DHI. No significant difference was noted between groups for their initial or posttreatment DHI scores. The two groups also did not differ significantly in their initial or posttreatment DHI subscale scores. The results of the study indicated that individuals with both objective and subjective BPPV demonstrated significant improvement in DHI scores following CRM treatment. Additionally, there was no difference in DHI improvement for the subjective versus objective group suggesting CRM are effective for both subjective BPPV and objective BPPV. This improvement in DHI scores was also noted in the five-question DHI subscale with no significant difference noted between groups. These findings combined with previous studies suggest the presence or absence of nystagmus during Dix-Hallpike maneuvers is not related to the effectiveness of treatment using CRM.

Bilateral benign paroxysmal positional vertigo: an unusual complication of orthognathic surgery

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo of labyrinthine origin and usually idiopathic. However, 15–20% of all cases occur after trauma to the head, and it has rarely been reported after maxillofacial surgery, so to the best of our knowledge this is the first report of its bilateral occurrence after orthognathic surgery. It resolves slowly, but symptoms are incapacitating. It can be diagnosed from the history and physical examination, including the Dix–Hallpike test. Maxillofacial surgeons should be aware of it in patients who complain of dizziness after orthognathic surgery, and should know how to manage it properly.

Is Benign Paroxysmal Vertigo of Childhood a migraine precursor?

IntroductionBenign Paroxysmal Vertigo of Childhood (BPVC) is a common cause of vertigo in children and it is characterized by recurrent attacks of vertigo without warning resolving spontaneously after minutes to hours. It has been considered the equivalent of migraine in childhood. MethodsTwenty-seven patients diagnosed with BPVC were recruited between 1991 and 1997 with a follow up of at least 15 years. The incidence of migraine, inner ear disorders and family medical history is analyzed. ResultsThe average age for the onset of the attacks of BPVC was 3 years and 11 months, and for spontaneous resolution, it was around 5 years and 7 months. The average age for follow up was 18 years. Nine patients developed migraine during adulthood. Nineteen of them had a family history of migraine. ConclusionWe have observed that the prevalence of migraine in patients that had been diagnosed with BPVC is higher than in the general population, which leads us to propose BPVC as a precursor of migraine during childhood.

Migraine-Related Vertigo and Somatoform Vertigo Frequently Occur in Children and Are Often Associated

Migraine-related syndromes are a common cause of episodic vertigo and dizziness in children. Somatoform vertigo (SV) is an important cause of chronic dizziness, especially in adolescents. Our aim was to elucidate the comorbidity of migraine and SV. Three diagnostic groups were defined: migraine-related vertigo (MRV), SV, and combined migraine-related and SV (MSV). A retrospective analysis was performed on patient data (demographics, diagnosis, neuro-orthoptic and neurologic status, and results of vestibular and balance testing) from 168 patients who were presented to the German Center for Vertigo and Balance Disorders (IFB) over a 2.5-year period. Mean age of patients was 12 ± 4 years (range: 1.4 to 18 years). The most frequent diagnosis was MRV (28%), followed by MSV (19%) and SV (14%). MSV occurred most frequently in adolescent girls (25%). MRV was the most common cause of dizziness in our cohort. MSV ranked second overall but ranked first in adolescent girls, followed by isolated SV. SV was most prevalent in adolescent girls. MRV, MSV, and SV account for about 60% of diagnoses established in our tertiary referral center. Competent care of childhood migraine should include skill in detecting both the clinical symptoms of vertigo and overlapping somatoform symptoms.

Practical approach to the management of dizzy patients

EnAbstract Introduction Dizziness is a common symptom that may be caused by diverse pathologies. It requires a multidisciplinary approach and comprehensive workup to diagnose and treat the cause. A practical and simplified approach is presented. Objectives After reading this article you should be able to: (1) Remember the basics of balance control; (2) Assess a dizzy patient in the office; (3) Be familiar with available vestibular tests and the clinical yield of each; (4) Plan a practical workup algorithm; (5) Differentiate between the common causes of dizziness; (6) Know the current management strategies; (7) Understand the concepts of vestibular rehab.