Complaints Of Dizziness Research Articles

Retinal Metastases as the Initial Presentation of Advanced Lung Adenocarcinoma.

Most lung cancers are diagnosed at an advanced stage. Common metastatic sites include the brain, bone, liver and adrenal glands. Ocular metastases, however, are extremely rare. We present a case of advanced lung adenocarcinoma presenting exclusively with photopsias attributable to retinal metastases. We describe a woman in her fifties, a lifetime non-smoker with an unremarkable medical and family history, who presented to the emergency department with photopsias for a week. Ophthalmology evaluation revealed decreased visual acuity bilaterally, and a fundus examination disclosed lesions suggestive of bilateral retinal metastases. A comprehensive evaluation diagnosed a stage IVb lung adenocarcinoma with exon 19 mutation on epidermal growth factor receptor gene. Subsequently, she developed complaints of headaches and dizziness. She received frontline osimertinib 80 mg daily, preceded by upfront whole-brain radiation therapy with partial orbital inclusion for symptomatic ocular and brain metastases. After ten radiation therapy sessions, her complaints were resolved and an ophthalmology revaluation revealed improvement in visual acuity and resolution of photopsia complaints. The patient is currently on osimertinib and preserves an ECOG score of 0. Retinal metastases usually indicate advanced disease, so presenting with isolated ocular symptoms is exceedingly rare. Especially in cases of uncommon metastases, a multidisciplinary approach is fundamental for a prompt diagnosis and timely treatment, impacting prognosis and quality of life. Ocular metastases in lung cancer are usually a sign of advanced disease.Advanced lung adenocarcinoma presenting solely with retinal metastases is extremely rare.A multidisciplinary team is essential for the diagnosis and treatment of lung cancer with uncommon metastases.

Prevalence of cervical dysfunction in those referred for treatment of vertigo or dizziness

BACKGROUND: Cervical spine dysfunction has been shown to cause symptoms of dizziness and vertigo in patients, due to its connection to the vestibular system. There is a sparsity of prospective studies describing the prevalence of cervical involvement in these patients. OBJECTIVE: To identify the prevalence of cervical mobility restrictions in patients with symptoms of dizziness and vertigo prospectively. METHODS: Eighty-two subjects referred to physical therapy were assessed for mobility restrictions from the Atlanto-occipital joint to the level of C5 using evidenced-based manual techniques. These techniques included the seated and supine cervical flexion rotation tests and posterior to anterior joint mobility assessments. RESULTS: The prevalence of cervical mobility restrictions was 72% overall. Restrictions were found in 70% of those referred for dizziness/vertigo, 64% with benign paroxysmal positional vertigo (BPPV) and 90% of those referred for concussion. None of the referring providers had considered cervical involvement prior to making the referral. CONCLUSIONS: Afferent input from the muscles, joint and connective tissues in the cervical spine can cause the symptoms associated with dizziness, vertigo and concussion. This prospective study demonstrates the high prevalence of cervical mobility restrictions in these patients. This study provides much needed evidence for the need for early manual assessment of the cervical spine and surrounding structures if an appropriate rehabilitation program is to be designed. Physical therapists, athletic trainers and those who care for patients with complaints of dizziness, vertigo, BPPV or concussion should assess their patient for mobility restrictions early on in the evaluation process and treat accordingly.

Effect of Vestibular Rehabilitation on Sleep Quality and Depression in the Elderly With Chronic Dizziness: A Prospective Study.

Dizziness and the accompanying complaints, including sleep disorders and depression, are common among the elderly. This study investigated the effect of vestibular rehabilitation on complaints of dizziness, sleep problems, and the severity of depression in older people with chronic dizziness. The study included 25 participants with chronic dizziness accompanied by comorbid sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] global score >5). Participants completed the Dizziness Handicap Inventory (three sub-scales: physical, emotional, and functional), the PSQI, and the Persian version of the shortened Beck Depression Inventory (BDI-13) before and after the vestibular rehabilitation. The findings showed that the handicap caused by dizziness, the severity of depression, and the quality of sleep in the study participants improved significantly after the intervention (p<0.05). Vestibular rehabilitation is an effective intervention to reduce dizziness handicap, comorbid sleep disturbance, and depression.

The effect of screen time on hearing and balance in 6–16 aged children

Background The increase in screen time and the decrease in physical- activity cause balance problems as well as many systemic handicaps. Aims/Objectives This study aimed to determine the effect of screen time on balance and the effect of headphone usage time on hearing. Method Thirty-four individuals aged 6–16 years who applied to our clinic with complaints of dizziness and/or balance disorder were included in the study. Participants were divided into 2 groups according to their screen time: Group 1 (4–8 h/day) and Group2(>8 h/day). The other two groups are grouped according to headphone usage time as Group A (2–4 h/day) and Group B (>4hours/day). Pure-tone audiometry, extended high frequency-audiometry, Videonystagmography (VNG) and Computerized Dynamic Posturography (CDP) tests and Pediatric Berg Balance Scale and Visual Analogue Scale were applied to all individuals. CDP scores and pure tone hearing thresholds between groups were compared. Results A significant difference was observed between Group 1 and Group 2 according to the CDP test (visual, vestibular and composite scores), and according to the VAS-dizziness and PBS (p ≤ .05). Pure tone average and pure tone thresholds at high frequencies were compared between Group A and Group B according to headphone usage time. Pure tone thresholds of Group B were worse at high frequencies than Group A (p ≤ .05). Conclusions It has been observed that prolonged screen time may cause balance impairment in children and prolonged use of headphones may affect high-frequency hearing thresholds.

Some neurological and laboratory indexes in active duodenal ulcer depending on Helicobacter pylori presence

Somatic-neurological and psychosomatic relationships are an integral part of the pathophysiological mechanisms in numerous diseases. The results of one of the fragments of a comprehensive clinical and paraclinical study of the nervous system state indexes in active duodenal ulcer (DU) are reported. It aimed to assess the effect of Helicobacter pylori (H.pylori) on clinical-neurological and laboratory indexes. Sixty persons with an average age of 39.80 ± 1.29 years were examined. The patients were divided into two groups based on H.pylori presence or absence. The examinations included the following: analysis of complaints according to the developed questionnaire, neurological status assessment, autonomic dysfunction analysis (by A.M. Vayn questionnaire), complete blood count, evaluating the levels of C-reactive protein, total cholesterol, urea and creatinine in blood, neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio calculation. The appropriate statistical methods were used for data processing. It was found that complaints of headache, dizziness and paresthesia as well as asthenodepressive syndrome and polyneuropathy of various severity and with different clinical manifestations were more common (p &lt; 0.05) in patients with active DU on the background of Н.pylori. Sympathicotonia was significantly more frequent and eutonia was significantly less frequent in the active DU in patients infected with Н.pylori. An increased C-reactive protein level was significantly more common in Н.pylori patients. The identified neurological and laboratory features indicate a probable pathophysiological significance of Н.pylori in somatoneurological relationships, particularly in DU.

Abstract 116: Reversal of Acute Ocular Ischemic Syndrome Following Rescue Carotid Revascularization: A Case Report

Introduction Ocular ischemic syndrome (OIS) is a rare, vision‐threatening condition resulting from severe carotid artery disease secondary to severe atherosclerosis or arteritis. Common clinical features include acute/subacute to gradual vision loss, ocular pain, amaurosis fugax, photophobia and diplopia. We are presenting a case of acute ocular ischemic syndrome secondary to acute re‐occlusion of the right internal carotid artery (RICA) post Carotid Endarterectomy (CEA), that reversed with carotid revascularization. Methods Case Summary: 59‐year‐old male with history of T2DM, hyperlipidemia, tobacco use presented to an outside hospital with complaints of dizziness, blurry vision, left upper extremity weakness and multiple falls with head trauma. Exam revealed left lower quadrantanopia, mild left arm weakness and left hemineglect. Computed Tomography (CT) Head showed scattered right middle cerebral artery (MCA) territory infarcts. CT Angiography (CTA) revealed ulcerated plaque with a small focus of thrombus intraluminally in the RICA. Subsequently, the patient was initiated on heparin infusion and underwent CEA. On postoperative day (POD) 2, the patient experienced severe stabbing right eye pain with reduced visual acuity and worsening of left arm weakness. Imaging revealed complete occlusion of the right common carotid artery (RCCA). Perfusion imaging did not reveal a core or a penumbra. Given acute loss of vision likely secondary to ocular ischemic syndrome, decision was taken to proceed with rescue stenting. Using a transfemoral approach, an 8‐French balloon guide catheter was advanced into the proximal RCCA. A primary suction thrombectomy was performed under proximal flow arrest. After achieving a complete recanalization in one pass, we started the patient on cangrelor 30 mcg/kg intravenous bolus followed by 4 mcg/kg/min infusion. Post bolus, we placed a tandem closed‐cell carotid stent measuring 8x36mm &amp; 10x37mm. The patient reported immediate relief of ocular pain, vision and weakness following the procedure. He transitioned from cangrelor infusion to ticagrelor 90 mg twice daily and aspirin 81 mg daily. On post‐stenting day 7, the patient experienced acute onset headache, and imaging revealed re‐occlusion of the entire carotid artery sparing only the ophthalmic segment of the RICA which now filled retrograde via anterior communicating artery (AcoA) from the contralateral carotid artery. However, his visual acuity remained unchanged and reported no ocular pain. At one month follow‐up the patient remains symptom‐free. Results Discussion: Incidence of OIS is estimated to be 7.5 cases per million every year. Carotid artery atherosclerosis is the most common etiology. Majority of OIS (∼90%) present with gradual vision loss and approximately 40% present with ocular pain. Gradual vision loss is predominantly related to chronic ocular hypoperfusion and resultant iris neovascularization and glaucoma. In this case, patient suffered acute vision loss secondary to acute ICA occlusion following CEA. Emergent carotid revascularization resulted in restoration of vision and resolution of ocular pain. Conclusion Our main goal is to emphasize the importance of rescue stenting to address symptoms of aOIS. Immediately post‐stenting, there was remarkable improvement in ocular pain and visual acuity. Although, the carotid re‐occluded within seven days post‐stenting, we hypothesize that gradual re‐occlusion while on DAPT provided enough time recruit and preserve collaterals into the right ophthalmic artery via retrograde flow into the ophthalmic segment of RICA from the contralateral carotid artery via the AcoA which was subsequently confirmed on imaging.

Abstract 265: A Curious Case Of Acute Binocular Diplopia, Ischemic Stroke Of The Interstitial Nucleus Of Cajal

Introduction The nuclei in the periaqueductal gray of the midbrain are critical structures that coordinate and control vertical and torsional gaze, as well as crucial components of the vestibulo‐occular reflex. These structures are so fine that they may be missed on routine imaging however, they represent distinct localizations for the neurological exam, with lesions of these structures being important clinical considerations. The Interstitial Nucleus of Cajal (inC) coordinates signals from the saccadic burst neurons in the rostral interstitial nucleus of the medial longitudinal fasiculus (riMLF), vestibular projections (utricular and semicircular canal pathways from the vestibular nuclei via the MLF), and descending pursuit fibers, the paired interstitial nuclei of Cajal act as neural integrators for vertical gaze and torsion. These nuclei lie adjacent but dorsal and caudal to the riMLF, For upgaze, fibers from the inC cross via the posterior commissure, then connect to the contralateral superior rectus and inferior oblique subnuclei. For downgaze, fibers travel across the posterior commissure, then innervate the contralateral inferior rectus subnucleus and fourth nerve nucleus. Blood supply is derived from the terminal branches of the basilar artery. Lesions of these interstitial nuclei and their tracts may produce vertical and torsional gaze‐holding deficits such as impairments in the vertical vestibulo‐occular reflex, hypertropia, counter‐rolling of the eyes, superior oblique palsy, and see‐saw and torsional nystagmus. Methods Case report and review of literature Results 45‐year‐old, right‐handed woman with history of turner syndrome, anemia, nephrolithiasis, horseshoe kidney, premature ovarian failure on hormone replacement therapy (HRT), suspected adrenal mass of undetermined significant, and degenerative disk disease presented to the emergency department with complaints of acute binocular diplopia and dizziness clarified to be sensation of the ground/objects bobbing in visual field. Neurological exam significant for left hypertropia and exotropia in primary gaze, equal in right/left gaze and right/left head tilt, as well as large amplitude medium frequency (see‐saw) nystagmus characterized by upbeat nystagmus with intorsion on the right, and downbeat nystagmus with extorsion left. Visual fields were intact to finger count with binocular diplopia and oscillopsia noted in primary gaze. CT head and CT angiogram of the head and neck were unrevealing. Initial MRI brain negative for diffusion restriction but with flair hyperintensity in periaqueductal gray prompting repeat MRI brain without contrast with thin slices through the brainstem with showed infarct in periaqueductal gray within the region of the interstitial nuclei, with stroke etiology undetermined at the time of presentation but suspicion of small vessel disease vs hypercoagulability given propensity for thrombophilia in Turner syndrome and patient being on HRT. Full dose aspirin and high intensity statin therapy was initiated given presentation out of tPA window, and hypercoagulability workup initiated prior to discharge. Conclusion Acute ischemic stroke and lesions of the interstitial nuclei in the periaqueductal gray are important, under recognized considerations for the evaluation of binocular diplopia, that may represent an opportunity for thrombolytic administration if providers had a higher index of suspicion. Hypercoagulability and Turner syndrome are also unique qualifiers, underscoring a nuanced approach to determination of stroke diagnosis and etiology in cases of isolated ocular symptomology.

THU323 Extreme Insulin Resistance In Type 1 Diabetic After Covid 19 Infection

Abstract Disclosure: A.A. Zakkar: None. M. Fadanelli: None. M. Al Mushref: None. Patient is a 46-year-old African American female with a medical history of Diabetes Mellitus Type 1 for 20 years, hypothyroidism, rheumatoid arthritis and celiac disease who presented with a complaint of dizziness and heavy menstrual periods. When she presented, labs were significant for a glucose of 513 mg/dL, anion gap of 22 with a bicarbonate of 8, HbA1c of 10%, Hemoglobin of 8.1 and UA revealed ketones and she was thus started on an insulin drip for diabetic ketoacidosis. Patient was also complaining of a cough and weakness and thus a sputum sample was obtained which was positive for Streptococcus pneumoniae and she was started on antibiotics. At the time of arrival the patient was A&amp;Ox4 and stated that her glucose has been really difficult to control over the last 6 months after she had been infected with COVID-19 and over that time she has also lost approximately 50 lbs. She stated that one month prior to the patient having COVID-19 infection, she was taking aspart 20 units per/meal and detemir 32 units qAM and 62 units qHS, and had an HbA1c of 8.5%. Just prior to presentation, the patient was taking 70 units of the U-100 aspart insulin per meal and 60 units of glargine U300 twice daily with persistent hyperglycemia. Insulin antibodies were tested and returned remarkably high. GAD-65 antibody was also high. The patient's glucose remained in the 500-600 mg/dL range and the acidosis worsened to a pH of 6.9 despite receiving continuous intravenous insulin aspart at 30units/hr with the addition of detemir 100 units q12-hours. The patient's acidosis resolved after two days and she was transitioned to Humulin R-U-500 at 80 units TID and aspart 40 units every 4-hours for tube feeding coverage but was still hyperglycemic in the 200-300 mg/dl range. Due to autoimmunity and extreme insulin requirements the patient was started on methylprednisolone 20 mg q8hr with improvement of glucose to the 150 to 200 mg/dl range and a decrease in her daily insulin requirements and thus she was transitioned to 60mg of prednisone daily with a 10mg taper weekly. By the time she was discharged 2 weeks later, her glucose was more controlled and her insulin requirements were decreased to aspart 14 units per/meal and detemir 40 units BID. Conclusion: In patients with diabetes mellitus who develop extreme insulin resistance following COVID -19 infection, consider autoimmune etiology in the differential diagnosis, such as insulin inactivating antibodies or insulin receptor blocking antibodies. In our experience laboratory testing of the specific antibodies was not available. Management of autoimmune mediated hyperglycemia will require immunosuppressivetherapy. Presentation: Thursday, June 15, 2023

Acute positional vertigo in the emergency department-peripheral vs. central positional nystagmus.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management. To evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo. Following routine ED care, patients with a primary complaint of dizziness, vertigo, light-headedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analyzed. Of 71 consented patients (21-91 years; mean 56 years, ±16.7 years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (mean 48.85 years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88 years, mean 66 years, ±12.22, 5 females), and six with central positional nystagmus (age range 23-59 years, mean 41.67 years, ±15.78, 6 females). Positional vertigo should be assessed with positional maneuvers such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity.

THU453 Chronic Headaches As A Presentation For Monostotic Craniofacial Fibrous Dysplasia: A Case Study

Abstract Disclosure: B. Dyer: None. R.K. Bhattacharya: None. Background: Monostotic craniofacial fibrous dysplasia (CFFD) is often asymptomatic and is found incidentally on imaging. Previous reports described cases in which CFFD diagnosis was preceded by chronic headaches, but there remains a lack of clinical association between these diagnoses. Clinical Case: Patient is a 22-year-old female with a long history of chronic headaches who presented to the emergency department two days after a motor vehicle accident with complaints of headache, blurred vision, nausea, and dizziness. CT revealed an incidental sclerotic mass in the left frontal region measuring 7.9x7.3x3.7cm extending inferiorly into the left ethmoid sinus. At her primary care follow-up, she reported a pounding, left-sided headache in addition to balance issues, dizziness, nausea, and blurry vision. Workup was significant for vitamin D level of 11.2ng/mL (n = 30-100ng/mL), alkaline phosphate of 106U/L (n = 35-104U/L), and calcium of 9.1mg/dL (n = 8.6-10.3mg/dL). MRI was significant for a heterogeneous, hypointense expansile calvarial lesion within the left frontal and left sphenoid bones. The patient was diagnosed with CFFD based on radiologic findings. The patient was advised against surgical intervention due to her disease’s large, invasive nature. The patient was seen by neurology for recurrent headaches and was subsequently started on topiramate with partial symptom relief. Endocrinologist management included confirmation of monostotic CFFD by bone scan. Biopsy was deferred due to the low likelihood of malignant transformation, and bisphosphonate treatment was initiated. She was subsequently started on 5000 IU per day of vitamin D to normalize the vitamin D level before the initiation of bisphosphonate treatment for her pain. She received 5mg intravenous infusion of zoledronic treatment. At follow-up, the patient states she had significant improvement in all symptoms. Conclusion: Pain from FD can be debilitating and often increases in severity as the patient ages, though pain is not strongly correlated to presentation or disease burden. The mechanism by which CFFD produces pain is not fully elucidated. The unique innervation of bone and the creation of new sensory nerve fibers during inflammatory states may contribute. Additionally, excess IL-6 during inflammatory states may also play a role in pain production due to lesion expansion from osteoclast activation, cystic formation within the lesion, and hormonal reactivity of the lesion. Bisphosphonates are believed to inhibit IL-6 production, reducing osteoclastic activity and leading to symptomatic pain relief. In the case presented, the patient’s chronic headaches improved significantly following combination therapy with migraine abortive medication and bisphosphonate therapy. Early recognition and multidisciplinary treatment are key in the long-term management of CFFD pain. Presentation: Thursday, June 15, 2023

Vestibular perceptual testing from lab to clinic: a review.

Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.

Vestibular disorders in blast injuries. The role of growth hormone

The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as a consequence of a blast injury, we have done present investigation. One hundred and ten patients were examined: 65 Anti-Terrorist Operation (ATO) participants with mild traumatic brain injury (mTBI), 44 non-ATO plus one patient with acromegaly was examined using posturography. Questionnaire “Types of Dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, showing that this complaint is not specific to mTBI. Objective vertigo (sensation of the subjects moving around the patient) was detected in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. Thus, we have two different qualitative groups. So, these complaints are specific to the patients, who survived blast injury. Complaints of subjective vertigo are also typical for those with blast injury. Complaints of pseudovertigo are specific to the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific to the people with blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) have been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not typical for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been revealed in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients; this complaint is not specific to mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is detected in 20 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. It is also an interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific to the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control). The results are discussed from the point of view of a severe vestibular disorder due to the blast injury. The tallness correlated with drop attacks (R29.6 according to ICD-10, the nosology is missing in the Ukrainian translation), it is suggested that growth hormone might cause the fluctuation of vestibular function. Conclusions. 1. ATO participants have pronounced vestibular disorders. 2. Patients with mTBI (ATO participants) experienced severe stress. 3. Signs of vestibular dysfunction such as complaints of objective and subjective vertigo, kinetosis differed quantitatively and qualitatively, therefore, being specific to the ATO participants. 4. Pseudovertigo, claustrophobia, descendophobia differed only qualitatively. 5. Dizziness, loss of consciousness, orthostatics, agoraphobia differed only quantitatively. 6. The tallness of patients with mTBI correlated with complaints of drop attacks, both quantitatively and qualitatively. 7. In statistical studies, it is important to use Fisher’s matrix test.

Vertigo as a Problem in the Emergency Department

Objectives: To assess patients with vertigo who came to the emergency department Design: Cross-sectional study. Setting(s): Emergency department of Imam Reza Hospital, Tabriz, Iran. Participants: 280 patients admitted to the emergency department with a complaint of vertigo. Outcome measures: The relationship between age, gender, previous medical history, computerized tomography (CT) scan, and magnetic resonance imaging (MRI) findings were investigated in this study. Results: Vertigo was the most common complaint among emergency department visitors, accounting for 2.1% of all visits. Furthermore, 30.3 % (85 of 280) of all patients with vertigo were identified with central vertigo. The average age of central vertigo patients was 65.9±10.9. Females made up 58.6% and 41.2% of all vertigo patients and central vertigo patients, respectively. In the group with central vertigo, hypertension (HTN) was the most common risk factor (44.7%). Conclusions: Patients who refer to the emergency department with vertigo often do not respond to the usual treatments, and this is the main reason for them to visit the emergency department, so a good history and complete examination along with a suitable imaging modality can help assess these patients.

Lidocaine-induced anaphylactic shock – A case report

IgE-mediated hypersensitivity reactions (HRs) to local anaesthetics are extremely uncommon. One of the most widely used local anaesthetics for minor dental and other surgical procedures is lidocaine. The incidence of anaphylactic reaction by Inj. Lidocaine among global population is &amp;#60;1%. The first anaphylactic reaction reported in 1902. A 69-year-old female patient shifted to community hospital emergency department. She presented with complaints of vertigo, anxiety, tachypnoea, hypoxia, and sudden onset of breathlessness. History revealed on administration of Inj. Lidocaine a local anaesthesia to her before knee surgery developed above-mentioned symptoms after 15 minutes. After receiving her from OT patient vitals observed as pulse rate-97bpm, GRBS-140mg/dl, blood pressure-170/70mmHg, spo95% with 0. On emergency basis treated her with anti-histamines (Inj. Chlorpheniramine), steroids (Inj. Hydrocortisone-400mg, Inj.solumedrol-1gm), oxygen support of 7 to 8 lit/min, after 4 days she recovered completely and discharged. We used a scale (Naranjo scale) to evaluate the severity of the adverse drug reaction as per scale, score was five that indicates probability of happening adverse reaction. We conclude the case as anaphylactic reaction to lidocaine could have been cause of the event. It is important to collect patients complete past medical history and their allergic history. Also by giving importance to drug sensitivity testing at least to the list of drugs that are reported to show allergic reactions or anaphylactic reactions in post marketing surveillance. Optimised management protocols can save both the patient life and dilemma faced by physicians.

Mild blast injury: vertigo complaints analysis

The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as the consequence of blast injury, we have done present investigation. One hundred and nine patients were examined: 65 Anti-Terroristic Operation (ATO) participants, who survived mild and moderate blast injury without cranial trauma, and 44 non-ATO patients (rhinitis, pharyngitis, otitis). Questionnaire “Types of dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, thus, showing that this complaint is not specific for mild traumatic brain injury (mTBI). Objective vertigo (sensation of subjects moving around the patient) met in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. So, we have two different qualitative groups. Тhese complaints are specific for the patients, who survived blast injury. Complaints of vertigo are also typical for the patients, who survived blast injury. Complaints of giddiness are specific for the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific for the patients, who survived blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) has been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not specific for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been detected in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients. This complaint is not specific for mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is met in 20.00 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. This is also interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific for the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control. It has been shown that among other signs, there is a positive correlation with age, imbalance, ascendophobia and dyspnea). The results are discussed from the point of view of the severe vestibular impairment due to the blast injury. Conclusions. 1. MBTI from blast injury is accompanied by severe stress, objective and subjective vertigo, giddiness and kinetosis, which are considered to be the symptoms of vestibular damage. 2. Dizziness, orthostatics and agoraphobia are quantitatively significantly increased in mBTI, but it might not be considered specific for blast injury consequences. 3. Giddiness, claustrophobia and descendophobia in ATO patients have no quantitative changes compared to the ENT patients, but are specific for mBTI after blast injury. 4. It is important to use matrix Fisher test in statistical examinations.

Speech Perception in Ménière Disease.

Introduction Ménière disease (MD) affects the inner ear, comprising the cochlea and semicircular canals. Symptoms include severe incapacitating vertigo, nausea, vomit, aural fullness, and sensorineural hearing loss - in which speech discrimination and intelligibility are impaired and can be quantified with speech audiometry. Objective To investigate the influence of the stimuli presentation level in speech audiometry and the quality of life in adults with and without a diagnosis of MD. Method Two groups were formed with nine individuals each - one with and the other without MD. The Speech Recognition Percentage Index was researched with stimuli presented above the self-reported comfort level or 5 dB below the discomfort level. Dizziness Handicap and Tinnitus Handicap Inventories were administered to individuals with tinnitus and vertigo complaints. Results Speech recognition was better in the study group with higher presentation levels, as 75% of the sample improved their performance. The presence of vertigo significantly impacted the quality of life of individuals in the study group. Conclusion Speech recognition improves with higher presentation levels. Also, MD impacts the quality of life, especially regarding limitations caused by vertigo.

Sleep and dizziness in middle-aged and elderly persons: A cross-sectional population-based study

ObjectivesDizziness is a physical and mental burden that affects 33% of the population at age 70. Research in clinical samples suggests that poor sleep may contribute to dizziness complaints, but this has yet to be determined in the general population. We assessed the association of self-reported and actigraphy-estimated sleep with dizziness in a population-based sample. MethodsData of 4702 participants from the population-based Rotterdam Study, included between 2011 and 2014, were analyzed (mean age: 65.8 years, 55.7% women). Sleep quality was measured with the Pittsburgh Sleep Quality Index. Experience of dizziness and associated characteristics were self-reported, characteristics were categorized as vestibular or non-vestibular. A subsample of 1440 participants (mean age: 64.9 years, 51.3% women) wore an actigraph for a median of 7 days to allow objective estimation of total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. We used logistic regression to assess the associations between different sleep parameters and dizziness. ResultsPoor self-reported sleep quality was associated with more dizziness (OR = 1.065, 95% CI: 1.043 to 1.087). This effect size was somewhat larger for dizziness with non-vestibular characteristics (OR = 1.108, 1.069 to 1.149) than for dizziness with vestibular characteristics (OR = 1.062, 0.988 to 1.142). Actigraphy-estimated sleep parameters were not associated with dizziness. ConclusionsA poor self-reported sleep quality is associated with more dizziness in a population-based sample of middle-aged and elderly persons. We encourage clinicians to assess sleep quality in patients presenting with dizziness, and vice versa.

Unusual Anatomic Variation: Intradural Conjugation of the Hypoplastic Left ICA and the Enlarged Accessory Meningeal Artery

The precise definition of the accessory meningeal artery was not available until 1961. It can originate from the maxillary artery or middle meningeal artery and supplies the meatus and membranous portion of the auditory tube, the lateral pharyngeal muscle, and the medial pterygoid muscle; Laterally, it supplies the lateral pterygoid muscle, the extracranial part of the mandibular nerve, the pterygoid venous plexus, and the sphenoid periosteum. Here, we present a 70-year-old male patient who applied to the neurosurgery clinic with complaints of chronic headaches and dizziness. Magnetic resonance angiography and computed tomography angiography showed hypoplasic appearance of the left internal carotid artery and an enlarged accessory meningeal artery variant merging with its ophthalmic segment.

Incidence of Anemia in Pregnant Women with Closer Spacing of Pregnancies and Multiparity: A Case Report

Background: One of the risk factors that can increase the incidence of anemia in pregnant women is the close spacing of pregnancies and multiparity. Closely spaced pregnancies refer to pregnancies that occur within a short time after the previous birth, while multiparity refers to a woman who has given birth to more than one child previously. The combination of these two factors can lead to an increased risk of anemia in pregnant women. This study presents the risk of closely spaced pregnancies and multiparity for the incidence of anemia in pregnant women. Case presentation: Mrs. SM, 27 years old pregnant woman, came with complaints of severe dizziness for the last 2 weeks. In addition, patients also complain of weakness, weakness, no energy, and no appetite. The patient said that she was currently pregnant with her 4th child, aged 27-28 weeks, with active fetal movements. Hemoglobin examination 7 mg/dL. Conclusion: The patient was diagnosed with anemia in pregnant women with risk factors for close pregnancy spacing and multiparity.

Features of Vestibular Changes in Patients with Vestibular Schwannoma. Historical Background and the Current State of the Problem.

The problem of vestibular disorders is one of the most urgent in the practice of a neurologist and otorhinolaryngologist. Dizziness patients can also ask for help specialists of any profile. Typical complaints require to conduct an appropriate examination and prescribe treatment. Due to the acute manifestation and rapid progression of symptoms, the patient's quality of life is significantly decreased and the ability to work is impaired. Vestibular disorders are even increased with age. Among the elderly, such complaints presented in about 48% of patients, almost every second one. Depends on the cause, vertigo can be of peripheral (otological), central and functional (psychological) origin. Often, the patient's condition assessed as serious and required immediate medical manipulations. For this reason, any specialist, to whom patient complains of dizziness, must be able to competently conduct an examination and perform the most complete examination. However, the lack of uniform standards for vestibular testing can lead to diagnostic errors and the choice of incorrect medical tactics. The article provides an overview of the literature data on the examination of patients with complaints of dizziness. An integral part of the diagnostic search for dizziness is the collection of complaints and anamnesis, a standard otorhinolaryngological examination, as well as audiometric and vestibular otoneurological tests. There is not much literature about vestibular testes in patients with vestibular schwannomas, here in this paper we present the literature dats and our experience in this topic.