Complaints Of Dizziness Research Articles

Specific features of bilateral otolith manifestations in patients with vestibular balance disorder

Bilateral asymmetry in the function of the semicircular canals underlies dizziness and vestibular balance disorders. According to the traditional view, otolith dysfunction does not have a significant effect on the clinical picture in individuals with peripheral vestibular disorders. In recent years, interest in studying the contribution of vestibular function to the control of posture and movements has increased. However, we have not identified any studies addressing the reactivity of otolith organs in vestibular balance disorders in the available literature.Aim: To study bilateral otolith reactions in patients with vestibular balance disorders using the method of cervical vestibular evoked myogenic potentials (cVEMP) in patients with episodic and chronic vestibular disorders.Material and Methods. A clinical examination was carried out in 63 patients complaining of dizziness and balance problems. They were hospitalized on an emergency and planned basis in the neurological departments of the clinics of the Siberian State Medical University and the Medical and Sanitary Unit No 2 in Tomsk. From the total group, 28 patients (8 men and 20 women aged from 22 to 84 years) were selected for assessment of vestibular function; the average age was 63.87 ± 11.52 years and 57.2 ± 18.5 years for men and women respectively. They had chronic and episodic vestibular dysfunction unrelated to acute or progressive neurological disease and inflammatory pathology of the inner ear.Results. 27 patients (96.4%) complained of dizziness. Systemic dizziness, characterized by a feeling of objects rotating around the subject, was detected in 29.63% of patients; non-systemic dizziness, including a feeling of “failing” – in 81.48%. Both types of complaints appeared in 10.71% of those examined, which made it possible to identify 2 groups of patients: Group A – with chronic vestibular disorders (7 patients) and Group B – with episodic vestibular disorders (21 patients). During the study of the groups of patients, differences were found in the amplitudes of cVEMP latency P13 and the coefficient of vestibular asymmetry between Groups A and B, as well as the absence of a difference in amplitudes in Group A and the presence of a difference in Group B on the right.Conclusion. Despite the fact that patients presented with predominantly one complaint of dizziness, clinical and instrumental tests of vestibular dysfunction showed the presence of damage to both the semicircular canals and otolithic organs; asymmetry of vestibular reflexes and/or bilateral damage to the vestibular organs. The results of the study allow us to consider the cVEMP method as one of the methods for objectively assessing the condition of the otolithic apparatus in patients with impaired vestibular function. In this regard, it is recommended to use this method in routine neurological practice.

Humoral serotonin and neuropsychological status of patients with dizziness

Dizziness is often accompanied by affective disorders such as anxiety and depression, in the occurrence of which the role of the serotonergic system is discussed.Objective: to investigate the serotonin content in blood serum and neuropsychological status in patients with vestibular and non-vestibular dizziness.Material and methods. The study included 97 patients. Two observation groups were formed according to the type of dizziness complaints. The first group (n=47) comprised patients with vestibular (systemic) dizziness against a background of peripheral vestibulopathy, the second group (n=35) comprised patients with non-vestibular (non-systemic) dizziness with a diagnosis of probable persistent postural-perceptual dizziness (PPPD). The control group (n=15) consisted of patients without complaints of dizziness. Neurological and otoneurological status, psychoemotional parameters (level of anxiety and depression) and cognitive functions were analyzed, and the quantitative level of serotonin in blood serum was determined by enzyme immunoassay.Results. The study revealed a significant decrease in the serum serotonin levels in vestibular and non-vestibular dizziness; a lower serotonin level was found in non-vestibular dizziness (p<0.05). The presence of affective disorders did not correlate with a decrease in serotonin levels in vestibular dizziness against a background of peripheral vestibulopathy. It is assumed that a decrease in serotonin content plays a role in pathogenesis of vestibular dizziness on the background of peripheral part of vestibular system involvement.Conclusion. We demonstrated possibility of using the level of serotonin in peripheral blood as an objective laboratory marker of vestibular and non-vestibular dizziness in general clinical medical practice.

Critical values for carbon monoxide in cases admitted to the emergency department in a local hospital

Abstract Carbon monoxide (CO) poisoning has been an important concern in winter particularly due to malfunctioning coal stoves, in many developing countries, including Turkey. Winter months, especially February, were the most dangerous periods for CO exposure. Carbon monoxide has no color or smell so has known as the silent killer. Brain, heart, and other organs are under risk in CO poisoning. Because patients usually present with non-specific symptoms, CO poisoning should be considered in the differential diagnosis of unexplained nausea and vomiting, neurological or cardiac signs and symptoms. Carboxyhemoglobin (COHb) is a reliable marker to monitor the patient. Lactate is also important as a measure of impaired systemic oxygen delivery. Fifteen patients with a diagnosis of CO poisoning were included in the study. This is the number of all cases admitted to the emergency in the last one and a half months in our local hospital located in a town with almost 48.918 residents. Blood gas analysis was performed by ABL90 FLEX, Radiometer. Reference for COHb was 0.6-1.5 % and for lactate was 0.5-1.6 mmol/L. Troponin I levels were also analyzed in some patients to assess possible myocardial ischemia. Troponin levels were analyzed by ARCHITECT i2000, Abbott and reference range was <16 ng/mL in woman, <34 ng/mL in men. Graph Pad Prism program was used for statistical analysis of the data. We had 15 cases aged between 4-56 years with COHb values with panic values (> 20%) except two of the cases with values 16.5% and 19%. The female-male ratio was 6/9. On admission to the Emergency Department, 46.6% of patients (n=7) had headache and vomiting, 40% of patients (n=6) had headache, 6.6% (n=1) fatigue and 6.6% of patients (n=1) had syncope. Median value of COHb % was 23.7(16.5-40.8), lactate was 1.9 (0.8-4.8), pH was 7.39 (7.30-7.47). Excluding three patients as outliers, lactate levels had a good correlation with carboxyhemoglobin values (R2=0.9413). It was notable that 1 patient had a higher-than-normal Troponin I level (24.9 ng/mL) who has highest lactate level (4.8 mmol/L). Four of the patients, from the same family was admitted for suspected food poisoning for the symptoms of nausea, vomiting, diarrhea. A diagnosis of CO poisoning was made after a COHb value between 16.5-25.7% for these patients. This was very critical for the accurate treatment given to those patients being hyperbaric oxygen treatment in CO poisoning cases. CO poisoning should be considered in patients admitting to the emergency department with complaints of headache, dizziness, weakness, nausea, and vomiting. Reporting panic values is a means of alerting the clinician for the right diagnosis.

Vertigo as Initial Symptom of Cerebellar Hemorrhage in Adult Woman : A Case Report

Vertigo, difficulty walking, and loss of balance/coordination are among the symptoms of stroke in 50% of stroke cases. Vertigo due to cerebrovascular disease is generally associated with other neurological signs such as cranial nerve abnormalities, hemiparesis, facial weakness, diplopia, hyperesthesia, and Horner's syndrome. A 42-year-old woman came to the emergency department with complaints of dizziness, nausea, and frequent vomiting for the previous 4 hours. The symptoms are also accompanied by a feeling of tingling on the left side of the face, and the left eyelid cannot open optimally. The patient has a history of uncontrolled hypertension. The HINTS test revealed central vertigo, and the patient also found dysdiadochokinesis, ataxia, and dysmethria. A non-contrast head CT scan showed ICH in the left cerebellum with a volume of 6.9 cc. Based on the results of these examinations, the patient was diagnosed with cerebellar hemorrhage. The blood supply to the brainstem, cerebellum, and inner ear comes from the vertebrobasilar vascular system. Blockage or rupture of blood vessels in one of the main branches of this system can cause symptoms of vertigo. Symptoms of vertebrobasilar stroke vary widely and depend on which of the three main circumferential branches is affected; posterior inferior cerebellar artery, anterior inferior cerebellar artery, or superior cerebellar artery. Vertigo in patients who have risk factors for stroke accompanied by other neurological symptoms should be considered for a thorough neurological examination to evaluate the possibility of cerebrovascular disease.

Idiopathic unilateral complete oculomotor nerve palsy: a case report of diagnostic quandary

Introduction and importance: When compared to other cranial nerve palsies idiopathic unilateral oculomotor nerve palsy with pupillary sparing is one of the least noted neurological conditions. Moreover, there lies a series of diagnostic dilemmas to come into a final diagnosis resulting in several array of clinical investigations. Hence, there is a delay in prompt management. Case summary: An elderly female without any known comorbidities presented with the complaint of headache, dizziness and dropping of left eyelid. Several arrays of diagnostic workups was done to come to a diagnosis, but even with rigorous laboratory investigations and radiological examinations, a common working diagnosis could not be made. Hence with a diagnosis of exclusion after proper neurological and neuro-ophthalmological examination, idiopathic unilateral common oculomotor nerve palsy was identified for which improvement with steroids was noted in the patient. Discussion: Idiopathic unilateral complete oculomotor nerve palsy is considered as a diagnosis of exclusion when all the diagnostic parameters fail to signify and positive results. The vague symptomatic presentation of the disease condition further compels the treating physician to carry out several panels of laboratory to radiological investigations. But if identified in time the treatment modality is straightforward. Conclusion: The diagnostic quandary in timely identification of such disease conditions needs a pertinent diagnostic guideline so as to avoid the unwanted panel of investigations.

Incidence of Vestibular Dysfunction in Frail Older Adults Attending an Integrated Care Programme for Older Persons (ICPOP)

Abstract Background The World Falls Guidelines (2022) recommend a vestibular assessment as part of a multifactorial falls risk assessment in older adults. There is a possibility however, of vestibular dysfunction being overlooked because of no subjective complaints in older fallers i.e. vestibular agnosia. This study aimed to determine the prevalence of vestibular dysfunction in older adults presenting to physiotherapy in Integrated Care Programme for Older Persons (ICPOP) regardless of complaints of dizziness. Methods This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or subjective indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. Results A vestibular assessment was carried out on 69% (n=52) of physiotherapy patients with a mean age of 80.9 years and mean Clinical Frailty Score of 5. 75% of patients that underwent a vestibular assessment had vestibular dysfunction with the most prevalent diagnoses being Benign Paroxysmal Positional Vertigo (40%), Unilateral Vestibular Hypofunction (13%) & reduced gain of Vestibulo-Ocular Reflex (13%). 77% of those who tested positively for vestibular dysfunction had a fall within the last 12 months. 48% of those patients that had vestibular dysfunction did not complain of dizziness. Conclusion Almost half of patients with vestibular dysfunction had no dizziness highlighting the incidence of vestibular agnosia. This study highlights the high prevalence of vestibular dysfunction amongst older adults and supports vestibular assessments in older fallers regardless of the presence of dizziness.

Postural Orthostatic Tachycardia Syndrome (POTS) as a Cause of Dizziness - Expanding the Etiological Spectrum.

Dizziness is a frequent complaint encountered in neurology clinics. Dizziness can be spontaneous or triggered, which includes orthostatic dizziness. Orthostatic dizziness can be acute (reflex/vasovagal syncope), chronic (orthostatic hypotension (OH), or postural orthostatic tachycardia syndrome (POTS). Since dizziness has numerous causes, these patients undergo extensive investigations before a diagnosis is made. Here, we describe five patients who presented with dizziness and were diagnosed to have POTS on evaluation. We conducted a retrospective study of patients who presented to the Department of Neurology from August 2020 to November 2021 with the complaint of dizziness and were diagnosed with POTS. The clinical history, neurological examination, treatment response, routine blood investigations, magnetic resonance imaging (MRI) brain, and autonomic function tests (AFTs) of the patients were reviewed from patients' clinical records. Patients with dizziness and with diagnosis other than POTS were excluded from the study. Among the five patients, males were predominant with a male to female ratio of 3:2. All the patients were in their early fourth decade with a mean age of 35.4 years. The presenting symptom was dizziness, and the key associated symptoms were anxiety and headache. Due to the orthostatic nature of symptoms and absence of orthostatic fall in blood pressure (BP), a detailed AFT was carried out, leading to the diagnosis of POTS. Patients were assessed at 3-6 months after treatment and there was a moderate response in one and no response in the remaining four patients. POTS should be considered a possible etiology when patients present with orthostatic dizziness in the absence of orthostatic fall in BP. Anxiety and headache may be associated with this type of dizziness.

Assessment of micronutrients in pediatric vertigo

Aim: This study aimed to evaluate the clinical characteristics of patients admitted to the pediatric neurology outpatient clinic with the complaint of vertigo and to investigate the role of micronutrients in the etiology of vertigo Materials and Methods: This study retrospectively evaluated the patients aged four to 18 years who were admitted to the pediatric neurology outpatient clinic with the complaint of vertigo to evaluate the clinical characteristics and the role of micronutrients in the etiology of vertigo. Patients, for whom the Z00.1 code, the routine child health examination code, was entered in the pediatric outpatient clinic in the same period when the patients presented with the complaint of vertigo were included as the healthy control group. Hemogram and hormone profiles [25(OH)D, FT4, TSH, vitamin B12, folic acid and ferritin] of the groups were compared. Results: There was no statistically significant difference between the study group and healthy controls in terms of age and gender. Hematocrit (p<0.001), platelet (p<0.001), vitamin B12 (p=0.015), vitamin D (p=0.043) and TSH (p=0.013) levels were found to be significantly lower in the vertigo group compared to the control group. Conclusion: The importance of micronutritional deficiencies cannot be denied in patients presenting with vertigo symptoms. Main point that makes our study valuable is that there are limited number of studies in the literature comparing laboratory parameters of pediatric patients with vertigo symptoms and healthy controls. There is a need for prospective studies, involving more cases and awareness on this issue.

Investigation of Post-Earthquake Dizziness After 2023 Türkiye Earthquakes: An Observational Case-Control Study.

The primary objective of this study was to investigate the etiological causes and the underlying mechanism of post-earthquake dizziness in affected persons. The present study utilized an observational case-control design to recruit 69 participants (33 with self-reported dizziness complaints and 36 healthy persons) who were exposed to the 2023 earthquakes in Türkiye. The participants underwent assessments including the Dizziness Handicap Inventory for measuring dizziness-related disability, stress, and anxiety assessment using various scales, and equilibrium evaluation through the use of videonystagmography, video head impulse test, and vestibular evoked myogenic potential. The 2 groups were compared based on these assessments. The results indicate that the Dizziness Handicap Inventory score was significantly higher in the patient group compared to the control group (P < .001). The mean score of the Peritraumatic Distress Inventory, as well as the mean scores of the Hospital Anxiety and Depression Scale anxiety score and depression score, were found to be significantly higher in the patient group compared to the control group (P=.012, P < .001, and P < .001, respectively). Furthermore, it was observed that the mean vestibulo-ocular reflex gain of the left posterior semicircular canal exhibited a statistically significant decrease in the patient group (P=.02). The observed equilibrium dysfunction experienced by individuals following a significant earthquake is likely attributable to heightened stress and anxiety stemming from multiple sources, including the impact of recurrent vibrations on the inner ear. Therefore, it is essential to establish a holistic healthcare approach that addresses the psychological needs of individuals affected by earthquakes.

Postural control behavior in women with dizziness

Vestibular dysfunctions normally manifest as dizziness, which is characterized by a subjective body balance disturbance. The present study aimed to analyze the influence of women’s self-perception of the level of dizziness on their postural behavior. This cross-sectional research was conducted with women 30 years old or more with a complaint of dizziness for at least three months. Anthropometric data were collected, as well as information on the level of dizziness and static postural control assessment (both with eyes open and closed). The descriptive and inferential analyses of the data were carried out with the SPSS 23.0 software. The clinical test scores were submitted to the Kolmogorov-Smirnov normality test and Student’s t-test for independent samples. The sample comprised 59 women, mean age 69.05 (±13.77) years. Regarding intensity, 37.2% had mild dizziness, 32.2% had moderate dizziness, and 30.5% had severe dizziness. The balance motor control pattern identified a lower limb prevalence on the total sway surface of the elliptic area both with eyes open (p = 0.012) and closed (p = 0.024), as well as anteroposterior sway with eyes open in the group with severe dizziness (p = 0.041). The self-perception of the level of dizziness influenced these women’s postural behavior.

Risk factors for imaging abnormalities in patients with dizziness complaints: an algorithm for ordering brain imaging

The diagnostic detection of abnormal findings with head imaging is low for dizziness. This study aimed to investigate the risk factors associated with abnormal computed tomography (CT) or magnetic resonance imaging (MRI) findings for patients with dizziness. Medical records of patients who had CT or MRI examinations for dizziness complaints between January 1, 2019, and December 31, 2020, were retrospectively reviewed. Imaging outcomes were grouped as normal or abnormal findings. Risk factors, including demographics, dizziness pattern, symptoms, comorbidities, and medical history were assessed. A Chi-square automatic interaction detection decision tree model was used to classify abnormal imaging findings based on risk factors identified through multivariable analyses. A total of 2,342 scans were examined. Detection of abnormal findings was 4.8% (n = 96), including acute cerebral infarction (n = 33), acute cranial hemorrhage (n = 15), cancer/tumor-like lesions (n = 27), and inner ear abnormalities (n = 21). The risk factor most indicative of abnormal findings were loss of consciousness and neurologic deficit (Odds Ratio 55.57, p < 0.001). The likelihood of abnormality indicating acute brain lesions was 44.4% for patients with loss of consciousness and neurologic deficits. Loss of consciousness and neurologic deficits, hearing loss, nausea/vomiting, and comorbid malignancy distinguished abnormal findings from negative imaging findings (AUC 0.729; 95%CI 0.672-0.785; p < 0.001). Patients with unspecific dizziness complaints were less likely to have abnormal imaging findings. These findings highlighted the significance of specific risk factors in recognizing individuals with dizziness complaints who may have abnormal imaging findings indicative of serious diseases. Further studies are warranted to verify the findings.

Our Experience with Labyrinthine Fistula: Prospective Hearing Outcomes.

Chronic otitis media with cholesteatoma is a locally destructive middle ear infection with bone erosive properties which can lead to fistula if erodes labyrinth. A prospective observational study was conducted at tertiary health care centre with a total of 12 patients who presented with complaints of otorrhoea, hearing loss and vertigo. Such patients were evaluated clinic audiologically and radiologically as a pre op assessment. Post-surgery audiological assessment was done. Hearing preservation was seen in 91.7% patients and none of the patients had iatrogenic sensorineural hearing loss. Complete removal of the cholesteatoma is beneficial and does not lead to any iatrogenic SNHL when performed meticulously. A newer way of diagnosing membranous labyrinthine breach utilizing Magnetic Resonance Imaging T2 Diffusion Weighted (MRI- T2 DW) sequence can be implemented.

Determining Adult Dizziness and Sleep Quality After the 2023 Earthquakes in Türkiye.

This study investigated the presence of dizziness and sleep quality in people affected by the earthquake disaster of 2023 in Türkiye and aimed to determine the relationship between dizziness and sleep disorders. A total of 384 earthquake survivors who had no previous complaints of dizziness or sleep disturbance and who presented to the neurology outpatient clinic with complaints of dizziness or sleep disturbance after the earthquake were included in the study.Demographic information of participants and scales such as the Dizziness Handicap Inventory (DHI) and the Pittsburgh Sleep Quality Index (PSQI) were recorded. It was determined that the majority of the patients in the 18-35 age group had poor sleep quality and there was a significant difference in the PSQI score. Additionally, a moderate positive significant relationship was found between the DHI score and the PSQI score. Exposure to major earthquakes and aftershocks can cause sleep disorders and dizziness complaints, which may emerge as public health problems. Earthquake victims should be followed up and necessary interventions should be made early.

Case Report: Grade II Hypertension Accompanied by Obesity with Consumption of Propolis Herbs

Hypertension is often said to be a silent killer, because it is a deadly disease without being accompanied by symptoms first as a warning for the victim. Hypertension with the incidence of obesity is still common. The prevalence of hypertension accompanied by obesity also continues to increase. According to some studies, obesity and hypertension have a meaningful relationship. One alternative treatment that can be an option to lower blood pressure is herbal therapy. Herbal medicine is classified as complementary medicine is a phenomenon that appears today among many other non-conventional treatment phenomena, such as treatment with herbs or herbal therapy, acupuncture, and cupping. The use of herbs is one of the alternative treatments chosen by the community other than conventional (medical) treatment.One of the natural products produced is propolis. Propolis is one of the natural products produced by bees and is widely used as a medicine or supplement, anti-inflammatory, disease treatment, accelerating wound healing, and others. The patient in this case is a woman with the age of 50 years. Patients come with complaints of dizziness, headache and low back pain accompanied by a history of hypertension, and obesity. The patient was diagnosed with Grade 2 Hypertension on Treatment, and Obesity was given therapy in the form of Amlodipine 10 mg 1x1, Paracetamol 500 mg 3x1 and Vitamin B Complex 2x1.Hypertension suffered by patients is hypertension obtained due to several predisposing factors in patients, namely diet, obesity, age, and gender.

EVERSION CAROTID ENDARTERECTOMY IN A PATIENT WITH COMPLETE BLOCKAGE OF THE CAROTID ARTERIES (CLINICAL CASE)

We present a clinical case that reflects the effectiveness of eversion carotid endarterectomy in a patient with complete blockage of the carotid arteries. A 62 y.o. patient was admitted to the clinic with complaints of dizziness and syncopal events such as “blackouts” when turning his head to the side. Angiography revealed that the right external carotid artery is stenotic up to 85%, the internal one is up to 90%, and the circle of Willis is closed. Endarterectomy was performed from the common carotid, internal carotid and external carotid arteries, with their complete cutting off and subsequent plastic suturing, i.e. formation of a trifurcation anastomosis. As shown in control angiography, the patency of the carotid segment was completely restored, and there was no neurological deficit.

Quality of life and level of physical activity of individuals with temporomandibular disorders with and without otological symptoms: Secondary analysis of a cross-sectional study.

Otological symptoms (OS) are highly prevalent in individuals with temporomandibular disorders (TMD). Individuals with TMD and OS have more neck disability and decreased deep neck muscles endurance when compared to individuals without OS. However, no studies have evaluated whether OS is associated with lower Quality of Life (QoL) and worse levels of physical activity. This study aimed to evaluate the QoL and level of physical activity of individuals with TMD with and without OS. In this cross-sectional study, 62 individuals with TMD were allocated into 2 groups: TMD with OS (n=36) or TMD without OS (n=26). Self-reported complaints of dizziness, vertigo, tinnitus, earache, ear fullness, or hypoacusis were considered as OS. QoL was assessed with the WHOQOL-Bref and physical activity with the IPAQ-SF. Independent t-test and chi-squared test were used for analysis between-groups. Effect sizes were reported using Cohen's d. A Pearson correlation was used to compare the number of OS and QoL scores. A significance level of p<0.05% and 95% confidence intervals were considered statistically significant. The total generic scores for QoL were not different between-groups (p=0.076), but individuals with TMD with OS had lower satisfaction (p=0.015; d: 0.63) and physical domain (p=0.015; d: 0.64) scores with a moderate effect size. In TMD with OS, 69.4% of individuals were irregularly active and 50% for the TMD without OS, with no statistical significance (p>0.05). The number of OSs was inversely and weakly associated with the QoL total score. Individuals with TMD and OS are associated with worsened QoL (physical domain and satisfaction) when compared to individuals with TMD without OS. The higher the number of OS, the worse the QoL score. Individuals with TMD with and without OS had similar levels of physical activity, but a high prevalence of irregularly active and sedentary individuals within TMD diagnosed population was found.

A case report of non hodgkin lymphoma presenting with upper gastrointestinal tract bleeding

Abstract: Initial evaluation of patients with acute gastrointestinal (GI) tract bleeding includes assessment of hemodynamic stability and resuscitation if necessary Case Report: A 48-year-old male patient was admitted to the emergency department with complaints of dizziness, intense weakness, vomiting in the form of coffee grounds and black diarrhea Conclusion: Aggressive non-hodgkin lymphoma may be among the etiologies of upper gastrointestinal bleeding. In cases where endoscopic and surgical methods are inadequate, chemotherapy may be a life-saving option considering the possible risks.

Isolated left ventricular non-compaction: clinical characterisation of a teenage male

Isolated Left Ventricular Non-compaction (LVNC) is a type of cardiomyopathy that usually has a genetic origin. Its diagnosis is based on findings such as deep intertrabecular recesses or sinusoids and ventricular trabeculations communicating with the left ventricular cavity. LVNC was first clinically recognised almost four decades back, yet its diagnostic and management challenges persist. In this report, we present the case of an 18-year-old boy, who presented at the National Institute of Cardiovascular Diseases, Karachi, in March 2023, with complaints of dizziness, pedal oedema, and shortness of breath. Echocardiography revealed signs suggestive of LVNC, which were confirmed conclusively on Cardiovascular Magnetic Resonance (CMR) (NC/C ratio&gt;2.4). The patient underwent implantable cardioverter defibrillator (ICD) placement, was discharged after a smooth post-procedure recovery, and is doing well on follow-ups. ---Continue

Dialysis disequilibrium syndrome: A case report

Dialysis disequilibrium syndrome (DDS) is a rare syndrome that can occur in patients with severe azotemia undergoing an initial hemodialysis (HD) session. DDS is associated with a more rapid decrease in urea concentration in the blood than in the brain during dialysis. Although severe DDS is less common, the milder forms of DDS may be missed by doctors. A 53-year-old male patient had the main complaint of severe dizziness in the last 10 months accompanied by a sensation of a wobbling head and tinnitus in his right ear. The patient had previously been diagnosed with polycystic kidney disease in 2018 and underwent regular hemodialysis two times a week since June 2019. In the patient's neurological status, cerebellar examination was positive for left dysmetria, left positive past pointing, Romberg test (open eye) fell to the right, and Romberg test (closed eye) fell to the right. There was no nystagmus on the patient's neuro-ophthalmological examination. Patients with kidney failure are at risk of developing DDS, so that appropriate precautions are needed. Due to the variability of symptoms, DDS often goes undiagnosed. Thus, it is important to be aware of the risk factors for DDS so that preventive steps can be taken appropriately. Continuous case reporting will raise awareness and the opportunity for further research to improve outcome in severe cases of DDS. Keywords: Dialysis; Disequilibrium; Dizziness; Polycystic Kidney. Citation: Yahya, Hidayati HB, Sugondo AT, Puspamaniar VA, Firdausa FS. Dialysis disequilibrium syndrome: A case report. Anaesth. pain intensive care 2024;28(1):191−195; DOI: 10.35975/apic.v28i1.2388 Received: October 10, 2023; Reviewed: December 20, 2023; Accepted: January 02, 2024

Occipital abscess developed after endovascular AVM treatment with liquid embolizing agent: case report

BackgroundIn arteriovenous malformations, endovascular embolization was first used in the 1960s to occlude feeding vessels. In recent years, the success of endovascular treatments has increased. Thus, the use of endovascular therapy in the treatment of arteriovenous malformation has become widespread. Recently, it is the primary treatment method or an adjunctive treatment to surgery. The development of intracranial abscess after endovascular treatment with a liquid embolizing agent has been reported very rarely in the literature. In this article, a case of intracerebral abscess that developed after endovascular treatment with a liquid embolizing agent was presented.Case PresentationA 24-year-old male patient was admitted to the hospital with the complaints of dizziness and syncope. Arteriovenous malformation was observed in radiological imaging. Endovascular treatment for the AVM was performed. He was admitted to the hospital with similar complaints 2 months after the treatment. An abscess was observed around the AVM in the patient's cranial imaging. Infected materials in the mall were surgically removed, and the abscess was drained. After antibiotic treatment, the patient was discharged with full recovery.ConclusionDue to the recent popularity of endovascular treatment methods, the incidence of abscess formation after embolization may change in the near future. Further research should be done to prevent this serious complication.