Episodic Vertigo Research Articles

Effectiveness of Brandt-Daroff exercises in benign paroxysmal positional vertigo: a systematic review

IntroductionBenign Paroxysmal Positional Vertigo (BPPV) is defined as a disorder of the inner ear characterised by repeated episodes of positional vertigo. BPPV is one of the most prevalent vestibular disorders in the general population, accounting for one-third of all vestibular disorders. The prevalence of BPPV is higher in females than males and this prevalence increases with increasing age. The common non-surgical treatments of BPPV are repositioning manoeuvres and habituation exercises. This review aimed to explore the effectiveness of Brandt-Daroff exercises in patients with BPPV.MethodsTwo search engines, PubMed and Cochrane, were used. Articles focusing on Brandt-Daroff exercises as management of BPPV were included in this review. All articles were published in English and results up to February 2023 were included.ResultsEpley’s repositioning manoeuvre is a better treatment option for posterior canal BPPV. Epley’s manoeuvre is more effective if applied alone as compared to its application along with Brandt-Daroff exercises or with medication. Epley’s manoeuvre was more effective than any other repositioning manoeuvre, such as the Semontmanoeuvre. The application of Brandt-Daroff was ineffective when applied alone. However, it was effective when applied in combination with the Cawthorne-Cooksey exercises in reducing the symptoms of BPPV.ConclusionsBrandt-Daroff exercises have inconsistent results in the treatment of BPPV; hence, high-quality randomised controlled trials should be carried out to investigate their efficacy.

Advancing personalized healthcare: leveraging explainable AI for BPPV risk assessment.

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder significantly impacting older adults, characterized by brief episodes of vertigo triggered by head movements. Accurate and timely diagnosis of BPPV can be challenging due to its overlapping symptoms with other conditions. Machine learning (ML) offers a promising approach to enhance diagnostic accuracy and efficiency. The primary purpose of this study was to evaluate the efficacy of various ML models in predicting BPPV. This common vestibular disorder significantly impacts older adults. This research sought to build models that could accurately predict BPPV using readily available clinical data and to assess the application of Explainable Artificial Intelligence (XAI) to enhance transparency and trust in ML-driven diagnoses. In this study, we trained and evaluated several ML models on a rich dataset from Froedtert Hospital involving 7,760 patients characterized by a diverse range of demographic and clinical features. This robust dataset enabled a detailed exploration of the factors influencing BPPV. By employing explainable AI techniques, we aimed to enhance the predictive accuracy of our models and provide clinicians with transparent and interpretable insights into diagnostic reasoning, bridging the gap between machine learning efficacy and clinical usability. Gradient Boosting emerged as the most effective model, exhibiting the highest accuracy (85.422%), F1 (0.851), and AUC (0.911). Statistical analysis revealed significant demographic disparities in BPPV occurrence. Specifically, the odds ratio (OR) for BPPV among "White or Caucasian" individuals was 2.433 (p < 0.001), indicating a higher prevalence compared to other races. Conversely, "Black or African American" individuals had an OR of 0.851 (p < 0.05), and "Asian" individuals had an OR of 0.791 (p = 0.26). The study also found an OR of 4.498 (p < 0.001) for "Not Hispanic or Latino" individuals, suggesting a significantly higher prevalence of BPPV in this group. The application of XAI facilitated a deeper understanding and trust in model decisions, particularly highlighting how model predictions align with clinical indicators. The study confirms that machine learning, complemented by Explainable AI, can effectively predict BPPV with high accuracy and interpretability. Leveraging XAI enhances the usability and acceptance of ML predictions in clinical settings, enabling healthcare providers to integrate these insights into their diagnostic processes. Future work should focus on further integrating these models into clinical practice to facilitate early and accurate BPPV diagnosis. The online version contains supplementary material available at 10.1007/s13755-024-00317-3.

Changes in symptom pattern in Meniere's disease by duration: the need for comprehensive management.

This retrospective study aimed to analyze the symptom profile of Meniere's disease (MD) patients, particularly focusing on the cessation of episodic vertigo and the disease's longitudinal course and the impact of major symptoms on quality of life (QoL). The study employed a cross-sectional design and was conducted on 365 out of 560 individuals with definite MD from the Finnish Vestibular and Meniere Federation, utilizing an internet-based questionnaire. Participants were surveyed on vertigo attacks, vestibular drop attacks (VDA), balance issues, selective cognitive complaints, hearing loss, and their effects on overall quality of life (QoL). The study population comprised 79.5% females and 20.5% males, with a mean age of 63 years and an average disease duration of 15.2 years. The onset of MD was characterized by simultaneous hearing loss, vertigo, and tinnitus in 38% of participants. There was a significant delay in diagnosis for many, with 20% experiencing a delay of over 5 years. The frequency and duration of vertigo attacks generally decreased over time, with attacks becoming shorter and less severe as the disease progressed. Spontaneous remission from episodic vertigo occurred in 34% of participants variably throughout the course of MD. Of the participants 65.5% reported balance issues, and 34% experienced mild VDAs, with severe falls occurring in 10%. VDAs were more common with longer disease duration. Bilateral hearing loss developed in 34.5% of participants over the long term, with a higher risk associated with younger onset age, migraines, and family history of MD. Fatigue, anxiety, and depression were prevalent, particularly among younger participants. Cognitive impairments were linked to the severity of these symptoms and the presence of constant dizziness. QoL was significantly lower among participants with constant dizziness, with factors like fatigue, depression, VDA, and hearing loss contributing to this reduction. The study highlights the complexity of MD. While vertigo may spontaneously remit, other symptoms such as VDAs, balance issues, cognitive complaints, and hearing loss often persist and worsen over time. Assessing MD solely on primary symptoms like vertigo and hearing loss is insufficient; a comprehensive evaluation is necessary for effective management.

Follow-up of a Cohort of Patients with Secondary Erythrocytosis Due to Testosterone Treatment

Introduction Erythrocytosis occurs in 5-66% of patients receiving testosterone, and is the main reason for dose adjustment. The exact mechanism by which it develops is not fully understood. Up-to-date main hypotheses include hepcidin suppression independent of the erythroferrone pathway and indirect stimulation of the bone marrow. Currently, the most common reasons for using this treatment include hypogonadism and gender transition. Objective The aim of the present study was to describe the characteristics, treatment, and evolution of a series of patients with erythrocytosis secondary to testosterone treatment. Methods We retrospective studied 512 patients diagnosed with polycythemia between February 2000 and May 2024 in a single tertiary academic center. The diagnosis of polycythemia was made in the presence of hemoglobin (Hb) &amp;gt;16.5g/dL. Patients included were under testosterone therapy, other causes of polycythemia were excluded. The patients were treated with phlebotomies or erythroapheresis. Results Of the 512 patients meeting polycythemia criteria, 29 patients (5.6%) had polycythemia secondary to testosterone therapy. The median age at diagnosis was 53 years [interquartile range (IQR) 40 - 64]. The causes for testosterone use were: 12 hypogonadotropic hypogonadism (41.3%), 9 hypergonadotropic hypogonadism (31%) and 8 transgender men (27.7%). According to the type of androgen: 15 received testosterone cyclopentylpropionate (51.7%), 11 testosterone undecanoate (37.9%) and 3 testosterone gel (10.3%). The median Hb and hematocrit at diagnosis were 18.5g/dL (IQR 18-19.5) and 57% (IQR 55-59), respectively. Erythropoietin was available in 26 patients; the median was within the normal range (8, IQR 6.3-13). None patient had JAK2 mutation. Seven patients had an abnormal spirometry (24.1%). Seven were diagnosed with sleep apnea-hypopnea syndrome (24.1%). In terms of cardiovascular risk factors, 16 patients were smokers (55.2%), 14 were obese (body mass index (BMI) &amp;gt;30) (48.3%), 12 had hypertension (41.4%), 8 had dyslipidemia (27.6%), 4 had heart disease (13.8%), and 4 were diabetic (13.8%). The median number of therapeutic procedures per patient was 8 (IQR 4-12), with 157 being erythroapheresis (60.6%) and 102 phlebotomies (39.4%). The most common adverse effects related to the procedures were: 4 extravasations (1.5%), 4 dizziness episodes (1.5%), and 1 paresthesia episode (0.4%). Nine patients (31%) were discharged after a median of 3 years (range 0-15). Before the diagnosis of polycythemia and while on testosterone treatment, 3 patients had a thrombotic episode. After diagnosis, 3 patients experienced thrombotic events: 1 ischemia in a lower limb in a patient with chronic vasculopathy, 2 transient ischemic attacks in one patient, and 1 patient with superficial venous thrombosis in a lower limb and 1 cardioembolic ischemic stroke associated with atrial fibrillation. These three patients were using different types of testosterone, two were obese, and the events occurred &amp;gt;5 years after starting testosterone. The six patients who had a thrombosis had at least 1 cardiovascular risk factor, median age 63 years (IQR 52.3-64.5), BMI 30 (IQR 25.9-33.8), and the use of testosterone was secondary to hypogonadism. No patient died during follow-up. The median follow-up duration was 3 years (IQR 2.2-8.8 or range 0-24). Conclusions In testosterone-induced polycythemia, erythropoietin does not appear to be involved in the mechanism of action. These patients have a high rate of thrombotic events, so it is important to maintain a good hematocrit level and effectively treat comorbidities.

Symptomatic Severe Stenosis of Cavernous Internal Carotid Artery Stenting: A Case Report with Short Literature Review

AbstractIntracranial internal carotid artery (ICA) stenosis is rarely reported as compared with extracranial ICA stenosis. Atherosclerosis is one of the major beginnings of stenosis of vasculatures, which may lead to ischemic stroke causing morbidity and mortality. We report the case of a 60 -year-old man presented to us with complaints of multiple episodes of dizziness, mild headache, and transient left arm weakness for 3 months and had history of smoking, hypercholesterolemia (high level of low-density lipoprotein level = 220 mg/dL), diabetes mellitus, and hypertension under medication. No neurological deficits were observed at the time of admission. Patient underwent angioplasty and stenting with drug-eluting balloon-expandable coronary stent. Patient was discharged well at the 3rd day of procedure. No recurrence of stroke and restenosis were noted till 3 months of follow-up period. Stenting following angioplasty for treatment of symptomatic severe cavernous ICA stenosis with everolimus-eluting coronary balloon-expandable stent, Xience Xpedition, is safe and effective.

Unveiling the Therapeutic Impact of Virtual Reality Game-Based Exercises on Cervicocephalic Kinesthetic Sensibility in Individuals Battling Cervical Vertigo

This study was aimed to investigate the therapeutic impact of Virtual Reality game-based exercises with Epley maneuver on cervicocephalic kinesthetic sensibility in individuals experiencing cervical vertigo. 8 subjects were selected by simple random sampling method included clinically diagnosed male and female cervical vertigo patients between 40-55 years of age, who had recurring symptom of dizziness over three months, episodic dizziness lasting minutes to hours .Written consent was taken and a detailed outcome assessment was done.Intervention includes Virtual Reality abyss sharks &amp;amp; sea worlds for a duration of 10 minutes with a five-minute rest period and Virtual Reality thrills, for a duration of 10 minutes with a five-minute rest period along with epley maneuver 10 minutes targeting cervicocephalic kinesthetic sensibility.Total duration of the intervention includes 40min/day for 6 days for 12 weeks. Pre test included Cervical Joint Position Error Test for cervicocephalic kinesthetic sensibility and Videonystagmography measures nystagmus, rapid eye movements with a slow and fast phase, to provide objective information about vertigo. Post test done on 6th and 12th week of intervention with the same measures. On comparing pre- and post-intervention outcomes shows higher mean value (P≤0.001).In conclusion the findings of this study had the potential to contribute valuable insights into the therapeutic utility of Virtual Reality game-based exercises in managing cervical vertigo, offering a novel and engaging approach to rehabilitation. Virtual Reality-based interventions is found effective treatment for individuals battling cervicocephalic kinesthetic sensibility among patients with cervical vertigo.

Postural control in episodic ataxia type 2: no evidence for increased vestibular excitability.

Patients with episodic ataxia type 2 (EA2) suffer from recurrent paroxysmal episodes of vertigo and oscillopsia. Pathophysiologically, altered neuronal excitability has been suspected. Vestibular excitability in 22 EA2 patients and 22 age-matched healthy participants was compared. Galvanic vestibular stimulation (GVS) was used to assess vestibular excitability by vestibular motion perception thresholds and mean postural sway velocity during various visual and proprioceptive conditions in the two groups. Control stimuli using sham and no GVS were established to identify the specificity of GVS-induced postural sway. In the baseline condition, EA2 patients showed larger postural instability. However, motion perception thresholds and the increase in mean postural sway velocity during vestibular stimulation (stimulation ratio) did not differ between groups. Postural sway during suprathreshold GVS increased with the vestibular motion perception threshold in EA2 patients, in contrast to healthy participants. The larger postural unsteadiness of EA2 patients probably reflects their progressive cerebellar degeneration. It is not related to abnormal visual (Romberg's ratio) or proprioceptive control of stance. Postural unsteadiness during vestibular stimulation does not indicate altered vestibular excitability in EA2 patients. However, vestibular stimulation increasingly destabilized postural control of EA2 patients with higher motion perception thresholds when proprioceptive information was diminished. This conclusion, however, is restricted to the postural control of EA2 patients in the interval between the vestibulo-cerebellar episodes.

Endolymphatic hydrops and cochlear synaptopathy after noise exposure are distinct sequelae of hair cell stereociliary bundle trauma

Endolymphatic hydrops, increased endolymphatic fluid within the cochlea, is the key pathologic finding in patients with Meniere’s disease, a disease of episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Endolymphatic hydrops also can occur after noise trauma and its presence correlates with cochlear synaptopathy, a form of hearing loss caused by reduced numbers of synapses between hair cells and auditory nerve fibers. Here we tested whether there is a mechanistic link between these two phenomena by using multimodal imaging techniques to analyze the cochleae of transgenic mice exposed to blast and osmotic challenge. In vivo cochlear imaging after blast exposure revealed dynamic increases in endolymph that involved hair cell mechanoelectrical transduction channel block but not the synaptic release of glutamate at the hair cell–auditory nerve synapse. In contrast, ex vivo and in vivo auditory nerve imaging revealed that synaptopathy requires glutamate release from hair cells but not endolymphatic hydrops. Thus, although endolymphatic hydrops and cochlear synaptopathy are both observed after noise exposure, one does not cause the other. They are simply co-existent sequelae that derive from the traumatic stimulation of hair cell stereociliary bundles. Importantly, these data argue that Meniere’s disease derives from hair cell transduction channel blockade.

Impact of proprioceptive cervical dizziness in chronic neck pain syndromes on gait and stance during active head-turn challenges

An earlier observational study described selected patients with acute neck pain syndrome, who experienced short bursts of cervical vertigo elicited by rapid head movements. The current study on a larger cohort of 20 patients with chronic or frequently recurring neck pain syndrome and age-matched controls focused on two major questions: (1) Can head movements in subjects with exacerbations of neck pain and restrictions of neck mobility also elicit bursts of vertigo? (2) What is the impact on postural balance measured by analysis of body sway and locomotion? A detailed questionnaire was applied, posture and gait were evaluated by use of instrumented posturography—and gait analysis with and without slow or rapid horizontal head rotations in the yaw plane with and without sight/visual input. All patients reported some or frequent episodes of dizziness in the range of seconds only elicited by rapid, not by slow head movements. Postural sway in patients was unremarkable in undisturbed conditions without head movements, but specifically increased by rapid but not slow head turns. The latter is best explained by the lack of continuous control of velocity and amplitude of saccadic head movements. Gait analysis revealed a slowed and cautious gait pattern already at undisturbed condition that was even exaggerated during rapid head turns. These observations demonstrate that chronic or recurrent neck pain is associated with episodic experiences of dizziness and above results in both chronic and episodic alterations of stance and gait that resemble those described for patients with phobic postural vertigo/persistent postural perceptual dizziness, a functional gait disorder.

Constant Dizziness Versus Episodic Vertigo in Ménière's Disease: Health-Related Quality of Life, Cognitive Dissonance, and Postural Problems.

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.

Epidemiological Evidence for Upper Respiratory Infections as a Potential Risk Factor for Meniere's Disease: A Korean National Health Sample Cohort Study.

Meniere's disease (MD) is a chronic inner ear disorder characterized by tinnitus, ear fullness, episodic vertigo, and fluctuating hearing loss, which significantly impacts quality of life and poses management challenges. Recent evidence suggests that upper respiratory infections (URIs) may contribute to MD's onset. This study examines the potential link between URIs and MD using data from the Korean National Health Insurance Service-National Sample Cohort (2002-2019). We analyzed 19,721 individuals with MD and 78,884 matched controls, adjusting for demographic factors and comorbidities using propensity score matching. Our results showed that individuals with a URI within one year prior to the index date exhibited a 2.01-fold greater likelihood of developing MD (95% confidence interval [CI] = 1.91-2.11, p < 0.001), while those with URIs within two years demonstrated a 1.54-fold higher probability (95% CI = 1.50-1.59, p < 0.001). Furthermore, we found that even remote URIs occurring up to two years before the index date significantly increased the risk of developing MD, underscoring the need for long-term patient follow-up. Overall, our study suggests that individuals with a history of URI may have an elevated risk of developing MD over multiple time frames, regardless of demographic or health profiles.

Hipertensão arterial resistente: um desafio diagnóstico

Introduction: Primary hyperaldosteronism is a leading cause of secondary arterial hypertension, affecting approximately 10% to 20% of the hypertensive population worldwide and in Brazil. This condition involves excessive aldosterone production due to factors such as adrenal adenoma, hyperplasia, or, less commonly, adrenal carcinoma and familial hyperaldosteronism. This study reports a case of resistant hypertension secondary to aldosterone-producing adenoma. Clinical Case: A 70-year-old male patient presented with episodes of dizziness, syncope, cramps, and asthenia. His medical history included resistant hypertension for over 30 years, despite treatment with five classes of antihypertensive medications. Additionally, he had a history of dyslipidemia, type 2 diabetes mellitus, non-dialysis chronic renal failure, and obstructive coronary arterydisease. Physical examination showed a BMI of 29 kg/m² (overweight), mean blood pressure of 140/90 mmHg (right arm) and 150/100 mmHg (left arm), and palpable nodules in both thyroid lobes, classified as Bethesda V based on aspiration cytopathology. Subsequently, he underwent total thyroidectomy and lymph node dissection. Laboratory tests revealed high plasma aldosterone levels with suppressed renin and an elevated aldosterone-renin ratio, raising suspicion of primary hyperaldosteronism. This diagnosis was confirmed by a computed tomography scan, which identified a 1.2 cm nodule in the right adrenal gland consistent with an adenoma. The patient underwent unilateral laparoscopic adrenalectomy. Two years post-surgery, the patient’s blood pressure was well-controlled with three antihypertensive medications, and his blood sugar, aldosterone, and renin levels were normal. Discussion and Conclusion: Most patients undergoing unilateral adrenalectomy for aldosterone-producing adenomas experience significant clinical improvement. Early screening and diagnosis of primary hyperaldosteronism are crucial for effective management, reducing the risk of complications in the cardiovascular and renal systems.

5155 Benign Paroxysmal Positional Vertigo as a Potential Manifestation of Hypothyroidism, a Case Report

Abstract Disclosure: M. Ahmad: None. M. Herrera: None. D. Deyar: None. P. Gill: None. Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a vestibular disorder characterized by recurrent episodes of vertigo triggered by specific head movements. The pathophysiology of BPPV involves the displacement of otoconia within the semicircular canals of the inner ear. However, emerging evidence suggests that BPPV may manifest as a consequence of hypothyroidism. In this case report, we present a clinical case of a patient who exhibited symptoms of BPPV and was subsequently diagnosed with hypothyroidism. We aim to elucidate the relationship between these two seemingly distinct conditions and highlight the importance of considering hypothyroidism as a potential cause of BPPV. Case presentation: A 56-year-old female with a past medical history of migraines presented to the hospital for three days of dizziness. She had multiple bouts of vomiting and right-sided headaches similar to her prior migraine headaches. The patient also noted dry skin, constipation, and hair loss for the past few months. The patient’s vital signs were as follows: temperature: 35.6 C, heart rate: 65 beats per minute, blood pressure: 153/66 mmHg, and respiratory rate: 18 breaths per minute. On physical examination, the Dix-Hallpike maneuver was positive on the right side and the patient was noted to have diffusely dry skin. The patient’s labs were significant for the following: sodium: 137 mmol/L, potassium: 3.7 mmol/L, creatinine: 0.88 mg/dL, thyroid stimulating hormone: 31.2 uIU/ml, free T4 ng/dL, hemoglobin: 10.8 g/dL (MCV of 87), and TPO antibody: 2350 IU/ml. The patient underwent CT and MRI imaging of the brain without contrast, which was negative for any acute intracranial abnormalities. The patient was diagnosed with BPPV and hypothyroidism secondary to Hashimoto’s thyroiditis and subsequently underwent vestibular physical therapy with improvement in her vertigo and was started on 112 mcg of levothyroxine daily. She is set to follow up with her primary care provider as an outpatient. Discussion: BPPV generates significant repercussions to an individual’s quality of life, autonomy, and functionality. Hypothyroidism is a common condition characterized by thyroid hormone deficiency that has been linked with a wide array of clinical manifestations, including vestibular disturbances. Autoimmune dysfunction, anomalies of the endolymphatic flow and low perfusion to the inner ear are potential etiological factors that can explain the relationship between thyroid disorders with BPPV. Some studies mention that thyroid autoantibodies could induce autoimmune-complex deposition in the inner ear, which might change the endolymphatic flow and induce BPPV. Raising awareness regarding this potential manifestation of hypothyroidism can guide clinical and diagnostic decisions that improve patient care, especially in individuals under evaluation for BPPV with other symptoms of hypothyroidism. Presentation: 6/3/2024

Detecting endolymphatic hydrops in patients with cranial nerve VIII schwannoma using hydrops MR examination.

This study utilized Hydrops MRI in patients with cranial nerve (CN) VIII schwannoma to assess the concomitance with endolymphatic hydrops (EH), aiming to elucidate the mechanism of hydrops formation in these patients. Twenty-six patients diagnosed as CN VIII schwannoma including vestibular schwannoma (VS) in 24 and intracochlear schwannoma (ICS) in 2 were enrolled. Fifteen patients received radiosurgery and 11 patients opted for a wait-and-scan approach. All patients underwent an inner ear test battery, followed by Hydrops MRI. Based on Hydrops MRI, 6 patients (23%) with positive EH were assigned to Group A, while the other 20 patients showing negative EH were assigned to Group B. The abnormality rates of inner ear test battery in Group A ran from the audiometry (100%), cervical vestibular-evoked myogenic potential (cVEMP) test (83%), ocular VEMP (oVEMP) test (67%) to the caloric test (33%), exhibiting a significantly declining sequence. This declining sequence is consistent with the decreasing order in the prevalence of EH from the cochlea (83%), saccule (50%) to utricle (50%). However, Group B did not show such decreasing trend, indicating that Groups A and B did not share the common mechanism. The mean tumor size prior to radiosurgery was 1.91 ± 0.89cm, which significantly reduced to 1.53 ± 0.60cm at a mean interval of 6years following radiosurgery. In contrast, tumor size remained unchanged in those opted for a wait-and-scan approach. It is recommended to utilize Hydrops MRI for patients with CN VIII schwannoma during annual follow-up, particularly those experienced episodic vertigo and/or deteriorated hearing. The Hydrops MRI can not only monitor tumor size, but also detect the presence of EH, so as to guide treatment decision.

A novel KCNC3 gene variant in the voltage-dependent Kv3.3 channel in an atypical form of SCA13 with dominant central vertigo.

Potassium channel mutations play an important role in neurological diseases, such as spinocerebellar ataxia (SCA). SCA is a heterogeneous autosomal-dominant neurodegenerative disorder with multiple sub-entities, such as SCA13, which is characterized by mutations in the voltage-gated potassium channel Kv3.3 (KCNC3). In this study, we present a rare and atypical case of SCA13 with a predominant episodic central rotational vertigo, while the patient suffered only from mild progressive cerebellar symptoms, such as dysarthria, ataxia of gait and stand, and recently a cognitive impairment. In this patient, we identified a heterozygous variant in KCNC3 (c.2023G > A, p.Glu675Lys) by next-generation sequencing. This Kv3.3E675K variant was studied using voltage-clamp recordings in Xenopus oocytes. While typical SCA13 variants are dominant-negative, show shifts in the voltage-dependence of activation or an altered TBK1 regulation, the Kv3.3E675K variant caused only a reduction in current amplitude and a more pronounced cumulative inactivation. Thus, the differences to phenotypes observed in patients with classical SCA13 mutations may be related to the mechanism of the observed Kv3.3 loss-of-function. Treatment of our patient with riluzole, a drug that is known to also activate potassium channels, turned out to be partly beneficial. Strikingly, we found that the Kv3.3 and Kv3.3E675K inactivation and the frequency-dependent cumulative inactivation was antagonized by increased extracellular potassium levels. Thus, and most importantly, carefully elevated plasma potassium levels in the physiological range, or novel drugs attenuating Kv3.3 inactivation might provide novel therapeutic approaches to rescue potassium currents of SCA13 variants per se. In addition, our findings broaden the phenotypic spectrum of Kv3.3 variants, expanding it to atypical phenotypes of Kv3.3-associated neurological disorders.

Study Protocol for Assessing Serum Superoxide Dismutase Response to a Novel Head Rotation Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo Treatment

Abstract Background: Benign paroxysmal positional vertigo (BPPV) is a condition with sudden onset which causes short episodes of severe vertigo on altering the position of the head. Superoxide dismutases (SODs) are antioxidant proteins that regulate oxidative stress response in the body. Through this study, we evaluate the role of SOD in causing BPPV and effect of a new alternating maneuver, head rotation maneuver, for the treatment of BPPV of the posterior canal in reducing oxidative stress levels. Methodology: For investigating the role of serum SOD in the occurrence of BPPV Posterior canal, 60 BPPV and 60 healthy controls will be recruited. Their serum samples will be collected and SOD levels will be evaluated through colorimetry. For evaluating the effectiveness of head rotation maneuver in reducing the oxidative stress, patients with posterior canal BPPV (PC-BPPV) will be enrolled and divided into two groups through random allocation. Both the groups will be treated with head rotation and Epley maneuvers, respectively, by two separate therapists. Post-therapy SOD level will also be assessed. Results: Two-way repeated measures analysis of variance will be used to compare the groups’ improvement; treatment measures will be referred to as intergroup variables. Binary logistic regression analysis will be used to determine how SOD levels affect BPPV and recurrent BPPV. Pre- and postmaneuver SOD level will also be compared. Conclusion: SOD can be established as a reliable and strong biomarker for the occurrence of BPPV. Moreover, head rotation maneuver which is easy to perform can be used for managing PC-BPPV if the results show promising outcomes.

Audiovestibular Correlates in an Individual with a Retrocerebellar Arachnoid Cyst

Abstract The central vestibular lesion is mainly responsible for vertigo without nausea and may manifest with localized neurological symptoms such as diplopia, ataxia, and decreased cranial nerve function. This case study focuses on detailed audiological and vestibular assessment procedures patient with unidentified and later identified with arachnoid cysts in the retrocerebellar region. A 40-year-old female presented with a complaint of giddiness and instability, with each episode of giddiness lasting up to 10–15 min with unconsciousness. The results of the audiological evaluation indicated bilateral moderate sensorineural hearing loss, with an “Add” type tympanogram in both the ears. The findings of vestibular evaluation suggested of positive central vestibular lesion. This case report emphasizes differential diagnosis between peripheral and central vestibular lesions and requires detailed analysis and correlation of audiological and neurological symptoms. We recommend to use HINTS or HINTS+, which can help in episode of acute vertigo.

Circulating levels of micronutrients and the risk of benign paroxysmal positional vertigo: A Mendelian randomization study

BackgroundBenign paroxysmal positional vertigo (BPPV) is a typical vestibular disease characterized by recurrent episodes of vertigo. The role of micronutrients in BPPV pathogenesis has not been extensively studied, prompting this investigation into the relationship between circulating micronutrients and BPPV risk. This research aimed to explore the relationship between blood micronutrient levels and BPPV risk via Mendelian randomization (MR) analysis, a robust method for inferring causality from observational data. MethodsA total of 15 circulating micronutrients were assessed for their association with BPPV risk. MR analysis was conducted via the following methods: MR‒Egger, weighted median, simple model, inverse variance weighting (IVW), and weighted mode. Sensitivity analyses were performed to assess heterogeneity and pleiotropy. A multivariate MR analysis was also conducted, incorporating potential confounders such as trauma, chronic otitis media, hearing loss, peripheral atherosclerosis, ageing, and osteoporosis. ResultsMR analysis revealed an obvious association between selenium and BPPV risk (OR 1.074, 95 % CI 1.005 to 1.148; P = 0.035). Folate was negatively related (OR 0.694, 95 % CI 0.501 to 0.962, P = 0.028) but was excluded because of inconsistent OR values across methods. Sensitivity analysis supported the IVW results, and there was no evidence of significant heterogeneity among the selenium-related instrumental variables included in the study, nor was horizontal pleiotropy detected among the instrumental variables. Multivariate MR analysis confirmed that selenium was an independent risk factor for BPPV (OR 1.22, 95 % CI 1.059 to 1.406, P = 0.006), with no significant associations observed for other micronutrients or exposure factors. ConclusionThis study provides evidence that blood selenium levels are positively associated with the risk of BPPV, suggesting a potential role for selenium in the pathogenesis of this disorder. These findings are robust to various sensitivity analyses and support the use of MR analysis to identify novel risk factors for BPPV. The identification of selenium as an independent risk factor for BPPV has implications for the development of preventive strategies and targeted interventions. It is necessary to analyse the biological mechanisms of this association and determine the therapeutic value of limiting selenium intake for BPPV to provide support for the treatment of such patients.

Why is vestibular migraine associated with many comorbidities?

Vestibular migraine (VM) is a usual trigger of episodic vertigo. Patients with VM often experience spinning, shaking, or unsteady sensations, which are usually also accompanied by photophobia, phonophobia, motor intolerance, and more. VM is often associated with a number of comorbidities. Recurrent episodes of VM can affect the patient's emotions, sleep, and cognitive functioning to varying degrees. Patients with VM may be accompanied by adverse moods such as anxiety, fear, and depression, which can gradually develop into anxiety disorders or depressive disorders. Sleep disorders are also a common concomitant symptom of VM, which significantly lower patients' quality of life. The influence of anxiety disorders and sleep disorders may reduce cognitive functions of VM, such as visuospatial ability, attention, and memory decline. Clinically, it is also common to see VM comorbid with other vestibular disorders, making the diagnosis more difficult. VM episodes are relieved but lingering, in which case VM may coexist with persistent postural-perceptual dizziness (PPPD). Anxiety may be an important bridge between recurrent VM and PPPD. The clinical manifestations of VM and Meniere's disease (MD) overlap considerably, and those who meet the diagnostic criteria for both can be said to have VM/MD comorbidity. VM can also present with positional vertigo, and some patients with VM present with typical benign paroxysmal positional vertigo (BPPV) nystagmus on positional testing. In this paper, we synthesize and analyze the pathomechanisms of VM comorbidity by reviewing the literature. The results show that it may be related to the extensive connectivity of the vestibular system with different brain regions and the close connection of the trigeminovascular system with the periphery of the vestibule. Therefore, it is necessary to pay attention to the diagnosis of comorbidities in VM, synthesize its pathogenesis, and give comprehensive treatment to patients.

The characteristics of three-dimensional real inversion recovery MRI sequence in delayed Meniere’s disease

Background Delayed Meniere’s disease (DMD) is characterized by episodic vertigo occurring after a significant delay following longstanding sensorineural hearing loss. However, its pathogenesis and characteristics remain unclear. Objectives To explore the characteristics of endolymphatic hydrops (EH) in DMD and investigate its pathology using MRI. Materials and methods 17 patients diagnosed with DMD were included in this study. A 3D-real-IR MRI sequence was utilized to visualize and grade EH. The signal intensity of the basal cochlear turn was compared to that of the cerebellar white matter to calculate the CC ratio. A paired t-test was employed to assess the differences in the CC ratio between the affected and unaffected sides in patients with unilateral DMD. Results EH was present in 100% of cases on the affected side. Unilateral EH was seen in 82.4%, and bilateral EH in 23.5%. Vestibular EH without cochlear involvement occurred in 29.4%, and cochlear EH without vestibular involvement in 5.9%. The CC ratio was significantly higher on the affected side (p < 0.01). Conclusions and significance A significant grade of vestibular EH was observed in DMD, with bilateral EH being relatively common. The increased contrast on the affected side may reflect the underlying pathology in DMD patients.