Form Of Vertigo Research Articles

Analysis of local anesthetics side effects and determination of ways for their minimization

According to the World Health Organization (WHO), the development of side effects of drugs is one of the serious medical problems.The relevance of this problem is proven by numerous statistical data obtained in different countries of the world. The aim of the study was to determine the assortment of local anesthetics (LAs) on the pharmaceutical market of Ukraine, to analyze the evidence base of the effectiveness and safety of modern LAs, to monitor the side effects (SEs) of LAs in Kharkiv and Kharkiv region for the period 2018–2021, and to provide recommendations for their minimization. The methods of passive pharmacovigilance, method of spontaneous reports, method of system approach and system analysis were used in the study. To analyze the clinical effectiveness and conditions of rational use of LAs, well-known data bases were used: Cochrane Library, Trip Database, and PubMed. These databases contain systematized primary or secondary information on a specific clinical issue: the effectiveness and safety of various medical technologies. The results of the analysis of the assortment of LAs on the pharmaceutical market of Ukraine showed that in 2023, based on 9 international non-patented names of LAs, 65 trade names were presented. Bupivacaine and procaine drugs (16 trade names each) and articaine drugs in combinations (13 trade names) are market leaders. The results of the analysis of notification cards with cases of SEs for 4 years revealed that the majority of them in the form of dizziness, weakness, changes in blood pressure, heart rate, edema, itching, hyperemia at the site of application were recorded when using lidocaine drugs, which are the most in demand and popular among doctors. According to the data of systematic reviews, the main directions for reducing the side effects of LAs have been established, such as administration under ultrasound control, the use of the least toxic modern anesthetics ropivacaine and levobupivacaine (not available on the Ukrainian market), the addition of substances with vasoconstrictive properties to the anesthetic solution, the use of combinations of long-acting and short-acting anesthetics. The results obtained can be used by practicing doctors and health care organizers to optimize LAs.

MOTION SICKNESS INCIDENCE (MSI) PREDICTION ON 80 M LNG SHIP CARRIER

The motion of ships is move up and down or shocking on the high seas caused by large and continuous waves can cause symptoms of illness in the form of dizziness, nausea and even vomiting which is often termed as seasickness (sea sickness or motion sickness). In this research, a study was conducted on the results of calculations and simulations of the vertical acceleration of the LNG ship's movement so that it could be seen the performance of the ship on crew comfort. Overall Motion Sickness Incidence (OMSI), is also presented as one of the outputs for this crew comfort level prediction, where in this OMSI calculation uses 3 different sea-states and also in each sea-state it is simulated with 3 types of periods (Tz) at service speed (Vs) 20 knots. ISO 2631 standard states seasickness is not experienced at speed 20 at 45, 135 or 180 degrees. After 8 hours, seasickness occurs when hit by 90 degrees. Moderate water conditions and rough water do not cause motion sickness at 0 and 45 degrees.

Benigna paroksizmalna poziciona vrtoglavica - put od smernica do svakodnevne kliničke prakse

BPPV is characterized by short periodic episodes of vertigo caused by changes in head position and abnormal stimulation of the cupula of one of the three semicircular canals in the inner ear, most commonly, the posterior. It represents the vertigo that is most often encountered in clinical practice. This narrative review aimed to indicate the latest guidelines and to provide an overview of the most important information related to the timely diagnosis and treatment of patients with this form of vertigo. We discussed the etiology and pathophysiology of the disease, the clinical picture, the paths of making the correct diagnosis, and the most effective types of treatment. A brief overview of the results of the research conducted in our country on the familiarity of clinicians with the guidelines and their application is also given. To avoid late diagnosis, delay in treatment, and additional costs of diagnostic procedures and examinations, it is necessary to formulate a strategy at the national level and constantly educate medical students, general practitioners, as well as doctors of other specialties about this disorder and its treatment methods.

Evaluating the Effectiveness of Escalating Intravenous Infusions of Lignocaine and Ketamine in Reducing Pain and Disability for Fibromyalgia Syndrome: A Prospective Observational Study

Introduction: Fibromyalgia is a chronic syndrome characterised by widespread musculoskeletal pain accompanied by fatigue, disability, sleep, memory and mood issues. The pain of fibromyalgia is difficult to manage and has no complete remission. While there is no cure for fibromyalgia, a variety of medications have been tried to minimise symptoms and improve general health. Hence, a trial was conducted to evaluate lignocaine and ketamine as pharmacological modalities to treat fibromyalgia. Aim: To evaluate effectiveness of intravenous (i.v.) lignocaineketamine infusions in reducing pain and disability in fibromyalgia syndrome. Materials and Methods: A prospective observational study was conducted at Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India, between March 2021 and March 2022, on patients aged between 18-60 years diagnosed with fibromyalgia syndrome. Sixty patients were included in the study. Escalating doses of i.v. lignocaine of 5 mg/kg, 6 mg/ kg and 7 mg/kg followed by escalating doses of i.v. ketamine of 0.4 mg/kg, 0.5 mg/kg and 0.6 mg/kg were administered on alternate days over a period of 12 days. Infusions were given in 50 mL normal saline through syringe pump over a period of 45 minutes. Pre and postinfusion 11 point Numerical Rating Scale (NRS) score was used to assess pain and World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 score to assess disability. Data are presented as mean and standard deviation. Statistical analysis was done by using the t-test for pre and post-treatment score, with a p-value<0.05 was considered statistically significant. Results: The present study showed female predominance of 42 out of 60 patients (70%) compared to males 18 out of 60 (30%). Pretreatment average baseline NRS score was 8.8. The mean reduction in NRS scores after lignocaine-ketamine infusions at the end of one month was 1.40 and at sixth month 1.25 which was statistically significant (p-value=0.001). Pretreatment mean average disability score was 2.70 and at the end of sixth month it was 0.59 which was statistically significant (p-value=0.001). Three patients did not have reduction in NRS scores and reported mild to moderate side-effects in the form of dizziness, headache and raised blood pressure. Conclusion: Combined infusions of lignocaine-ketamine resulted in significant reduction in pain and disability in patients with fibromyalgia. Higher and repeated doses seem to be more effective and resulted in longer pain relief. Long-term follow-up periods are needed to determine the effectiveness, dose response and safety of these infusions as a therapeutic modality for fibromyalgia.

A guide to vertigo

Assessing a dizzy patient in primary care can be challenging. The richness of human vocabulary and use of terms such as ‘wobbly’, ‘woozy’ or ‘lightheaded’ often present the first challenge of identifying true vertigo. This can make eliciting which of a wide variety of disease processes may be causing symptoms a confusing process. True vertigo is considered a perception of movement in the absence of said movement – this is often, but not exclusively a rotating or swaying sensation. In this article we will cover how to approach a patient with suspected vertigo, including key discriminators in the history and examination that can help make a diagnosis. We will also cover treatment of the conditions causing vertigo, while considering other conditions that may cause other forms of dizziness.

Benign paroxysmal positional vertigo : Typical and unusual clinical findings

Benign paroxysmal positional vertigo (BPPV) is the most frequent form of vertigo seen in patients attending emergency departments. Leading symptoms are short attacks of vertigo provoked by head or body rotations. BPPV is caused by small calcium crystals, so-called otoconia, which are dislocated from the macula of the utricle mostly into the posterior semicircular canal. Free floating otoconia can move under the influence of gravity inside the semicircular canal (canalolithiasis) or adhere to the cupula (cupulolithiasis) causing displacement of the cupula. This results in positional nystagmus, whose directions and time courses are characteristic for the affected semicircular canal and the underlying cause. In recent years, however, anumber of cases were reported, in which direction and times course of nystagmus differed from typical clinical findings. This may cause diagnostic problems.

Falls in the elderly due to vestibular dysfunction: clinical and pathogenetic aspects

This article discusses the clinical features and causes of falls in the elderly due to vestibular dysfunction. The sociomedical significance of this problem is emphasized. Almost 50% of older people who have suffered repeated falls have a restriction of physical activity because of psychological reasons (fear of repeated falls). The most common cause of falls is balance disorders, and the corresponding complaint in patients with falls is vertigo. The description of peripheral and central forms of vertigo is provided. The clinical and pathogenetic aspects of these disorders are considered. It emphasizes that research conducted in recent years using methods of functional neuroimaging has significantly advanced our understanding of the mechanisms of functioning of the vestibular system, especially its central parts. Based on the results of studies aimed at studying the human connectome in patients with cochleovestibular disorders, the significance of multimodal sensory integration disorders with this pathology is shown.

Dizziness and nausea vomitting induced by ropinirole therapy in an elderly patient with Parkinson’s disease : a case report

Background: Ropinirole is a non-ergoline dopamine agonist drug that is widely used in a therapy for patients diagnosed with Parkinson’s disease. In long-term use, several published studies have mentioned the occurrence of side effects of ropinirole in the therapy of Parkinson’s disease, but there has been no case report on the occurrence of side effects in the form of dizziness and nausea-vomiting, especially in Indonesia. Case Presentation: This case study reported the occurrence of side effects in the form of dizziness and nausea-vomiting experienced by a 74-year-old elderly who was undergoing a treatment in a hospital in Indonesia. The patient was diagnosed with Parkinsons 8 months ago and has been given a combination therapy of levodopa-benserazide and trihexyphenidyl. During such period, no side effects occurred. The therapy was then supplemented with 2 mg ropinirole because the patient complained that his hand started shaking again. Some side effects arose after the addition of 2mg ropinirole; therefore, the side effects were thought to be associated with ropinirole. The assessment methods used were the time-series data collection followed by causality analysis using the Naranjo Scale. The analysis showed a score of 6, indicating Probable. Based on the literature review, side effects such as nausea and vomiting may occur due to the activation of dopamine D2 receptors in the Chemoreceptor Trigger Zone (CTZ) area. The CTZ area consists of several receptors, which are sensitive to the causative agent of emesis and produce information on the vomiting center that has a role in triggering the vomiting reflexes.Conclusion: Analysis using Naranjo Scale shows a score of 6 which indicates a probable association between dizziness, nausea-vomiting and ropinirole in an elderly patient with Parkinson’s Disease.Keywords: ropinirole, Parkinson, case report, elderly, side-effects

Hypertension and Dizziness: is there a Relation?

One of the most frequent complaints of patients with hypertension (HT) is dizziness. Dizziness is understood as a variety of subjective sensations that patients define as “dizziness” – a sense of instability when walking, the illusion of rotation of surrounding objects, the feeling of approaching fainting, the inability to concentrate, and “fog” in the head. Experts share the systemic dizziness (vertigo) and non-systemic. The causes of vertigo in most cases are diseases of the inner ear (Meniere's disease, benign paroxysmal positional vertigo [BPPV], vestibular neuronitis. The most common form of dizziness is psychogenic dizziness. In the vast majority of cases, HT is not the cause of dizziness. The most common cause of vestibular (systemic) dizziness in patients with HT, as in the general population, is BPPV, and the most common cause of non-systemic dizziness is psychogenic dizziness. Among other causes of dizziness in patients with HT should be kept in mind too fast and/or intensive lowering of blood pressure, rhythm and conduction disorders, orthostatic hypotension (especially in elderly and senile patients in the presence of concomitant diabetes).

Diagnosis and current therapy of vestibular syndromes

Vertigo and dizziness are with an annual incidence of more than 10% and a lifetime prevalence of more than 30% among the most frequent symptoms. The keys to the diagnosis are the patient history and the bedside examination: a) for the patient history the time course, type and triggers of symptoms and accompanying symptoms, b) for the clinical examination of the vestibular system the head-impulse test (HIT), the examination for a spontaneous nystagmus, a displacement of subjective visual vertical, a positional nystagmus and the Romberg test, and c) for the differentiation between an acute peripheral and central vestibular lesion the skew deviation, central fixation nystagmus, gaze-evoked nystagmus, saccadic smooth pursuit and a normal HIT. The various forms of vertigo are treated with pharmacological therapy, physical therapy, psychotherapeutic measures and, rarely, surgery. For pharmacotherapy there are basically eight groups of drugs that can be used: anti-emetics, -inflammatory, -menières, -migraineous medications, anti-depressants, -convulsants, aminopyridines and acetyl-DL-leucine, however, with a currently often low level of evidence.

A specialized approach to diagnosing and treating vertigo

Vertigo is one of the most common reasons for visits to physicians of different specialties. Thorough collection of history data and neurovestibular examination by a set of simple clinical tests are of great importance for the diagnosis of diseases of the vestibular system. The paper gives an update on the principles of diagnosis of different forms of vertigo, diagnostic errors, and treatment of major diseases manifesting by vertigo. The authors present their own data concerning the diagnosis and treatment of the most common vestibular disorders, such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuronitis, and postural phobic instability. They also describe a clinical case of a female patient with vestibular neuronitis, in whom a specialized examination (neurovestibular examination, videonystagmography, and caloric testing) could identify right labyrinthine hypofunction that could not be detected prior to the examination in the clinic.

Is the flumazenil administration diagnosis or treatment? Two case reports

Benzodiazepine has the central nervous system (CNS), cardiac and respiratory side effects when intaked more than therapeutic doses. Acute benzodiazepine poisoning may be manifest taken in the form of dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, hypotension, bradycardia, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Alprazolam is the most toxic form of benzodiazepines and unless combined with the other CNS depressants such as barbiturates and alcohol, death is rare. When benzodiazepine intoxication is suspected, the next step is flumazenil administration to reverse the CNS and respiratory system depression. In this case report, we aimed to point to the diagnosis and treatment of benzodiazepine intoxications by representing two intoxicated patients with coma. J. Exp. Clin. Med., 2013; 30:395-397

Utriculusfunktion

For vestibular disorders competence in otorhinolaryngology (ENT) is required to diagnose disorders in the complete vestibular system. It seems difficult, however, to evaluate otolithic functions although the influence and importance regarding vestibular dysfunction could be relevant. Currently it is possible to unilaterally diagnose different functions of the saccule by recording cervically registered vestibular evoked myogenic potentials (c-VEMP). Partial functions of the utricle can be checked through the so-called turn-over manoeuvre during thermal examination, a gravitation-dependant caloric examination. Ocular recorded VEMPs and registration of the subjective visual vertical (SVV) are further tools for the discrimination of utricular function. This paper evaluates whether the results using these diagnostic tools are in agreement for distinct ENT-relevant vestibular disorders. In this study 100 unselected patients attending the vestibular outpatient department of the tinnitus clinic Dr. Hesse in Bad Arolsen and who were suffering from various forms of dizziness were consecutively and prospectively examined. In addition to standard diagnostic examinations (i.e. caloric testing, rotary chair, optocinetics and posturography) the turnover manoeuvre during caloric testing, o-VEMP recording and registration of the SVV were also performed. For 62% of the patients all 3 methods that measure partial functions of the utricle concurred. For an additional 6% the results of the turnover manoeuvre and o-VEMP matched. The most conformity, with respect to sufficient utricular function was found for patients with non-vestibular dizziness, psychogenic vertigo and for the majority of patients with Menière's disease. In the context of specific vestibular examinations it is possible to test utricular function through o-VEMO recordings and the turnover manoeuvre during caloric (cold) testing which allow clear conclusions especially with sufficient (positive) function. With 68% conformity between o-VEMP and the turnover manoeuvre it is obvious that both tests give strong indications for possible utricular dysfunction but do not give complete proof alone. The SVV is easy to register but is discriminating for utricular function only in cases of acute disorders.

Schwindel aus psychosomatischer Sicht

Somatoform dizziness is one of the most frequent forms of dizziness besides vestibular neuritis and benign peripheral positional vertigo. Due to false diagnoses patients often suffer from the symptoms for months and even years and because of this the working and private activities are severely restricted. An early interdisciplinary diagnosis is very important and a specific psychosomatic therapy should be started as early as possible. Somatoform dizziness can be due to a variety of mental or psychosomatic disorders. It can occur without a preceding peripheral vestibular disorder (primary somatoform dizziness) or it can develop after a peripheral vestibular disorder (secondary somatoform dizziness). The clinical symptomatology, diagnosis and differential diagnosis are described and illustrated by clinical vignettes. Risk factors and preventive measures are briefly summarized.

Anxiety in a Dizzy Patient

Most patients with dizziness have a benign self-limited condition, often of labyrinthine origin; however, some develop a more intractable form of dizziness that can be challenging to evaluate. In many of these patients, brain imaging, vestibular testing, and clinical examination are normal, but the patient is significantly impaired. Many such patients have coexisting anxiety, which can make it difficult to determine whether the anxiety is a reaction to the dizziness or its primary cause. A careful history, including an assessment of the impact of symptoms on quality-of-life, social, and work-related issues is critical, and effective patient communication is essential. The following case exemplifies how a high-functioning person can become severely limited because of the complex intertwining of several types of dizziness with anxiety.

Cognitive and Physio-Therapies for Positional Vertigo Disorders

The common cause of persistent vertigo is affective in 2.4% of the universal population. Benign paroxysmal positional vertigo is produced when calcium carbonate material originating from the macula of the utricle falls into one of the semicircular canals. Due to their density relative to the endolymph, they move in response to gravity and activate excitation of the ampullary nerve of the exaggerated canal. This, in turn, produces a burst of vertigo connected with nystagmus unique to that canal. Recognition of this condition is important not only to avert expensive and often unnecessary testing, but also to easily, rapidly, and effectively treatment 90% of cases. Two well-established methods of treating BPPV form the basis for this project. By making people conscious of the phenomenon, helping them to cognitive choices, and brining awareness in humans and finding the symptoms and proactive measures to diminish the risk of positional vertigo. In forms of vertigo, where the inner ear has suffered damage and the function of that ear is fixed, not changing over time, physical therapy and behavioral therapy can be quite helpful. When the inner ear is damaged, people commonly experience severe spinning for several days. If after several weeks the person still has a loss of balance, then physical therapy can help restore this balance. The reason physical therapy and Behavioral therapy which is helpful to train the brain to compensate for the loss of function in the ear. Just as we can make a muscle stronger by exercising it, you can make the balance system in the brain work better by exercising it. The paper will give indispensable knowledge and understanding of vertigo and its effective treatment techniques. Keywords - Vertigo, paroxysmal, , nystagmus, utricle, inner ear.

Évolution et surveillance des patients grévistes de la faim : expérience d’une unité hospitalière sécurisée interrégionale

Purpose A hunger strike is a voluntary fast, performed to protest publicly against an issue deemed unfair. In the case of French prisoners, hospitalization in an interregional hospital secured units (UHSI) may be necessary. Methods A retrospective epidemiological study based on one UHSI medical records was performed on the period of May, 2006 to December, 2008, and focused on symptoms, outcomes and ethical problems encountered. Results Seven men and one woman with a mean age of 32.6 years were hospitalized in an UHSI, with nine episodes of hunger strike of a median duration of 57 days. Clinical symptoms began after two weeks of voluntary deprivation in the form of dizziness, weakness, muscle pain and headache. Laboratory tests showed hypoglycemia (< 0.4 g/L) on admission, 16.3% decrease of albumin after 40.5 days, and dehydration in case of thirst strike. The clinical tolerance was good and no patient presented Wernicke's encephalopathy. A diabetic patient developed acidocetosis during two hunger strikes. All hunger strikes were respected by medical staff, and treatment was based upon surveillance of symptoms, vitamin B and sweetened drinks administration and explanations of the clinical hazards on a daily basis. Conclusion The special problem encountered in the medical management of these strikers was to convince them to accept treatments in order to avoid a coercive life-saving treatment as requested by French law.

Basic problems in the diagnosis and treatment of vestibular vertigo

The paper describes the basic problems in the diagnosis and treatment of diseases accompanied by vertigo. In particular, it discusses the specific features of vertigo terminology, the overestimation of the value of cerebrovascular diseases and degenerative cervical spine changes in the development of vertigo and the underestimation of a role of peripheral vestibular diseases and psychogenic disorders in the genesis of different forms of vertigo. Emphasis is placed on the importance of vestibular exercises in the complex treatment of diseases manifesting themselves as vertigo. In addition, the possibilities of drug-induced stimulation of vestibular compensation are discussed.

Challenges in Neuro-Otology

This article provides an overview of the current methods of diagnosis and treatment of patients with vertigo, dizziness, or imbalance, as well as an analysis of ongoing problems besetting the field of neuro-otology. Aims and challenges are also described with the hope of stimulating basic and clinical research on these very frequent symptoms. Vertigo and dizziness are among the most frequent symptoms that patients experience at some time in their lives. With a lifetime prevalence of about 30% and an annual incidence that increases with age, vertigo and dizziness will become even more important in the future. Despite this high prevalence and burden of disease, considerable challenges remain. Most patients with acute vertigo and dizziness are uncertain who to consult, because their problem lies inbetween the specializations of ear, nose, and throat (ENT) and neurology, and in some cases, ophthalmology, internal medicine, or psychiatry. While neurologists are very familiar with the anatomy, physiology, and pathophysiology of the central nervous system (central vestibular and ocular motor systems), ENT physicians specialize in the peripheral vestibular and audiological systems. However, very few have detailed knowledge of both the central and peripheral systems. Moreover, most ENT physicians practice mainly as ENT surgeons, and therefore, they are not necessarily specialists on vertigo and dizziness. With a few exceptions (South Korea, and some centers in the USA, UK, and Australia) cooperation between neurology and ENT as well as neuro-otology and oto-neurology is far from perfect. The underlying diseases resulting in vertigo and dizziness cover a broad spectrum of anatomical structures. Possible etiologies include ischemia, infection, autoimmune disorders, mechanical inner ear disorders, psychosomatic, and somatoform disorders. Therefore, the approach to patients requires a broad-based knowledge of anatomy, physiology, pathophysiology, and pharmacology as well as in-depth practical experience with the different methods available for evaluating the vestibular and ocular motor systems. Medical education in neuro-otology is also less than optimal. The problem begins in Medical School, where the vestibular and ocular motor systems are assumed to be among the most complicated anatomical and physiological systems of humans. Therefore, most medical students are not attracted to this field, which may also explain their limited knowledge of the subject. This downward trend continues during post-graduate training for most neurologists and ENT physicians, and is further exacerbated by the above-mentioned overlapping of the two disciplines. Moreover, to establish a correct diagnosis, physicians must examine the vestibular, audiological, and ocular motor systems. Furthermore, many physicians have difficulties examining the ocular motor system and ultimately interpreting their findings. What is pathological and what do the findings mean? Thus, topographical anatomical diagnosis remains a challenge: it is imperative to be able to discriminate between peripheral and central vestibular lesions is imperative. The link between basic physiology and the modeling of the vestibular and the ocular motor systems, on the one hand, and their clinical implications and applications, on the other, are far from ideal. While we know the detailed workings of the vestibular and ocular motor systems and can model their function and dysfunction, this knowledge has not yet been fully integrated in clinical practice. Conversely, clinical findings have to be linked with basic knowledge in order to stimulate the knowledge of physiology and the modeling of these systems. State-of-the-art randomized controlled clinical trials on the frequent causes of vertigo and dizziness as well as their underlying disorders are still lacking. This is true for phobic postural vertigo, vestibular migraine, Meniere's disease, vestibular paroxysmia, downbeat and upbeat nystagmus, episodic ataxia, and perilymphatic fistula. The number of studies available on the impact of vertigo and dizziness, as well as impaired vestibular function on patients’ quality of life and functioning are limited. Long-term studies on the natural course of the different forms of vertigo, their recurrence rates, or the long-term efficacy of available treatments are non-existent. This is true for most forms of vertigo and dizziness. In brief our growing knowledge of the anatomy and physiology of the vestibular and related ocular motor systems, as well as basic and clinical research must still overcome a number of shortcomings and limitations to improve diagnosis, develop new diagnostic criteria, and better understand the pathophysiology of these disorders. Hopefully, new treatment strategies and state-of-the-art prospective clinical trials will improve the quality of life and functioning in patients with vertigo and dizziness.

Postural Orthostatic Tachycardia Syndrome: A Rare Complication Following Electrical Injury

We report on two previously healthy patients who developed severe form of postural orthostatic tachycardia syndrome (POTS) following an electric injury. Both the patients developed symptoms of orthostatic intolerance in the form of dizziness, fatigue, lightheadedness, and palpitations, weeks to months after electrical injury. Orthostatic intolerance produced considerable functional impairment in these patients. Early recognition of POTS when it occurs after an electrical injury allows for prompt evaluation and management to occur.