Vertigo Syndromes Research Articles

Identifying predictors of persistent post-earthquake dizziness among adolescents after the 2023 earthquakes in Türkiye: A cross-sectional, multicenter study

ObjectiveThe impacts of earthquakes on the mental health of individuals have been well-documented. Additionally, individuals frequently report experiencing dizziness akin to seasickness or carsickness. This phenomenon, termed “post-earthquake dizziness syndrome” (PEDS), has garnered increasing attention due to its unclear etiology. This study investigates the prevalence and predictors of ongoing PEDS within an adolescent population more than one year after the 2023 Kahramanmaraş earthquakes. MethodsThis cross-sectional study was conducted between April 2024 and June 2024 across five cities officially designated as an “earthquake zone” by relevant authorities. The sample comprised 551 adolescents aged 11 to 18 years who were recruited from child psychiatry outpatient clinics within these cities. Results402 participants (73.0 %) reported experiencing PEDS following the earthquake, while 105 (19.1 %) reported ongoing PEDS. Multivariate logistic regression analysis revealed that higher trait anxiety and post-traumatic stress disorder (PTSD) symptoms, as well as being located on a higher floor during the earthquake, were positively correlated with the persistence of PEDS symptoms. ConclusionsThe findings underscore the potential association between PEDS and psychiatric disorders, such as anxiety and PTSD. However, the underlying mechanisms of PEDS remain elusive, requiring further research to elucidate the links between PEDS and psychiatric conditions for more effective treatment strategies.

Use of the Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment to aid differential diagnosis in acute vestibular syndrome in the hyperacute stroke setting.

Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment is a clinical bedside test used to aid diagnosis. Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed. Further education was completed with more members of the stroke and emergency department multi-disciplinary team. Quality improvement measures including magnetic resonance imaging use and bed utilisation were explored. Following training of one stroke consultant, the Head Impulse, Nystagmus, Test of Skew assessment was found to be a feasible, accurate bedside test within this acute stroke service. Further training for the multi-disciplinary team was completed, but outcome measures were not explored because of the coronavirus disease 2019 pandemic and maternity leave. There is a role for trained members of the multi-disciplinary team to successfully use the Head Impulse, Nystagmus, Test of Skew assessment in hyperacute stroke settings, to aid diagnosis in acute vertigo syndrome.

RISK FACTORS FOR FALLS IN REHABILITATION OF OLDER PATIENTS WITH OSTEOPOROSIS

Osteoporosis represents a chronic disorder that has highest prevalence in post-menopausal women and predisposes to fragility fractures. A series of factors increase the risk of falls and fractures in women with osteoporosis that undergo rehabilitation programs. The aim of the study was to identify characteristics of risk factors for falls in rehabilitation of older women with osteoporosis. We carried out an observational, retrospective, case-control study on 120 patients with osteoporosis consecutively admitted to National Institute of Gerontology and Geriatrics “Ana Aslan”, patients that have been involved in rehabilitation programs. Only female subjects with osteoporosis and undergoing rehabilitation programs have been considered. A series of risk factors for falls had a higher prevalence in older women and the difference from adult subjects reached statistical significance: presence of neurocognitive deficit, of cardiovascular disorders, vertigo syndrome, visual disorders, concomitant use of at least 7 medicines that increase the risk of falls and concomitant presence of at least 4 chronic disorders. Other risk factors for falls had also a high prevalence in older subjects, but the difference from adult women did not reach statistical significance: degenerative disorders of weight bearing joints and depression. A special attention is warranted for women with osteoporosis that are involved in rehabilitation program, particularly taking into account the risk factors that have a significantly higher prevalence in this age group. Keywords: risk of falls, osteoporosis, older people, rehabilitation.

Subgroups of High-Cost Patients and Their Preventable Inpatient Cost in Rural China.

High-cost patients account for most healthcare costs and are highly heterogeneous. This study aims to classify high-cost patients into clinically homogeneous subgroups, describe healthcare utilization patterns of subgroups, and identify subgroups with relatively high preventable inpatient cost (PIC) in rural China. A population-based retrospective study was performed using claims data in Xi county, Henan province. 32 108 high-cost patients, representing the top 10% of individuals with the highest total spending, were identified. A density-based clustering algorithm combined with expert opinions were used to group high-cost patients. Healthcare utilization (including admissions, length of stay, and outpatient visits) and spending characteristics (including total spending, and the proportion of PIC, inpatient and out-of-pocket spending on total spending) were described among subgroups. PIC was calculated based on potentially preventable hospitalizations (PPHs) which were identified according to the Agency for Healthcare Research and Quality Prevention Quality Indicators algorithm. High-cost patients were more likely to be older (Mean=51.87, SD=22.28), male (49.03%) and from poverty-stricken families (37.67%) than non-high-cost patients, with 2.49 (SD=2.47) admissions and 3.25 (SD=4.52) outpatient visits annually. Fourteen subgroups of high-cost patients were identified: chronic disease, non-trauma diseases which need surgery, female disease, cancer, eye disease, respiratory infection/inflammation, skin disease, fracture, liver disease, vertigo syndrome and cerebral infarction, mental disease, arthritis, renal failure, and other neurological disorders. The annual admissions ranged from 1.83 (SD=1.23, fracture) to 12.21 (SD=9.26, renal failure), and the average length of stay ranged from 6.61 (SD=10.00, eye disease) to 32.11 (SD=28.78, mental disease) days among subgroups. The chronic disease subgroup showed the largest proportion of PIC on total spending (10.57%). High-cost patients were classified into 14 clinically distinct subgroups which had different healthcare utilization and spending characteristics. Different targeted strategies may be needed for subgroups to reduce preventable hospitalizations. Priority should be given to high-cost patients with chronic diseases.

Hidrocefalus - prikaz slučaja

Hydrocephalus is a pathological condition with many variations which is always characterized by an increase in cerebrospinal fluid that is or has been under increased pressure, and it can occur at any age. It is displayed as different neurological and psychiatric conditions. The most important symptoms in adults are dizziness, cognitive decline, dementia, gait apraxia, and problems with bladder control. This paper presents the case of an elderly person with hydrocephalus. A 74-year-old male patient contacted the doctor of the Healthcare Center because of dizziness, instability when walking or climbing stairs. There is also forgetfulness, poor concentration, and weaker urination control. Orientation neurological examination showed a wide-based gait, with positive Romberg's sign with eyes closed. He was referred to a neurologist with a questionable diagnosis of vertigo syndrome R 42.0. After neurological and radiological examinations, the diagnosis of communicating, normotensive hydrocephalus was confirmed and the patient underwent neurosurgical intervention. The therapeutic approach to this condition depends on age, clinical findings, and comorbidities and is determined individually for each patient. Surgery takes the main place in therapy because by installing a shunt, a rapid reduction of symptoms is achieved. The role of the selected doctor is to implement all aspects of treatment and care based on anamnestic data, and clinical examination according to the diagnostic algorithm, to improve the functional status and quality of life of these patients and their families.

The Clinical Study of Anti-Anxiety Drugs on Different Types of Vertigo Syndromes

The Clinical Study of Anti-Anxiety Drugs on Different Types of Vertigo Syndromes

Animal models of balance pathologies: New tools to study peripheral vestibulopathies

The different types of peripheral vestibulopathies (PVs) or peripheral vestibular disorders (PVDs) are essentially diagnosed on the basis of their clinical expression. The heterogeneity of vestibular symptoms makes it difficult to stratify patients for therapeutic management. Animal models of PVs are a good mean to search for clinical evaluation criteria allowing to objectively analyze the kinetics of expression of the vertigo syndrome and to evaluate the benefits of therapeutic strategies, whether they are pharmacological or rehabilitative. The question of the predictability of these animal models is therefore crucial for the identification of behavioral and biological biomarkers that could then be used in the human clinic. In this review, we propose an overview of the different animal models of PVs, and discuss their relevance for the understanding of the underlying pathophysiological mechanisms and the development of new and more targeted therapeutic approaches.

Phenotypes, bedside examination, and video head impulse test in vestibular migraine of childhood compared with probable vestibular migraine and recurrent vertigo in childhood.

Vestibular impairment and vertigo in the pediatric population have an estimated prevalence ranging between 0.4% and 5.6% and are a topic of interest in recent years. The Bárány Society has recently reclassified migraine-related vertigo syndromes as vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (probable VMC), and recurrent vertigo of childhood (RVC). Applying the criteria established by the Bárány Society, we retrospectively analyzed data on 95 pediatric patients suffering from episodic vertigo that were recruited from 2018 to 2022. In applying the revised criteria, 28 patients had VMC, 38 had probable VMC, and 29 had RVC. Visuo-vestibular symptoms (external vertigo) or internal vertigo were reported by 20 of 28 VMC patients (71.4%) compared to 8 of 38 probable VMC patients (21%) (P < .001). None of the RVC patients reported external vertigo. Duration of vertigo was demonstrably longer in the VMC patients than in the probable VMC (P < .001) and RVC (P < .001) patients. Cochlear symptoms were reported by 28.6% of VMC patients and by 13.1% of probable VMC patients. No cochlear symptoms were reported by any RVC patients. Familial cases for headache and episodic vertigo showed no significant difference between groups. The most frequent finding during bedside examination in all three groups was central positional nystagmus. Differences in the duration of attacks and in accompanying symptoms may underline different pathophysiological mechanisms.

Stroke and peripheral vestibulopathy as a part of acute vestibular syndrome

The scope of the review is the problem of differential diagnosis between stroke and peripheral vestibulopathy in patients with acute vestibular vertigo. A vertebrobasilar stroke manifesting with the isolated vertigo has been previously recognized to be extremely rare, and the symptoms have been related to the involvement of peripheral parts of the vestibular analyzer. Recently there has been growing evidence that the isolated vertigo syndrome is commonly related to the central involvement of the vestibular analyzer. The author presents published clinical cases of acute cerebrovascular accident with a single symptom of acute vestibular vertigo. It can be also a symptom of a hemispheric stroke due to an injury of vestibular pathways connecting the vestibular nuclei with the parietal cortex. These observations extend the understanding of the common classic pathognomonic picture of central vestibular vertigo, which implies that its development is related exclusively to the brain matter lesion in vestibulobasilar stroke.&#x0D; Current clinical rating scales and tests (NIHSS, FAST) used for the diagnosis of an acute stroke, are frequently not sensitive to the vertebrobasilar stroke, and neuroimaging, including brain magnetic resonance imaging at DWI mode, may give false negative results. The most informative differential diagnostic method in acute vestibular syndrome is an otoneurological assessment including identification of nystagmus characteristics and head turn impulse test, for the assessment of vestibuloocular reflex and at bed tests (for example, tests included into the HINTS PLUS protocol). In this regard, it is important that neurology specialists in regional vascular centers and departments for acute cerebrovascular care should master the otoneurological assessment skills.

Vestibular, Central, and Non-Vestibular Etiologies of Vertigo and Disequilibrium: A Rural Hospital-Based Cross-Sectional Comparative Analysis.

Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin. A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo. Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps. The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium."Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.

Instrumental and Non-Instrumental Measurements in Patients with Peripheral Vestibular Dysfunctions.

Vestibular dysfunction is a disturbance of the body's balance system. The control of balance and gait has a particular influence on the quality of life. Currently, assessing patients with these problems is mainly subjective. New assessment options using wearables may provide complementary and more objective information. Posturography makes it possible to determine the extent and type of posture dysfunction, which makes it possible to plan and monitor the effectiveness of physical rehabilitation therapy. This study evaluates the effectiveness of non-instrumental clinical tests and the instrumental mobile posturography MediPost device for patients with unilateral vestibular disorders. The study group included 40 patients. A subjective description of the symptoms was evaluated using a questionnaire about the intensity of dizziness using the Dizziness Handicap Inventory (DHI) and Vertigo Syndrome Scale-short form (VSS-sf). The clinical protocol contained clinical tests and MediPost measurements using a Modified Clinical Test of Sensory Interaction on Balance. All patients underwent vestibular rehabilitation therapy (VRT) for four weeks. The non-instrumental measurement results were statistically significant, and the best was in the Timed Up and Go test (TUG). In MediPost, condition 4 was the most valuable. This research demonstrated the possibilities of using an instrumental test (MediPost) as an alternative method to assess balance.

针刺治疗颈性眩晕研究进展

针刺治疗颈性眩晕研究进展

What Predictability for Animal Models of Peripheral Vestibular Disorders?

The different clinical entities grouped under the term peripheral vestibulopathies (PVs) or peripheral vestibular disorders (PVDs) are distinguished mainly based on their symptoms/clinical expression. Today, there are very few commonly accepted functional and biological biomarkers that can confirm or refute whether a vestibular disorder belongs to a precise classification. Consequently, there is currently a severe lack of reliable and commonly accepted clinical endpoints, either to precisely follow the course of the vertigo syndrome of vestibular origin or to assess the benefits of therapeutic approaches, whether they are pharmacological or re-educational. Animal models of PV are a good means to identify biomarkers that could subsequently be exploited in human clinical practice. The question of their predictability is therefore crucial. Ten years ago, we had already raised this question. We revisit this concept today in order to take into account the animal models of peripheral vestibular pathology that have emerged over the last decade, and the new technological approaches available for the behavioral assessment of vestibular syndrome in animals and its progression over time. The questions we address in this review are the following: are animal models of PV predictive of the different types and stages of vestibular pathologies, and if so, to what extent? Are the benefits of the pharmacological or reeducational therapeutic approaches achieved on these different models of PV (in particular the effects of attenuation of the acute vertigo, or acceleration of central compensation) predictive of those expected in the vertiginous patient, and if so, to what extent?

MEASUREMENT OF CORRELATION BETWEEN DIZZINESS HANDICAPPED INVENTORY AND PURE TONE AUDIOMETRY FOR EARLY DIAGNOSIS OF MENIERES DISEASE

Background: Menieres Disease (MD) is a chronic, non-life threatening inner ear disease, with attacks of disabling vertigo, progressive hearing loss, and tinnitus as the major symptoms. All three symptoms, separately or in combination, cause great distress and have a considerable impact on the quality of life of the patients. Objective: Aim of this study was to find out whether subjective assessment or objective assessment will be significant towards diagnosis of early Menieres disease and to find out early diagnosis of Menieres disease by comparision between Dizziness Handicapped Inventory (DHI) &amp; Pure tone audiometry. Materials and Methods: This hospital-based retrospective study was carried out at Al Ameen Medical College Hospital, Vijayapur, Karnataka, India. The study population was composed of 93 subjects referred to the audiology department of the ENT Hospital in 01 year period, between May 2021 to April 2022. All 93 subjects underwent the following diagnostic procedures: Collecting detailed clinical history, complete neuro-otological bedside examination and pure-tone audiometry. The inclusion criteria are the presence of complete symptoms compatible with MD (tinnitus, hearing loss and vertigo) associated by documented unilateral sensorineural hearing loss. The exclusion criteria are: incomplete presentation complete presentation associated to conductive, mixed or retrocochlear hearing loss complete presentation, characterized by vertigo syndromes that are not compatible for clinical features and duration for MD. Other clinical exclusion criteria are tympanic perforations, active infections, inflammatory and non-inflammatory stenosis (exostoses, osteomas). Dizziness handicapped inventory was utilized for subjective assessment of Menieres disease whereas Pure tone audiometry was utilized for objective assessment of Menieres disease. In the DHI questionnaire, the patient answered yes, sometimes or no to each question and the strength of the responses were designated with numeric values of 0, 2, and 4. The questionnaire had 25 items, such that the total score ranges from 0 to 100, with a higher score indicating a higher handicap. The relevant data was collected using a pre-tested pro-forma and after collection it was entered in Microsoft Excel to maintain the quality of data. Result:In our study, Forty-five (48.4%) patients were male, 48 (51.6%) were female and the mean age was 48.9±12.1 years. The mean duration of MD was 5.6±4.7 (min: 10 months max: 14 years) years.The means of 0.5-2 kHz air conduction thresholds (dB HL) for unilateral MD in Pathological ear and Healthy ear were 46.8±21.4 and 15.6±13.9, respectively. Speech discrimination scores (%) for unilateral MD in Pathological ear and Healthy ear were 71.5±23.6 and 93.7±6.3, respectively. The mean scores for Physical subscore, Emotional subscore and Functional subscore as per Dizziness Handicap Inventory among the study population was 15.93±8.91, 7.3±4.78 and 16.62±8.85, respectively. The total mean score for all 25 items of DHI was 38.8±19.5. Conclusion: In our study, There was a significant relationship between pure tone audiometry and DHI for some variables. As a part of a clinical follow-up tool for patients with MD, the DHI is a valid, early and reliable health-related, disease-specific QoL scale.

Vestibular Migraine.

To explore recent developments in vestibular migraine (VM). This review discusses the current diagnostic criteria for VM in the adult and pediatric populations, as proposed by the International Headache Society and Bárány Society. Recent VM studies confirm the prior findings and reveal new insights, including the wide range of vestibular symptoms, symptoms in the attack-free period, and triggers. Many patients experience persistent vestibular symptoms, even in the absence of acute attacks, which often significantly impact patients' quality of life. The syndrome of benign recurrent vertigo and its relationship to migraine, VM, and Meniere's disease is also discussed. There is a dearth of randomized controlled trials in VM treatment. Prospective and retrospective studies support the benefit of many migraine treatments are effective in VM, including neuromodulation, and calcitonin gene-related peptide monoclonal antibodies. VM affects almost 3% of the population, but remains under-diagnosed. Recent diagnostic criteria can help clinicians diagnose VM in adults and children.

Dependent head posture dizziness syndrome: a case report

Dizziness is a symptom frequently encountered in clinical settings and requires a comprehensive differential screening process. The dizziness types commonly referred to rehabilitation are peripheral and central vestibular disorders, vestibular hypofunction, and cervicogenic dizziness. While cervicogenic dizziness continues to present as a diagnosis of exclusion, there is some agreement that cervical mobility is important to maintain vestibular integrity. This case report highlights the importance of cervical mobility in the maintenance of balance and equilibrium. Consequently, its lack thereof, in causing dizziness, is also described. While the relevance of cervical hypomobility to dizziness has been previously described, the possible correlation between cervical hypomobility and dependent postures of the semicircular canals is brought to light. Functional and postural compensations caused by cervical hypomobility which may in turn favor potential otoconia displacement, is described as a speculation. A case study relevant to this speculation is presented. Further research is needed to support and validate this speculation. The importance of restoring functional cervical mobility during routine vestibular rehabilitation is emphasized.

Hormones and Vestibular Disorders: The Quest for Biomarkers.

The vestibular system exerts control over various functions through neural pathways that are not yet fully mapped. Functional dysregulations or tissue lesions at different levels of the peripheral and the central vestibular networks can alter these different functions, causing a wide variety of symptoms, ranging from posturo-locomotor alterations to psychiatric syndromes such as PPPD, including the deregulation of the main biological functions. These different symptoms differ by their expression kinetics (they each appear and regress with their own kinetics) by the targets affected (muscles, organs, and brain areas) and by the sensitivity specific to each individual. Vestibular pathologies thus cover a mosaic of distinct effects, and they involve various effectors—which constitute the many markers of their different types and stages. It is therefore crucial, to predict the onset of a vertigo syndrome, to follow its temporal course, or to monitor the impact of therapeutic approaches, and to have specific and reliable biomarkers. Hormonal variations are among the possible sources of biomarkers for neurotology. We know that specific hormonal profiles can promote the appearance of vestibular disorders. We also know that the expression of vertigo syndrome is accompanied by measurable hormonal variations. The link between endocrine deregulation and vestibular alterations therefore no longer needs to be proven. However, there are still few data on their precise correlations with the vertigo syndrome. This study was undertaken with the aim to deliver an extensive review of the hormonal alterations linked to vestibular disorders. A review of the literature covering the last two decades was carried out using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system or vestibular pathologies and hormones. Bibliographic data provides several outcomes in terms of therapeutic innovation in the diagnosis and therapeutic follow-up of vestibular pathologies.

AB211. SOH22ABS077. Intratympanic dexamethasone injection for tinnitus

Background: Tinnitus affects over 60% of people at some stage of their lives and are often short-lived. A small cohort of patients experience intractable debilitating tinnitus, unrelated to hearing loss or vertigo syndromes. Management strategies include tinnitus masking techniques, cognitive behavioural therapy, and more recently, neuromodulation. Intratympanic dexamethasone injection for intractable tinnitus has been described although the evidence for such intervention is not strong.

Acute Vertigo Syndrome as an Initial Manifestation of Sepsis-Associated Brain Dysfunction with an High Mortality: A Descriptive Study in ICU

Acute Vertigo Syndrome as an Initial Manifestation of Sepsis-Associated Brain Dysfunction with an High Mortality: A Descriptive Study in ICU

A Study of Etiopathogenesis of Different Vertigo Syndromes

Background: Dizziness or disturbed postural awareness is common presentation in varying age groups. Dizziness can be classified into various types like Rotatory Vertigo, Imbalance/disequilibrium, Pre syncope/Light headedness and Psychogenic. Classically, there are four vertigo syndromes which are most commonly accepted among Otolaryngologists. However, cervicogenic vertigo is missing from the list of these vertigo syndromes. This study aims to assess the etiological factors for vestibular and central vertigo and other non-vestibular forms of vertigo and dizziness.&#x0D; Methodology: This will be a prospective observational study conducted in the Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Wardha. About 75 patients presenting with symptoms of dizziness, tinnitus with associated nausea vomiting in the out-patient department will be included in this study. Patients will undergo clinical examination including Special Clinical Tests for vertigo like Dix-Hall pike Manoeuvre, Tandem walking and Dysdiadokokinesis. Collected data will be fed to appropriate statistical programme and analysed.&#x0D; Expected Results: Relevant data on different etiopathogenic causes of vertigo will be obtained.&#x0D; Conclusion: Better understanding of the various etiologies of various vertigo syndromes, their associations in various age groups and systemic diseases help better treatment outcomes.