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Choi JY, Kim S, Boo D, Yoo S, Kim HJ, Kim JY, Lee KJ, Kang J, Kim BJ, Han MK, Bae HJ, Kim JS. Risk of Future Stroke in Patients with a Diagnosis of Peripheral Vertigo in the Emergency Department. Eur J Neurol 2022. [PMID: 36056876 DOI: 10.1111/ene.15543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the temporal characteristics of stroke risks in the emergency department patients who had a diagnosis of peripheral vertigo. We also attempted to reveal the stroke risk factor among those with peripheral vertigo. METHODS This is a parallel group cohort study in a tertiary referral hospital. After assigning each of matched 4367 patients to the comparative set of peripheral vertigo and appendicitis-ureterolithiasis groups and each of matched 4911 to the comparative set of peripheral vertigo and ischemic stroke groups, we evaluated the relative stroke risk. In addition, to predict the individual stroke risk in patients with peripheral vertigo, any association between the demographic factors and stroke events was evaluated in the peripheral vertigo group. RESULTS The peripheral vertigo group had a higher stroke risk than the appendicitis-ureterolithiasis group (HR=1.73, 95% CI=1.18-2.55) but a lower risk than the ischemic stroke group (HR=0.30, 95% CI=0.24-0.37). The stroke risk of the peripheral vertigo group was just below that of small vessel stroke. The stroke risk of the peripheral vertigo group differed markedly by time: higher within seven days, moderate between seven days and one year, and diminished thereafter. Old age (>65), male gender, and diabetes mellitus were the risk factors for stroke in the peripheral vertigo group. CONCLUSION Patients with a diagnosis of peripheral vertigo in the ED showed a moderate future stroke risk so that requires a stroke preventive strategy tailored to the timing of symptom onset and individual risk.
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Affiliation(s)
- Jeong-Yoon Choi
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dachung Boo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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Kwon H, Kwon E, Kim H, Choi J, Kim J. Vestibular syncope: clinical characteristics and mechanism. Ann Clin Transl Neurol 2022; 9:1616-1625. [PMID: 36056529 PMCID: PMC9539380 DOI: 10.1002/acn3.51661] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives Vestibular syncope is a condition in which vertigo‐induced hemodynamic changes cause syncope. This study investigated the clinical and laboratory findings of vestibular syncope and tried to refine our knowledge of the mechanism underlying this newly recognized entity. Methods This study retrospectively analyzed 53 patients (33 women, median age = 63 years [interquartile range = 54–71 years]) with vestibular syncope from January 2017 to December 2021. To explain the mechanism of vestibular syncope, we incorporated a velocity‐storage model into the dual reflex pathways comprising the vestibulo‐sympathetic reflex and baroreflex and predicted the cardiovascular responses. Results Twenty (37.7%) patients had multiple episodes of vestibular syncope, and seven (13.2%) had potentially life‐threatening injuries. Meniere's disease (20.8%) and benign paroxysmal positional vertigo (9.4%) were the most common underlying vestibular disorders. Abnormal vestibular function tests included impaired cervical vestibular‐evoked myogenic potentials (57.5%) and positive head impulse tests (31.0%). Orthostatic hypotension was found in 19.5% of patients. Dyslipidemia (30.2%) and hypertension (28.3%) were common medical comorbidities. The dual reflex pathways incorporating the function of the velocity‐storage circuit in the brainstem and cerebellum suggest that vestibular syncope is a neurally mediated reflex syncope associated with a sudden hemodynamic change during vertigo. This change can be arterial hypertension triggered by a false downward inertial cue, as suggested previously, or hypotension driven by a false upward inertial cue. Conclusions Vestibular syncope is associated with various vestibular disorders and requires careful evaluation and intervention to prevent recurrent falls and significant injuries.
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Affiliation(s)
- Hanim Kwon
- Department of NeurologyKorea University Ansan HospitalAnsanSouth Korea
| | - Eunjin Kwon
- Department of NeurologyChungnam National University HospitalDaejeonSouth Korea
| | - Hyo‐Jung Kim
- Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jeong‐Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of NeurologySeoul National University College of MedicineSeoulSouth Korea
| | - Ji‐Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of NeurologySeoul National University College of MedicineSeoulSouth Korea
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Bogle JM, Benarroch E, Sandroni P. Vestibular-autonomic interactions: beyond orthostatic dizziness. Curr Opin Neurol 2022; 35:126-134. [PMID: 34839339 DOI: 10.1097/wco.0000000000001013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current literature describing vestibular-autonomic interactions and to describe their putative role in various disorders' clinical presentations, including orthostatic dizziness and motion sensitivity. RECENT FINDINGS The vestibular-autonomic reflexes have long been described as they relate to cardiovascular and respiratory function. Although orthostatic dizziness may be in part related to impaired vestibulo-sympathetic reflex (orthostatic hypotension), there are various conditions that may present similarly. A recent clinical classification aims to improve identification of individuals with hemodynamic orthostatic dizziness so that appropriate recommendations and management can be efficiently addressed. Researchers continue to improve understanding of the underlying vestibular-autonomic reflexes with recent studies noting the insular cortex as a cortical site for vestibular sensation and autonomic integration and modulation. Work has further expanded our understanding of the clinical presentation of abnormal vestibular-autonomic interactions that may occur in various conditions, such as aging, peripheral vestibular hypofunction, traumatic brain injury, and motion sensitivity. SUMMARY The vestibular-autonomic reflexes affect various sympathetic and parasympathetic functions. Understanding these relationships will provide improved identification of underlying etiology and drive improved patient management.
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Affiliation(s)
- Jamie M Bogle
- Mayo Clinic Arizona, Department of Otolaryngology - Head and Neck Surgery, Division of Audiology, Scottsdale, AZ, USA
| | | | - Paola Sandroni
- Mayo Clinic Arizona, Department of Neurology, Division of Autonomic Disorders, Scottsdale, AZ, USA
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Abstract
PURPOSE OF REVIEW In the last three decades, the use of eye movements and vestibular testing in many neurological disorders has accelerated, primarily because of practical technologic developments. Although the acute vestibular syndrome is a prime example of this progress, more chronic neurologic and systemic disorders have received less attention. We focus here on recent contributions relating vestibular and ocular motor abnormalities in inflammatory, demyelinating, metabolic, and peripheral nervous system disorders RECENT FINDINGS: Vestibular abnormalities have been identified in acute demyelinating neuropathies (AIDP), in novel genetic mutations responsible for CANVAS (cerebellar ataxia, neuropathy vestibular areflexia syndrome), and in other inherited neuropathies (variants of Charcot-Marie-Tooth disease). In addition, there are differentiating characteristics between the most common CNS demyelinating disorders: multiple sclerosis and neuromyelitis optica (NMO). We summarize new information on Vitamin D metabolism in benign paroxysmal positional vertigo (BPPV), followed by a brief review of the vestibular and ocular motor findings in Wernicke's encephalopathy. We conclude with findings in several paraneoplastic/autoimmune disorders. SUMMARY This literature review highlights the impact of a careful vestibular and ocular motor evaluation in common neurologic disorder, not only for the initial diagnosis but also for monitoring disease and rehabilitation. A careful examination of eye movements and vestibular function, supplemented with new video techniques to quantify the findings, should be part of the standard neurologic examination.
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Liu W, Dong H, Yang L, Zhao H, Dong W, Yang Y. Severity and Its Contributing Factors in Patients With Vestibular Migraine: A Cohort Study. Front Neurol 2021; 11:595328. [PMID: 33391160 PMCID: PMC7772208 DOI: 10.3389/fneur.2020.595328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: As a recently defined disease entity, vestibular migraine (VM) is a variant of migraine with broad spectrum of manifestations. We evaluated a prospective cohort of patients with VM in two centers to assess severity of VM attacks and investigate its contributing factors in patients with VM. Methods: Adult participants with the diagnosis of VM or probable VM were enrolled according to the 2012 International Headache Society-Bárány Society Criteria. Every outpatient was followed up for 6 months to record the occurrence of VM attacks. Clinical data such as age, sex, number of VM attacks, severity on the visual analog scale, and lipid intake were collected and analyzed. Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Horne and Ostberg Morningness-Eveningness Questionnaires, and Pittsburgh Sleep Quality Index were also administered to find contributing factors. Results: During a 6-month clinical follow-up, 313 VM attack were reported. According to the Visual Analog Scale, the patients were divided into two groups. Then univariate and multivariable analyses were conducted. Among the risk factors, duration of illness (adjusted OR, 1.041; 95% CI, 1.010-1.073; P = 0.009), time of onset: 00:00:00-12:00:00 (adjusted OR, 3.961; 95% CI, 1.966-7.979; P < 0.001) and PSQI scores (adjusted OR, 1.086; 95% CI, 1.002-1.178; P = 0.046) were significantly associated with the severity of VM attack assessed by VAS. Conclusion: The data suggest that patients tended to experienced more severe VM attacks in early hours of a day, especially for those sufferers with longer duration of illness or poor sleep quality. Targeted management of such factors is required to reduce the severity of attacks.
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Affiliation(s)
- Wei Liu
- Departments of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Hongli Dong
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Le Yang
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Hongru Zhao
- Departments of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wanli Dong
- Departments of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Yang
- Departments of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Choi JY, Park YM, Lee SH, Choi J, Hyun SW, Song JM, Kim HJ, Oh HJ, Kim JS. Linear Vertigo in Benign Paroxysmal Positional Vertigo: Prevalence and Mechanism. THE CEREBELLUM 2020; 20:160-168. [PMID: 33015731 DOI: 10.1007/s12311-020-01196-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Abstract
This study aimed to determine the prevalence and mechanism of linear vertigo reported by the patients during the attacks of benign paroxysmal positional vertigo (BPPV). We prospectively evaluated the characteristics (rotational vs. linear) of positional vertigo in 70 patients with posterior and horizontal canal BPPV using a questionnaire allowing multiple choices. In patients with linear vertigo, we further assessed the directionality of linear vertigo. We adopted the velocity-storage model to explain the occurrence and direction of linear vertigo in these patients with BPPV. Patients reported only rotational vertigo in 46 (46/70, 65.7%), only linear vertigo in 10 (14.3%), and both rotational and linear vertigo in 14 (20%). The patients experienced fear from rotational vertigo in 54 (54/70, 77.1%) and from linear vertigo in 20 (20/70, 28.6%). The direction of linear vertigo was concordant with the direction of inertial acceleration predicted by the velocity-storage model. Patients with BPPV may experience linear as well as rotational vertigo during the attacks. This linear vertigo may be ascribed to centrally estimated inertial acceleration.
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Affiliation(s)
- Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Department of Neurology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Young-Min Park
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Seung Hoon Lee
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jieun Choi
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Seung Won Hyun
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Mi Song
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hui Jong Oh
- The MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, Daegu, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea. .,Department of Neurology, College of Medicine, Seoul National University, Seoul, South Korea.
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Papathanasiou ES. Vestibular evoked myogenic potentials (VEMPs) in systemic disease. Clin Neurophysiol 2019; 130:789-790. [DOI: 10.1016/j.clinph.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/16/2022]
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