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Ahmed JA, Ahmed KA, Ahmed MH. Severe Bilateral Vertebral Arterial Disease Masquerading as Vertigo. Cureus 2023; 15:e50410. [PMID: 38213331 PMCID: PMC10782191 DOI: 10.7759/cureus.50410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Vertebral artery stenosis (VAS), manifesting as vertebrobasilar insufficiency (VBI), results from the narrowing of the vertebral artery's lumen because of diverse vascular pathological processes, leading to various clinical presentations. We present the case of a 71-year-old male who experienced vertigo for almost two years and was ultimately diagnosed with severe bilateral VAS. Despite initial management for vertigo, the patient's symptoms persisted, prompting a referral to a cardiologist. Several assessments were performed, including an MRI of the brain, which ruled out acute intracerebral hemorrhage or infarction. After some visits to the cardiologist's office, the patient was referred to a neurologist who conducted a magnetic resonance angiography (MRA) of the neck, which showed an occlusion of the left vertebral artery at the origin and a patent right vertebral artery. Because of worsening symptoms of vertigo and the results of the MRA, the patient underwent invasive angiography that confirmed the occlusion of the left vertebral artery and also revealed severe stenosis of the right vertebral artery. This case report discusses an unusual presentation of VAS with vertigo as the primary symptom, emphasizing the importance of recognizing seemingly minor symptoms as manifestations of the underlying vascular pathology that requires careful evaluation. Furthermore, this case emphasizes the limitation of relying solely on noninvasive imaging for diagnosis as, in this instance, noninvasive imaging failed to detect the severe stenosis of the right vertebral artery, which was revealed by invasive angiography. Finally, this case report underscores the significance of collaboration across several disciplines, such as cardiology, neurology, and radiology, as well as endovascular medicine in diagnosing and managing atypical manifestations of complex conditions.
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Gentile CP, Aguirre GK, Hershey AD, Szperka CL. Symptoms associated with headache in youth. Cephalalgia 2023; 43:3331024231187162. [PMID: 37435790 PMCID: PMC10852031 DOI: 10.1177/03331024231187162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To determine the underlying relationships between a broad range of headache-associated symptoms and how they relate to headache burden. BACKGROUND Symptoms associated with head pain inform classification of headache disorders. However, many headache-associated symptoms are not included in the diagnostic criteria, which is largely based on expert opinion. Large symptom databases can assess headache-associated symptoms irrespective of pre-existing diagnostic categories. METHODS We conducted a large single-center cross-sectional study on youth (6-17 years old) assessing patient-reported outpatient headache questionnaires between June 2017 and February 2022. Multiple correspondence analysis, an exploratory factor analysis, was applied to 13 headache-associated symptoms. RESULTS 6662 participants (64% female; median age 13.6 years) were included. Multiple correspondence analysis dimension 1 (25.4% of the variance) captured the absence or abundance of headache-associated symptoms. A greater number of headache-associated symptoms correlated with greater headache burden. Dimension 2 (11.0% of the variance) revealed three symptom clusters: (1) cardinal features of migraine (light, sound, and smell sensitivity, nausea, and vomiting), (2) nonspecific global neurologic dysfunction symptoms (lightheadedness, trouble thinking, blurry vision), (3) vestibular and brainstem dysfunction symptoms (vertigo, balance problems, ear ringing, double vision). CONCLUSION Assessing a broader range of headache-associated symptoms reveals clustering of symptomatology and a strong relationship with headache burden.
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Affiliation(s)
- Carlyn Patterson Gentile
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Geoffrey K. Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew D. Hershey
- Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christina L. Szperka
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Alateeq M, Hafiz TA, Alnizari O. Measuring the Effect of Smoking or Tobacco Use on Vertigo Among the Adult Population in the Kingdom of Saudi Arabia. Cureus 2023; 15:e38516. [PMID: 37288209 PMCID: PMC10243229 DOI: 10.7759/cureus.38516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Background Smoking is widespread at all ages in Saudi society. In addition, complaints of vertigo are common. A key problem is how smoking affects vertigo and, thus, quality of life. Researchers have investigated the association between smoking and vertigo and found that smoking may be a risk factor for vertigo, but this association is not clear. The current study aims to investigate the association between smoking and vertigo. Materials and methods We conducted a cross-sectional study from March 2022 to January 2023 to investigate the effect of smoking on vertigo in Saudi Arabia's adult population. Results We found that smokers were more prone to vertigo than non-smokers. In addition, the severity of vertigo increases as the number of cigarettes smoked or the length of time in years that the person has smoked increases. Conclusion The findings of the study should inspire more research into the impact of demographic factors on vertigo among smokers.
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Affiliation(s)
- Mohahmmed Alateeq
- Otolaryngology-Head and Neck Surgery, University of Hail College of Medicine, Hail, SAU
| | | | - Osama Alnizari
- Family Medicine, University of Hail College of Medicine, Hail, SAU
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Huang FM, Luo CW, Lee SS, Ho YC, Li YC, Chang YC, Kuan YH. Relationship between periodontal disease and dizziness in Taiwanese adults: A nationwide population-based cohort study. Medicine (Baltimore) 2023; 102:e32961. [PMID: 36827024 DOI: 10.1097/md.0000000000032961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Periodontal disease is often neglected and overlooking its initial symptoms can lead to tooth loss and systemic diseases. Patients with otitis media are at high risk of vestibular and balance dysfunction, consequently, and vertigo. Vertigo and dizziness are conditions with high reported incidences; they worsen with age and can burden health systems. The present study investigated whether periodontal disease causes dizziness. Research data covering 2008 through 2013 were retrieved from the National Health Insurance Research Database of Taiwan. Patients who were newly diagnosed as having periodontal disease or dizziness after at least 1 hospital admission or 3 outpatient visits were enrolled as participants. For our controls, we randomly selected individuals without periodontal disease who were sex- and age-matched with the investigated participants. In total, we enrolled 445 patients with periodontal disease and 1780 controls. The Kaplan-Meier curve indicated that the cumulative incidence of dizziness was significantly higher among the patients with periodontal disease relative to the controls. After adjustment for sex, age, income level, urbanization level, month of onset, and comorbidities, Cox proportional-hazards analysis revealed that patients with periodontal disease had an increased risk of dizziness (hazard ratio [HR]: 1.306, 95% confidence interval (CI): 1.155, 1.475). Compared with the controls, the risk of dizziness among patients with periodontal disease was higher for both female (HR: 1.439, 95%: 1.203, 1.720) and male patients (HR: 1.284, 95%: 1.123, 1.468); this risk was higher even when January (HR: 1.302, 95% CI: 1.145, 1.480), February (HR: 1.337, 95% CI: 1.178, 1.518), or March was excluded (HR: 1.308, 95% CI: 1.151, 1.487) and for patients without Ménière disease. Therefore, periodontal disease is not only a risk factor for dizziness but also an independent risk factor for dizziness. Future studies could clarify the mechanisms linking periodontal disease to dizziness.
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Affiliation(s)
- Fu-Mei Huang
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Ci-Wen Luo
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shiuan-Shinn Lee
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Chuan Ho
- School of Medical Applied Chemistry, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Ching Li
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Chao Chang
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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Demori I, Molinari E, Rapallo F, Mucci V, Marinelli L, Losacco S, Burlando B. Online Questionnaire with Fibromyalgia Patients Reveals Correlations among Type of Pain, Psychological Alterations, and Effectiveness of Non-Pharmacological Therapies. Healthcare (Basel) 2022; 10:1975. [PMID: 36292422 DOI: 10.3390/healthcare10101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Fibromyalgia (FM) is a chronic pain syndrome with an unclear etiology. In addition to pain, FM patients suffer from a diverse array of symptoms and comorbidities, encompassing fatigue, cognitive dysfunction, mood disorders, sleep deprivation, and dizziness. Due to the complexity of FM, the diagnosis and treatment of it are highly challenging. The aim of the present work was to investigate some clinical and psychological characteristics of FM patients, and to uncover possible correlations with pharmacological and non-pharmacological therapies. We conducted a cross-sectional, questionnaire-based study aimed at evaluating pain, psychological traits, and the self-perceived effectiveness of pharmacological and non-pharmacological treatments in an Italian population of FM patients. Descriptive statistics, correlation, and inference analyses were performed. We found a prevalence of a neuropathic/nociplastic type of pain, which correlated with psychological traits such as anxiety, low mood, psychophysical discomfort, and the inability to relax. The pain type and psychological traits proved to play a role in determining the self-perceived effectiveness of therapeutic interventions. Patients revealed a better response to non-pharmacological therapies, particularly dietary interventions, relaxation techniques, and psychotherapy rather than pharmacological interventions. The sum of our data indicates that for better outcomes, the type of pain and psychological traits should be considered for tailor-made treatments considering non-pharmacological protocols as a complement to the use of drugs.
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Kammerlind AS, Peolsson A, Johansson MM. Dizziness in older persons at high risk of future hospitalization: prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention. BMC Geriatr 2022; 22:315. [PMID: 35399055 PMCID: PMC8996541 DOI: 10.1186/s12877-022-02910-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dizziness is a common reason for seeking care, and frequently affects older persons. The aims were to determine the prevalence of dizziness in older persons at high risk of hospitalization, to compare subjects with and without dizziness, and to examine the effects on dizziness of a proactive primary care intervention in comparison with conventional care after one year. Methods Data were derived from a prospective multicentre clinical trial in persons aged 75 and older and at high risk of hospitalization. A baseline questionnaire included demographic data, use of aids, questions about everyday physical activity and exercise, pain (intensity, frequency, and duration), activities of daily living measured using the ADL Staircase, and health-related quality of life measured using the EQ-5D-3L vertical visual analogue scale. Both at baseline and after one year, subjects were asked about dizziness, and those with dizziness answered the Dizziness Handicap Inventory – Screening version. Subjects in the intervention group were evaluated by a primary care team and when needed proactive care plans were established. Groups were compared using the Mann Whitney U-test or chi-squared test. Results Of the 779 subjects, 493 (63%) experienced dizziness. Persons with dizziness differed regarding sex, homecare service, aids, activities of daily living, health-related quality of life, physical activity, and pain. The intervention did not significantly reduce the level of dizziness. Conclusions Dizziness is common in vulnerable older persons, and individuals with dizziness differ in several respects. Further studies are needed employing more dizziness-specific assessment and individually tailored interventions. Trial registration ClinicalTrials.gov 170608, ID: NCT03180606.
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Rodríguez-Almagro D, Barassi G, Bertollo M, Obrero-Gaitán E, Di Iorio A, Prosperi L, Achalandabaso-Ochoa A, Lomas-Vega R, Ibáñez-Vera AJ. Manual Therapy Approach to the Extraocular Muscles in Migraine Treatment: A Preliminary Study. Advances in Experimental Medicine and Biology 2022; 1375:29-37. [DOI: 10.1007/5584_2021_704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ribeiro dos Santos ERR, Oliveira DAD, Leite AFB, Rocha Filho PAS, Valença MM. Headache catastrophization and its relationship with disability, depression, anxiety, stress and sleep quality. HM 2021. [DOI: 10.48208/headachemed.2021.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
IntroductionCross-sectional studies on headache have not yet explored the influence of pain catastrophizing and associations with other psychosomatic comorbidities. The migraine-affected group of individuals was frequently associated with other clinical conditions such as depression, anxiety, stress, and poor sleep quality. These conditions exert a significant influence on carrier’s coping with daily pain and helplessness, since disability hampers work and daily living activities and overly burden individual, their family, society and the health system. Identifying the elements that contribute to disability is crucial in assisting interventions that minimize these conditions.ObjectiveThe aim of this cross-sectional study was to evaluate how the combination of migraine and catastrophizing, associated with functional disability, depression, anxiety, stress, and sleep quality in college students, can influence the perception of pain.MethodsThe 340 participants were selected by drawing lots, in which individuals with primary headaches were assigned. Therefore, the final analysis sample consisted of 288 individuals. The sample was divided into Group with migraine and Group with other primary headaches, with the application of scales: HIT-6 and the scale of pain catastrophizing.ResultsOf the 360 participants, 20 losses were recorded due to inadequate completion of scales, leaving out 340 participants. Of these, 52/340 (15.25%) did not suffer from headaches. 288/340 (84.7%) participants that reported headaches were included in this study, of which 133/288 (46.2%) had migraine, and 155/288 (53.8%) had non-migraine headache. Women who had migraine attacks were those with the most intense anxious symptoms, worse sleep quality, and catastrophization. The odds ratio of catastrophizing was higher for the Migraine Group. Linear and multivariate logistic regression revealed that the greater the presence of catastrophizing, the greater the occurrence of migraine. Catastrophizing had a greater power of contribution related to the disability generated by the crises in the group of migrainous (β = 0.564). The migraine group has a greater perception of pain.ConclusionHigher catastrophization was also associated with a greater intensity of depressive and anxiety symptoms, higher perceived stress, and worse quality of sleep in headache-affected individuals in our study.
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Liu P, Ma S, Du G, Sun S, Zhang X, Tang P, Hou C, Liu Y, Zhao J, Zhang X, Chen L, Gu C, Zhang L, Chong L, Yang X, Li R. Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China. J Gen Intern Med 2021; 36:3064-3070. [PMID: 33501533 PMCID: PMC8481407 DOI: 10.1007/s11606-020-06475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China. OBJECTIVE To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction. DESIGN Retrospective before-after study. PARTICIPANTS Sample of 29,793 patients with vertigo/dizziness as primary complaint. MEASURES Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China. KEY RESULTS The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001). CONCLUSIONS AND RELEVANCE Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.
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Affiliation(s)
- Peng Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Shaolin Ma
- Clinic for Vertigo and Dizziness, Xinyuan Hospital of Yulin, Yulin, 719000 Shaanxi People’s Republic of China
| | - Guixiang Du
- Clinic for Vertigo and Dizziness, The First Municipal Hospital of Weinan, Weinan, 714000 Shaanxi People’s Republic of China
| | - Shengde Sun
- Otorhinolaryngology Head and Neck Surgery, Wuwei People’s Hospital, Wuwei, 733000 Gansu People’s Republic of China
| | - Xin Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Peng Tang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chen Hou
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Yue Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Jiaxing Zhao
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xiaohui Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chen
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chaochao Gu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Lina Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chong
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Aerospace Clinical Medical College of Peking University, Beijing, 100049 People’s Republic of China
| | - Rui Li
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
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Abstract
The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15–20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.
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Seckler E, Regauer V, Krüger M, Gabriel A, Hermsdörfer J, Niemietz C, Bauer P, Müller M. Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation. BMC Fam Pract 2021; 22:62. [PMID: 33794802 PMCID: PMC8017844 DOI: 10.1186/s12875-021-01410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. METHODS This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council's Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. RESULTS A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs' adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients' treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. CONCLUSION Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. TRIAL REGISTRATION Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).
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Affiliation(s)
- Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 17, 81377 Munich, Germany
| | - Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 17, 81377 Munich, Germany
| | - Melanie Krüger
- Institute of Sports Science, Leibniz University Hannover, Am Moritzwinkel 6, 30167 Hannover, Germany
| | - Anna Gabriel
- Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Carolin Niemietz
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences and Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences and Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
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Phillips JS, Newman JL, Cox SJ. Clinical Techniques and Technology: Vestibular Telemetry. Otolaryngol Head Neck Surg 2021; 165:751-753. [PMID: 33650899 PMCID: PMC8564261 DOI: 10.1177/0194599821993411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
When a patient presents to a clinician with dizziness, it can be difficult for the
patient to describe their symptoms in a clear manner, and clinical examination often
yields entirely normal results. Ideally, it would be favorable to measure key
physiological parameters during their episodes of dizziness. From a clinical perspective,
this would allow a more timely and more accurate diagnosis. From a research perspective,
it would allow a greater understanding of how the vestibular system malfunctions as a
consequence of vestibular disease. The authors of this report have been funded by the UK
Medical Research Council to develop and test a novel technology to measure, record, and
analyze key physiological parameters provided by the dizzy individual during an episode of
dizziness while active in the community. We provide the context to evolving work in this
field, the outcome of preliminary studies, and a consideration of future
opportunities.
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Affiliation(s)
- John S Phillips
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Rodríguez-Almagro D, Obrero-Gaitán E, Lomas-Vega R, Zagalaz-Anula N, Osuna-Pérez MC, Achalandabaso-Ochoa A. New Mobile Device to Measure Verticality Perception: Results in Young Subjects with Headaches. Diagnostics (Basel) 2020; 10:E796. [PMID: 33036468 PMCID: PMC7601549 DOI: 10.3390/diagnostics10100796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
The subjective visual vertical (SVV) test has been frequently used to measure vestibular contribution to the perception of verticality. Recently, mobile devices have been used to efficiently perform this measurement. The aim of this study was to analyze the perception of verticality in subjects with migraines and headaches. A cross-sectional study was conducted that included 28 patients with migraine, 74 with tension-type headache (TTH), and 93 healthy subjects. The SVV test was used through a new virtual reality system. The mean absolute error (MAE) of degrees deviation was also measured to qualify subjects as positive when it was greater than 2.5°. No differences in the prevalence of misperception in verticality was found among healthy subjects (31.18%), migraineurs (21.43%), or those with TTH (33.78%) (p = 0.480). The MAE was not significantly different between the three groups (migraine = 1.36°, TTH = 1.61°, and healthy = 1.68°) (F = 1.097, p = 0.336, and η2 = 0.011). The perception of verticality could not be explained by any variable usually related to headaches. No significant differences exist in the vestibular contribution to the perception of verticality between patients with headaches and healthy subjects. New tests measuring visual and somatosensory contribution should be used to analyze the link between the perception of verticality and headaches.
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Affiliation(s)
| | | | - Rafael Lomas-Vega
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (D.R.-A.); (E.O.-G.); (N.Z.-A.); (M.C.O.-P.); (A.A.-O)
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Obrero-Gaitán E, Manrique-Navarro M, Lérida-Ortega MÁ, Rodríguez-Almagro D, Osuna-Pérez MC, Lomas-Vega R. Misperception of Visual Verticality in Patients with Primary Headache Disorders: A Systematic Review with Meta-Analysis. Brain Sci 2020; 10:brainsci10100664. [PMID: 32987639 PMCID: PMC7598580 DOI: 10.3390/brainsci10100664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
Migraine and tension-type headache (TTH) are the two most prevalent primary headache disorders (PHDs) that may involve visual and vestibular impairments, neck pain, and postural unsteadiness. The perception of visual verticality (VV) has been studied in patients diagnosed with PHD to assess balance disorders showing varying findings. Our study aimed to assess the VV perception in patients diagnosed with PHD in comparison to healthy controls. A systematic review with meta-analysis was carried out in PubMed MEDLINE, Scopus, WOS, CINAHL, and SciELO. The Cohen standardized mean difference (SMD) was used to estimate the differences between exposed and healthy controls. Seven studies with 816 participants were included. The quality of included studies, according to the Newcastle–Ottawa Scale (NOS), was moderate (mean score of 5.2). Patients diagnosed with PHD showed a moderate misperception of VV as assessed with the subjective visual vertical (SVV) test (SMD = 0.530; 95% CI = 0.225, 0.836; p < 0.001). Specifically, a misperception of the SVV was found in patients with migraine (SMD = 0.369; 95% CI = 0.1, 0.638; p = 0.007) and with TTH (SMD = 1.122; 95% CI = 0.540, 1.704; p < 0.001). This review shows a misperception of VV in patients with migraine and TTH when assessed with the SVV test, being higher in patients with TTH, although the THH sample size was low.
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Affiliation(s)
- Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
| | | | - Miguel Ángel Lérida-Ortega
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
- Hospital San Agustín de Linares, 23700 Linares, Spain
- Escuela de Osteopatía de Madrid S.L., 28807 Alcalá de Henares, Madrid, Spain
| | - Daniel Rodríguez-Almagro
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
- Correspondence: ; Tel.: +34-953-212-381
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
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Iljazi A, Ashina H, Lipton RB, Chaudhry B, Al-Khazali HM, Naples JG, Schytz HW, Cvetkovic VV, Burstein R, Ashina S. Dizziness and vertigo during the prodromal phase and headache phase of migraine: A systematic review and meta-analysis. Cephalalgia 2020; 40:1095-1103. [PMID: 32349538 PMCID: PMC7483950 DOI: 10.1177/0333102420921855] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the proportion of individuals who report dizziness and/or vertigo during the prodromal phase or headache phase of migraine. METHODS The databases of MEDLINE and EMBASE were searched for studies on dizziness and/or vertigo during the prodromal phase or headache phase of migraine. Pooled relative frequencies were estimated using a random-effects meta-analysis. RESULTS We identified nine articles eligible for inclusion. Of these, one study reported results for the prodromal phase, seven studies for the headache phase and one study for both the prodromal and headache phase. In the prodromal phase, 9.0% of individuals with migraine reported dizziness, while 3.3% reported vertigo. During the headache phase, relative frequency of dizziness ranged from 6.7% to 59.6%, while vertigo ranged from 6.4% to 44.7%. The meta-analysis showed a relative frequency of 35.7% for dizziness (95% CI = 13.7-61.5%, I2 = 99%) and 33.9% for vertigo (95% CI = 26.7-41.5%, I2 = 87%). Study quality was rated 5/9 or below for seven studies and 6/9 or above for two studies. CONCLUSION We found that there is a scarcity of literature on dizziness and vertigo as prodromal- and headache-associated symptoms in individuals with migraine. Methodological variations confound comparisons of epidemiological patterns, although it appears that dizziness and vertigo are more frequent during the headache phase of migraine, compared with the prodromal phase. Future studies should ensure use of standardized definitions and rigorous methodology to enable accurate measurements of dizziness and vertigo in migraine.
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Affiliation(s)
- Afrim Iljazi
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Basit Chaudhry
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Haidar M. Al-Khazali
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - James G. Naples
- Department of Otolayngology-Head and Neck Surgery, Otology, Neurotology, and Skull Base Surgery Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Henrik W. Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vlasta Vukovic Cvetkovic
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rami Burstein
- Comprehensive Headache Center, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sait Ashina
- BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Landon-lane RL, Piker EG, Jacobson GP, Hatton K, Roberts RA. Test-Retest Reliability of the Dizziness Symptom Profile. Ear Hear 2021; 42:206-213. [DOI: 10.1097/aud.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pyykkö I, Pyykkö N, Manchaiah V. Vestibular drop attacks in Ménière’s disease and its association with migraine. Eur Arch Otorhinolaryngol 2020; 277:1907-1916. [DOI: 10.1007/s00405-020-05890-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022]
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Wolf J, Sattel H, Limburg K, Lahmann C. From illness perceptions to illness reality? Perceived consequences and emotional representations relate to handicap in patients with vertigo and dizziness. J Psychosom Res 2020; 130:109934. [PMID: 31972479 DOI: 10.1016/j.jpsychores.2020.109934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Vertigo and dizziness (VD) are frequent symptoms that can occur due to various structural pathologies or due to functional impairment. Independent of their aetiology, the symptoms are often associated with physical and psychological burden which manifests in severe handicap in more than half of the patients. It is suggested that illness perceptions, the patients' cognitive and emotional concept of their disease, most likely impact the degree of handicap. For patients with VD, however, this relation of illness perceptions and handicap is so far not well understood. This study aimed to investigate the relation of illness perceptions and handicap for patients with VD. METHODS In a cross-sectional study design, n = 419 patients with VD were examined (53.7% female, age 53.5 ± 15.5 years). Participants underwent neurological and psychiatric examinations as well as a comprehensive assessment using self-report questionnaires. RESULTS Illness perceptions, specifically perceived consequences and emotional representations showed a moderate correlation with VD related handicap (r(419) = 0.62, p < .001). Our regression model including symptom severity, psychiatric comorbidity, and aspects of cognitive and emotional illness perceptions accounted for 52% of the variance in VD related handicap. In a moderation analysis, this relation did not differ significantly in patients with functional VD symptoms. CONCLUSION Findings of the present study provide evidence for the relevance of illness perceptions to handicap in patients with VD symptoms.
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Affiliation(s)
- Johannes Wolf
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karina Limburg
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany
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Pyykkö I, Manchaiah V, Färkkilä M, Kentala E, Zou J. Association between Ménière’s disease and vestibular migraine. Auris Nasus Larynx 2019; 46:724-733. [DOI: 10.1016/j.anl.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/16/2019] [Accepted: 02/03/2019] [Indexed: 12/17/2022]
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Staibano P, Lelli D, Tse D. A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic. J Otolaryngol Head Neck Surg 2019; 48:11. [PMID: 30857559 PMCID: PMC6413454 DOI: 10.1186/s40463-019-0336-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background Vertigo remains a diagnostic challenge for primary care, emergency, and specialist physicians. Multidisciplinary clinics are increasingly being employed to diagnose and manage patients with dizziness. We describe, for the first time in Canada, the clinical characteristics of patients presenting with chronic and acute dizziness to both a multidisciplinary chronic dizziness clinic (MDC) and a rapid access dizziness (RAD) clinic at The Ottawa Hospital (TOH). Methods We performed a retrospective review of all patients presenting to the MDC and RAD clinics at TOH from July 2015 to August 2017. Results Overall, 211 patients (median age: 61 years old) presented to the RAD clinic and 292 patients (median age: 55 years old) presented to the MDC. In the RAD clinic, 63% of patients had peripheral dizziness, of which 55% had BPPV, and only one patient had functional dizziness. Interestingly, only 25% of RAD diagnoses were concordant with emergency department diagnoses; moreover, only 33% of RAD patients had HiNTS completed, while 44% had CT scans, of which only one scan had an abnormal finding. Prior to assessment, all patients in the MDC had an unclear cause of dizziness. 28% of patients had vestibular dizziness and 21% had functional dizziness, of which 43% had persistent postural perceptual dizziness. Moreover, 12% of patients with functional dizziness also suffered from comorbid severe anxiety and depression. Conclusions Dizziness is a heterogeneous disorder that necessitates multidisciplinary care, and clinics targeting both the acute and chronic setting can improve diagnostic accuracy, ensure appropriate diagnostic testing, and facilitate effective care plans for patients with dizziness.
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Affiliation(s)
- Phillip Staibano
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Lelli
- Division of Neurology, Department of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Darren Tse
- Department of Otolaryngology-Head & Neck Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Sağıroğlu S, Orhan FO, Ekici NY, Doğaner A. Vestibüler disfonksiyonlu hastalarda psikolojik profil ve kişilik özellikleri. Cukurova Medical Journal 2018. [DOI: 10.17826/cumj.389789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Carvalho G, Almeida C, Florencio L, Pinheiro C, Dach F, Bigal M, Bevilaqua-Grossi D. Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study. Physiotherapy 2018; 104:424-429. [DOI: 10.1016/j.physio.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 09/12/2017] [Accepted: 10/17/2017] [Indexed: 01/03/2023]
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Albera A, Canale A, Dagna F, Gervasio CF, Albera R. Hearing loss in Menière’s disease and sensorineural low-frequency fluctuating hearing loss without vertigo: are there any differences? Hearing, Balance and Communication 2018. [DOI: 10.1080/21695717.2018.1507578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea Albera
- Otolaryngology Unit, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Andrea Canale
- Department of Surgical Sciences, Otolaryngology Unit, University of Turin, Turin, Italy
| | - Federico Dagna
- Department of Surgical Sciences, Otolaryngology Unit, University of Turin, Turin, Italy
| | | | - Roberto Albera
- Department of Surgical Sciences, Otolaryngology Unit, University of Turin, Turin, Italy
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Abstract
Differential diagnosis between peripheral and central spontaneous nystagmus can be difficult to classify (as peripheral or central) even on the basis of criteria recommended in the recent literature. The aim of this paper is to use the combination of spontaneous nystagmus and ocular tilt reaction to determine the site of origin of the disease that causes nystagmus. We propose to classify the nystagmus in: 1) "Uphill" nystagmus in which the nystagmus takes on an inclined plane and the direction of the fast phase is towards the hypertropic eye (this type of nystagmus is likely peripheral); 2) "Downhill" nystagmus when the nystagmus beats toward the hypotropic eye (this type of nystagmus is likely central); 3) "Flat" nystagmus when the plane on which nystagmus beats is perfectly horizontal: in this case, we cannot say anything about the site of lesion (it was only detected in 15% of cases). The spatial position of nystagmus vector has to be considered as an intrinsic characteristic of the nystagmus itself (as direction, frequency, angular velocity etc.) and must be reported in the description, possibly giving an indication of the site of damage (peripheral or central). In particular, similar results are obtained by comparing the inclination of the nystagmus with the head impulse test (HIT, considered the best bedside test now available). It seems that this sign may confirm HIT for safer diagnosis or replace it in case of doubt. In contrast, in case of "Flat" nystagmus (probably attributable to the fact that the utricular maculae are spared), HIT can replace observation of the plane of the nystagmus. Thus, the two signs confirm and integrate each other. The test does not require additional time and is not tedious for the patient. It is proposed that it be included in the evaluation of spontaneous nystagmus in everyday clinical practice.
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Affiliation(s)
- M Gufoni
- Department of Otorhinolaryngology, Spedali Riuniti Livorno, Italy
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Ahmed SS, Giardina M, Nicks KL, Huang HH. Physical therapy examination and management of a 48-year-old male with vertigo, cephalalgia, and cervicalgia secondary to unilateral vestibular hypofunction. Physiother Theory Pract 2018; 36:1056-1067. [PMID: 30198814 DOI: 10.1080/09593985.2018.1517848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE This case report presents evidence-based physical therapy assessments and interventions for a patient with unilateral vestibular hypofunction (UVH). UVH is the result of peripheral vestibular dysfunction in the inner ear. Case Description : The patient was a 48-year-old male with symptoms of dizziness, cephalalgia, and cervicalgia. The examination and treatment were focused on impaired cervical proprioception, which is a vital component of balance training in addition to visual, vestibular, and somatosensory re-education for patients with dizziness. Toward the end of the physical therapy episode of care, the patient was medically diagnosed with Chiari malformation, a congenital cerebellar tonsillar herniation. Outcomes : The patient made significant strides on the Dizziness Handicap Inventory, Ten Meter Walk Test, Single Leg Stance, Balance Error Scoring System, Fukuda Stepping Test, Cervical Joint Position Error Sense Test, Convergence Distance, Global Rate of Change, and cervical range of motion assessments. The patient did not demonstrate comparable improvements on the Dynamic Visual Acuity Test. Conclusion : This case report demonstrates a physical therapy program for a patient with peripheral UVH-related symptoms. This approach may also be applicable for patients with the central cause of dizziness such as Chiari malformation. Future directions for research and clinical practice are also suggested in this report.
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Affiliation(s)
- Syeda S Ahmed
- Pinecrest Rehabilitation Hospital, Delray Medical Center , Delray Beach, FL, USA
| | - Michael Giardina
- Department Sports Medicine and Rehabilitation, Memorial Hermann Convenient Care Center-Spring , Spring, TX, USA
| | - Kendra L Nicks
- Department of Physical Therapy, Angelo State University, Texas Tech University System , San Angelo, TX, USA
| | - Han-Hung Huang
- Department of Physical Therapy, Angelo State University, Texas Tech University System , San Angelo, TX, USA
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Carvalho GF, Vianna-Bell FH, Florencio LL, Pinheiro CF, Dach F, Bigal ME, Bevilaqua-Grossi D. Presence of vestibular symptoms and related disability in migraine with and without aura and chronic migraine. Cephalalgia 2018; 39:29-37. [DOI: 10.1177/0333102418769948] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To assess the presence and handicap due to vestibular symptoms in three subgroups of patients with migraine and controls. Methods Women between 18–55 years old were diagnosed by headache specialists and stratified as migraine with aura (n = 60), migraine without aura (n = 60), chronic migraine (n = 60) and controls (n = 60). Information regarding demographics, headache and vestibular symptoms were collected in this cross-sectional study. The self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire. Results A total of 85% of women with migraine with aura and chronic migraine had vestibular symptoms contrasted to 70% of the migraine without aura group ( p < 0.05), and 12% of the control group reported symptoms ( p < 0.0001). Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls ( p < 0.001); and migraine with aura and chronic migraine groups reached greater scores than migraine without aura ( p < 0.01). Presence of migraine is associated with a greater risk of vestibular symptoms (migraine without aura: 5.20, migraine with aura: 6.60, chronic migraine:6.20, p < 0.0003) and with a greater risk of moderate-to-severe handicap (migraine without aura: 20.0, migraine with aura: 40.0, chronic migraine: 40.0, p < 0.0003). The presence of aura and greater migraine frequency adds to the risk of any handicap (migraine with aura: 1.9, chronic migraine: 1.7, p < 0.04) and to the risk of moderate-to-severe handicap (migraine with aura: 2.0, chronic migraine: 2.0, p < 0.0003). Migraine aura, intensity and frequency predict 36% of the dizziness handicap. Conclusion The prevalence of vestibular symptoms is increased in migraine during and between headache attacks, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Vestibular symptoms among subgroups of migraine should be considered when evaluating the functional impact of migraine.
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Affiliation(s)
- Gabriela F Carvalho
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Flávia Heck Vianna-Bell
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Lidiane L Florencio
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Carina F Pinheiro
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
| | - Marcelo E Bigal
- Research and Development Department, Teva Pharmaceuticals, Frazer, PA, USA
| | - Debora Bevilaqua-Grossi
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation – Ribeirão Preto Medical School, , Ribeirão Preto, Sao Paulo, Brazil
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Das S, Chakraborty S, Shekar S. Dizziness in a Tertiary Care Centre in Sikkim: Our Experience and Limitations. Indian J Otolaryngol Head Neck Surg 2017; 69:443-8. [PMID: 29238671 DOI: 10.1007/s12070-017-1221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022] Open
Abstract
Dizziness is a common symptom and though most of the causes are benign yet some may be potentially life threatening. Diagnosis can be a challenge sometimes due to lack of dedicated vestibular lab and injudicious use of vestibular suppressant medications. A 2 year retrospective study of the hospital records from September 2014 to August 2016 was done to study the causes of dizziness and the limitations and challenges in the diagnosis. 75 complete records of patients presenting with dizziness were accessed and analysed. 54.7% of the patients were males and most patients were young adults. Most of the cases were benign and Benign paroxysmal positional vertigo was the commonest diagnosed case (20%). Potentially life threatening cases diagnosed were cerebellar infarct and posterior fossa space occupying lesion (5.3%). Complete evaluation of a dizzy patient must be done to arrive at a causal diagnosis. Injudicious use of vestibular sedatives should be discouraged. Proper training and education to the primary care physician should be imparted so that they can adopt a practical approach for evaluation and management of a dizzy person.
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Blasberg TF, Wolf L, Henke C, Lorenz MW. Isolated transient vertigo: posterior circulation ischemia or benign origin? BMC Neurol 2017; 17:111. [PMID: 28615008 PMCID: PMC5471715 DOI: 10.1186/s12883-017-0894-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Isolated transient vertigo can be the only symptom of posterior circulation ischemia. Thus, it is important to differentiate isolated vertigo of a cerebrovascular origin from that of more benign origins, as patients with cerebral ischemia have a much higher risk for future stroke than do those with ‘peripheral’ vertigo. The current study aims to identify risk factors for cerebrovascular origin of isolated transient vertigo, and for future cerebrovascular events. Methods From the files of 339 outpatients with isolated transient vertigo we extracted history, clinical and technical findings, diagnosis, and follow-up information on subsequent stroke or transient ischemic attack (TIA). Risk factors were analyzed using multivariate regression models (logistic or Cox) and reconfirmed in univariate analyses. Results On first presentation, 48 (14.2%) patients received the diagnosis ‘probable or definite cerebrovascular vertigo’. During follow-up, 41 patients suffered stroke or TIA (event rate 7.9 per 100 person years, 95% confidence interval (CI) 5.5–10.4), 26 in the posterior circulation (event rate 4.8 per 100 person years, 95% CI 3.0–6.7). The diagnosis was not associated with follow-up cerebrovascular events. In multivariate models testing multiple potential determinants, only the presentation mode was consistently associated with the diagnosis and stroke risk: patients who presented because of vertigo (rather than reporting vertigo when they presented for other reasons) had a significantly higher risk for future stroke or TIA (p = 0.028, event rate 13.4 vs. 5.4 per 100 person years) and for future posterior circulation stroke or TIA (p = 0.044, event rate 7.8 vs. 3.5 per 100 person years). Conclusions We here report for the first time follow-up stroke rates in patients with transient isolated vertigo. In such patients, the identification of those with cerebrovascular origin remains difficult, and presentation mode was found to be the only consistent risk factor. Confirmation in an independent prospective sample is needed.
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Affiliation(s)
- Tobias F Blasberg
- Department of Neurology, Frankfurt University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Lea Wolf
- Department of Neurology, Frankfurt University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Christian Henke
- Department of Neurology, Frankfurt University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,Department of Neurology, Helios HSK Wiesbaden, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany
| | - Matthias W Lorenz
- Department of Neurology, Frankfurt University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,Department of Neurology, Krankenhaus Nordwest, Steinbacher Hohl 2-16, 60488, Frankfurt/Main, Germany
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Probst T, Dinkel A, Schmid-Mühlbauer G, Radziej K, Limburg K, Pieh C, Lahmann C. Psychological distress longitudinally mediates the effect of vertigo symptoms on vertigo-related handicap. J Psychosom Res 2017; 93:62-68. [PMID: 28107895 DOI: 10.1016/j.jpsychores.2016.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vertigo symptoms can lead to more or less vertigo-related handicap. This longitudinal study investigated whether depression, anxiety, and/or somatization mediate the relationship between vertigo symptoms and vertigo-related handicap. METHODS N=111 patients with vertigo/dizziness provided complete data on the following measures: Vertigo symptoms at baseline, depression at 6-month follow-up, anxiety at 6-month follow-up, somatization at 6-month follow-up, and vertigo handicap at 12-month follow-up. Mediation analyses with bootstrapping were performed to investigate the mediating role of anxiety, depression, and somatization in the relationship between vertigo symptoms and vertigo-related handicap. RESULTS When the mediating role of anxiety, depression, and somatization was evaluated separately from each other in single mediation models, the effect vertigo symptoms at baseline exerted on vertigo-related handicap at 12-month follow-up was significantly mediated by depression at 6-month follow-up (p<0.05), by anxiety at 6-month follow-up (p<0.05), as well as by somatization at 6-month follow-up (p<0.05). When statistically controlling for the other mediators in a multiple mediator model, only depression at 6-month follow-up mediated the effect of vertigo symptoms at baseline on vertigo-related handicap at 12-month follow-up (p<0.05). CONCLUSION Psychological distress is an important mechanism in the process how vertigo symptoms lead to vertigo-related handicap.
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Affiliation(s)
- Thomas Probst
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany; Department of Psychology, Regensburg University, Regensburg, Germany.
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany.
| | | | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany.
| | - Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany.
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria; Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany.
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
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