[Isolated vertigo as the first symptom of posterior circulation infarction:reporot of 11 cases]

Objective:To analyze the clinical characteristics of patients with cerebellar and brainstem infarction who initially presented with isolated vertigo to avoid misdiagnosing of this disease.Method:Eleven patients with cerebellar and brainstem infarction who initially presented with isolated vertigo treated in our clinic between January 2014 and September 2017 were reviewed and the clinical characteristics and imaging presentation of the patients were evaluated.Result:Vertigo as the first attack was in 5 cases, recurrent attacks was in 6 cases,10 cases were with vascular risk factors except for 1 case, initially diagnosed as vestibular neuritis was 4 cases, Meniere's disease was 1 case, posterior circulartion ischemia was 1 case,and unknown causes was 5 cases; delayed neurological symptoms and signs occurring was 4 cases, but not in other cases; finally determined by brain MRI as acute cerebellar infarction was 5 cases, brainstem infarction was 5 cases, and concurrent cerebellar and brainstem infarction was 1 case. All patients had good prognosis.Conclusion:Isolated vertigo due to posterior circulation infarction is easy to be misdiagnosed as peripheral vertigo.Patients presenting with isolated vertigo, when with vascular risk factors, should receive MRI and DWI examinations. Properly diagnosis and treatment may lead a good prognosis.

[Significance of the seated supine positioning nystagmus for the diagnosis of benign paroxysmal positional vertigo]

Objective:To observe and assess the significance of seated supine positioning nystagmus (SSPN) in the diagnosis of benign paroxysmal positional vertigo(BPPV).Method:Two hundreds patients who were diagnosed BPPV were tested with the seated supine positioning test(SSPT) to observe SSPN,then were tested Supine roll test(SRT) and Dix-Hallpike test(DHT). According to the result of SRT and DHT,patients were divided into different groups. The positive rate and feature of SSPN in different types of BPPV was analyzed.Result:Among the 200 patients,116 cases(58.0%) of them showed SSPN. Among the 116 cases who were divided to the posterior semicircular canal BPPV(PSC-BPPV) group,72 cases of them showed SSPN. Horizontal semicircular canal BPPV(HSC-BPPV) group were 60 cases,44 cases showed SSPN. Anterior semicircular canal BPPV(ASC-BPPV) group were 4 cases and none of them showed SSPN. The direction of SSPN was a combination of torsional nystagmus with the upper pole of the eyes beating toward the affected side combined with vertical nystagmus beating upward (toward the forehead) typically in the PSC-BPPV group. Canalolithiasis of HSC were 41 cases,and 28 cases showed SSPN,and SSPN was contralesional in 22 cases(78.6%) and ipsilesional in 6 cases. Cupulolithiasis of HSC were 19 cases and 16 cases showed SSPN,and SSPN was ipsilesional in 16 cases.Conclusion:Significance of the seated supine positioning nystagmus in different types of BPPV is different.

[Efficacy of semicircular canal occlusion in the treatment of stage 3 or 4 Ménière's disease]

Objective:To investigate the efficacy of semicircular canal occlusion in the treatment of intractable Ménière's disease in stage 3 or 4.Method:Retrospective analysis of clincal date of twenty-nine patients who were referred to our institute and diagonsed with Ménière's disease. According to the preoperative staging of hearing, there were 12 cases in stage 3 and 17 cases in stage 4, and all patients underwent semicircular canal occlusion. The preoperative and postoperative frequency of vertigo, hearing, caloric test, functional level and tinnitus level were compared. Postoperative following-up period was 6-23 months, with an average of 13 months.Result:Postoperatively, vertigo was controlled effectively in all 29 cases, of which 26 cases(89.7%) were completely controlled and 3 cases(10.3%) were basic controlled. The hearing stabilized in 25 cases(86.2%), worse in 2 cases(6.9%) and improved in 2 cases(6.9%). The semicircular canal function of all patients were in low status by caloric test. The rate of tinnitus relief and functional improvement was 41.4%(12/29) and 96.6%(28/29).Conclusion:Semicircular canal occlusion is an effective measure for treatment of Ménière's disease in stage 3 or stage 4, especially in controlling vertigo and improving functional level, but the long-term follow-up is necessary.

Evaluation of the effectiveness of preoperative embolization in surgery for nasopharyngeal angiofibroma

We retrospectively analyzed the clinical data of 21 patients (22 procedures) with histologically proven nasopharyngeal angiofibromas. Eleven patients underwent preoperative intra-arterial digital subtraction angiography (IADSA) and embolization with Gelfoam. Embolization reduced the intraoperative blood loss from an average of 1136 ml in the non-embolized patients to 677 ml in the embolized cases (P < 0.05) and transfusions from an average of 836 ml to 400 ml (P < 0.01). Results again show that preoperative embolization is effective in reducing intraoperative blood loss.