THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO

The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.

Audiovestibular disturbance in patients with systemic lupus erythematosus

OBJECTIVE

The aim of this study was to evaluate the audiovestibular disturbance in patients with systemic lupus erythematosus (SLE).

STUDY DESIGN AND SETTING

Twenty-eight patients with SLE and 28 healthy control subjects were included. Pure-tone audiometry, impedance audiometry, and electronystagmography (ENG) were used for baseline evaluation. Laboratory tests were carried out. Cranial and brain stem magnetic resonance imagings (MRI) were undertaken.

RESULTS

Nineteen (67%) patients reported audiovestibular symptoms. Sensorineural hearing loss was found in 6 (21%) patients. Abnormal results on ENG were significantly higher (50%) (P < 0.01). Abnormal laboratory data were available from 26 patients (P < 0.05). MRI did not show any pathosis.

CONCLUSION

The audiovestibular disturbances in SLE are more prevalent than previously recognized. Although no cause and effect relationship can be established by this type of study, it appears that a relationship exists.

SIGNIFICANCE

Audiologic research should be directed toward routine, pure tone audiometry, and ENG assessment for patients with SLE to enable crucial treatment.

[Arterial blood gas abnormalities during attacks of dizziness]

OBJECTIVES

We investigated arterial blood gas abnormalities in patients presenting with dizziness.

PATIENTS AND METHODS

The study included 58 patients (39 females, 19 males; mean age 46 years; range 22 to 74 years) who presented during attacks of dizziness. The duration of vertigo complaints ranged from one day to 30 years. Arterial gas measurements were performed at presentation and one month after treatment. The patients were examined in five groups according to the diagnoses: Meniere's disease (n=14), benign paroxysmal positional vertigo (n=13), vertebrobasilar insufficiency (n=12), vestibular neuritis (n=4), and craniocervical myofascial syndromes (n=15).

RESULTS

At presentation, pH was low (acidosis) in two patients (3.5%), and high (alkalosis) in 15 patients (25.9%). After treatment, all abnormal pH values returned to normal. Twenty-four patients had high or low HCO3- values. High HCO3- values persisted in three patients together with dizziness. Patients with vestibular neuritis had significantly higher PO2 values compared to those with craniocervical myofascial syndrome and vertebrobasilar insufficiency (p<0.05). However, one month after treatment, there were no significant differences between five groups with respect to PO2 levels (p>0.05). Consecutive blood gas measurements did not differ significantly within each diagnosis group (p>0.05).

CONCLUSION

Our results suggest that arterial blood gas abnormalities may be related to vertigo attacks.

Lipoprotein (a) and acute-phase response in patients with vestibular neuronitis

BACKGROUND

Vestibular neuronitis (VN) is a relatively common condition characterized by the acute onset of vertigo, nausea and vomiting, in the absence of auditory or central nervous system involvement. The exact aetiology (inflammatory, viral or vascular?) remains obscure. Lipoprotein (a) [Lp(a)] is an atherogenic particle. Its serum levels are mainly genetically determined and vary widely between individuals. Whether Lp(a) is consistently a positive acute-phase reactant is controversial.

PURPOSE

We evaluated the alterations in lipidaemic parameters and serum biological markers (including acute-phase reactants) in adult patients presenting acutely with VN.

SUBJECTS AND METHODS

A total of 34 consecutive VN patients (24 men and 11 women) and 37 apparently healthy controls (25 men and 12 women) were studied. Laboratory evaluation was performed during the acute episode and 6 months later (stable state).

RESULTS

Serum Lp(a) concentrations were significantly lower at the time of presentation (median value 6.4 vs. 16.4 mg dL-1 in the stable state, P < 0.001), whereas fibrinogen levels were significantly higher during the acute episode than in the stable state (median value 293.0 vs. 202.0 mg dL-1, respectively, P < 0.0001). During the acute episode, plasma fibrinogen correlated with CRP levels (Spearman r = 0.84, P < 0.0001). By contrast, inverse correlations were noted between Lp(a) levels and CRP (Spearman r = -0.47, P = 0.007) as well as between Lp(a) and fibrinogen levels (Spearman r = -0.35, P = 0.05).

CONCLUSION

Vestibular neuronitis episodes are associated with evidence of an acute inflammatory response as reflected by significant elevations in plasma fibrinogen and CRP concentrations, whereas Lp(a) behaves as a negative acute-phase reactant.

Relevance of plasma D-dimer measurement in patients with acute peripheral vertigo

The aetiopathogenesis of acute unilateral peripheral vestibular dysfunction (APV), also known as vestibular neuritis, is still debated: the principal cause is viral infection with vascular factors second in importance. Plasmatic D-dimer, considered a plasmatic index of hypercoagulation, was measured in a group of 45 APV patients and in a group of 25 patients suffering from Ménière's disease. Measurements were taken both during the acute stage and after a four to six week period of pharmacological washout. The mean D-dimer levels were significantly higher than those measured in the controls both during the acute phase (301 SD161 vs 202 SD113 ng/mL) and after follow up (304 SD211 vs 192 SD111 ng/mL) (p = 0.008). Moreover, during the acute stage 23 of the APV patients (51.1 per cent) had plasmatic D-dimer levels above the upper normal limit (i.e.: <300 ng/mL), compared to four of those with Ménière's disease (16 per cent). Our results lead us to postulate an involvement of the haemostatic system in APV.