Drop attacks and vertical vertigo after transtympanic gentamicin: diagnosis and management.
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Drop attacks represent a significant problem during the natural course of Meniere's disease. They are characterized by a sudden fall to the ground without loss of consciousness. Diagnosis is clinical and based on the typical description of the patient. Involvement of vertical canal is possible during Meniere's disease and also after gentamicin application. Treatment of drop attacks is still a matter of discussion; most cases have a benign course with spontaneous remission and no treatment is necessary. In severe cases, aggressive treatment (surgical or pharmacological) is necessary. A case of drop attack associated with vertical vertigo is presented. Vestibular tests were performed in order to assess the involvement of inner ear. Caloric test and ice water test reveal no response. Vestibular Evoked Myogenic Potentials are present even after high doses of gentamicin. Drop attacks and vertical vertigo can occur after transtympanic gentamicin and can be well managed with high doses of local gentamicin. (+info)
Effects of anti-vertigo drugs on medial vestibular nucleus neurons activated by horizontal rotation.
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The effects of anti-vertigo drugs on medial vestibular nucleus (MVN) neurons were examined to assess the site and mode of action using cats anesthetized with alpha-chloralose. Single neuron activity in the MVN was extracellularly recorded using a silver wire microelectrode attached along a seven-barreled micropipette, each of which was filled with diphenhydramine, diphenidol, betahistine, glutamate or NaCl. Type I of the MVN neurons were identified according to the responses obtained when the animal placed on a turn-table was rotated sinusoidally. The effects of the drugs were examined on type I neurons which received impulses primarily from the labyrinth and sent them to the oculomotor nuclei. The microiontophoretic application of diphenhydramine, diphenidol and betahistine inhibited rotation-induced firing of type I MVN neurons. Diphenhydramine and diphenidol were more potent than betahistine. These results suggest that these drugs directly act on MVN neurons to reduce the responsiveness to rotatory stimulation. (+info)
Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study.
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Benign paroxysmal positional vertigo (BPPV) is characterized by episodic vertigo and nystagmus provoked by head motions. To study the characteristics of BPPV in a large group of patients in Korea, we retrospectively analyzed clinical features of 1,692 patients (women: 1,146, 67.7%; men: 54.6, 32.3%; mean age: 54.8+/-14.0 yr), who had been diagnosed as BPPV by trained neuro-otologists Dizziness Clinics. The diagnosis of BPPV was based on typical nystagmus elicited by positioning maneuvers. Posterior semicircular canal was involved in 60.9% of the patients, horizontal canal in 31.9%, anterior canal in 2.2%, and mixed canals in 5.0%. The horizontal canal type of BPPV (HC-BPPV) comprised 49.5% of geotropic and 50.5% of apogeotropic types. We could observe significant negative correlation between the proportion of HC-BPPV of each clinic and the mean time interval between the symptom onset and the first visit to the clinics (r=-0.841, p<0.05). Most patients were successfully treated with canalith repositioning maneuvers (86.9%). The high incidence of HC-BPPV in this study may be explained by relatively shorter time interval between the symptom onset and visit to the Dizziness Clinics in Korea, compared with previous studies in other countries. (+info)
Endolymphatic sac tumour: a rare cause of recurrent vertigo.
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Endolymphatic sac tumour occurring in a 32-year-old man presenting with Meniere's like symptoms of recurrent vertigo, hearing loss and tinnitus is described. Magnetic resonance imaging and computed tomography showed a vascular bone tumour centred over the retrolabyrinthine aspect of the temporal bone where the endolymphatic sac was located. Surgical excision via a translabyrinthine approach was performed. Endolymphatic sac tumours are rare papillary adenocarcinomas that arise from the endolympatic sac. It can be mistaken both on radiology and histology for other tumours such as paragangliomas, renal or papillary thyroid carcinoma metastases. Surgical excision is the treatment of choice but sacrifice of the auditory and facial nerve may be needed in advanced cases to achieve tumour clearance. (+info)
Binocular coordination of saccades in children with vertigo: dependency on the vergence state.
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The present study examines the quality of binocular coordination of saccades at far and near distance in 15 children with symptoms of vertigo headache and equilibrium disorders; these children show normal vestibular function but abnormal convergence eye movements (e.g., long time preparation, slow execution and poor accuracy, see ). The results show normal binocular saccade coordination at far distance, but large abnormal disconjugacy for saccades at near distance. During combined saccade-vergence movements (studied in six of these children), convergence remains abnormally slow. This supports the interpretation according to which poor binocular yoking of the saccades is linked to the reduced ability to produce fast convergence during the saccade; a learning mechanism based on rapid vergence would help to reduce the abducting-adducting asymmetry of the saccades. An alternative interpretation would be reduced learning ability for monocular adjustment of the saccade signals. (+info)
Is it important to restrict head movement after Epley maneuver?
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The effectiveness of postmaneuver postural restrictions is controversial in patients with benign paroxysmal positional vertigo. AIM: To verify the role of postural restrictions in patients with benign paroxysmal positional vertigo of posterior canal, submitted to a single Epley maneuver. STUDY DESIGN: clinical prospective. MATERIAL AND METHOD: Fifty eight patients with benign paroxysmal positional vertigo of posterior canal were randomly divided in two groups following the application of a unique Epley maneuver. The patients from group 1 were informed to restrict their head movements and to use a cervical collar and group 2 patients were not informed about these postmaneuver restrictions. The patients from both groups were reevaluated one week after Epley maneuver, regarding the presence of symptoms and positional nystagmus. RESULTS: One week after Epley maneuver 82.1% of the patients from group 1 and 73.3% from group 2 didn't present positional nystagmus (p=0.421). There was a clinical improvement in 96.0% of the patients from group 1 and in 94.0% from group 2 (p=0.781). CONCLUSION: The use of postural restrictions in patients with benign paroxysmal positional vertigo of posterior canal didn't interfere in their clinical evaluation, one week after a unique Epley maneuver. (+info)
The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo.
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AIM: To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and/or semicircular canal involvement. STUDY DESIGN: clinical prospective with transversal cohort. MATERIAL AND METHOD: Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement. Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus. Analysis of Variance was used to verify differences between the variables. RESULTS: An average of 2.13 procedures (from 1 to 8) was needed to eliminate the positioning nystagmus. Canalithiasis required an average of 1.53 procedures, while cupulolithiasis needed 2.92 procedures (p=0.0002). An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement, 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement (p=0.5213). CONCLUSIONS: From one to eight weekly canalith repositioning procedures were needed, with an average of two, to eliminate positioning nystagmus in benign paroxysmal positional vertigo. Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus. Semicircular canal involvement didn't influence the number of therapeutic maneuvers. (+info)
Quality of life in patients with benign paroxysmal positional vertigo and/or Meniere's disease.
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Patients with benign paroxysmal positional vertigo and/or Meniere's disease relate damages in quality of life. AIM: To compare the impact of dizziness on quality of life, in patients with benign paroxysmal positional vertigo and/or Meniere's disease, in crisis and out of crisis, and to evaluate the influence of gender, age and impaired semicircular canal. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: The prospective study was realized in 2003/04 at Federal University of Sao Paulo. The Dizziness Handicap Inventory was applied in seventy patients with positional vertigo, seventy with Meniere's disease and fifteen with both. Two-proportion equality test and the Analysis of variance were employed in this study. RESULTS: When comparing the groups, Dizziness Handicap Inventory results evidenced higher averages in crisis and out of crisis for Meniere's disease group than for positional vertigo group. The same occurred only during the crisis period in the group when comparing with both disorders (p<0,05). No significant statistical differences were observed, when comparing the results considering age, gender and, in the group with positional vertigo, affection of posterior semicircular canal as variables. CONCLUSIONS: Meniere's disease patients presented worse quality of life when compared to BPPV patients, in and out of crisis, and during the crisis when regarding the patients with association of both disorders. The damage on quality of life was independent of gender, age and in the BPPV cases it was independent of posterior canal affection. (+info)