Diagnoses made in a secondary care "fits, faints, and funny turns" clinic.
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AIMS: To investigate the diagnoses made for children referred to a "fits, faints, and funny turns" clinic. METHODS: Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period. RESULTS: Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non-epileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment. CONCLUSIONS: In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non-epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non-epileptic cause are common and can be safely managed expectantly. (+info)
Rehabilitation exercise for treatment of vestibular disorder: a case study.
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Vertigo and dizziness are common symptoms in the general population. While the clinical picture is well known and widely described, there are different interpretations of Benign Paroxysmal Positional Vertigo. The purpose of this case report was to describe the treatment of a 56 year old woman with complains of positional vertigo for 35 consecutive years. She suffered from a sudden onset of rotatory, unilateral horizontal canal type benign paroxysmal positional vertigo (BPPV). The symptoms started a day after falling from a bus, where she injured her head. Otherwise her medical history was unremarkable. She was treated with an individualized home exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning exercises (i.e., laying on the left side from sitting on the bed, while the head rotated 45 degrees to the right, waiting for about one minute; twice a day on gradual basis, not laying on the side all the way, but to use enough pillows to lay about at 60 degrees). Four weeks from the start of physical therapy, the patient was free of symptoms, even when her neck was in the extended position. (+info)
Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial.
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BACKGROUND: Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common vestibular disorder and can be easily treated with Epley's manoeuvre. Thus far, the short-term efficacy of Epley's manoeuvre for treatment of PC-BPPV is unknown. OBJECTIVES: To evaluate the efficacy of Epley's manoeuvre for treatment of PC-BPPV 24 h after applying the manoeuvre. METHODS: The short-term efficacy of Epley's manoeuvre was compared with a sham procedure in 66 patients with PC-BPPV by using a double-blind randomised study design. RESULTS: 24 h after treatment, 28 of 35 (80%) patients in the Epley's manoeuvre group had neither vertigo nor nystagmus on positional testing compared with 3 of 31 (10%) patients in the sham group (p<0.001). CONCLUSION: Epley's manoeuvre is shown to resolve PC-BPPV both effectively and rapidly. (+info)
Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis.
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A new strategy for the diagnosis and treatment both of geotropic and apogeotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is proposed. To this end, a new strategy of approach to Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is described in order to rapidly highlight both the side and the affected canal. Thus, in the first treatment session, using the so-called "strategy of the minimum stimulus", a large percentage of cases are successfully treated, with the lowest number of vertigos for the patient. Following a review of the literature, 269 case studies, personally observed over a 4-year period, are described. The diagnostic strategy is performed by a single manoeuvre to determine whether the posterior semicircular canal or the lateral canal is affected. In the latter case, it is possible to highlight the affected sides both of the geotropic and apogeotropic forms. The therapeutic strategy comprises several liberatory manoeuvres, barbecue rotation techniques (Vannucchi-Asprella, Lempert), and Gufoni manoeuvre by continuously monitoring the ampullofugal movement of the otoliths. Almost 98% of cases are successfully treated at the first treatment diagnostic-therapeutic session. This approach to Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo allows a two-fold goal to be achieved, i.e., to effect both diagnosis and treatment at the first examination. Furthermore, thanks to the philosophy of the approach to Benign Paroxysmal Positional Vertigo, called the "Strategy of the minimum stimulus", patient compliance is very good since a very small number of vertigos are produced, and few neuro-vegetative disorders. (+info)
Interaction of somatoform and vestibular disorders.
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BACKGROUND: The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders. OBJECTIVE: To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study. METHODS: Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Meniere's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-otological diagnostic procedures included electro-oculography with rotatory and caloric testing, orthoptic examination with measurements of subjective visual vertical (SVV) and ocular torsion, and a neurological examination. Psychosomatic diagnostic procedures comprised interviews and psychometric instruments. RESULTS: Patients with BPPV (35.3%) and with vestibular neuritis (52.2%) had pathological test values on caloric irrigation (p<0.001). Otolith dysfunction with pathological tilts of SVV and ocular torsion was found only in patients with vestibular neuritis (p<0.001). Patients with Meniere's disease, vestibular migraine, and psychiatric disorders showed normal parameters for vestibular testing but pathological values for psychometric measures. There was no correlation between pathological neurological and pathological psychometric parameters. CONCLUSIONS: High anxiety scores are not a result of vestibular deficits or dysfunction. Patients with Meniere's disease and vestibular migraine but not vestibular deficits showed the highest psychiatric comorbidity. Thus the course of vertigo syndromes and the possibility of a pre-existing psychopathological personality should be considered pathogenic factors in any linkage between organic and psychometric vertigo syndromes. (+info)
Historical Lassa fever reports and 30-year clinical update.
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Five cases of Lassa fever have been imported from West Africa to the United States since 1969. We report symptoms of the patient with the second imported case and the symptoms and long-term follow-up on the patient with the third case. Vertigo in this patient has persisted for 30 years. (+info)
Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque.
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The authors describe two patients suffering from demyelinating central nervous system disease who developed intense vertigo and downbeat nystagmus upon tilting their heads relative to gravity. Brain MRI revealed in both cases a single, small active lesion in the right brachium conjunctivum. The disruption of otolithic signals carried in brachium conjunctivum fibres connecting the fastigial nucleus with the vestibular nuclei is thought to be causatively involved, in agreement with a recently formulated model simulating central positional nystagmus. Insufficient otolithic information results in erroneous adjustment of the Listing's plane in off-vertical head positions, thus producing nystagmic eye movements. (+info)
Jinger moxibustion for treatment of cervical vertigo --a report of 40 cases.
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In order to observe the therapeutic effects of jinger moxibustion for cervical vertigo, 78 cases were randomly divided into 2 groups, of whom 40 were treated with jinger moxibustion and 38 treated with acupuncture. The results showed a cure rate of 72.5% with a total effective rate of 97.5% in the jinger moxibustion group, while 44.7% and 73.7% respectively in the acupuncture group. The comparisons between the two groups in the cure rate and the total effective rate showed significant differences (P < 0.05). THE CONCLUSION: Jinger moxibustion has a good therapeutic effect for treating cervical vertigo, superior to that of the acupuncture treatment. (+info)