Articles: vertigo.
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The majority of patients who present to the Emergency Department with vertigo suffer from benign conditions. However, a few percent of these patients have life-threatening conditions, such as a cerebellar stroke. ⋯ There is no role for computed tomography in the evaluation of patients with isolated acute vestibular syndrome in the Emergency Department. For patients with benign paroxysmal positional vertigo, simple reposition maneuvers are effective for symptom relief.
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Herein we discuss the recent literature concerning cervicogenic vertigo including vertigo associated with rotational vertebral artery syndrome, as well as whiplash and degenerative disturbances of the cervical spine. We conclude with a summary of progress regarding diagnostic methods for cervicogenic vertigo. ⋯ Little progress has been made over the last year concerning cervicogenic vertigo. As neck disturbances combined with dizziness are commonly encountered in the clinic, the lack of a diagnostic test that establishes that a neck disturbance causes vertigo remains the critical problem that must be solved.
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Arch Phys Med Rehabil · Feb 2015
ReviewSystematic review of patient-reported outcome measures in clinical vestibular research.
To identify the most commonly used patient-reported outcome (PRO) measures in clinical vestibular research, and to assess their test characteristics and applicability to the study of age-related vestibular loss in clinical trials. ⋯ None of the most commonly used PRO instruments were validated for use in community-dwelling older adults with age-related vestibular loss. Nevertheless, the 3 common domains of items identified across these 4 PRO instruments may be generalizable to older adults and provide a basis for developing a PRO instrument designed to evaluate the effectiveness of interventions targeted toward age-related vestibular loss.
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Clin Neurol Neurosurg · Feb 2015
Preoperative MRI in neurovascular compression syndromes and its role for microsurgical considerations.
Neurovascular compression (NVC) in the posterior fossa is characterized by complex, three-dimensional (3D) neurovascular relationships at the root entry zones (REZ) and other parts of cranial nerves, resulting in syndromes such as trigeminal neuralgia (TN), hemifacial spasm, vertigo and glossopharyngeal neuralgia. Microvascular decompression (MVD) requires microsurgical experience and 3D orientation within the cisternal spaces to achieve adequate clinical results. The vascular structures in anatomical relation to the trigeminal nerve root at the lateral pontine aspect of the brainstem should be examined and maximally decompressed to minimize the risk of recurrent TN. Indication was traditionally based on clinical decisions, only. New MR techniques have become available, and their chances and potential impact should be evaluated in this study. ⋯ We show that high resolution MR images provide reliable and detailed information on corresponding intraoperative anatomy. Especially in unusual cases, the application of such MR techniques and preoperative evaluation may contribute to indication, planning, and also for teaching purposes.
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AJR Am J Roentgenol · Jan 2015
Journal Club: Head CT scans in the emergency department for syncope and dizziness.
The purpose of this study was to determine the yield of acutely abnormal findings on head CT scans in patients presenting to the emergency department with dizziness, near-syncope, or syncope and to determine the clinical factors that potentially predicted acutely abnormal head CT findings and hospital admission. ⋯ Our results suggest that most patients presenting with syncope or dizziness to the emergency department may not benefit from head CT unless they are older, have a focal neurologic deficit, or have a history of recent head trauma.