Articles: vertigo.
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This retrospective study assessed several clinical, case history and functional parameters to investigate benign paroxysmal positional vertigo (BPPV) in patients with migraine. ⋯ A high prevalence of BPPV and earlier onset in migraine are the main findings of this study. There is a higher incidence of a range of neurotological patterns in the intervals between BPPV episodes in migraineurs with recurrent vertigo. No direct pathophysiological link between migraine and BPPV has yet been established; comorbidity seems to affect clinical features in a sub-population of patients and make BPPV more debilitating.
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In patients presenting with acute vertigo or dizziness, identifying the posterior fossa stroke as the underlying cause can be a major challenge. We therefore evaluated the serum biomarkers for the differential diagnosis of nonvascular vertigo and posterior circulation stroke. ⋯ Serum levels of S100β were significantly higher in stroke patients than in nonvascular vertigo patients. Serum concentrations of MMP-9 tended to be higher in stroke patients, whereas no significant differences among groups were found for sVCAM-1 and GFAP. Receiver-operating characteristic analysis revealed a sensitivity of 94.4% and a specificity of 31.8% for detecting stroke in patients presenting with vertigo for S100β. S100β may serve as a biomarker for distinguishing between vertigo of vascular causes and nonvascular, acute vertigo.
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A 30-year-old woman with chronic foot pain after an orthopaedic surgery and chronic neck pain presented to the emergency department (ED) with a history of self-rotatory vertigo with unsteadiness. She had started low-dose pregabalin, 25 mg two times a day 9 months before experiencing symptoms with the dose gradually increased to 150 mg two times a day over this period. ⋯ Pregabalin was tapered over 2 months with a complete disappearance of the symptoms. We concluded that symptoms were due to pregabalin treatment.
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Randomized Controlled Trial
Intravenous promethazine versus lorazepam for the treatment of peripheral vertigo in the emergency department: A double blind, randomized clinical trial of efficacy and safety.
Vertigo imposes considerable health restrictions with significant impact on the patient's quality of life. The most effective antivertigo agent is undetermined thus far. ⋯ Our study demonstrated the evidence that promethazine is superior to lorazepam in management of peripheral vertigo and vertigo-related nausea in ED adults.