Articles: vertigo.
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Comparative Study
Vestibular functioning and migraine: comparing those with and without vertigo to a normal population.
This study compared vestibular functioning in a migrainous vertigo group, a migraine without vertigo group and a control group. It was hypothesised that the migrainous vertigo group would perform worse in tests of vestibular function and gait than the other groups during a non-migrainous period. ⋯ These findings indicate underlying differences in the vestibular ocular reflexes and function of migraine sufferers compared with those who do not suffer migraines, but the difference is most pronounced for those with migrainous vertigo. This suggests that vestibular rehabilitation for migrainous vertigo should focus on vestibular ocular reflexes and functional retraining.
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J. Neurol. Neurosurg. Psychiatr. · Dec 2013
MRI and neurophysiology in vestibular paroxysmia: contradiction and correlation.
Vestibular paroxysmia (VP) is defined as neurovascular compression (NVC) syndrome of the eighth cranial nerve (N.VIII). The aim was to assess the sensitivity and specificity of MRI and the significance of audiovestibular testing in the diagnosis of VP. ⋯ Only the combination of clinical examination, neurophysiological and imaging techniques is capable of (1) defining the affected side of a NVC and to (2) differentiate between a deficit syndrome and increased excitability in VP.
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Randomized Controlled Trial
Comparison of the effectiveness of intravenous piracetam and intravenous dimenhydrinate in the treatment of acute peripheral vertigo in the emergency department.
We aimed to compare the effectiveness of intravenous piracetam with that of intravenous dimenhydrinate in the treatment of acute peripheral vertigo in the emergency department. ⋯ Dimenhydrinate and piracetam have similar levels of effectiveness with regard to acute vertigo. We conclude that piracetam, which has fewer side effects than dimenhydrinate, better vestibular compensation, and is effective for both acute and chronic vertigo, could be more frequently used in the emergency treatment of acute vertigo.
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Editorial Comment
Diagnosing dizziness: we are teaching the wrong paradigm!
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Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2]). ⋯ HINTS substantially outperforms ABCD2 for stroke diagnosis in ED patients with AVS. It also outperforms MRI obtained within the first 2 days after symptom onset. While HINTS testing has traditionally been performed by specialists, methods for empowering emergency physicians (EPs) to leverage this approach for stroke screening in dizziness should be investigated.