Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury.
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ABSTRACT:
SUBMITTER: Misale P
PROVIDER: S-EPMC8648866 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We present recent advances in the genetics of recurrent vertigo, including familial episodic ataxias, migraneous vertigo, bilateral vestibular hypofunction and Meniere's disease.Although several vestibular disorders are more common within families, the genetics of vestibulopathies is largely not known. Genetic loci and clinical features of familial episodic ataxias have been defined in linkage disequilibrium studies with mutations in neuronal genes KCNA1 and CACNA1A. Migrainous vertigo is a clinical disorder with a high comorbidity within families much more common in females with overlapping features with episodic ataxia and migraine. Bilateral vestibular hypofunction is a heterogeneous clinical group defined by episodes of vertigo leading to progressive loss of vestibular function which also can include migraine. Meniere's disease is a clinical syndrome characterized by spontaneous episodes of recurrent vertigo, sensorineural hearing loss, tinnitus and aural fullness and familial Meniere's disease in around 10-20% of cases. An international collaborative effort to define the clinical phenotype and recruiting patients with migrainous vertigo and Meniere's disease is ongoing for genome-wide association studies.
| S-EPMC3178912 | biostudies-literature
Project description:VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix-Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p?<?0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.
| S-EPMC6582164 | biostudies-literature
Project description:ObjectiveTo explore the composition of vestibular disorders presenting with the acute vestibular syndrome (AVS).MethodsWe performed a case analysis of 209 AVS patients between January 2016 and December 2020. These patients were grouped into different disorder categories according to the relevant diagnostic criteria.ResultsWe classified the 209 patients into 14 disorder categories, including 110 cases of vestibular neuritis, 30 of idiopathic sudden sensorineural hearing loss with vertigo, 17 of the first attack of continuous vertigo with migraine, 15 of Ramsay Hunt syndrome, 11 of acute labyrinthitis secondary to chronic otitis media, 8 of vestibular schwannoma, 6 of posterior circulation infarction and/or ischemia, 3 of cerebellar abscess secondary to chronic otitis media, 3 of AVS caused by trauma or surgery, 2 of AVS with down-beating nystagmus, 1 of multiple sclerosis of the medulla oblongata, 1 of epidermoid cyst of the posterior cranial fossa, 1 of a probable acute otolithic lesion, and 1 of AVS without measurable vestibular dysfunction.ConclusionWhen a group of disorders present with AVS, characteristic clinical manifestations and imaging help with an accurate diagnosis.
| S-EPMC9326068 | biostudies-literature
Project description:ObjectivesBenign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease. This article aims to summarize research findings and key discoveries of BPPV. The pathophysiology, diagnosis, nonsurgical, and surgical management are discussed.MethodsA comprehensive review of the literature regarding BPPV up through June 2018 was performed.ResultsBPPV is typified by sudden, brief episodes of vertigo precipitated by specific head movements. While often self-limited, BPPV can have a considerable impact on quality of life. The diagnosis can be established with a Dix-Hallpike maneuver for the posterior and anterior canals, or supine roll test for the horizontal canal, and typically does not require additional ancillary testing. Understanding the pathophysiology of both canalithiasis and cupulolithiasis has allowed for the development of various repositioning techniques. Of these, the particle repositioning maneuver is an effective way to treat posterior canal BPPV, the most common variant. Options for operative intervention are available for intractable cases or patients with severe and frequent recurrences.ConclusionsA diagnosis of BPPV can be made through clinical history along with diagnostic maneuvers. BPPV is generally amenable to in-office repositioning techniques. For a small subset of patients with intractable BPPV, canal occlusion can be considered.Level of evidenceN/A.
| S-EPMC6383320 | biostudies-literature
Project description:Objective: The objective of our study was to investigate the potential association between the occurrence of benign paroxysmal positional vertigo (BPPV) and saccular dysfunction using cervical vestibular evoked myogenic potentials (cVEMP) testing. Methods: The databases including Pubmed, Embase, and CENTRAL were systemically searched for case-control literatures investigating saccular dysfunction using cVEMP testing in BPPV patients compared with healthy controls. The literatures were published up to 16 April 2019 and were limited to the English language. All statistical processes were carried out using software Review Manager, version 5.3. Subgroup analysis and sensitive analysis were performed simultaneously. Results: Of the 12 case-control studies confirmed for meta-analysis, p13 latency of cVEMP was assessed in 8 studies, n23 latency in 6 studies, amplitude in 5 studies, asymmetry ratio (AR) in 3 studies, proportion of absent response in 9 studies, and abnormal cVEMP in 8 studies. Compared with healthy controls, the p13 mean latency of cVEMP was longer (MD = 0.88, 95% CI = 0.64-1.12, p < 0.00001), the mean amplitude was lower (SMD = -0.60, 95% CI = -0.80 to -0.41, p < 0.00001), and the proportions of absent response (OR = 8.76, 95% CI = 2.28-33.61, p = 0.002), and abnormal cVEMP (OR = 7.47, 95% CI = 4.65-12.01, p < 0.00001) were higher in BPPV patients. But there was no significant difference in the n23 mean latency (MD = 0.37, 95% CI = -0.23-0.98, p = 0.22) and the AR of cVEMP (MD = 3.95, 95% CI = -4.75-12.65, p = 0.37) between BPPV patients and healthy controls. In the sub-group analysis based on age, only the result of the proportion of absent response of cVEMP indicated a significant difference existed (p = 0.002) between the studies with age-matched controls (OR = 2.78, 95% CI = 1.09-7.10, p = 0.03) and the studies without age-matched controls (OR = 53.85, 95% CI = 10.09-287.13, p < 0.00001). In the sub-group analysis of the proportion of abnormal cVEMP according to the diagnostic criteria of abnormal cVEMP, the result indicated no significant difference existed between the four groups (p = 0.61, I 2 = 0%). In the sensitivity analysis, we obtained the consistent results after removing each study sequentially. Conclusion: The meta-analysis reveals that saccular dysfunction may be associated with BPPV occurrence, and neural degeneration in the saccular macula may be a potential pathogenesis for BPPV.
| S-EPMC6779767 | biostudies-literature
Project description:Background and purposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV).MethodsWe retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver.ResultsTorsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0-60.0°/s (median=18.5°/s) vs. range=2.7-40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082).ConclusionsSHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
| S-EPMC8490902 | biostudies-literature
Project description:Vestibular schwannoma (VS) is commonly accompanied by hearing loss, tinnitus, and dizziness and tends to be chronically progressive in nature. We report a case of VS presenting as left vestibular neuritis (VN) in a previously healthy 57-year-old patient. Right-beating horizontal-torsional spontaneous nystagmus was observed, and the bedside head impulse test revealed a left catch-up saccade. The bithermal caloric test showed left canal paresis, and pure-tone audiometry revealed an average threshold of 22.5 dB bilaterally. Brain magnetic resonance imaging (MRI) demonstrated a 0.7-cm enhancing mass in the left internal auditory canal, consistent with VS. The patient was administered with high-dose systemic corticosteroids and vestibular suppressants with antiemetic, which relieved acute vertigo. Although dizziness in VS is chronically progressive in nature, VS may present as an acute vestibular syndrome that mimics VN. VS should be considered a potential cause of acute vestibular syndrome, and thorough neurological examination with MRI may be helpful for accurate diagnosis.
| S-EPMC9830296 | biostudies-literature
Project description:Positional downbeat nystagmus (pDBN) represents a relatively frequent finding. Its possible peripheral origin has been widely ascertained. Nevertheless, distinguishing features of peripheral positional nystagmus, including latency, paroxysm and torsional components, may be missing, resulting in challenging differential diagnosis with central pDBN. Moreover, in case of benign paroxysmal positional vertigo (BPPV), detection of the affected canal may be challenging as involvement of the non-ampullary arm of posterior semicircular canal (PSC) results in the same oculomotor responses generated by contralateral anterior canal (ASC)-canalolithiasis. Recent acquisitions suggest that patients with persistent pDBN due to vertical canal-BPPV may exhibit impaired vestibulo-ocular reflex (VOR) for the involved canal on video-head impulse test (vHIT). Since canal hypofunction normalizes following proper canalith repositioning procedures (CRP), an incomplete canalith jam acting as a "low-pass filter" for the affected ampullary receptor has been hypothesized. This study aims to determine the sensitivity of vHIT in detecting canal involvement in patients presenting with pDBN due to vertical canal-BPPV. We retrospectively reviewed the clinical records of 59 consecutive subjects presenting with peripheral pDBN. All patients were tested with video-Frenzel examination and vHIT at presentation and after resolution of symptoms or transformation in typical BPPV-variant. BPPV involving non-ampullary tract of PSC was diagnosed in 78%, ASC-BPPV in 11.9% whereas in 6 cases the involved canal remained unidentified. Presenting VOR-gain values for the affected canal were greatly impaired in cases with persistent pDBN compared to subjects with paroxysmal/transitory nystagmus (p < 0.001). Each patient received CRP for BPPV involving the hypoactive canal or, in case of normal VOR-gain, the assumed affected canal. Each subject exhibiting VOR-gain reduction for the involved canal developed normalization of vHIT data after proper repositioning (p < 0.001), proving a close relationship with otoliths altering high-frequency cupular responses. According to our results, overall vHIT sensitivity in detecting the affected SC was 72.9%, increasing up to 88.6% when considering only cases with persistent pDBN where an incomplete canal plug is more likely to occur. vHIT should be routinely used in patients with pDBN as it may enable to localize otoconia within the labyrinth, providing further insights to the pathophysiology of peripheral pDBN.
| S-EPMC7593380 | biostudies-literature
Project description:With the exception of migraines, benign paroxysmal positional vertigo (BPPV) in patients with preexisting central neurologic disorders (CND) is rarely discussed in the literature. Demographic features of this patient group and the efficacy of repositioning therapy are still unknown. We hypothesized that a CND may alter the function of the central vestibular pathway, thus changing the pattern of BPPV and outcomes of repositioning. In this study, we enrolled 93 consecutive idiopathic BPPV patients and categorized them into two groups according to the presence or absence of a CND. In our series, 31.2% of BPPV cases had a CND. The most common associated CNDs were cerebrovascular disease and migraines. The two groups showed similar age distributions, canal involvement, success rates of repositioning, and cycles of treatment used to achieve complete resolution. The major differences were the proportion of females (89.7%) and a right-side predominance (75.9%) in the CND group. There was a trend of more residual dizziness (RD) after successful repositioning in the CND group, but the difference was not significant. The reason for the female and right-side predominance in the CND group is unclear. We concluded that the efficacy of repositioning therapy was excellent (with a success rate of 80.6% with one cycle and 93.5% within two cycles of treatment) for BPPV with or without a preexisting CND. Clinicians are encouraged to diagnose and treat BPPV in patients with a preexisting CND as early as possible to improve patients' quality of life, avoid complications, and reduce medical costs.
| S-EPMC6037198 | biostudies-literature
Project description:BackgroundSome individuals present positional end-point nystagmus when the Dix-Hallpike tests are performed on them if they unintentionally look towards the examined ear.ObjectiveTo describe the prevalence and the characteristics of end-point nystagmus during positional testing in healthy subjects.MethodsSixty healthy subjects were included. Eight positional tests were performed on them, two Pagnini-McClure tests and six Dix-Hallpike tests, while keeping the eyes in different positions; one on each side. Two independent observers filled in a questionnaire about the presence of positional nystagmus, its latency, duration, direction, and sense.Results and conclusionsOf the subjects, 65% showed positional end-point nystagmus. This nystagmus had a short latency and last for as long as the head is maintained in the test position. They can show any direction or sense, but the most common are torsional clockwise in left tests and anticlockwise in right tests. Unlike BPPV, this nystagmus did not appear with the eyes in the straight-ahead position, it is asymptomatic, and its intensity does not decline.
| S-EPMC9821112 | biostudies-literature