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Vestibular system paresis due to emergency endovascular catheterization.

ABSTRACT: OBJECTIVE: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. CONCLUSION: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

SUBMITTER: Simoceli L

PROVIDER: S-EPMC4432541 | biostudies-other | 2012 Apr

REPOSITORIES: biostudies-other

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Project description:ObjectiveTo determine whether saccadic velocity in the suppression head impulse paradigm (SHIMP) test is a reliable indicator of vestibular loss at the acute and at the chronic stage in patients suffering from different vestibular pathologies.MethodsThirty-five normal subjects and 57 patients suffering from different vestibular pathologies associated with unilateral vestibular loss (UVL) or bilateral vestibular loss (BVL) were tested in the SHIMPs paradigm. SHIMPs were performed by turning the head 10 times at high velocities to the left or right side, respectively. The patients were instructed to fixate on a red spot generated by a head-fixed laser projected on the wall. In this SHIMPs paradigm, healthy subjects made a large anti-compensatory saccade at the end of the head turn (a SHIMP saccade). The peak saccadic velocity, the percentage of the trials completed with saccades in 10 trials, and the latency of the saccades were quantified in each group. A video-head impulse test (v-HIT) was systematically performed in all of our subjects as well as a caloric test. The dizziness handicap inventory questionnaire was also given to chronic UVL and BVL patients.ResultsAt the acute stage after a complete UVL, patients had zero or a few anti-compensatory saccades for low velocity head turns toward the lesioned side. These saccades had lower velocity than the anti-compensatory saccades recorded during head rotation toward the intact side and/or compared with the saccades measured in control subjects. At the chronic stage, some of the patients recovered the ability to perform SHIMP saccades at each head turn toward the lesioned side, but very often these saccades were of significantly lower velocity. In BVL patients, no anti-compensatory saccades, or only significantly smaller ones, could be detected for head turns to both sides.ConclusionSHIMP is a specific and sensitive test to detect a complete horizontal canal loss at the acute stage. In addition, it reflects the ability of patients with moderate horizontal vestibulo-ocular reflex gain decrease to generate anti-compensatory saccades in the chronic stage. In association with v-HIT, it allows determination of the residual vestibular function and to detect anti-compensatory saccades.

Project description:Introduction: Vestibular dysfunction is a common disorder that results in debilitating symptoms. Even after full compensation, the vestibulo-ocular reflex (VOR) could be further improved by using rehabilitation exercises and visual-vestibular adaptation. We hypothesized that in patients with asymmetric vestibular function, the system could be rebalanced by unidirectional rotations toward the weaker side (i.e., a pure vestibular stimulation). Methods: Sixteen subjects (5 female and 11 male, 43.2 ± 17.0 years old) with chronic vestibular dysfunction that was non-responsive to other types of medical treatment were recruited for the study (ClinicalTrials.gov Identifier: NCT01080430). Subjects had VOR asymmetry quantified by an abnormal directional preponderance (DP) with rotation test and no previous history of central vestibular problems or fluctuating peripheral vestibular disorders. They participated either in the short-term study (one session) or the long-term study (7 visits over 5 weeks). Rehabilitation consisted of five trapezoid unidirectional rotations (peak velocity of 320°/s) toward the weaker side. Care was taken to slowly stop the rotation in order to avoid stimulation in the opposite direction during deceleration. To study the short-term effect, VOR responses were measured before and 10, 40, and 70 min after a single unidirectional rotational rehabilitation session. For long-term effects, the VOR gain was measured before and 70min after rehabilitation in each session. Results: We observed a significant decrease in VOR asymmetry even 10 min after one rehabilitation session (short-term study). With consecutive rehabilitation sessions in the long-term study, DP further decreased to reach normal values during the first 2 sessions and only one subjects required further rehabilitation after week 4. This change in DP was due to an increase in responses during rotations toward the weaker side and a decrease in VOR responses during rotations in the other direction. Conclusion: Our results show that unidirectional rotation can reduce the VOR imbalance and asymmetry in patients with previously compensated vestibular dysfunction and could be used as an effective supervised method for vestibular rehabilitation even in patients with longstanding vestibular dysfunction.

Project description:BackgroundDizziness and vertigo-like symptoms, often caused by common peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV), may significantly impact function and quality of life. These symptoms often result in emergency department (ED) presentations. Evidence-based clinical practice guidelines strongly recommend using physical assessment and treatment manoeuvres for the assessment, diagnosis and treatment of these symptoms. This study aimed to evaluate the process of implementing specialised vestibular physiotherapy (SPV) in an emergency department from the clinician's perspective.MethodsThis implementation study utilised a retrospective mixed-methods process evaluation to understand how SVP operated in an Australian emergency department. The i-PARiHS framework was embedded within the methodology and analytical approach of the study to ensure a comprehensive approach closely aligned to implementation science. Nine clinicians retrospectively completed the Organisational Readiness for Change Assessment (ORCA), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Seven clinicians also participated in a focus group or interview.ResultsA range of barriers and facilitators to the implementation process were identified by participants, some of which spanned multiple domains of the i-PARiHS framework. Relationships with service leaders, champions and medical staff were pivotal facilitators to implementation, along with a generally held perception that SVP was acceptable and feasible. The main barrier identified was a lack of capacity to deliver and facilitate this innovation within the physiotherapy workforce and the broader multidisciplinary recipients.ConclusionsThis study demonstrates that the process of implementing an SVP service in an ED context was generally well-received by clinicians but also involved some challenges and barriers. Services looking to implement SVP in the ED should aim to build stakeholder relationships; develop a shared vision with clear goals and intended outcomes; embed the innovation in organisation processes, procedures and policies; and increase workforce capacity to deliver and facilitate SVP to guide their approach to this innovation.

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Vestibular system paresis due to emergency endovascular catheterization.

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