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Vertigo emergency

James E McKinley, Allen Perkins
Dizziness is seen frequently in patients in the family medicine and emergency department settings. The differential diagnosis of dizziness can be expansive but with a targeted history and physical examination, a correct diagnosis often can be established and appropriate treatment offered. Common etiologies of dizziness include hypotension, benign paroxysmal positional vertigo (BPPV), and Meniere disease. Strokes and malignancies also can cause this symptom. Imaging is indicated if intracranial pathology is suspected...
February 2019: FP Essentials
Narushi Sugii, Alexander Zaboronok, Hiroyuki Fujimori, Naoaki Sato, Keishi Fujita, Eiichi Ishikawa, Akira Matsumura
BACKGROUND: Stroke mimics (SMs)are medical conditions that are at first considered to be of cerebrovascular etiology but turn out to be a condition other than stroke. While many reports on SMs have been published, there have been none from Japan. Thus, we sought to assess the current state of SMs in a Japanese population. METHODS: We collected data of patients referred with suspicion of stroke to neurosurgeons by emergency department (ED) doctors, and we retrospectively evaluated the diagnosis concordance rate between the ED doctors and the neurosurgeons...
January 9, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Dorota Kozera-Strzelińska, Michał Karliński, Grzegorz Rak, Magdalena Wojdacz, Halina Sienkiewicz-Jarosz, Iwona Kurkowska-Jastrzębska
INTRODUCTION: Our aim was to compare the structure and management of conditions mimicking acute cerebrovascular events (ACE) defined as stroke or transient ischemic attack between patients referred directly to neurological emergency department (ED) by non-ambulance physicians, ambulance physicians and paramedics. METHODS: It is a retrospective study of 802 consecutive patients referred to a Polish urban neurological ED with prehospital suspicion of ACE between January and December 2014...
January 7, 2019: Neurologia i Neurochirurgia Polska
William J Meurer, Kathryn E Beck, Brigid Rowell, Devin Brown, Alexander Tsodikov, Angela Fagerlin, Steven A Telian, Laura Damschroder, Lawrence C An, Lewis B Morgenstern, Misty Ujhely, Laura Loudermilk, Sandeep Vijan, Kevin A Kerber
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and accounts for 8% of individuals with moderate or severe dizziness. BPPV patients experience substantial inconveniences and disabilities during symptomatic periods. BPPV therapeutic processes - the Dix-Hallpike Test (DHT) and the Canalith Repositioning Maneuver (CRM) - have an evidence base that is at the clinical practice guideline level. The most commonly used CRM is the modified Epley maneuver...
December 22, 2018: Trials
Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hang Joo Cho
Benign paroxysmal positional vertigo (BPPV) is a comorbid condition prevalent in patients recovering from trauma. Due to the paucity of studies investigating the etiology of this condition, the present study sought to analyze the high-risk group of BPPV patients following trauma.Trauma patients visiting the emergency department from January to December 2016 were enrolled. The study excluded patients with minor superficial injuries, those who were dead, and those discharged within 2 days after their visit. The medical records were reviewed, and every abbreviated injury score, injury severity score, and other clinical characteristics, such as age and sex, were gathered...
December 2018: Medicine (Baltimore)
J Löhler, D Eßer, B Wollenberg, L E Walther
No abstract text is available yet for this article.
November 30, 2018: HNO
Pablo Young, Melissa Castillo-Bustamante, Carlos J Almirón, Julio E Bruetman, Bárbara C Finn, María A Ricardo, Ana C Binetti
Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway...
2018: Medicina
Anne Mucha, Sheri Fedor, Danielle DeMarco
The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment...
2018: Handbook of Clinical Neurology
Manan U Shah, Seth Lotterman, Daniel Roberts, Marc Eisen
OBJECTIVES/HYPOTHESIS: Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix-Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests...
November 26, 2018: Laryngoscope
Ian Gerard Parker, Gunter Hartel, Jennifer Paratz, Nancy Low Choy, Ann Rahmann
OBJECTIVES: To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time. DATA SOURCES: Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016. STUDY SELECTION: Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics...
November 13, 2018: Otology & Neurotology
Do Kyeun Jeong, Sung-Kyun Hwang
We describe the case of a patient who had infarction of the posterior inferior cerebellar artery (PICA) after a chiropractic cervical manipulation. A 39-year-old man visited the emergency room with signs of cerebellar dysfunction, presenting with a 6-hour history of vertigo and imbalance. Two weeks ago, he was treated by a chiropractor for intermittent neck pain. At the time of admission, brain computed tomography, magnetic resonance imaging, and angiography revealed an acute infarction in the left PICA territory and occlusion of the extracranial vertebral artery (VA; V1/2 junction) as a result of the dissection of the VA...
October 2018: Korean Journal of Neurotrauma
Pavlina Sverak, Meredith E Adams, Stephen J Haines, Samuel C Levine, David Nascene, Katherine Sommer, Kathryn Dusenbery, Tina C Huang, Christopher Moertel
OBJECTIVE: Bevacizumab for hearing preservation in patients with neurofibromatosis type 2 (NF2) is an emerging practice. We set out to characterize the effectiveness and toxicity of bevacizumab in our patient group. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Seventeen consecutive patients with NF2 received bevacizumab treatment for vestibular schwannomas, including 2 patients treated to maintain cochlear implant performance...
October 30, 2018: Otolaryngology—Head and Neck Surgery
Tomislav Pavlović, Marina Milošević, Sanja Trtica, Hrvoje Budinčević
BACKGROUND: Vertigo is a common symptom and reason for admission to the emergency department (ED). AIM: This research aimed to determine the incidence of clinically significant findings on computed tomography (CT) in patients with vertigo without focal neurological abnormalities in the ED. MATERIAL AND METHODS: The results of the native CT scans in the ED were retrospectively analysed. Exclusion criteria included: focal neurological abnormalities, underlying malignancy, brain metastasis, previous brain operation, headache, fever, nausea, vomiting, head trauma, coagulopathy...
September 25, 2018: Open Access Macedonian Journal of Medical Sciences
Marcello Covino, Emanuele Gilardi, Alberto Manno, Benedetta Simeoni, Veronica Ojetti, Chiara Cordischi, Evelina Forte, Luigi Carbone, Simona Gaudino, Francesco Franceschi
INTRODUCTION: Well recognized guidelines are available for the use of cranial computed tomography (CCT) in traumatic patients, while no definitely accepted standards exists to for CCT in patients without history of head injury. The aim of this study is to propose an easy clinical score to stratify the need of CCT in emergency department (ED) patients with suspect non-traumatic intracranial pathology. METHODS: We retrospectively evaluated patients presenting to the ED for neurological deficit, postural instability, acute headache, altered mental status, seizures, confusion, dizziness, vertigo, syncope, and pre-syncope...
September 19, 2018: American Journal of Emergency Medicine
Melanie Lloyd, Alexandra Mackintosh, Catherine Grant, Fiona McManus, Anne-Maree Kelly, Harin Karunajeewa, Clarice Y Tang
AIM: To determine whether patients presenting to the emergency department (ED) with possible benign paroxysmal positional vertigo (BPPV) are managed in accordance with best practice guidelines, and whether physiotherapists are involved in their care. DESIGN: Retrospective observational study. PARTICIPANTS: Ninety-six consecutive patients presenting to one of three EDs with vertigo, dizziness or imbalance symptoms documented at triage. Individuals with a clear non-vestibular cause of symptoms were excluded...
October 17, 2018: Physiotherapy Theory and Practice
Stoyan Popkirov, Jon Stone, Dagny Holle-Lee
PURPOSE OF REVIEW: Persistent postural-perceptual dizziness (PPPD) is a newly defined disorder of functional dizziness that in the International Classification of Diseases in its 11th revision (ICD-11) supersedes phobic postural vertigo and chronic subjective dizziness. Despite efforts to unify the diagnosis of functional (somatoform) dizziness, patients will present with a variety of triggers, perpetuating factors, and comorbidities, requiring individualized treatment. This article will review different treatment strategies for this common functional neurological disorder and provide practical recommendations for tailored therapy...
October 13, 2018: Current Treatment Options in Neurology
Bassel Abou-Khalil, Pavel Klein, Aashit Shah, Philippe Ryvlin, Luigi M Specchio, Helena Gama, Francisco Rocha, David Blum, Todd Grinnell, Hailong Cheng, JungAh Jung
OBJECTIVE: To evaluate and compare the effects of concomitant lamotrigine (LTG) or carbamazepine (CBZ) on the incidence of treatment-emergent adverse events (TEAEs) in patients taking adjunctive eslicarbazepine acetate (ESL) for focal (partial-onset) seizures (FS). METHODS: These post-hoc analyses of data pooled from three randomized, double-blind, placebo-controlled studies of adjunctive ESL (BIA-2093-301, -302 and -304) included adults (≥16 years) with FS refractory to 1-3 antiepileptic drugs (AEDs)...
November 2018: Epilepsy Research
L Harenberg, H M Oßwald, H Jaschonek, S Nagel
BACKGROUND: The proportion of patients with neurological disorders as well as the absolute number of patients in German emergency departments is rising. OBJECTIVE: This article presents the results of a survey among patients with self-referral to a dedicated neurological emergency department (ED). We sought to find out if the individual evaluation of urgency for treatment was comparable for patients and physicians. METHODS: During a prospective trial to validate a new and specific neurological triage system over a time period of three months (October 2015 to January 2016), patients who presented themselves to the ED were handed a questionnaire and asked to provide information on the symptoms, including duration and the subjective urgency for evaluation by a physician (priority 1-4, 1 = emergency, 4 = elective)...
October 1, 2018: Der Nervenarzt
Paloma Del C Monroig-Bosque, Jonathan Balk, Francisco Segura, Eric Salazar, Christopher M Leveque, Tina S Ipe
Medication error is a preventable cause of morbidity and death in the inpatient population. We describe a patient with an antifungal overdose treated with therapeutic plasma exchange (TPE). The patient was diagnosed with cryptococcal meningitis and received an acute overdose of amphotericin B deoxycholate instead of the prescribed liposomal amphotericin B. Consequently, the patient developed clinical symptoms including tremors, hypertension, visual hallucinations, vertigo, fever, and acute renal failure. A series of four TPEs was emergently initiated, resulting in complete resolution of most symptoms...
September 18, 2018: Transfusion and Apheresis Science
Tanzer Korkmaz, Yusuf Ozgur Bicer, Erdinc Serin, Sinan Seyhan, Serap Koybasi Sanal
We aim to demonstrate possible autonomic dysfunction based on salivary α-amylase measurements during and after the vertigo attacks associated with Ménière disease (MD) and benign paroxysmal positional vertigo (BPPV). Patients admitted to the emergency room with a diagnosis of vertigo attacks caused by either MD (n = 15) or BPPV (n = 9) constituted the study groups. The control group (n = 10) consisted of volunteer patients admitted to the emergency department with minor soft-tissue trauma. The first saliva samples were obtained immediately during the attacks and the second and third samples were obtained on the third and fifteenth days of the attack, respectively...
September 2018: Ear, Nose, & Throat Journal
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