Vertigo in pilots

OBJECTIVES: The aim was to evaluate endolymphatic hydrops in patients with Ménière's disease before and after vestibular neurectomy to verify if the endolymphatic space dilatation, observed in magnetic resonance imaging, regressed within several months after surgery. METHODS: Magnetic resonance imaging was performed after intravenous gadolinium injection in four patients with unilateral definite Ménière's disease before and eight months after vestibular neurectomy...

Posterior strokes are frequently misdiagnosed as they present with non-specific complaints such as dizziness/vertigo. Emergency department (ED) practice often relies on CT/CTA to "exclude" infarct in such patients, providing false reassurance due to lower sensitivity of CT (42%) for stroke in the posterior circulation. We describe a pilot at our institution using a specialized MRI protocol with 95% sensitivity for posterior stroke, which may be used in place of CT/CTA or conventional MRI for stroke evaluation...

BACKGROUND: Cryptogenic stroke leading to cerebellar infarction is a rare but serious cause of acute nausea and vomiting. This has the potential of devastating consequences if this occurs in aviators during flight. We present a case of cryptogenic stroke causing incapacitating nausea and vomiting in a U.S. Air Force pilot. CASE REPORT: A 36-yr-old active-duty U.S. Air Force male pilot developed acute onset severe vertigo, nausea, and vomiting during initial descent. Initial computed tomography imaging was normal and his initial assessment yielded a diagnosis of benign paroxysmal positional vertigo...

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) unifies the main characteristics of chronic subjective dizziness, visual vertigo and related diseases, which is a common chronic disease in neurology. At present, the pathology of PPPD is not fully understood. OBJECTIVE: In this single-center retrospective case series review, we aim to investigate the potential risk factors of PPPD. METHODS: Eighty inpatients diagnosed with PPPD were recruited with 81 apparently healthy controls...

The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo has yet to be identified. The aims of the current study were (1) to elucidate whether there are functional changes of the intrinsic brain activity in the auditory and vestibular cortices of the ISSNHL patients with vertigo using resting-state functional magnetic resonance imaging (rs-fMRI) and (2) whether the connectivity alterations are related to the clinical performance associated with ISSNHL with vertigo...

BACKGROUND: We assessed whether detection of stroke underlying acute vertigo using HINTS plus (head-impulse test, nystagmus type, test of skew, hearing loss) can be improved by video-oculography for automated head-impulse test (V-HIT) analysis. METHODS: We evaluated patients with acute vestibular syndrome (AVS) presenting to the emergency room using HINTS plus and V-HIT-assisted HINTS plus in a randomized sequence followed by cranial MRI and caloric testing. Image-confirmed posterior circulation stroke or vertebrobasilar TIA were the reference standards to calculate diagnostic accuracy...

Objective: The main goal of this study is to clarify the electroencephalogram (EEG) characteristics of the stress response caused by vestibular endurance training under real conditions. Methods: Ten pilot trainees received a series of acute anti-vertigo training stimulations on the rotary ladder while recording electroencephalographic data (64 electrodes). Afterward, the anti-vertigo ability of the subject was tested for the best performance after 1 month of training and verified whether it is related to the EEG signals we collected before...

BACKGROUND: Dizziness is a common complaint that often persists and leads to disability and distress. Several cognitive and behavioural responses may contribute to the neurobiological adaptations that maintain persistent vestibular symptoms. This paper will present the protocol of a two-arm parallel group feasibility randomised controlled trial designed to determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of an integrated cognitive behavioural therapy and vestibular rehabilitation (CBT-VR) treatment for people with persistent dizziness...

Background: People living with multiple sclerosis (MS) experience a high symptom burden that interferes with daily functioning. Virtual reality (VR) is an emerging technology with a range of potential therapeutic applications that may include ameliorating the experience of some common MS symptoms. Objective: We tested the feasibility and tolerability of a VR intervention and its preliminary effects on affect. Methods: Participants with MS were recruited to complete a pilot study of eight sessions of VR over four weeks...

OBJECTIVE: To investigate the correlation between benign paroxysmal positional vertigo (BPPV) and abnormal bone metabolism and to evaluate the value of otoconial protein otoconin-90 in the pathogenesis research and clinical treatment of BPPV. STUDY DESIGN: Prospective pilot clinical trial (Level of Evidence: 2b). SETTING: Outpatient otolaryngologic department. PATIENTS: Twenty seven patients with a diagnosis of BPPV referred to the otolaryngologic department and 25 controls with no history of dizziness from 2018...

Objective: To analyze the clinical features of Vestibular migraine（VM） and provide evidence for its accurate diagnosis and medical identification of flight personnel. Method: A total of 490 samples of VM patients were collected. Among them, 88 samples were secondary to benign paroxysmal positional vertigo（BPPV）, and 11 samples were co-occurring with Meniere's disease（MD）. All patients received drugs, lifestyle management, vestibular rehabilitation and other comprehensive treatment, and analyzed the clinical features and effect within 6 months...

BACKGROUND AND PURPOSE: The short-term evolution of pediatric migraine remains unclear. We aimed to describe the evolution of migraine before and after puberty and its relationship with lifestyle habits. METHODS: We prospectively selected prepuberal patients from a neuropediatric unit who had a migraine diagnosis. Their medical history, migraine characteristics and impact, and lifestyle habits were recorded at the baseline visit. After 2 years we performed a telephone follow-up assessment...

All-trans-retinoic acid (ATRA) is highly active in acute promyelocytic leukemia but not in other types of acute myeloid leukemia (AML). Previously, we showed that ATRA in combination with Lysine-specific demethylase 1 (LSD1) inhibition by tranylcypromine (TCP) can induce myeloid differentiation in AML blasts. This phase I/II clinical trial investigated the safety and efficacy of TCP/ATRA treatment as salvage therapy for relapsed/refractory (r/r) AML. The combination was evaluated in 18 patients, ineligible for intensive treatment...

OBJECTIVE: This is a small pilot study to evaluate the effectiveness of an intravenous (IV) valproate sodium therapy protocol for migraine prevention in a population of patients with chronic migraine refractory to multiple preventive medications. BACKGROUND: Valproate sodium is an anti-epileptic and mood stabilizer that has been shown to prevent migraine when used daily in oral form. The specific mechanism of action in migraine is unknown, but it may be related to suppressing inflammation and increasing brain Gamma-aminobutyric acid levels...

Background: Whether the abnormal caloric test (C-test) affects recurrence rate in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) with residual dizziness (RD) is not clear. Objectives: 1) Analyze the association of the cycles of canalith repositioning procedure (CRP), C-test and RD after CRP and 2) determine which affects the recurrence rate in idiopathic HSC-BPPV. Materials and methods: Eighty-four patients with HSC-BPPV (canal type) were included in this work. The cycles of CRP, C-test, the RD after CRP and HSC-BPPV recurrence rate were recorded...

OBJECTIVE: Caesarean section is a well-known cause of difficulties in breastfeeding initiation. Mother-infant skin-to-skin contact allows to improve breastfeeding and maternal comfort but remains few practiced during caesarean section. Our objective was to evaluate maternal comfort before and after immediate skin-to-skin contact in case of elective caesarean section. METHODS: This was a prospective, observational, monocenter study including patients with elective caesarean section...

Background: The treatments of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) have low remission rates ranging between 60% and 90%, connected to the difficulty in correctly identifying the affected side of HSC-BPPV. Objective: To propose and compare the efficacy of the latency test (LT) in identifying the affected ear in patients with HSC-BPPV. Materials and methods: Twenty-one subjects diagnosed with HSC-BPPV, as ascertained by head rolling test (HRT), were prospectively identified...

BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA. AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend...

INTRODUCTION: Menière's Disease (MD) is a disorder of the inner ear consisting of episodic attacks of vertigo associated with aural fullness, tinnitus, and fluctuating hearing loss. Hearing levels in MD can often fluctuate over time, and may eventually decline permanently in a step-wise fashion. There are no current studies examining daily hearing fluctuations for prolonged periods in patients with MD. Portable audiometry has the potential to allow the patient to monitor their hearing on a daily basis without attending a center for formal audiology...

OBJECTIVE: The aim of this study was to investigate the efficacy and safety of tadalafil add-on therapy with α1 -adrenoceptor antagonists. METHODS: Patients with persistent storage symptoms refractory to α1 -adrenoceptor antagonists for benign prostatic hyperplasia were enrolled in the study. Patients were randomly assigned to either a 5 mg tadalafil or 5 mg solifenacin treatment group for 12 weeks. International Prostate Symptom Score, Overactive Bladder Symptom Score, urinary flow rates, residual urine volume, and blood pressure were measured prospectively before treatment and after 4 and 12 weeks of treatment...