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Journal of Neuro-ophthalmology : the... Sep 2020The visual, ocular motor and vestibular systems have intimate neural and close anatomical relationship that dictates their assessment in a patient with dizziness and... (Review)
Review
BACKGROUND
The visual, ocular motor and vestibular systems have intimate neural and close anatomical relationship that dictates their assessment in a patient with dizziness and vertigo.
RESULTS
Recognition of the pearls and pitfalls of a targeted clinical examination HINTS/HINTS "Plus" allows the clinician to probe at the bedside the most crucial hypothesis in a patient with acute isolated vestibular syndrome, "Is this a stroke?"
CONCLUSION
By applying a methodical approach to examination of patients with dizziness and vertigo, localization of the offending lesion, management, and even elucidation of the underlying diagnosis is feasible.
Topics: Dizziness; Eye Movements; Humans; Vertigo; Visual Acuity
PubMed: 32804459
DOI: 10.1097/WNO.0000000000000980 -
Otolaryngologic Clinics of North America Oct 2021Dizziness is a common chief complaint with an extensive differential diagnosis that ranges from peripheral, central, to nonvestibular conditions. An understanding of... (Review)
Review
Dizziness is a common chief complaint with an extensive differential diagnosis that ranges from peripheral, central, to nonvestibular conditions. An understanding of nonvestibular conditions will aid accurate diagnosis and initiation of appropriate management. Thus, the objective of this article is to present an overview of nonvestibular etiologies that may plague a dizzy patient and the recommended treatment options.
Topics: Diagnosis, Differential; Dizziness; Humans; Vertigo
PubMed: 34538360
DOI: 10.1016/j.otc.2021.05.017 -
Archives de Pediatrie : Organe Officiel... Oct 2023Vertigo is common in childhood and adolescence. Although children and adults share common causes of vertigo, epidemiology changes with aging. For instance, ischemic... (Review)
Review
Vertigo is common in childhood and adolescence. Although children and adults share common causes of vertigo, epidemiology changes with aging. For instance, ischemic stroke is less frequent in childhood, whereas audiovestibular disorders, such as vestibular neuritis and the migraine equivalent, are the leading causes of vertigo. However, even if severe causes of vertigo are rare, clinicians must not miss them. In this review, we discuss the neurological causes of central vertigo in children. The diagnostic approaches reviewed here are focused on the search for signs of severity, such as an abrupt onset, infectious context, or intracranial hypertension, which may subsequently require brain imaging.
Topics: Adolescent; Child; Humans; Dizziness; Vertigo; Migraine Disorders
PubMed: 37537083
DOI: 10.1016/j.arcped.2023.07.001 -
Missouri Medicine 2022Posterior fossa lesions can occur in patients of all ages. Patients present with subtle findings of hearing loss, tinnitus, headache, cranial neuropathies, imbalance,... (Review)
Review
Posterior fossa lesions can occur in patients of all ages. Patients present with subtle findings of hearing loss, tinnitus, headache, cranial neuropathies, imbalance, vertigo, nausea, and vomiting depending on the location and type of lesion. The presentation can be particularly insidious as the most common symptom is slowly progressive hearing loss. Posterior fossa lesions should be included in the differential diagnosis for patients with this presentation and appropriate audiologic testing and imaging should be performed. Management involves collaboration between multiple subspecialties and has evolved significantly over the years leading to increased patient involvement and improved outcomes.
Topics: Humans; Hearing Loss; Deafness; Tinnitus; Vertigo; Diagnosis, Differential
PubMed: 36588644
DOI: No ID Found -
European Archives of... Nov 2023Vestibular symptoms, including vertigo, dizziness, and gait unsteadiness, are a frequent reason of urgent medical assistance. Their causes are numerous and diverse,... (Review)
Review
INTRODUCTION
Vestibular symptoms, including vertigo, dizziness, and gait unsteadiness, are a frequent reason of urgent medical assistance. Their causes are numerous and diverse, including neurological, otorhinolaryngological, and systemic diseases. Therefore, following a systematic approach is essential to differentiate striking but benign conditions from others that can compromise the patient's life. This study is intended to review vestibular disorders from a practical perspective and provide guidance to physicians involved in the emergency care of patients with vestibular symptoms.
MATERIALS AND METHODS
A narrative review was performed, revisiting the main causes of vestibular disorders.
RESULTS
Based on the speed of onset, duration, and history of similar episodes in the past, vestibular disorders can be categorized into three syndromic entities (acute, recurrent, and chronic vestibular syndromes). The most representative conditions pertaining to each group were reviewed (including their diagnosis and treatment) and a practical algorithm was proposed for their correct management in the acute care setting.
CONCLUSIONS
Carrying out a correct categorization of the vestibular disorders is essential to avoid diagnostic pitfalls. This review provides useful tools for clinicians to approach their patients with vestibular symptoms at the emergency room.
Topics: Humans; Emergencies; Vertigo; Vestibular Diseases; Dizziness; Emergency Medical Services
PubMed: 37548703
DOI: 10.1007/s00405-023-08125-3 -
Current Opinion in Neurology Feb 2015Vertigo and dizziness occur with considerable frequency in childhood and adolescence. Most causes are benign and treatable. This review aims to make physicians more... (Review)
Review
PURPOSE OF REVIEW
Vertigo and dizziness occur with considerable frequency in childhood and adolescence. Most causes are benign and treatable. This review aims to make physicians more alert to the frequent causes of dizziness in the young.
RECENT FINDINGS
Epidemiological data confirm that migraine-related syndromes are the most common cause of vertigo in children. Vestibular migraine and benign paroxysmal vertigo have now been defined by the International Classification of Headache Disorders. About half of the adolescents with vertigo and dizziness show psychiatric comorbidity and somatization. Vestibular paroxysmia has been described as a new entity in children that can be treated with low doses of carbamazepine. To assess vestibular deficits, video head impulses (for the semicircular canals) and vestibular-evoked myogenic potentials (for the otoliths) are increasingly being used.
SUMMARY
Pediatricians and neuro-otologists should be aware of the full spectrum of causes of vertigo and dizziness in children and adolescents. Vestibular function can reliably be tested nowadays. Although treatment for the common migraine-related syndromes can be done in analogy to the treatment of migraine in general, specific approaches are required for somatoform vertigo, the most frequent diagnosis in adolescent girls.
Topics: Adolescent; Child; Dizziness; Humans; Migraine Disorders; Vertigo
PubMed: 25502049
DOI: 10.1097/WCO.0000000000000157 -
Seminars in Neurology Feb 2020Isolated dizziness and vertigo due to vascular mechanisms are frequently misdiagnosed as peripheral vestibulopathy or vestibular migraine. For diagnosis of strokes... (Review)
Review
Isolated dizziness and vertigo due to vascular mechanisms are frequently misdiagnosed as peripheral vestibulopathy or vestibular migraine. For diagnosis of strokes presenting with an acute prolonged (≥ 24 hours) vestibular syndrome, findings on clinical examination, such as HINTS (negative head impulse tests, detection of direction-changing gaze-evoked nystagmus, and presence of skew deviation), are more sensitive than findings on neuroimaging. Since HINTS alone cannot securely detect anterior inferior cerebellar artery strokes, additional attention should be paid to the patients with unexplained hearing loss in addition to acute prolonged vestibulopathy. For diagnosis of transient (< 24 hours) spontaneous vestibular syndrome due to vascular mechanisms, the presence of associated craniocervical pain and focal neurological symptoms/signs is the clue. Even without these symptoms or signs, however, vascular imaging combined with perfusion- and diffusion-weighted MRI should be performed in patients with multiple vascular risk factors or a high ABCD2 score (age, blood pressure, clinical features, duration of symptom, and presence of diabetes).
Topics: Cerebrovascular Disorders; Humans; Vertigo
PubMed: 31935768
DOI: 10.1055/s-0039-3402737 -
Journal of the Neurological Sciences Dec 2022Recent advances in artificial intelligence are transforming healthcare and there are increasing efforts to apply these breakthroughs to the diagnosis of acute vertigo.... (Review)
Review
Recent advances in artificial intelligence are transforming healthcare and there are increasing efforts to apply these breakthroughs to the diagnosis of acute vertigo. Because the diagnosis of vertigo relies on the analysis of eye movements, there are several unique considerations that must be made when implementing deep learning approaches to vertigo. This review discusses the need for diagnostic aids for acute vertigo, the techniques used to preprocess eye movement data and adapt deep learning models to vertigo, and summarizes and analyzes all published models to date.
Topics: Humans; Dizziness; Artificial Intelligence; Deep Learning; Vertigo; Eye Movements
PubMed: 36379134
DOI: 10.1016/j.jns.2022.120454 -
The Nurse Practitioner Oct 2019Dizziness is a common patient complaint with multiple etiologies. Many causes are benign, but NPs should consider red flags for serious differential diagnoses. A... (Review)
Review
Dizziness is a common patient complaint with multiple etiologies. Many causes are benign, but NPs should consider red flags for serious differential diagnoses. A systematic patient history and physical exam are crucial to accurately diagnosing conditions related to dizziness. This article reviews common etiologies of dizziness and vertigo, assessment techniques, and treatment options.
Topics: Diagnosis, Differential; Dizziness; Humans; Nurse Practitioners; Nursing Assessment; Vertigo
PubMed: 31568028
DOI: 10.1097/01.NPR.0000579744.73514.4b -
Continuum (Minneapolis, Minn.) Apr 2021This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo,... (Review)
Review
PURPOSE OF REVIEW
This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome.
RECENT FINDINGS
The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered.
SUMMARY
This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.
Topics: Dizziness; Hearing Loss, Sensorineural; Humans; Vertigo; Vestibular Aqueduct
PubMed: 34351115
DOI: 10.1212/CON.0000000000000977