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Journal of Vestibular Research :... 2017This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on...
This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on the patient history, bedside examination and laboratory evaluation. Bilateral vestibulopathy is a chronic vestibular syndrome which is characterized by unsteadiness when walking or standing, which worsen in darkness and/or on uneven ground, or during head motion. Additionally, patients may describe head or body movement-induced blurred vision or oscillopsia. There are typically no symptoms while sitting or lying down under static conditions.The diagnosis of BVP requires bilaterally significantly impaired or absent function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the angular VOR by the head impulse test (HIT), the video-HIT (vHIT) and the scleral coil technique and for the low frequency range by caloric testing. The moderate range can be examined by the sinusoidal or step profile rotational chair test.For the diagnosis of BVP, the horizontal angular VOR gain on both sides should be <0.6 (angular velocity 150-300°/s) and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side <6°/s and/or the horizontal angular VOR gain <0.1 upon sinusoidal stimulation on a rotatory chair (0.1 Hz, Vmax = 50°/sec) and/or a phase lead >68 degrees (time constant of <5 seconds). For the diagnosis of probable BVP the above mentioned symptoms and a bilaterally pathological bedside HIT are required.Complementary tests that may be used but are currently not included in the definition are: a) dynamic visual acuity (a decrease of ≥0.2 logMAR is considered pathological); b) Romberg (indicating a sensory deficit of the vestibular or somatosensory system and therefore not specific); and c) abnormal cervical and ocular vestibular-evoked myogenic potentials for otolith function.At present the scientific basis for further subdivisions into subtypes of BVP is not sufficient to put forward reliable or clinically meaningful definitions. Depending on the affected anatomical structure and frequency range, different subtypes may be better identified in the future: impaired canal function in the low- or high-frequency VOR range only and/or impaired otolith function only; the latter is evidently very rare.Bilateral vestibulopathy is a clinical syndrome and, if known, the etiology (e.g., due to ototoxicity, bilateral Menière's disease, bilateral vestibular schwannoma) should be added to the diagnosis. Synonyms include bilateral vestibular failure, deficiency, areflexia, hypofunction and loss.
Topics: Bilateral Vestibulopathy; Caloric Tests; Consensus; Diagnosis, Differential; Functional Laterality; Head; Head Impulse Test; Humans; Motion; Movement Disorders; Nystagmus, Pathologic; Point-of-Care Testing; Reflex, Vestibulo-Ocular; Rotation; Sclera; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests; Vision Disorders
PubMed: 29081426
DOI: 10.3233/VES-170619 -
The Neuroradiology Journal Dec 2021Carotid web is thought to be a focal intimal variant of fibromuscular dysplasia, which comprises a high risk of stroke because of blood stasis and subsequent coagulative...
Carotid web is thought to be a focal intimal variant of fibromuscular dysplasia, which comprises a high risk of stroke because of blood stasis and subsequent coagulative reactions that occur distal to the web. These lesions generally involve the posterolateral wall of the carotid and their developmental pathogenesis is controversial. This case report describes a 51-year-old woman who presented to the hospital with sudden onset aphasia, right hemi-sensory loss, and right visual field cut. Magnetic resonance imaging (MRI) of the brain demonstrated a left middle cerebral artery (MCA) distribution embolic ischemic infarct with shelf-like linear filling defects in the carotid bulb bilaterally on a computed tomography angiography (CTA) of the head and neck consistent with bilateral carotid webs that were confirmed by catheter angiography. The carotid webs were projecting on the left posteriorly and on the right anteriorly into the inferior aspects of the bilateral proximal internal carotid arteries. The patient was started on clopidogrel and a high-intensity statin and remained on Plavix monotherapy for a 10-month follow up without a recurrent ischemic event.
Topics: Brain Ischemia; Carotid Arteries; Carotid Artery, Internal; Female; Fibromuscular Dysplasia; Humans; Middle Aged; Stroke
PubMed: 34000900
DOI: 10.1177/19714009211017783 -
Maedica Dec 2022Synovial osteochondromatosis is a rare benign pathology arising from the synovial membrane of the joints, synovial sheaths or uncommonly the bursae around the joints....
Synovial osteochondromatosis is a rare benign pathology arising from the synovial membrane of the joints, synovial sheaths or uncommonly the bursae around the joints. Baker's cysts are fluid filled, synovium-lined lesions arising in popliteal fossa. Synovial chondromatosis involving the Baker`s cyst is extremely rare. The aim of this case report is to document this exceedingly rare extra articular synovial pathology involving Baker's cysts of bilateral knees and to emphasize the importance of radiographs and sonography in the diagnosis.
PubMed: 36818241
DOI: 10.26574/maedica.2022.17.4.999 -
PloS One 2022Spondylolysis occurs bilaterally or unilaterally and bilateral spondylolysis increases the risk of developing isthmic spondylolisthesis. The characteristics of the...
OBJECTIVES
Spondylolysis occurs bilaterally or unilaterally and bilateral spondylolysis increases the risk of developing isthmic spondylolisthesis. The characteristics of the lumbar lordosis angle (LLA), sacral slope angle (SSA), and spondylolysis fracture angle (SFA) in bilateral spondylolysis compared with those in unilateral spondylolysis have not been clarified. The purpose of this study was to compare the LLA, SSA, and SFA of bilateral and unilateral spondylolysis.
MATERIALS AND METHODS
Thirty-eight patients with lumbar spondylolysis who visited our clinic for an initial visit and 15 age-matched patients with a chief complaint of low back pain were included as controls. Computed tomography films were used to classify all spondylolysis patients into two groups: those with bilateral fractures (bilateral) and those with unilateral fractures (unilateral). The LLA and SSA were measured using lateral X-ray films and the SFA was measured using computed tomography films.
RESULTS
The LLA was significantly higher in all spondylolysis patients than in the control group (p = .026). There was no significant difference in SSA between the spondylolysis and control groups (p = .28). The LLA was significantly higher in the bilateral group than in the unilateral group (p = .018). There was no significant difference in SSA between the bilateral and unilateral groups (p = .15). The SFA was significantly lower in the bilateral group than in the unilateral group (p = .024).
CONCLUSIONS
This study suggests that physical therapy for spondylolysis may be considered bilaterally and unilaterally.
Topics: Humans; Lumbar Vertebrae; Spondylolysis; Spondylolisthesis; Lumbosacral Region; Lordosis; Fractures, Bone
PubMed: 36256612
DOI: 10.1371/journal.pone.0276337 -
Seminars in Hearing Nov 2021Children with hearing loss require early access to sound in both ears to support their development. In this article, we describe barriers to providing bilateral hearing... (Review)
Review
Children with hearing loss require early access to sound in both ears to support their development. In this article, we describe barriers to providing bilateral hearing and developmental consequences of delays during early sensitive periods. Barriers include late identification of hearing loss in one or both ears and delayed access to intervention with hearing devices such as cochlear implants. Effects of delayed bilateral input on the auditory pathways and brain are discussed as well as behavioral effects on speech perception and other developmental outcomes including language and academics. Evidence for these effects has supported an evolution in cochlear implant candidacy in children that was started with unilateral implantation in children with profound deafness bilaterally to bilateral implantation to implantation of children with asymmetric hearing loss including children with single-side deafness. Opportunities to enhance the developmental benefits of bilateral hearing in children with hearing loss are also discussed including efforts to improve binaural/spatial hearing and consideration of concurrent vestibular deficits which are common in children with hearing loss.
PubMed: 34912166
DOI: 10.1055/s-0041-1739371 -
Science Advances Mar 2022Movement initiation and control require the orchestrated activity of sensorimotor cortical and subcortical regions. However, the exact contribution of specific pathways...
Movement initiation and control require the orchestrated activity of sensorimotor cortical and subcortical regions. However, the exact contribution of specific pathways and interactions to the final behavioral outcome are still under debate. Here, by combining structural lesions, pathway-specific optogenetic manipulations and freely moving electrophysiological recordings in rats, we studied cortico-striatal interactions in the context of forelimb bilaterally coordinated movements. We provide evidence indicating that bilateral actions are initiated by motor cortical regions where intratelencephalic bilateral cortico-striatal (bcs-IT) projections recruit the sensorimotor striatum to provide stability and duration to already commanded bilateral movements. Furthermore, striatal spiking activity was correlated with movement duration and kinematic parameters of the execution. bcs-IT stimulation affected only the representation of movement duration but spared that of kinematics. Our findings confirm the modular organization of information processing in the striatum and its involvement in moment-to-moment movement control but not initiation or selection.
PubMed: 35245127
DOI: 10.1126/sciadv.abk2241 -
BMJ Case Reports Aug 2017'Painful tic convulsif' (PTC) describes the coexistence of hemifacial spasm and trigeminal neuralgia. In this report, we describe a unique presentation of bilateral PTC...
'Painful tic convulsif' (PTC) describes the coexistence of hemifacial spasm and trigeminal neuralgia. In this report, we describe a unique presentation of bilateral PTC in a man with bilateral hemifacial spasm and trigeminal neuralgia secondary to neurovascular conflict of all four cranial nerves. Following failed medical and radiofrequency therapy, microvascular decompression of three of the four involved nerves was performed, where the offending vessels were mobilised and Teflon used to prevent conflict recurrence. He continues to respond to Botox for right hemifacial spasm. Since surgery, he remains pain free bilaterally and spasm free on the left.
Topics: Acetylcholine Release Inhibitors; Aged; Botulinum Toxins, Type A; Cranial Nerves; Disease Progression; Hemifacial Spasm; Humans; Male; Microvascular Decompression Surgery; Tics; Treatment Outcome; Trigeminal Neuralgia
PubMed: 28801514
DOI: 10.1136/bcr-2017-221380 -
Biology Aug 2023Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half...
Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional-national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6-9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant ( > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally ( < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally ( < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally ( < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction.
PubMed: 37759573
DOI: 10.3390/biology12091173 -
American Journal of Ophthalmology Case... Dec 2020To report a case of bilateral spontaneous filtering bleb, scleral thinning, microspherophakia, and mild craniofacial dysmorphism.
PURPOSE
To report a case of bilateral spontaneous filtering bleb, scleral thinning, microspherophakia, and mild craniofacial dysmorphism.
OBSERVATIONS
An 18-year-old girl was referred to our clinic for evaluation of bilateral spontaneous filtering blebs. Her corrected distance visual acuity (CDVA) was 20/400 in the right eye (RE) and 20/100 in the left eye (LE). She had superior scleral thinning, multicystic filtering bleb, and microspherophakia bilaterally. The IOP was 9 mmHg in the RE and 8 mmHg in the LE. A mild craniofacial dysmorphism including downward slanting of palpebral fissures and malar hypoplasia was present. There was no sign of corneal ectasia in tomography. Anterior segment optical coherence tomography revealed the filtering blebs as subconjunctival low reflective fluid-filled spaces. Due to severe scleral thinning un the RE we performed a tectonic scleral patch graft. 6 months after surgery the depth of the anterior chamber increased and CDVA improved.
CONCLUSION AND IMPORTANCE
This case indicated that the formation of spontaneous filtering blebs may occur in a syndromic condition. In any case with this symptom, special attention should be paid to craniofacial features, sclera, crystalline lens, and IOP. Tectonic scleral patch graft could be a valuable option in selected patients.
PubMed: 33020746
DOI: 10.1016/j.ajoc.2020.100948