1/15. Development of focal chronic epilepsy following focal status epilepticus in adult patients.In several experimental models, status epilepticus (SE) leads to secondary brain hyperexcitability and epileptogenesis. In humans, such phenomena have been rarely demonstrated, particularly in cases of SE involving the neocortical structures. We report a 36 year old woman that presented partial SE in May 1991 involving the right cerebral hemisphere. The patient was then treated in the intensive care unit with artificial ventilation and anesthesia by pentobarbital and clometiazole. MRI showed transient right parietal and temporal posterior cortical hyperintensity. The cause of SE was not determined. Three months later, the patient developed partial complex seizures with aura characterized by vertigo, nausea and auditory hallucination. Ictal video/EEG recording showed a clear right temporal posterior onset of the discharges. We speculate that status epilepticus created the lesions which subsequently caused the focal chronic epilepsy.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
2/15. What inner ear diseases cause benign paroxysmal positional vertigo?Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder that is easy to diagnose and usually easy to treat. The majority of patients with BPPV have no known inner ear disease; they have "primary" or "idiopathic" BPPV. However, a minority does have objective evidence of an inner ear disease on the same side as the BPPV and this group has "secondary" or "symptomatic" BPPV. Previous publications differ on the prevalence of secondary BPPV and about the types of inner ear diseases capable of causing it. In order to determine what proportion of patients have secondary as opposed to primary BPPV and which inner ear diseases are capable of causing secondary BPPV, we searched our database for the 10-year period from 1988 to 1997 and found a total of 2847 patients with BPPV. Of these, 81 (3%) had definite pSCC-BPPV secondary to an ipsilateral inner ear disease. Sixteen had Meniere's disease, 24 had an acute unilateral peripheral vestibulopathy, 12 had a chronic unilateral peripheral vestibulopathy, 21 had chronic bilateral peripheral vestibulopathy and 8 had unilateral sensorineural hearing loss. It seems that any inner ear disease that detaches otoconia and yet does not totally destroy pSCC function can cause BPPV and that a case can be made for audiometry and caloric testing in all patients with BPPV.- - - - - - - - - - ranking = 5keywords = vertigo (Clic here for more details about this article) |
3/15. Chronic isolated vertigo.vertigo can be the first manifestation of vertebrobasilar ischaemia or brainstem and cerebellar stroke. Chronic isolated vertigo may pose a diagnostic dilemma. We report the case of a patient who presented with chronic isolated vertigo, and highlight the clinical use of magnetic resonance imaging and angiography in his management.- - - - - - - - - - ranking = 6keywords = vertigo (Clic here for more details about this article) |
4/15. Possible estuary-associated syndrome: symptoms, vision, and treatment.The human illness designated as possible estuarine-associated syndrome (peas) by the Centers for Disease Control and Prevention (CDC) has been associated with exposure to estuaries inhabited by toxin-forming dinoflagellates, including members of the fish-killing toxic Pfiesteria complex (TPC), pfiesteria piscicida and Pfiesteria shumwayae. humans may be exposed through direct contact with estuarine water or by inhalation of aerosolized or volatilized toxin(s). The five cases reported here demonstrate the full spectrum of symptoms experienced during acute and chronic stages of this suspected neurotoxin-mediated illness. The nonspecific symptoms most commonly reported are cough, secretory diarrhea, headache, fatigue, memory impairment, rash, difficulty in concentrating, light sensitivity, burning skin upon water contact, muscle ache, and abdominal pain. Less frequently encountered symptoms are upper airway obstruction, shortness of breath, confusion, red or tearing eyes, weakness, and vertigo. Some patients experience as few as four of these symptoms. The discovery that an indicator of visual pattern-detection ability, visual contrast sensitivity (VCS), is sharply reduced in affected individuals has provided an objective indicator that is useful in diagnosing and monitoring peas. VCS deficits are present in both acute and chronic peas, and VCS recovers during cholestyramine treatment coincident with symptom abatement. Although peas cannot yet be definitively associated with TPC exposure, resolution with cholestyramine treatment suggests a neurotoxin-mediated illness.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
5/15. Hypertrophic chronic pachymeningitis associated with chronic otitis media and mastoiditis.We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo. Radiological tests of temporal bone revealed soft tissue in the mastoid and tympanic cavities, and T1 weighted MRI revealed prominent Gd enhancement of the middle skull basal meninges. Middle ear inflammation appeared to induce pachymeningitis and to exacerbate associated symptoms, leading to a decline in the patient's overall condition. Bilateral mastoidectomies were effective in improving her general condition. Her hearing improved only on the right side because ossiculoplasty was performed only on that side. Her facial movement progressively improved and pachymeningitis diminished over time. We speculate that removal of the infectious granulation within the middle ears and mastoids ameliorated the acute inflammation. The etiology remains unknown in this case.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
6/15. Differences in diffusion-weighted and T2-weighted magnetic resonance imaging findings in the acute and chronic stages of ischemic cerebrovascular disease--two case reports.A 71-year-old man presented with sudden onset of vertigo and a 77-year-old man suffered consciousness disturbance. diffusion-weighted magnetic resonance (MR) imaging on admission showed hyperintense areas in the left cerebellar hemisphere in the first patient and in the brainstem in the second patient. Both patients were treated with argatroban and edaravone, and the neurological deficits markedly improved one month after admission. T2-weighted MR imaging one month after the onset showed much smaller hyperintense areas compared with the findings on admission in both patients. These results indicate that findings of hyperintense areas by diffusion-weighted MR imaging in the acute stage of ischemic cerebrovascular disease indicate not only the ischemic core but also parts of the reversible incomplete ischemic lesion and suggest that intensive treatment in the acute stage might reverse ischemic brain damage in some patients.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
7/15. Chronic lupus peritonitis with ascites.A 28 year old woman with systemic lupus erythematosus who developed chronic lupus peritonitis and ascites is described. Lupus peritonitis appeared with abdominal fullness, postprandial abdominal discomfort, and painless ascites. Four months later the patient developed vertigo, headaches, visual disturbances, serositis, and glomerulonephritis. Lupus peritonitis and the other disease manifestations responded to treatment with intravenous pulse methylprednisolone (four 1 g/m2 injections at one week intervals), oral azathioprine (200 mg daily), and diuretics.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
8/15. vestibular nerve section in patients with chronic otitis media.Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.- - - - - - - - - - ranking = 3keywords = vertigo (Clic here for more details about this article) |
9/15. Gentamicin-induced ototoxicity complicating treatment of chronic osteomyelitis.Ototoxicity, though a significant disabling complication of aminoglycoside antibiotic therapy, is monitored infrequently. Chronic osteomyelitis patients treated with an aminoglycoside are in a group at higher risk due to the length of therapy and large total dose of drug required for treatment. serum levels of gentamicin should be maintained within therapeutic ranges but below toxic levels. Gentamicin ototoxicity is vestibular in two thirds of patients and cochlear in one third. One half of the patients with cochlear toxicity also have vestibular symptoms. Symptoms are often vague, insidious in onset, and masked by the critical presentation of the primary infectious process. Symptoms may occur immediately upon initiation of therapy, any time during the course of treatment, or after administration has been completed. The development of toxicity should be monitored on a regular basis by specifically asking the patient whether there has been any subjective hearing loss, ear fullness, tinnitus, or vertigo supplemented by pretreatment and follow-up audiogram and electronystagmogram (ENG). Therapy should be discontinued at the first sign of alteration of cochlear or vestibular function. Ototoxic recovery occurs in only about 50% of the patients affected.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
10/15. Ten-year follow-up on the first five inner ear valve implants for intractable vertigo in sweden.Ten-year clinical results are reported on the first five inner ear valve implants done in sweden in 1975 and 1976. If the patient had a positive glycerol dehydration test (n = 4) the chances of excellent results for hearing at one year as well as complete elimination of vertigo were high. At ten years, two of the four patients with positive glycerol dehydration tests maintained excellent hearing and complete elimination of vertigo. One patient's hearing deteriorated, but he was still completely free of vertigo at ten years. One patient had a labyrinthectomy at three years, but now we would have considered a revision valve implant before a destructive procedure. The patients who had clinical evidence of bilateral disease did not do as well at ten years as patients with unilateral disease. With ten year follow-up it has been shown that the inner ear valve implant is a safe and effective nondestructive alternative to labyrinthectomy for salvaging patients who failed medical therapy.- - - - - - - - - - ranking = 7keywords = vertigo (Clic here for more details about this article) |
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