1/6. Poststeroid balance disorder--a case report in a body builder.The authors describe a case of poststeroid balance disorder in a 20-year-old athlete. Previous information of such a doping pathology among sportsmen taking anabolics was not found. That anabolic steroids had a harm to central activities and could be suspected especially on the basis of reported psychiatric sequels and cerebrovascular disorders. The case described is of a patient who had been given metandienone, oxymetholone, and nandrolone phenyloproprionate in two courses. vertigo appeared twice just after introducing doping and persisted in spite of a 1.5 year break in taking anabolics. In the electronystagmography a positional nystagmus was detected, the eye-tracking test was distempered, and abnormal responses in the caloric tests were obtained. In the computed dynamic posturography the number and length of body sway were increased and, consequently, the field of the outspread area was enlarged. The moment of appearance and long-lasting vertigo as well as the results of laboratory examinations indicate a poststeroid permanent disorder of the central part of the equilibrium organ. Such a diagnosis seems to be most probable here.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
2/6. Otorhinolaryngologic manifestations in Chiari malformation.The Chiari malformation causes herniation of the cerebellar amygdalae through the foramen magnum, resulting in the descent of the brain stem and/or traction on the lower cranial pairs. It is important for otolaryngologists to recognize Chiari malformations as part of the differential diagnosis of balance disorders, because patients may initially exhibit symptoms related to the vestibular system, including ataxia, nystagmus, or vertigo. We report 2 cases.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
3/6. Disequilibrium after cochlear implantation caused by a perilymph fistula.OBJECTIVES: cochlear implantation has become a safe and effective method for the auditory rehabilitation of the profoundly hearing impaired. incidence of disequilibrium and vertigo after cochlear implantation ranges from 13% to 74% in the literature. Most patients report resolution of these symptoms with medical therapy and vestibular rehabilitation. We present a case of persistent disequilibrium after cochlear implantation. Further workup of this patient revealed radiographic findings suggestive of a perilymphatic fistula, with immediate and complete resolution of symptoms after exploratory tympanotomy and packing around the cochleostomy. STUDY DESIGN: Case report. methods: A retrospective chart review of a patient with postoperative disequilibrium unresponsive to maximal medical and vestibular rehabilitation therapy. RESULTS: Diagnostic workup of the patient included a temporal bone computed tomography (CT) scan, which revealed air in the vestibule and the ampulla of the superior and lateral semicircular canals. After failure of 5 months of conservative therapy, the patient was taken to the operating room for middle ear exploration and repacking of the cochleostomy site. The patient reported immediate and complete resolution of vertigo postoperatively. CONCLUSION: We present a case of disequilibrium as a result of an apparent perilymphatic fistula after cochlear implantation that was refractory to standard therapy. In such cases, appropriate workup should include a temporal bone CT scan to look for air in the vestibule or other abnormalities that may indicate potential etiology. Surprisingly, this patient had immediate and complete resolution of symptoms after surgery. If conservative therapy fails, middle ear exploration by way of an exploratory tympanotomy and packing of the cochleostomy with periosteum and muscle is a viable option and may lead to resolution of symptoms.- - - - - - - - - - ranking = 2keywords = vertigo (Clic here for more details about this article) |
4/6. vertigo and imbalance caused by a small lesion in the anterior insula.The exact location of the vestibular cortex in humans has not yet been established. Isolated lesions in the insula are exceptional. We describe a patient with recurrent episodes of vertigo and imbalance following a small lesion in the anterior insula. Myogenic and neurogenic vestibular evoked potentials were both performed using auditory stimuli. The former was recorded from the sternocleidomastoid muscle and the latter from the parietal areas on the scalp. Brainstem auditory evoked potentials, threshold latency series, pure tone audiometry and video nystagmography were also performed, as was brain MRI. All evoked potential studies and pure tone audiometry were within normal limits, ruling out peripheral and brainstem causes for the patient's symptoms. Video nystagmography revealed high slow phase velocities bilaterally with caloric stimulation, and saccadic tracking on the smooth pursuit examination. The MRI revealed a small lesion in the right anterior insula. To our knowledge this is the first reported case of vestibular symptoms and signs from a lesion in the anterior insula on MRI. In addition, its effects on the nystagmogram suggest that this area may be part of the pathway that controls smooth pursuit.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
5/6. The medullary vascular syndromes revisited.There are two major vascular syndromes of the medulla oblongata: the medial and the lateral. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. Lateral medullary infarction commonly presents with Horner's syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. Combinations of the two major syndromes occur as bilateral medial medullary, hemimedullary and bilateral lateral medullary syndromes. Each of these syndromes frequently manifests with incomplete or atypical findings depending on the extent of the lesion. magnetic resonance imaging has been useful in the clinical diagnosis of medullary infarctions. The site of the lesion may help predict the arteries involved.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
6/6. Neurotologic manifestations of Chiari 1 malformation.It is important for otolaryngologists to recognize Chiari malformations as part of the differential diagnosis of balance disorders because patients may initially be seen with symptoms referable to the vestibular system, including ataxia, nystagmus, or vertigo. The objective of this paper is to review the signs, symptoms, and vestibular test findings of a series of patients with Chiari 1 malformation. Six patients were identified by retrospective chart review with a diagnosis of Chiari malformation. Each patient had a complete otoneurologic examination and vestibular function testing. The results indicated that patients fell into two different vestibular test result profiles. First, patients with advanced symptoms demonstrated oculomotor dysfunction, central vestibular nystagmus, abnormal vestibular visual interaction, and abnormal tilt suppression of postrotatory nystagmus. On the other hand, a number of patients were identified with incidentally noted Chiari malformation on magnetic resonance imaging scan who had a vestibular test profile consistent with peripheral vestibulopathy without signs and symptoms of central nervous system dysfunction. Guidelines are provided to help determine the extent of the group of symptoms attributable to an incidentally discovered Chiari malformation.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |