1/6. Drop attacks in older patients secondary to an otologic cause.The clinical features and treatment of seven patients with drop attacks attributable to inner ear disease presenting after age 65 are described. A neurologic or cardiovascular cause of drop attacks was initially suspected. Audiovestibular testing documented a unilateral inner ear disorder. The salient clinical features of these cases are discussed. The patients underwent ablative vestibular surgery, and all compensated well and were free of vertigo and falls up to 10 years postoperatively.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
2/6. Drop attacks and vertigo secondary to a non-meniere otologic cause.BACKGROUND: Tumarkin falls are sudden drop-attack falls that occur in a subset of patients with Meniere syndrome (endolymphatic hydrops), an inner ear disorder characterized by vertigo spells and hearing loss. OBJECTIVE: To describe the clinical features and quantitative audiovestibular testing results in a case series of patients with Tumarkin falls, episodic vertigo, and normal hearing. SETTING: University referral center for disorders of balance and hearing. methods: Case series (unselected) of all patients with Tumarkin falls and a normal audiogram at least 1 year after onset of vestibular symptoms (n = 6) from a retrospective analysis of the records of all patients with Tumarkin falls presenting to neurotology Clinic at UCLA Medical Center, los angeles, Calif, from October 1, 1975, to February 1, 2001 (N = 55). Quantitative audiologic and vestibular function testing, neurologic history, and examination were performed. RESULTS: Five of 6 patients had unilateral caloric paresis, and 1 had bilateral vestibulopathy. Five of 6 had a personal and/or family history of migraine headaches meeting International headache Society criteria. All patients had a subjective sensation of feeling pushed by an external force, and half of the patients had a subjective tilt of the environment concurrent with the fall. CONCLUSIONS: The incidence of migraine is high in this subgroup of patients with Tumarkin falls and normal hearing. The clinical description of the falls is similar to those associated with Meniere syndrome. Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.- - - - - - - - - - ranking = 6keywords = vertigo (Clic here for more details about this article) |
3/6. vertigo secondary to isolated pica insufficiency: successful treatment with balloon angioplasty.BACKGROUND: The posterior inferior cerebellar arteries (pica) arise from the intracranial segments of the vertebral artery (VA). We report a case where a nondominant isolated vertebral artery, which terminated in pica, was stenotic. This resulted in brainstem-lower cerebellar ischemia, corrected with balloon angioplasty. CASE DESCRIPTION: A 62-year-old male presented primarily with transient vertigo, syncope, and dizziness and was diagnosed with transient ischemic attack. Angiography of the left vertebral artery (VA) demonstrated a small-caliber vessel terminating in pica with a 90% stenosis at the C6 level. angioplasty of the left VA was performed with excellent resolution of the stenosis. CONCLUSIONS: This case illustrates cerebellar insufficiency in a unique case where the pica was isolated, supplied by a small- caliber VA. Correction of the stenosis improved the patient's symptomatology and prevented an inferior brainstem-cerebellar infarction.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
4/6. Drop attacks and vertical vertigo after transtympanic gentamicin: diagnosis and management.Drop attacks represent a significant problem during the natural course of Meniere's disease. They are characterized by a sudden fall to the ground without loss of consciousness. diagnosis is clinical and based on the typical description of the patient. Involvement of vertical canal is possible during Meniere's disease and also after gentamicin application. Treatment of drop attacks is still a matter of discussion; most cases have a benign course with spontaneous remission and no treatment is necessary. In severe cases, aggressive treatment (surgical or pharmacological) is necessary. A case of drop attack associated with vertical vertigo is presented. Vestibular tests were performed in order to assess the involvement of inner ear. Caloric test and ice water test reveal no response. vestibular evoked myogenic potentials are present even after high doses of gentamicin. Drop attacks and vertical vertigo can occur after transtympanic gentamicin and can be well managed with high doses of local gentamicin.- - - - - - - - - - ranking = 6keywords = vertigo (Clic here for more details about this article) |
5/6. carotid sinus syndrome: an overlooked cause of syncope.carotid sinus syncope was diagnosed during a 2-year period in 21 men and 5 women, aged 51 to 80 years, who had experienced 1 to 30 syncopal episodes during periods of time which varied from 1 day to 6 years. In 19 of these patients there was evidence of organic heart disease. carotid sinus hypersensitivity of the cardioinhibitory type was present in 14 patients, the vasodepressor type in 1 patient, and a mixed type in 7 patients. In four patients with the cardioinhibitory response, the possibility of the vasodepressor response was not excluded. A pacemaker was placed in 17 patients, deferred in 4 patients and refused by 5 patients. Follow-up of patients with pacemakers over 9.5 /- 7.0 (SD) months revealed recurrence of symptoms in two patients due to a previously unrecognized vasodepressor response. Follow-up of the patients without pacemakers was brief (4.6 /- 3.7 months), and they remained asymptomatic, except for one patient with recurring vertigo.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
6/6. diffusion-weighted MRI in transient global amnesia precipitated by cerebral angiography.BACKGROUND: Transient global amnesia is a well-described complication of cerebral angiography. Speculation about the pathophysiology exists but is as yet unsubstantiated. diffusion-weighted MRI is a new imaging technique that is very sensitive in detecting acute ischemia. Its use in the evaluation of transient amnesia precipitated by cerebral angiography has not previously been reported. CASE DESCRIPTION: A 44-year-old man underwent posterior circulation cerebral angiography for the investigation of episodic vertigo. Shortly after completion of the procedure, he was noted to have symptoms of transient global amnesia. diffusion-weighted MRI at 6 and 44 hours after the procedure demonstrated increased signal in the right hippocampus and other areas within the posterior circulation bilaterally consistent with ischemia from emboli. Abnormalities on conventional MRI images performed at the same time points were noted only in retrospect. A follow-up MRI at 2 months was normal. CONCLUSIONS: ischemia from cerebral emboli may cause transient global amnesia precipitated by cerebral angiography. diffusion-weighted MRI may be useful in defining the pathophysiology.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |