Cases reported "Dizziness"

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1/6. dizziness and headache: a common association in children and adolescents.

    vertigo has long been recognized by the clinician as a frequent accompanying symptom of the adult migraine syndrome. This association has not been so readily identified in the pediatric population, and, as a consequence, children undergo unnecessary evaluations. We reviewed the charts of all children and adolescents referred for vestibular function testing to the Balance Center at the Barrow Neurological Institute between July 1994 and July 2000 (N = 31). Items analyzed included age, gender, symptoms that prompted the referral, test outcomes, family medical history, and final diagnosis. The most common justification for vestibular testing referral was the combination of dizziness and headache. Other less common reasons were "passing out" episodes, poor balance, and blurred vision. Normal test results were obtained from 70% of patients (n = 22). The most common abnormal test outcome was unilateral vestibular dysfunction (n = 5). Bilateral peripheral vestibular dysfunction was present in three patients. One patient had central vestibular dysfunction. The final diagnoses were vestibular migraine (n = 11), benign paroxysmal vertigo of childhood (n = 6), anxiety attacks (n = 3), Meniere's disease (n = 2), idiopathic sudden-onset sensorineural hearing loss (n = 1), vertigo not otherwise specified (n = 1), familial vertigo/ataxia syndrome (n = 1), and malingering (n = 1); in five patients, no definitive diagnosis was established. The stereotypical patient with vestibular migraine was a teenage female with repeated episodes of headache and dizziness, a past history of carsickness, a family history of migraine, and a normal neurologic examination. patients who fit this profile are likely to have migrainous vertigo. Consequently, a trial of prophylactic migraine medication should be considered for both diagnostic and therapeutic purposes. brain imaging and other tests are appropriate for patients whose symptoms deviate from this profile.
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ranking = 1
keywords = sickness
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2/6. Migraine-associated dizziness.

    We reviewed the clinical histories, examinations and results of quantitative vestibular testing in 91 patients with migraine-associated dizziness. nausea and vomiting, hypersensitivity to motion and postural instability accompanied the dizziness. In the majority of patients, the temporal profile of the dizziness was more typical of the headache phase of migraine than of the aura phase. Nineteen patients (20.9%) had unilateral hypoexcitability to caloric stimulation, which represents a modestly increased risk of damage to the peripheral vestibular apparatus. We propose two separate pathophysiologic mechanisms for the production of dizziness with migraine: Short-duration vertiginous attacks lasting minutes to 2 hours and temporally associated with headache are due to the same mechanism as other aura phenomena (spreading wave of depression and/or transient vasospasm). Longer-duration attacks of vertigo and motion sickness lasting days, with or without headache, result from the release of neuroactive peptides into peripheral and central vestibular structures, causing an increased baseline firing of primary afferent neurons and increased sensitivity to motion.
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ranking = 68.969466114109
keywords = motion sickness, sickness, motion
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3/6. Vestibular processing in human paramedian precuneus as shown by electrical cortical stimulation.

    The authors describe a 16-year-old patient with recurrent episodes of epileptic linear self-motion perception and occasional body tilts. Intracranial seizure monitoring located the seizure onset, caused by a circumscribed ependymoma, in the right paramedian precuneus. Electrical cortical stimulation of this area could reproduce the same vestibular sensations, which ceased after lesionectomy. The findings implicate the paramedian area of the precuneus in the processing of static and dynamic vestibular, probably otolithic, information.
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ranking = 0.0092601376695588
keywords = motion
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4/6. Weber's syndrome and sixth nerve palsy secondary to decompression illness: a case report.

    We describe the first case of Weber's syndrome to present as a manifestation of decompression illness in a recreational scuba diver. Weber's syndrome is characterized by the presence of an oculomotor nerve palsy and contralateral hemiparesis. The patient was a 55 year-old male with a past medical history of a pulmonary cyst, in whom symptoms developed after a multilevel drift dive to a depth of 89 feet for 53 minutes, exceeding no-decompression limits. Symptom onset was within 30 minutes of surfacing and included the Weber's syndrome, a sixth nerve palsy, dizziness, nausea, sensory loss, and ataxia. The patient received four U.S. Navy Treatment tables with complete resolution of all neurological signs and symptoms. The mechanism of injury remains unclear, but may involve aspects of both air gas embolism and decompression sickness. Individuals with pre-existing pulmonary cysts may be at increased risk for dive-related complications.
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ranking = 1
keywords = sickness
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5/6. motion sickness: part II--a clinical study based on surgery of cerebral hemisphere lesions.

    Man has always been intrigued with the localization of function within the brain but has paid insufficient attention to the long and the short association fiber pathways which, when stimulated, may fire distant areas evoking unusual responses. Three cases of intracerebral lesions are presented to demonstrate the significance of these structures. The vestibular symptoms of dizziness may occur from excitation of the temporal operculum. If, added to this symptom, the patient has spatial disorientation, such as feeling upside down, it suggests that the region of the supramarginal gyrus and the angular gyrus are involved. When unformed visual hallucinations (such as flashes of light) or formed hallucinations (such as distorted images) are present the occipital and midtemporal regions of the brain, respectively, are considered to be the sources of such responses. The symptoms described above were reminiscent of those experienced by some of the cosmonauts and astronauts and it called the authors' attention to this "motion sickness in space." The areas from which such responses may be elicited are the temporoparieto-occipital regions, which are nourished by the posterior cerebral artery and its branches. Vascular insufficiency to this area by spasm of the vessel may be responsible for this symptomatology.
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ranking = 72.95094583877
keywords = motion sickness, sickness, motion
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6/6. motion sickness: part III--a clinical study based on surgery of posterior fossa tumors.

    Three patients who had large, benign cerebellar tumors were operated upon in the sitting position and developed symptoms referable to the temporoparieto-occipital region of the brain 24-48 h postoperatively. They consisted of dizziness, nausea, vomiting, formed and unformed hallucinations, and inversion of image or disorientation in space, some of which were experienced by some of the astronauts and cosmonauts during space flight. Such findings are not due to stimulation of the cerebellum, the site of the lesion, but must come from the cerebral hemisphere. The symptoms were believed to be caused by "the luxury perfusion" of Lassen with the development of local lactic acidosis secondary to vascular insufficiency to the brain in the distribution of the posterior cerebral artery thus stimulating the temporoparieto-occipital region. This theory is suggested to some degree by the work of Endo et al. using CT scans, which showed the shifting of increased blood flow from the frontal region to the temporoparieto-occipital region following removal of a benign posterior fossa tumor. The mechanism for the compression of the posterior cerebral artery may be due to uncal herniation at the tentorium. The authors believe that it might be well to consider further testing in a vertical or oblique plane rather than only in a centrifugal horizontal one. This method would tend to cause uncal herniation more readily. Monitoring of such effects could be done with the colored CT scan.
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ranking = 4
keywords = sickness
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