Clinical diagnosis and treatment of chronic dizziness

Pal'chun, V T

doi:10.17116/jnevro2020120121131

Cited by 5 publications

(1 citation statement)

References 53 publications

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“…Meanwhile, due to arteriosclerosis, the internal caliber of the arteriole is reduced. This combination of blood pressure dysregulation secondary to reduced adrenergic regulation and shrinking of the arterial lumen results in damage to the vestibular nerve fibers ( 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebral Small Vessel Disease in Elderly Patients With Vestibular Neuritis

et al. 2022

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BackgroundAcute audiovestibular loss is a neurotologic emergency of which the etiology is frequently unknown. In vestibular neuritis a viral genesis is expected, although there is insufficient evidence to support viruses as the only possible etiological factor. In sudden deafness, a vascular etiology has been proposed in elderly patients, since cardiovascular risk factors are more frequently present and a higher risk of developing a stroke was seen compared to the general population. So far, very little research has been carried out on vascular involvement in elderly patients with vestibular neuritis. Cardiovascular risk factors have a positive correlation with cerebral small vessel disease, visible as white matter hyperintensities, brain infarctions, microbleeds and lacunes on MRI. The presence of these characteristics indicate a higher risk of developing a stroke.AimWe investigated whether elderly patients with vestibular neuritis have a higher prevalence of vascular lesions on MRI compared to a control cohort.Materials and MethodsPatients of 50-years and older, diagnosed with vestibular neuritis in a multidisciplinary tertiary referral hospital, were retrospectively reviewed and compared to a control cohort. The primary outcome was the difference in cerebral small vessel disease on MRI imaging, which was assessed by the number of white matter hyperintensities using the ordinal Fazekas scale. Secondary outcomes were the presence of brain infarctions on MRI and the difference in cardiovascular risk factors.ResultsPatients with vestibular neuritis (N = 101) had a 1.60 higher odds of receiving a higher Fazekas score than the control cohort (N = 203) (p = 0.048), there was no difference in presence of brain infarctions (p = 1.0). Hyperlipidemia and atrial fibrillation were more common in patients experiencing vestibular neuritis.ConclusionWe found a positive correlation of white matter hyperintensities and VN which supports the hypothesis of vascular involvement in the pathophysiology of vestibular neuritis in elderly patients. Further prospective research is necessary to confirm this correlation.

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Section: Discussionmentioning

confidence: 99%

Cerebral Small Vessel Disease in Elderly Patients With Vestibular Neuritis

et al. 2022

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Chronic dizziness: modern treatment methods taking into account comorbidity

Zastenskaia,

Antonenko

2023

RJTAO

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In most cases, chronic dizziness is persistent postural perceptual dizziness (PPPD), which is often combined with other diseases of the vestibular system and anxiety disorders. In real-life clinical practice, PPPD and comorbid disorders are rarely diagnosed and effective treatments are rarely prescribed, so the development of modern methods for managing patients with PPPD with comorbid diseases is important.Objective: to analyze the typical management practices and evaluate the effectiveness of complex therapy in patients with PPPD and comorbid disorders.Material and methods. We examined 60 patients (mean age – 42.5±13.8 years) with diagnosis of PPPD (according to the diagnostic criteria of the Barany Society) and comorbid diseases. All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. The integrated approach in the treatment of patients with PPPG, taking into account concomitant disorders, has demonstrated high efficacy.

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The Romberg's sign: from walking in the dark to tests on the force plate

Mezenchuk¹,

Kubryak

2022

Almanac of Clinical Medicine

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A quantitative assessment of stability (body balance, equilibrium) and sensory support of the upright position, with identification of the "contributions" from various sensory systems, is the basis for the force plate tests similar to the Romberg's test. The purpose of this paper is to describe the Romberg's test evolution from its introduction to objective quantitative force plate tests (stabilometry) in the context of studies into the sensory support of the upright position in humans. The use of force plates for quantitative characterization of the body balance in the upright position with changing sensory conditions has added a higher sensitivity and accuracy to this assessment, providing for a more precise differentiation of various conditions. The tests originating from the Romberg's one but performed on a force plate can be considered as a quantitative investigation into the functioning of the sensory systems participating in the support of the upright position, as well as a tool for the assessment of their isolated contributions and central integration. The value of such tests for clinical medicine is related to a higher level of verification of the body balance abnormalities in various disorders, with an improvement of diagnosis and potential for differential diagnosis. With these assessments being non-invasive, it is feasible to use them for evaluation of changes of the upright equilibrium over time under treatment and rehabilitation procedures in neurology, traumatology and orthopedics, otolaryngology, sports medicine and other areas.

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Clinical diagnosis and treatment of chronic dizziness

Cited by 5 publications

References 53 publications

Cerebral Small Vessel Disease in Elderly Patients With Vestibular Neuritis

Cerebral Small Vessel Disease in Elderly Patients With Vestibular Neuritis

Chronic dizziness: modern treatment methods taking into account comorbidity

The Romberg's sign: from walking in the dark to tests on the force plate

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