Cases reported "Vertigo"

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1/13. Acute transient monocular disequilibrium (Halpern's syndrome).

    An acute transient form of monocular disequilibrium (Halpern's syndrome) was found in two patients. Misjudgement of verticality and motion was induced by looking with one eye and was alleviated by use of the fellow eye. This symptomatology is discussed in the light of recent concepts of oculovestibulocerebellar integration.
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keywords = motion
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2/13. vertigo in virtual reality with haptics: case report.

    A researcher was working with a desktop virtual environment system. The system was displaying vector fields of a cyclonic weather system, and the system incorporated a haptic display of the forces in the cyclonic field. As the subject viewed the rotating cyclone field, they would move a handle "through" the representation of the moving winds and "feel" the forces buffeting the handle as it moved. Stopping after using the system for about 10 min, the user experienced an immediate sensation of postural instability for several minutes. Several hours later, there was the onset of vertigo with head turns. This vertigo lasted several hours and was accompanied with nausea and motion illusions that exacerbated by head movements. Symptoms persisted mildly the next day and were still present the third and fourth day, but by then were only provoked by head movements. There were no accompanying symptoms or history to suggest an inner ear disorder. physical examination of inner ear and associated neurologic function was normal. No other users of this system have reported similar symptoms. This case suggests that some individuals may be susceptible to the interaction of displays with motion and movement forces and as a result experience motion illusions. Operators of such systems should be aware of this potential and minimize exposure if vertigo occurs.
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keywords = motion
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3/13. Vertical oscillopsia in bilateral superior canal dehiscence syndrome.

    A patient sought treatment for vertical oscillopsia and impaired vision during locomotion, and unsteadiness of gait. Positive fistula tests and CT of the temporal bones confirmed a diagnosis of bilateral superior canal dehiscence. An impairment of the superior canal vestibulo-ocular reflex, documented by three-dimensional search coil eye movement recordings for oblique (single) and downward pitch head motion (bilateral canal testing), is proposed to induce vertical rather than torsional-vertical oscillopsia during locomotion.
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keywords = motion
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4/13. Acrophobia and pathological height vertigo: indications for vestibular physical therapy?

    BACKGROUND AND PURPOSE: Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. CASE DESCRIPTION: Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. OUTCOMES: After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. DISCUSSION: Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.
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ranking = 1
keywords = motion
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5/13. Partitioning of the labyrinth: application in benign paroxysmal positional vertigo.

    Partitioning of the labyrinth is a new laser technique that creates a fibrous band within the inner ear. The application of this technique to benign paroxysmal positional vertigo (BPPV) is described in the first two patients to undergo this procedure. The partitioning technique involves blue-lining the posterior semicircular canal near its ampulla and lasing the blue-lined area. The technique provides a prompt decrease and the ultimate elimination of BPPV. There is some mild motion sensitivity of 6 to 8 weeks duration, and some transient (3-week) sensorineural hearing loss. The use of immediate postoperative low dose steroids provides marked decrease in the motion sensitivity and elimination of the transient sensorineural hearing loss. Lasing two adjacent areas on the posterior semicircular canal may prevent transient recurrence of the positional vertigo during the healing process.
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ranking = 2
keywords = motion
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6/13. In search of pathologic correlates for hearing loss and vertigo in Paget's disease. A clinical and histopathologic study of 26 temporal bones.

    Mixed sensorineural and conductive hearing loss is a common clinical manifestation of Paget's disease of the temporal bone, and while there are numerous clinical and pathologic reports on the condition, none have identified a consistent pathologic explanation for the hearing loss. We performed histologic studies on 26 temporal bones exhibiting Paget's disease from 16 persons, of whom 7 had audiometric testing performed. Contrary to common opinion, the conductive hearing loss is not caused by ossicular fixation; in fact, no cause could be found in the seven ears with documented conductive hearing losses. While the sensorineural hearing losses were greater than normal for age, we could not identify cochlear disorders that could be attributed to Paget's disease. It is concluded that the hearing losses in Paget's disease are caused by changes in bone density, mass, and form that serve to dampen the finely tuned motion mechanics of the middle and inner ears.
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keywords = motion
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7/13. depersonalization, vertigo and Meniere's disease.

    Meniere's disease is generally accepted to be a consequence of distention of the endolymphatic sac of the inner ear. Although the exact etiology is unclear, there is a body of research suggesting that Meniere's disease is of psychosomatic origin. While we do not intend to review the literature exhaustively, we briefly review several frequently cited studies. Even though this literature is so severely flawed that no solid conclusions may be drawn from it, certain questions about the psychological aspect of this disorder continue to surface. Our limited access to patients with vertigo has not allowed us to undertake a carefully designed study. However, in clinical practice we have noted that many persons who complain of vertigo (whether due to Meniere's disease or other causes) also report symptoms of depersonalization and derealization. In this paper we present the cases of two women with Meniere's disease who also experienced concurrent feelings of unreality. It appears likely that feelings of unreality may occur regularly in association with syndromes causing vertigo, presumably as a consequence of vestibular dysfunction. We argue that emotional disturbances previously identified as predisposing causes of Meniere's disease are more likely effects of the disease. Although the discussion of two uncontrolled cases can do little to help solve nagging questions about a psychosomatic component to this disorder, we believe it may suggest a different perspective from which to investigate these complex phenomena.
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ranking = 1
keywords = motion
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8/13. Abnormal oculovestibular response.

    In normal individuals, the visual and vestibular systems interact through a common subcortical center located near the vestibular nuclei. When the patient is healthy, this interaction allows appropriate integration of what might otherwise be conflicting information regarding environmental motion and moving within the environment. In patients with active peripheral vestibular lesions, such as those seen in Meniere's disease, this delicate interaction loses effectiveness. In such patients, optokinetic stimuli are capable of precipitating episodes of incapacitating vertigo with its associated vegetative symptoms (abnormal oculovestibular response--AOVR). Since the brainstem is unable to accommodate for active peripheral lesions, suffering may be prolonged for many years. Vestibular nerve section, however, converts this active lesion to a static peripheral lesion, allowing for brainstem compensation and cessation of optokinetic-induced vertiginous symptoms.
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keywords = motion
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9/13. Vestibular atelectasis.

    The temporal bone collection at the massachusetts eye and Ear Infirmary includes specimens from several cases in which the only reasonable explanation for vertigo is collapse of the walls of the ampullae and utricle, a disorder we have termed vestibular atelectasis. The clinical histories and temporal bone studies support the existence of a primary type that may have a paroxysmal or insidious onset, and a secondary type that occurs in association with other inner ear disorders. The principal clinical symptom is chronic unsteadiness, precipitated or aggravated by head movement, and sometimes associated with short episodes of spinning vertigo. It is presumed that the collapsed membranes interfere with the motion mechanics of the cupulae and otolithic membranes.
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keywords = motion
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10/13. Migraine equivalent as a cause of episodic vertigo.

    There are many transient neurologic disturbances associated with various types of migraine. Visual symptoms, such as scintillating scotomata are most common, but somatosensory, motor, cranial nerve, and brain stem symptoms also occur. Among the brain stem symptoms, vestibular manifestations are quite common and include nonspecific dizziness, disequilibrium, vertigo, and motion intolerance. Auditory symptoms are less common. These transient neurologic symptoms can precede the headache as an aura, can occur during the headache, or, uncommonly, can immediately follow the headache. It is also well documented that the neurologic symptoms can occur in the period between headaches, a situation termed "migraine equivalent." Migraine equivalents usually occur in patients who have experienced typical migraine headaches earlier in life or who have migraine headaches at times other than when they experience equivalent symptoms. Rarely, typical migraine equivalent symptoms precede the development of the headaches by months or years, or occur in individuals who never develop headaches. Five patients with migraine equivalent symptoms that include vertigo are presented. The vertigo was the dominant symptom in some cases and was accompanied by nausea and vomiting. Differentiation from peripheral labyrinthine disorders is difficult, but a personal or family history of migraine, the temporal association of the neuro-otologic symptoms with other migraine equivalent symptoms, a characteristic pattern of occurrence of the symptoms, and a positive response to antimigrainous therapy are features that strengthen the diagnosis of a migraine equivalent phenomenon.
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keywords = motion
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