1/13. Systemic lupus erythematosus with presentation as vertigo and vertical nystagmus: report of one case.An 11-year-old boy suffered from fever, headache, severe vertigo and unsteady gait. physical examination showed bilateral vertical nystagmus, mild corneal reflex delay of the right eye and asymmetric facial expression. Laboratory data showed leukopenia, high ESR and normal CSF study. Brain CT showed diffuse brain edema. electronystagmography showed upbeat nystagmus and central vertigo. EEG revealed diffuse slow wave and mild to moderate cortical dysfunction. MRI of the head showed focal abnormal signal intensity at the ventral portion of the medulla oblongata on both sides. Under suspicion of enteroviral encephalitis, mannitol and IVIG were given. The virological profiles were negative, ANA 1:640 nucleolar type, low complements and proteinuria. Anti-ds dna was elevated and anti-ribosomal-P antibodies were positive. Under impression of SLE with CNS involvement, betamethasone was given. fever, nystagmus and ataxia subsided gradually. Steroid was tapered and imuran was added. The following laboratory data were normal. In his past history, the patient was diagnosed Kikuchi disease. The manifestations of SLE were rare initial presentations as vertigo or vertical nystagmus. We present a case with review of literature and conclusion that physicians should keep in mind the possibility of SLE if patients present with unspecific neurological symptoms and concomitant systemic symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Clinical diagnosis of vertebrobasilar insufficiency: resident's case problem.STUDY DESIGN: Resident's case problem. BACKGROUND: vertigo and visual disturbances are common symptoms associated with vertebrobasilar insufficiency (VBI), but the physical examination procedures to verify the existence of VBI have not been validated in the literature. The objective of this resident's case problem is to demonstrate how a patient's complaint of vertigo and visual disturbances, combined with positive clinical examination findings, can be a potential medical screening tool for VBI. diagnosis: The patient in this report was initially referred to physical therapy for neck pain. However, the patient's chief concerns identified during the history were (1) vertigo, (2) visual disturbances, (3) headache, and (4) right shoulder region pain. Clinical VBI tests were performed, whereby the patient's vertigo and visual disturbances were reproduced with cervical spine extension. The patient was sent back to the referring physician to be evaluated for possible VBI. diagnostic imaging tests were ordered. Carotid ultrasound revealed 80% to 90% stenosis in the proximal left internal carotid artery, and magnetic resonance angiography of the extracerebral vessels showed greater than 90% stenosis of the left internal carotid artery. DISCUSSION: VBI may be present in patients with subjective reports of vertigo and visual disturbances that are reproduced with VBI physical examination procedures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. The team approach to treatment of the dizzy patient.This report describes how a rehabilitation team treats dizziness and vestibular disorders. Team members include a nurse, physician, audiologist, physical therapist, occupational therapist, and a research scientist. Although unusual, this multidisciplinary approach, involving a close-knit group of professionals, is of great benefit in the treatment of vestibular and balance disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. Evaluation of acute vertigo: unusual lesions imitating vestibular neuritis.The acute onset of vertigo is a common clinical problem presenting to primary care physicians or otologists for evaluation. Usually the underlying disease process is benign and self-limited in nature. In the absence of hearing loss or additional neurologic findings, a common initial diagnosis is vestibular neuritis. The patient is treated symptomatically and observed for spontaneous resolution. However, other more serious disease processes may mimic the presentation of vestibular neuritis and be misdiagnosed. Five cases of serious central nervous system disorders that were similar to vestibular neuritis in their initial presentation are reviewed to illustrate this point. Each patient presented with the acute onset of continuous vertigo without associated hearing loss. The correct diagnosis was established only after further evaluation was pursued. Recommendations for the initial and subsequent evaluation of these patients are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. audiology in medicine.Among the most common complaints a physician confronts are those concerned with hearing loss and dizziness. It is essential that all practitioners acquaint themselves with the diagnostic information provided by an audiological evaluation. The authors describe the frequently used tests and present case studies to illustrate the value and scope of diagnostic audiology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. Acute bilateral sequential vestibular neuritis.Two cases of bilateral sequential vestibular neuritis demonstrate the significant persistent disequilibrium that follows involvement of the second ear. The etiology for the loss of vestibular function is postulated to be a viral neuritis. Vestibular suppressant drugs are helpful in relieving nausea and vomiting in the acute phase of the disease; however, they are of no therapeutic value for the protracted disequilibrium following involvement of the second ear. An awareness of this disorder as a disease entity will minimize diagnostic and therapeutic frustration on the part of the physician and provide a realistic prognosis for the patient. Unfortunately, the prognosis is for permanent but somewhat lessening disequilibrium with the passage of time and depends in great part on the subject's age.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. Clinical evaluation of vertigo.In attempting to outline the clinical evaluation of these patients with vertigo we have discussed examples which range in order from benign self-limited disease to those requiring emergency surgery or extensive diagnostic evaluation. We sought also to illustrate how the logic of hypothesis testing is generally employed by clinicians in approaching this or other diagnostic problems. The examples were chosen to illustrate the indications for, as well as the limitations of, the various diagnostic modalities--caloric testing, electronystagmography, audiometric testing, roentgenographic and nuclear medicine procedures--which may be employed by the clinician. Most of the skills discussed in our paper, though traditionally accorded to the fields of neurology and otolaryngology, would seem to be fundamental for any general physician, while the problem of vertigo is an example of how common ambulatory problems may require knowledgeable approach to sort self-limited from more serious illnesses as well as to utilize procedures with purpose and efficiency.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. dissection of dizziness: with emphasis on labyrinthine vertigo.The three most common types of vertiginous episodes area benign positional vertigo, postural vertigo, and endolymphatic hydrops. One of these conditions will be found in more than 90% of patients who present with vertigo as their main complaint. A clear understanding of the differences among these three entities will enable the physician not only to prescribe appropriate effective medical treatment but also to counsel and educate the patient about his or her particular condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. Posterior scleritis--an unusual manifestation of Cogan's syndrome.Cogan's syndrome is characterized by a non-luetic interstitial keratitis associated with vertigo, tinnitus and profound deafness. Evidence of a systemic vasculitis is found in up to 50% of patients. Atypical forms of Cogan's syndrome have been described in which the ocular inflammatory disease may be more severe. We describe a case of atypical Cogan's syndrome in association with bilateral posterior scleritis. Serial B-scan ultrasound measurements of posterior scleral thickness were found to be useful in assessing disease activity, in combination with clinical findings. Combination therapy with prednisolone and cyclosporin controlled the ocular disease but the deafness was irreversible. The length of follow-up of this case highlights the frequent relapses and difficult management problems which may be faced. This multisystem disease requires the close co-operation of ophthalmologist, physician and otorhinolaryngologist. Aggressive therapeutic intervention with high-dose combined immunosuppressive agents may be necessary to control severe ocular inflammatory disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. cogan syndrome: autoimmune-mediated audiovestibular symptoms and ocular inflammation.BACKGROUND: cogan syndrome is an uncommon disorder that presents with symptoms involving the eyes and ears. At its onset, it can mimic many common entities. family physicians should be aware of cogan syndrome because it can be successfully treated if it is recognized early in its course. It is one of the few treatable causes of deafness. methods: medline files were searched from 1982 to the present for "Cogan's syndrome." Additional references were obtained by cross-referencing bibliographies from available articles. RESULTS AND CONCLUSIONS: As first defined in 1945, cogan syndrome includes nonsyphilitic interstitial keratitis and attacks of vertigo, tinnitus, and hearing loss. Although it usually begins with only one symptom, most patients have both auditory and ocular findings within 1 year of the onset. If untreated, most patients become deaf within 36 months. blindness occurs in about 5 percent of patients, but ocular symptoms relapse during a period of years. The disease eventually involves other organs with clinical and pathologic findings that suggest vasculitis. Aortic insufficiency, the most serious complication, develops in 15 percent of patients. The cause of cogan syndrome remains unknown, but several studies suggest an autoimmune-mediated process. Many reports document an improvement in symptoms with immunosuppressive therapy, particularly if started early in the course of the illness. family physicians should include cogan syndrome in their differential diagnosis when a young adult seeks care with audiovestibular symptoms or ocular inflammation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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