1/4. 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 = 1keywords = environment (Clic here for more details about this article) |
2/4. Acute peripheral vestibular deficits after whiplash injuries.We report 3 patients who had acute peripheral vestibular dysfunction minutes to hours after a car collision with whiplash injury without head trauma. The accident was a frontal collision in 1 case, a rear impact in the second, and lateral in the third. All patients complained immediately of cervicalgia, headache, acute vertigo with a sensation of erroneous body movements, and slipping of image with head movements. A sudden sensation of tilting of the environment when driving, tinnitus, and hyperacusis were also described. The otoneurologic findings showed bilateral canalolithiasis in 1 patient and an acute peripheral vestibular deficit in 2 patients. Tilt of the subjective visual vertical was measured in all patients. Cerebral magnetic resonance imaging yielded normal findings. As angular and linear accelerometers, the vestibular organs are directly exposed to high forces generated by whiplash mechanisms. vertigo generated by peripheral vestibular lesions is probably underestimated in whiplash injuries and may often be incorrectly attributed to cervical or cerebral lesions.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/4. Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy.Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We studied the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/4. The clinical use of dynamic posturography in the elderly.We provide an overview of the clinical uses of dynamic posturography. Although the equipment described to perform this testing is expensive, the concepts, especially those for sensory organization, can be applied for 20.00. To apply the six sensory organization conditions, one merely needs some way to disrupt proprioceptive information by maintaining ankle angle and providing for visual conflict stimuli. We found that proprioceptive information can be disrupted easily by asking the patient to stand on a thick (4-inch) dense piece of foam rubber like that used in cushions for furniture. Visual stabilization conflict can be provided by having the patient wear a 19- to 20-inch Japanese lantern with a head-mounting system in the center so that the patient's movements do not reflect themselves in relative movements to the visual environment. With use of these two simple tools, the six sensory organization tests can be approximated in a clinical situation in a short time and can provide some relative information about a patient's postural control capabilities. With minor additional work, a quantitative measure of output that gives indications of the amount of anterior-posterior sway also can be provided. For elderly patients with a variety of problems ranging from general unsteadiness to frank vertigo, the risk of falling can be devastating, and it is important to provide a thorough investigation of the total balance system. The systematic investigation, qualitatively or quantitatively, of integration of sensory input and motor outputs provides a dimension that typically has been lacking in the routine "dizzy patient workup" for all ages but especially for elderly patients. Therefore, the application of the postural maintenance theory with the above-described procedures or variations in these procedures appears to have a great deal of clinical relevance in the evaluation of patients with gait and balance disorders. These types of evaluations represent an adjunct or addition to the evaluation of the vestibular system and the vestibulo-ocular reflexes and by no means should be considered a substitute for that traditional evaluation. It is the combination of information that can provide the clinician with a more global picture of the entire balance system and its functional capabilities.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |