1/25. Unsuspected intravestibular schwannoma.The intravestibular schwannoma is physically minute and will often elude preoperative diagnosis. From time to time, such a tumor will be unexpectedly encountered during transcanal labyrinthectomy. A review of pathologic and surgical literature suggests that the lesion can be well managed by the transcanal route. A standard labyrinthectomy may be sufficient, but the translabyrinthine approach may be necessary for more extensive tumors.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/25. basilar artery and vertigo.Our goal was to identify by magnetic resonance angiography the specific vascular abnormalities of the basilar artery that can be related to hypoperfusion disorders and produce symptoms of vertebrobasilar insufficiency. A classification of regional vascular perfusion disorders based on developmental malformations and intrinsic and extrinsic angiopathies was formulated from an analysis of individuals with these disorders. Specific angiographic abnormalities such as tortuosity, stenosis, thrombosis, and dolichoectasia were identified in subjects with vestibulocerebellar dysfunction. charts and radiographic images were examined with respect to the history, physical evidence, and vascular configuration, and the data were integrated for comprehensive analysis. We found that abnormalities identified by magnetic resonance angiography could be correlated with symptoms due to vascular insufficiency. Cases are presented that document the developmental and acquired arterial disorders that may be considered the etiologic factors for regional perfusion deficits.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/25. A liberatory maneuver for the treatment of horizontal canal paroxysmal positional vertigo.OBJECTIVE: The purpose of this study was to determine the effectiveness of a new liberatory maneuver in the management of the geotropic variant of horizontal canal paroxysmal positional vertigo (HC-PPV). STUDY DESIGN: Case review. SETTING: Outpatient clinic. patients: The diagnosis of HC-PPV was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal geotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were 11 men and 21 women ranging in age from 30 to 85 years (average 55.43 years), and the average duration of symptoms was 7.68 days. INTERVENTIONS: All patients were treated with a liberatory maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the posterior arm of the semicircular horizontal canal. The maneuver favors their outmigration into the utricle. patients were reexamined immediately after the treatment and again 2 days later. MAIN OUTCOME MEASURE: The treatment outcome was considered as responsive when, after one or more liberatory maneuvers, the clinical signs of PPV disappeared at the end of physical therapy. RESULTS: The liberatory maneuver resulted in a complete remission of the positioning vertigo and nystagmus in all patients after the first session. CONCLUSIONS: This approach represents a simple and effective approach to the management of the geotropic form of HC-PPV.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/25. High-resolution three-dimensional magnetic resonance imaging of the vestibular labyrinth in patients with atypical and intractable benign positional vertigo.Benign paroxysmal positional vertigo (BPPV) is a most common cause of dizziness and usually a self-limited disease, although a small percentage of patients suffer from a permanent form and do not respond to any treatment. This persistent form of BPPV is thought to have a different underlying pathophysiology than the generally accepted canalolithiasis theory. We investigated 5 patients who did not respond to physical treatment, presented with an atypical concomitant nystagmus or both with high-resolution three-dimensional magnetic resonance imaging of the inner ear. This method provides an excellent imaging of the inner ear fluid spaces. In all 5 patients, we found structural changes such as fractures or filling defects in the semicircular canals which we did not find in control groups. One patient clinically presented with the symptoms of a 'heavy cupula'. Whereas crosssections through the ampullary region and the adjoining utricle showed no abnormalities, there were significant structural changes in the semicircular canals, which are able to provide an explanation for the symptoms of a heavy cupula.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/25. Childhood vertigo: a case report and review of the literature.vertigo is a relatively uncommon pediatric complaint, with correct diagnosis made even more challenging by the patient's inherent difficulty in describing his or her symptoms. confusion may exist among vertigo, dizziness, dysequilibrium, ataxia, pre-syncope or syncope, and seizure activity by both the pediatric patient and his or her family. A complete history and physical examination, as well as appropriate ancillary studies, may assist in clarifying the diagnosis. This paper attempts, via case report and literature review, to discuss the various etiologies of acute vertigo in the pediatric population, provide diagnostic clues, and evaluate some of the available diagnostic modalities.- - - - - - - - - - ranking = 2.6066885345067keywords = physical examination, physical (Clic here for more details about this article) |
6/25. vertigo and the enlarged vestibular aqueduct syndrome.An enlarged vestibular aqueduct (EVA) is one of the most commonly identified inner ear bony malformations in children with sensorineural hearing loss of unknown cause. Most previous reports have focused on hearing loss, but individuals with EVA may also experience paroxysmal vertigo lasting minutes to hours. We report the clinical vestibular features and vestibular function testing of two children and one adult with EVA who had a history of sensorineural hearing loss and presented to our neurotology Clinic for the evaluation of episodic vertigo. All the patients had an antecedent history of profound bilateral sensorineural hearing loss that had been present since early childhood. The onset of vertigo was delayed into adulthood in one patient. Episodes of vertigo could be triggered by minor head trauma or vigorous physical activity. Despite recurrent episodes of vertigo, vestibular function was normal or moderately impaired compared with the severe auditory deficit. Careful analysis of temporal bone CT demonstrated EVA. Associated enlargement of the membranous endolymphatic sac was evident on brain MRI. While hearing loss is a prominent symptom in patients with EVA, vestibular symptoms may cause referral to a neurologist. Although hearing loss occurs early in childhood, vestibular symptoms can be delayed into adulthood, a finding not previously reported.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/25. Horizontal canal type BPPV: bilaterally affected case treated with canal plugging and Lempert's maneuver.A 54-year-old woman complained of positional vertigo. During 3 months' observation, the patient showed mostly geotropic or apogeotropic nystagmus due to right canalolithiasis or cupulolithiasis, however, she sometimes showed nystagmus which suggested left horizontal canalolithiasis. We suspected that she suffered from bilateral horizontal canal type benign paroxysmal positional vertigo (BPPV) and performed Lempert's maneuver for both directions, however, they were ineffective. She underwent canal plugging for right horizontal canal. After surgery she showed no positional nystagmus of right horizontal canal origin. However, apogeotropic nystagmus of the left horizontal canal origin was still observed. This nystagmus changed to geotropic nystagmus and finally disappeared following Lempert's maneuver for the left side. Bilateral horizontal canal BPPV is difficult to be resolved, probably because physical treatment for one side would move debris to the cupula in the other canal. Canal plugging combined with Lempert's maneuver to the other side is one treatment option for intractable bilateral horizontal canal BPPV.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/25. Labyrinthine concussion and positional vertigo after osteotome site preparation.An incident of positional vertigo associated with osteotome technique for installation of multiple maxillary dental implants is reported. The symptoms resolved after 2 weeks with restricted physical activity and prohibition of lifting. There is a discussion of labyrinthine concussion and treatments. Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/25. Investigating the causes of vertigo in breast cancer survivors.The vertigo symptom in breast cancer survivors has rarely been mentioned. The aim of this study was to investigate the causes of vertigo in breast cancer survivors with vertigo. From May 1997 to April 2003, 36 consecutive female breast cancer survivors with vertigo underwent a battery of tests including physical examination, neurological examination, serum lipid profile, plain chest radiograph, whole body bone scan, liver sonography, audiometry, electronystagmography (ENG) and MRI scan. Based on these tests, the causes of vertigo were attributed to peripheral labyrinthine origin in 14 patients (39%) and central origin in 22 patients (61%) consisting of 11 cases of vascular insufficiency, eight of hyperlipidemia and three of posterior fossa metastases (8%). The latter included one case of cerebellopontine angle and two of cerebellum, accompanied by extracranial systemic metastases, e.g., of the lung, bone or liver. In conclusion, vertigo in breast cancer survivors warrants concern, especially in those with extra-cranial systemic metastasis accompanied by headache. In addition to 8% occurrence of posterior fossa metastasis, other possible causes for vertigo in breast cancer survivors consist of vascular insufficiency, hyperlipidemia and labyrinthine lesion.- - - - - - - - - - ranking = 2.6066885345067keywords = physical examination, physical (Clic here for more details about this article) |
10/25. 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.- - - - - - - - - - ranking = 10keywords = physical (Clic here for more details about this article) |
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