Quality of life at 6 months in the Idiopathic Intracranial Hypertension Treatment Trial.

Quality of life at 6 months in the Idiopathic Intracranial Hypertension Treatment Trial.

Neurology. 2016 Sep 30;:

Authors: Bruce BB, Digre KB, McDermott MP, Schron EB, Wall M, NORDIC Idiopathic Intracranial Hypertension Study Group

Abstract
OBJECTIVE: To examine the changes in vision-specific and overall health-related quality of life (QOL) at 6 months in participants with idiopathic intracranial hypertension (IIH) and mild visual loss enrolled in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and to determine the signs and symptoms of IIH that mediate the effect of acetazolamide on QOL.
METHODS: We assessed QOL using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), the 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement, and the 36-Item Short Form Health Survey (SF-36). We examined associations among changes in QOL measures over 6 months, treatment status, and changes in signs and symptoms using linear and structural equation models.
RESULTS: Among the 165 participants with IIH (86 randomized to acetazolamide, 79 to placebo), beneficial effects of acetazolamide were seen on all QOL scales evaluated, as well as on the Near Activities (5.60 points, p = 0.03), Social Functioning (3.85 points, p = 0.04), and Mental Health (9.82, p = 0.04) subscales of the NEI-VFQ-25. Positive acetazolamide-related effects on QOL appeared to be primarily mediated by improvements in visual field, neck pain, pulsatile tinnitus, and dizziness/vertigo that outweighed the side effects of acetazolamide.
CONCLUSIONS: The marked reductions in baseline QOL seen among patients with mild visual loss from IIH are improved by treatment with acetazolamide. When combined with acetazolamide-associated improvements in visual field and other aspects of IIH, our findings with respect to QOL provide further support from the IIHTT in favor of acetazolamide to augment a dietary intervention in the treatment of IIH with mild visual loss (clinicaltrials.gov: NCT01003639).

PMID: 27694262 [PubMed - as supplied by publisher]

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[The thinking of clinical diagnosis and treatment of vertigo based on the international classification of vestibular disorders].

[The thinking of clinical diagnosis and treatment of vertigo based on the international classification of vestibular disorders].

Zhonghua Nei Ke Za Zhi. 2016 Oct 1;55(10):746-749

Authors: Tian JR, Zhao XQ

PMID: 27686430 [PubMed - as supplied by publisher]

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[Importance of clinical reasoning in diagnosis and treatment of vertigo/dizziness].

[Importance of clinical reasoning in diagnosis and treatment of vertigo/dizziness].

Zhonghua Nei Ke Za Zhi. 2016 Oct 1;55(10):745

Authors: Zhao XQ

PMID: 27686429 [PubMed - as supplied by publisher]

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Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis.

Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis.

Acta Otolaryngol. 2016 Aug 12;:1-8

Authors: Zhang X, Qian X, Lu L, Chen J, Liu J, Lin C, Gao X

Abstract
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. This study aimed to evaluate the effects of the Semont maneuver (SM) for BPPV treatment, compared with other methods.
METHODS: Studies were selected in relevant databases under pre-defined criteria up to June 2015. The Cochrane evaluation system was used to assess the quality of the studies. Effect size was indicated as a risk-ratio (RR) with corresponding 95% confidential interval (CI). Statistical analysis was conducted under a randomized- or fixed-effects model. Sub-group analysis was performed.
RESULTS: Ten studies were included in the meta-analysis. All of the studies presented a low attrition bias, but a high selection and reporting bias. SM had a much higher recovery rate (SM vs no treatment: RR = 2.60, 95% CI = 1.97-3.44, p < 0.01; SM vs sham: RR = 4.89, 95% CI = 3.01-7.94, p < 0.01), and lower recurrence rate than those from controls (SM vs no treatment: RR = 0.11, 95% CI = 0.04-0.31, p < 0.01). Overall, SM had similar outcomes with Epley maneuver (EM) and Brandt-Daroff exercise (BDE) in terms of recovery rate, recurrence rate, and side-effects.
CONCLUSION: SM is as effective as EM and BDE for BPPV treatment.

PMID: 27683970 [PubMed - as supplied by publisher]

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Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial.

Related Articles

Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial.

Arch Gynecol Obstet. 2016 May;293(5):993-9

Authors: Maged AM, Hassan AM, Shehata NA

Abstract
OBJECTIVE: The objective of this study is to compare the effectiveness and safety of carbetocin vs. oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery.
METHODS: A prospective randomised study was conducted in which 100 pregnant women were randomised into 2 equal groups: group 1 received Carbetocin 100 µgm (Pabal(®) Ferring, UK) and group 2 received oxytocin 5 IU (Syntocinon(®), Novartis, Switzerland).
RESULTS: The amount of blood loss and the need for other uterotonics were significantly lower in the carbetocin group (811 ± 389.17 vs. 1010 ± 525.66 and 10/50 vs. 21/50). There was no significant difference between the carbetocin and oxytocin groups regarding occurrence of major PPH (6 vs. 11), the need for blood transfusion (6 vs. 9), the difference between blood haemoglobin levels before delivery and 24 h after delivery (0.6 ± 0.28 vs. 0.56 ± 0.25), respectively. There was no significant difference between the 2 study groups regarding both systolic and diastolic blood pressure measured immediately after the drug administration and at 30 and 60 min later. Regarding the drugs side effects, there was no significant difference between the 2 groups in the occurrence of nausea, vomiting, tachycardia, flushing, dizziness, headache, shivering, metallic taste, dyspnea, palpitations and itching.
CONCLUSIONS: Carbetocin is a better alternative to oxytocin in management of atonic PPH with non-significant hemodynamic changes or side effects .

PMID: 26511939 [PubMed - indexed for MEDLINE]

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20th Anniversary JDP-LCD student colloquium a huge success!

The 20th Annual Doctoral Student Colloquium of the SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders (JDP-LCD), on September 23, 2016, was a big success!

• See the speaker abstracts (docx).

Pictured (L-R) are JDP-LCD students who presented research from their 1st and 2nd year doctoral projects: Erin Smolak, Philip Combiths, Brittany Lee, and Gabriela Meade.

 

 

 

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Effect of a vestibular rehabilitation protocol to improve the health-related quality of life and postural balance in patients with peripheral vertigo.

Effect of a vestibular rehabilitation protocol to improve the health-related quality of life and postural balance in patients with peripheral vertigo.

Ann Phys Rehabil Med. 2016 Sep;59S:e125

Authors: Jeribi S, Yahia A, Achour I, Hammemi B, Ghorbel A, Elleuch MH, Ghroubi S

Abstract
OBJECTIVE: To determine the effect of completing a vestibular rehabilitation treatment protocol on postural balance, dizziness and quality of life in patients with peripheral vertigo.
MATERIAL/PATIENTS AND METHODS: A prospective study concerning patients with instability due to unilateral peripheral vestibular disorder. The patients were evaluated with a clinical examination and a test of static and dynamic balance on the Satel(®) platform in which length, mediolateral (LongX) and anterior-posterior deviations (long Y) were monitored. Information regarding vertigo symptoms and quality of life were assessed through the vertigo symptom Scale (VSS) and the Dizziness Handicap Inventory (DHI). Patients were treated in two sessions per week for two months by a custom protocol. The rehabilitation program included substitutional and/or habitudinal exercises, exercises on a stability platform, and optokinetic stimulation.
RESULTS: Thirty patients with mean age of 52.26±8.45 years were included: 7 men and 23 women. Twelve patients had vestibular neuritis sequelae (46,7%), 10 otolith disorders (33,33%),and 6 Meniere's disease (20%). An improvement in the intensity of dizziness, postural parameters and quality of life was considered (0.01) with the intervention. The main balance parameters (Long X and Long Y) have decreased after the rehabilitation protocol. This improvement was significant in the static condition eyes closed. The mean of Long X decreased from 489.05±327.07 to 365.09±268.82mm (P<0.001). The average Y Long decreased from 853.49±734.19 to 569.08±530.55 (P<0.001). We noted an improvement of vertigo condition (the mean total score of VSS decreased from 22.2±6.74 to 10.86±3.54 (P<0.001)) and the quality of life (the mean total score DHI has decreased from 37.6±8.35 to 18.1±5.56 (P<0.01).
DISCUSSION-CONCLUSION: Postural balance and quality of life improve with postural rehabilitation and optokinetic stimulation in patients with peripheral vertigo. This technique must be applied as early as possible by a specialized physiotherapist to promote the elimination of the unpleasant symptoms related to this dysfunction.

PMID: 27676762 [PubMed - as supplied by publisher]

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[Analysis of the relevant factors for recurrent sudden sensorineural hearing loss].

[Analysis of the relevant factors for recurrent sudden sensorineural hearing loss].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Sep 7;51(9):691-694

Authors: Liang H, Zhong SX

Abstract
Objective: To investigate the possible factors related to recurrence and prognosis of sudden sensorineural hearing loss(SSNHL). Methods: Four hundred and ninety-five patients with unilateral sudden sensorineural hearing loss between January 2013 to April 2014 were analyzed retrospectively(34 patients lost to follow-up with a dropout rate of 6.87%). Twenty of the 495 patients were diagnosed as recurrent SSNHL and treated again in the same hospital. The data of the patients were summarized to analyze the related factors which might influence the recurrence and prognosis of SSNHL. Results: In the 20 patients with recurrent SSNHL, 19 had the second attack in same ear as the first attack, and the other one had in both ears. There were seven male patients, and thirteen female patients. Patients ranged in age from 24 to 77years, with a median age of 39.5 years. Types of hearing loss: low frequency in eight patients, high frequency in two patients, flat frequency in eight patients, total deafness in two patients, the types of the second attack in 17 patients were same as the first attack, only one patient was changed from total deafness to flat frequency, one case was changed from flat frequency to high frequency, one case changed from flat frequency to total deafness. The intervals between of the first attack time and the second attack time were 1-36 months with the median time of 3.5 months. After systemic oral and (or) transtympanic steroid treatment, recovered in three cases, effective in three cases and 14 cases invalid, the cure rate was 15%, and the total effective rate was 30%. There were statistically significant differences in the recovery rate(χ(2)=8.640, P<0.05) and the overall response rate(χ(2)=12.379, P<0.01)between the first and the second treatments. For the patients with vertigo and/or dizziness, with a history more than seven days, with hypertension or diabetes mellitus, and with a type of hearing loss except low frequency type, the treatment effect was invalid. The patients with hearing loss at low frequency had the best outcomes. The total effective rates were significant different between patients younger and old than 34 years old(P<0.05). There was no difference in the total effective rate between genders, and patients with or without tinnitus and/or aural fullness in the recurrent SSNHL(P>0.05). The recurrence rates of patients with various types of hearing loss were different(F=7.744, P<0.05), with a highest recurrence rate in patients with hearing loss at low frequency. Other factors such as gender, age, accompanied diseases (hypertension or diabetes mellitus), associated symptoms, interval from onset to treatment had no effects on the recurrence rate. Conclusions: Recurrence of SSNHL is more likely to be found in patients with hearing loss of low frequency and flat type. The prognosis of recurrent SSNHL is poorer than that of the first episode, and may be related to the age and type of hearing loss.

PMID: 27666709 [PubMed - as supplied by publisher]

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The Use of Release-Active Antibody-Based Preparations for Vertigo Prevention in Adults.

Related Articles

The Use of Release-Active Antibody-Based Preparations for Vertigo Prevention in Adults.

Bull Exp Biol Med. 2015 Nov;160(1):61-3

Authors: Barchukov VV, Zhavbert ES, Dugina YL, Epstein OI

Abstract
The effectiveness of antibody-based release-active preparations Impaza (antibodies to eNOS), Tenoten (antibodies to brain-specific protein S-100), Dietressa (antibodies to type 1 cannabinoid receptor), Brizantin (combined preparation, antibodies to brain-specific protein S-100 and type 1 cannabinoid receptor), and Divaza (combined preparation, antibodies to brain-specific protein S-100 and eNOS) in the prevention of vertigo was studied on the model of intermittent accumulation of Coriolis accelerations (ICCA). Modification of activity of vestibular receptors and signal systems by release-active preparations contributed to an increase in ICCA tolerance time. Combined preparation Impaza possessed the most significant antinaupathic properties. Brizantin was less potent in this respect.

PMID: 26608378 [PubMed - indexed for MEDLINE]

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Postpartum vertebral artery dissection.

Related Articles

Postpartum vertebral artery dissection.

BMJ Case Rep. 2015;2015

Authors: Finley A, Rogers B, Richards T, Vogel H

Abstract
We report a case of a right vertebral artery dissection in a 35-year-old woman, 3 weeks post partum, with manifestations of vertebrobasilar disease. She was 3 weeks out from the uneventful delivery of her fourth child, with presentation of acute neurological symptoms, predominantly intractable vertigo. Vertigo can have many non-specific generalised symptoms and clinical findings. Postpartum women have a lengthy list of possible aetiologies of vertigo not limited to our initially suspected preeclampsia, dural venous thrombosis and vertebral dissection.

PMID: 26604230 [PubMed - indexed for MEDLINE]

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Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns.

Related Articles

Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns.

Br J Sports Med. 2016 Sep 21;

Authors: Murray DA, Meldrum D, Lennon O

Abstract
OBJECTIVE: Concussion symptoms normally resolve within 7-10 days but vertigo, dizziness and balance dysfunction persist in 10-30% of cases causing significant morbidity. This study systematically evaluated the evidence supporting the efficacy, prescription and progression patterns of vestibular rehabilitation therapy (VRT) in patients with concussion.
DESIGN: Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis.
DATA SOURCES: Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May 2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science (1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches and grey literature.
ELIGIBILITY CRITERIA FOR STUDY SELECTION: Article or abstract of original research, population of patients with concussion/mild traumatic brain injury (mTBI) with vestibular symptoms, interventions detailing VRT, measurement of outcomes pre-VRT/post-VRT. Study type was not specified.
RESULTS: Following a double review of abstract and full-text articles, 10 studies met the inclusion criteria: randomised controlled trial (n=2), uncontrolled studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single intervention. 6 studies incorporated VRT in multimodal interventions (including manual therapy, strength training, occupational tasks, counselling or medication). 9 studies reported improvement in outcomes but level I evidence from only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to 11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT (combined with cervical therapy) was compared with usual care. Heterogeneity in study type and outcomes precluded meta-analysis. Habituation and adaptation exercises were employed in 8 studies and balance exercises in 9 studies. Prescription and progression patterns lacked standardisation.
CONCLUSIONS: Current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited. Available evidence, although weak, shows promise in this population. Further high-level studies evaluating the effects of VRT in patients with mTBI/concussion with vestibular and/or balance dysfunction are required.

PMID: 27655831 [PubMed - as supplied by publisher]

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[Reporting quality and effect size comparison in randomized controlled trials of bo's abdominal acupuncture using CONSORT statement and STRICTA].

Related Articles

[Reporting quality and effect size comparison in randomized controlled trials of bo's abdominal acupuncture using CONSORT statement and STRICTA].

J Tradit Chin Med. 2016 Jun;36(3):382-91

Authors: Wen W, Yang L, Liu S, Zhong Y, Hu X, Huang X, Guo X

Abstract
OBJECTIVE: To evaluate the reporting quality of randomized controlled trials (RCT) that compared Bo's abdominal acupuncture with conventional body acupuncture, and compare the efficacy and safety between them by performing a Meta-analysis.
METHODS: All RCTs comparing Bo's abdominal acupuncture with conventional body acupuncture were included. English and Chinese databases were searched from their respective inceptions to March 2014. The reporting quality was assessed according to the "Consolidated Standards of Reporting Trials" (CONSORT) checklist for parallel RCTs and the revised "Standards for Reporting Interventions in Clinical Trials of Acupuncture" (STRICTA). A Meta-analysis was conducted to synthesize the effect sizes, and publication bias was evaluated by the Egger linear regression test using Stata.
RESULTS: Ninety-seven studies were included, of which most lacked adequate reporting information, and 80.4% showed that the efficacy of abdominal acupuncture is superior to conventional body acupuncture, especially for the following diseases: lumbar disc herniation, cervical spondylosis, omarthritis and cervical vertigo, except simple obesity. Effect-sizes were controversial when evaluating different outcomes.
CONCLUSION: The international standard CONORT statement and STRICTA guidelines should be strictly applied when reporting acupuncture RCTs in the future. Abdominal acupuncture appears to be more effective compared with conventional body acupuncture for some diseases. However, fur-her high quality blind RCTs using validated out-ome indexes and standard reporting are warranted.

PMID: 27468555 [PubMed - indexed for MEDLINE]

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Comparative pharmacokinetics of gastrodin in rats after intragastric administration of free gastrodin, parishin and Gastrodia elata extract.

Related Articles

Comparative pharmacokinetics of gastrodin in rats after intragastric administration of free gastrodin, parishin and Gastrodia elata extract.

J Ethnopharmacol. 2015 Dec 24;176:49-54

Authors: Tang C, Wang L, Liu X, Cheng M, Qu Y, Xiao H

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Gastrodia elata Blume, a traditional Chinese herb, was widely used against convulsant, vertigo, paralysis, epilepsy, tetanus, asthma and immune dysfunctions. Gastrodin is one of the major bioactive components of G. elata and it is known for its anticonvulsive, anti-inflammatory, antiepileptic and neuroprotective effects.
MATERIALS AND METHODS: An ultra high performance liquid chromatography-fluorescence detection (UHPLC-FLD) method was developed to determine gastrodin in rat plasma. Gastrodin and Thiamphenicol (internal standard, IS) were extracted from rat plasma by immediately protein precipitation. The pharmacokinetics of gastrodin in rats by following differently administered types was studies: intragastric administration of gastrodin (100mg/kg), parishin (116 mg/kg, with the same mole of gastrodin moiety) and G. elata extract (2.3g/kg, with the same mole of gastrodin moiety). Non-compartmental pharmacokinetic profiles were constructed using the software of WinNonlin (Phoenix, version 6.3), and the pharmacokinetic parameters were compared using unpaired Student's t-test.
RESULTS: The results showed that the pharmacokinetic parameters, including Cmax, Tmax, AUC0-∞, t1/2, MRT, Vd, CL, were quite different among the three types of gastrodin administration. The administration of parishin and G. elata extract, which either could convert to gastrodin in vivo or contained free gastrodin and abundant gastrodin conjugates, gave rise to higher elimination half-life (t1/2) and mean residence time (MRT) values for gastrodin compared to free gastrodin administered.
CONCLUSION: The comparison of the pharmacokinetics of gastrodin among three different administered types of gastrodin in rats suggested that administration of parishin or G. elata extract in clinic may result in a longer duration time of action than that of the administration of free gastrodin. The results may provide some guidance for the clinical applications of parishin and G. elata.

PMID: 26471288 [PubMed - indexed for MEDLINE]

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Medial Cranial Fossa Meningioma Diagnosed as Mixed Anxiety Disorder with Dissociative Symptoms and Vertigo.

Medial Cranial Fossa Meningioma Diagnosed as Mixed Anxiety Disorder with Dissociative Symptoms and Vertigo.

Case Rep Psychiatry. 2016;2016:3827547

Authors: Ceylan EM, Önen Ünsalver B, Evrensel A

Abstract
Meningiomas are mostly benign tumors of the meninges that may stay clinically silent or present first with psychiatric symptoms only. We present a case of medial cranial fossa meningioma that was first diagnosed as mixed anxiety disorder with dissociative symptoms and vertigo. In light of the intact neurological and vestibular system examination, our patient's vertigo and depersonalization were firstly addressed as psychosomatic symptoms of the psychiatric syndrome. Despite decreased anxiety and improved mood, dissociative symptoms and vertigo were resistant to treatment which prompted further research yielding a left hemisphere localized meningioma. Resection of meningioma resulted in full remission of the patient proving it to be responsible for the etiology of the psychiatric syndrome and vertigo. We suggest that brain imaging should be performed for patients with late-onset (>50 years) psychiatric symptoms and those with treatment resistance. It is important to keep in mind always that medically unexplained symptoms may become explicable with detailed assessment and regular follow-up of the patient.

PMID: 27651969 [PubMed - as supplied by publisher]

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Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo.

Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo.

Neural Regen Res. 2016 Aug;11(8):1267-1273

Authors: Wen Y, Zhang C, Zhao XF, Deng SZ, He S, Huang LH, Tian G, Meng ZH

Abstract
Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3-4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.

PMID: 27651774 [PubMed - as supplied by publisher]

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Repeated courses of intratympanic dexamethasone injection are effective for intractable Meniere's disease.

Repeated courses of intratympanic dexamethasone injection are effective for intractable Meniere's disease.

Acta Otolaryngol. 2016 Sep 21;:1-7

Authors: Leng Y, Liu B, Zhou R, Liu J, Liu D, Zhang SL, Kong WJ

Abstract
CONCLUSION: Intra-tympanic dexamethasone injection (ITD) could serve as a first-line intra-tympanic (IT) treatment for Meniere's disease (MD), regardless of hearing level. Even if the response to initial ITD course was unsatisfactory, a repeated course may be beneficial with some patients.
OBJECTIVES: This study examined the effect of repeated courses of ITD administered on demand and investigated the possibility of ITD as an initial IT treatment for medically intractable MD patients.
METHOD: Fifty-one patients who had been diagnosed with definite MD and given course(s) of ITD treatment were included. Vertigo control, pure tone average and functional disability scores were evaluated against the American Academy of Otolaryngology-Head and Neck Surgery guidelines for MD.
RESULTS: Vertigo disappeared or was substantially controlled in 58.8% and 23.5% of the patients, respectively, after the first ITD course. A repeated course further raised the complete vertigo control rate by 15.7% and intra-tympanic gentamycin injection could be postponed or avoided in 78.6% of the patients who required repeated IT treatment. Hearing was unchanged after the first course of ITD (p > .05). No significant differences were detected in the clinical profiles or laboratory findings between patients receiving single course of ITD and those on multiple courses (p > .05).

PMID: 27650470 [PubMed - as supplied by publisher]

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Treatment of Temporal Bone Fractures.

Treatment of Temporal Bone Fractures.

J Neurol Surg B Skull Base. 2016 Oct;77(5):419-429

Authors: Diaz RC, Cervenka B, Brodie HA

Abstract
Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted.

PMID: 27648399 [PubMed - as supplied by publisher]

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Cochleovestibular nerve compression syndrome due to intrameatal Anterior Inferior Cerebellar Artery loop: synthesis of best evidence for clinical decisions.

Cochleovestibular nerve compression syndrome due to intrameatal Anterior Inferior Cerebellar Artery loop: synthesis of best evidence for clinical decisions.

World Neurosurg. 2016 Sep 16;

Authors: Esposito G, Messina R, Carai A, Colafati GS, Randi F, De Benedictis A, Cossu S, Fontanella MM, Marras CE

Abstract
INTRODUCTION: Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic in order to systematically present the best available evidence to guide clinical decisions.
MATERIALS AND METHODS: We performed a literature review on reported cases of surgically treated intrameatal anterior inferior cerebellar artery (AICA) - cochleovestibular nerve (CVN) neurovascular conflict, analyzing preoperative clinical data, surgical techniques, and outcomes. We analyzed the levels of evidence using the King's college guidelines DISCUSSION: We found 35 studies of neurovascular compression of CVN by AICA for a total of 536 patients operated to resolve their neurovascular conflict. Only four of these studies describe intrameatal AICA neurovascular conflicts, for a total of 9 cases, including our own. Tinnitus was the most frequent symptom (9/9), followed by vertigo (2/9). Our case was the only one showing unilateral hearing loss. Surgery consisted in microsurgical mobilization of AICA loop performed through a retrosigmoid craniotomy. Tinnitus and vertigo resolved after surgery in all cases, whereas hearing loss did not improve after surgery.
CONCLUSION: Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss.

PMID: 27647022 [PubMed - as supplied by publisher]

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Vertigo and dizziness in children.

Vertigo and dizziness in children.

Handb Clin Neurol. 2016;137:353-63

Authors: Jahn K

Abstract
Vertigo and dizziness of at least moderate severity occur in >5% of school-aged children and cause considerable restrictions in participation in school and leisure activity. More than 50% of dizzy children also have headache. Vestibular migraine and benign paroxysmal vertigo as a migraine precursor are the most common diagnoses in dizziness clinics for children and adolescents. They account for 30-60% of diagnoses. Other common causes are somatoform, orthostatic, or posttraumatic dizziness. All other disorders that are known to cause vertigo and dizziness in adults also occur in children, but incidence rates are usually lower. The vestibular and balance systems are largely developed after 1 year of age. Therefore, clinical and laboratory testing is reliable. Brain magnetic resonance imaging to exclude severe conditions, such as a brainstem tumor, is necessary only if clinical - in particular, ocular motor - testing is abnormal. Most conditions causing vertigo and dizziness in childhood and adolescence are treatable. Nonpharmacologic prophylaxis should always be recommended in vestibular migraine. Behavioral support is useful in somatization. Evidence for the effectiveness of drug therapy is largely based on experience in adult populations. High-quality controlled studies in childhood cohorts are sparse. It is important to make a correct diagnosis early on, as counseling and appropriate treatment may avoid chronic illness.

PMID: 27638083 [PubMed - in process]

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Vestibular migraine.

Vestibular migraine.

Handb Clin Neurol. 2016;137:301-16

Authors: von Brevern M, Lempert T

Abstract
During the last decades a new vestibular syndrome has emerged that is now termed vestibular migraine (VM). The main body of evidence for VM is provided by epidemiologic data demonstrating a strong association between migraine and vestibular symptoms. Today, VM is recognized as one of the most common causes of episodic vertigo. The clinical presentation of VM is heterogeneous in terms of vestibular symptoms, duration of episodes, and association with migrainous accompaniments. Similar to migraine, there is no clinical or laboratory confirmation for VM and the diagnosis relies on the history and the exclusion of other disorders. Recently, diagnostic criteria for VM have been elaborated jointly by the International Headache Society and the Bárány Society. Clinical examination of patients with acute VM has clarified that the vast majority of patients with VM suffer from central vestibular dysfunction. Findings in the interval may yield mild signs of damage to both the central vestibular and ocular motor system and to the inner ear. These interictal clinical signs are not specific to VM but can be also observed in migraineurs without a history of vestibular symptoms. How migraine affects the vestibular system is still a matter of speculation. In the absence of high-quality therapeutic trials, treatment is targeted at the underlying migraine.

PMID: 27638080 [PubMed - in process]

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