First trial response to sudden support surface displacement: the effect of vestibular compensation.

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First trial response to sudden support surface displacement: the effect of vestibular compensation.

Acta Otolaryngol. 2015;135(10):1036-44

Authors: de Abajo J, Perez-Fernandez N

Abstract
CONCLUSION: The effect of visual condition is more intense in the first trial response in normal subjects and patients and in last trial response only in patients. The first trial effect is more evident in compensated patients in the eyes open condition with any type of perturbation, and in non-compensated patients with the angular displacements in either visual condition.
OBJECTIVE: The study of body reaction to FTR can help to understand the complex mechanisms involved in the postural response and to develop new therapies to improve stability and prevent falls in unilateral vestibular deficit (UVD). This work describes the adaptation effect and the visual influence on the postural response to repetitive balance perturbation stimulus in normal subjects, compensated, and uncompensated UVD patients.
METHODS: The magnitude of displacement has been measured when the support surface is linearly or angularly displaced. The differences between results in the first and late trial, and the differences between the eyes open and eyes closed situation have been compared.
RESULTS: Compensated patients recover the adaptation ability to unexpected changes on the support surface through visual preference mechanism. Not compensated patients present hypermetric postural response with greater instability in the eyes open and eyes closed situations.

PMID: 26004282 [PubMed - indexed for MEDLINE]

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Frequency preference in cervical vestibular evoked myogenic potential of idiopathic otolithic vertigo patients. Does it reflect otolithic endolymphatic hydrops?

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Frequency preference in cervical vestibular evoked myogenic potential of idiopathic otolithic vertigo patients. Does it reflect otolithic endolymphatic hydrops?

Acta Otolaryngol. 2015;135(10):995-9

Authors: Murofushi T, Komiyama S, Hayashi Y, Yoshimura E

Abstract
CONCLUSION: Idiopathic otolithic vertigo (IOV) with relatively long duration of attacks might be caused by endolymphatic hydrops in the otolith organ.
OBJECTIVES: To clarify the pathophysiology underlying IOV, episodic tilting or translational sensation attacks by unknown causes, especially the possibility of endolymphatic hydrops in the otolith organ.
METHODS: Sixteen patients (6 men and 10 women) diagnosed with having IOV were enrolled. In these subjects, frequency preference in cervical vestibular evoked myogenic potential (cVEMP) was studied. The subjects underwent cVEMP testing using 500 Hz and 1000 Hz short tone bursts (STB) (125 dB SPL, air-conducted sound). The 500-1000 Hz cVEMP slope was calculated and assessed in comparison with data from healthy subjects in the preceding study.
RESULTS: Twelve of the 16 examined patients had a significant preference of 1000 Hz to 500 Hz, which was suggestive of endolymphatic hydrops in the saccule. Patients with frequency preference of 1000 Hz to 500 Hz showed a tendency for longer vertigo attacks than patients without preference of 1000 Hz.

PMID: 25990760 [PubMed - indexed for MEDLINE]

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The efficacy of vestibular rehabilitation in patients with benign paroxysmal positional vertigo: a rapid review.

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The efficacy of vestibular rehabilitation in patients with benign paroxysmal positional vertigo: a rapid review.

Otolaryngol Head Neck Surg. 2014 Nov;151(5):740-5

Authors: van der Scheer-Horst ES, van Benthem PP, Bruintjes TD, van Leeuwen RB, van der Zaag-Loonen HJ

Abstract
OBJECTIVE: To systematically review the evidence on the effectiveness of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo.
DATA SOURCES: A literature search was performed in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE databases.
REVIEW METHODS: A comprehensive search was performed up to July 2013. Two authors independently scanned the search results to identify randomized controlled trials of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies were methodologically assessed using the Cochrane risk of bias tool. Primary outcome was the effect on vertigo attacks and balance.
RESULTS: Of 76 identified trials, only 2 trials fulfilled our inclusion criteria and were included in this review, involving 106 patients. One study was methodologically weak, the other strong. The studies differed in type of intervention, type of outcome, and follow-up time. Both studies reported no significant difference in the vertigo intensity between groups. A small effect was found on balance.
CONCLUSION: Two level II studies in benign paroxysmal positional vertigo showed no effect of vestibular rehabilitation in addition to a canalith repositioning maneuver on vertigo intensity and a small, beneficial effect on balance. We therefore conclude that there is no evidence for an effect of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo.

PMID: 25155900 [PubMed - indexed for MEDLINE]

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[Tanakan as a multimodal cytoprotective factor in general medicine (part II)].

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[Tanakan as a multimodal cytoprotective factor in general medicine (part II)].

Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(12):177-82

Authors: Esin RG, Naprienko MV, Mukhametova ER, Khairullin IKh, Esin OR

Abstract
The second section of the review provides an update of the data on mechanisms of action of a standardized extract of Ginkgo biloba EGb761® (tanakan) and its efficacy in treatment of depression, pain, complications of diabetes, Parkinson disease, tinnitus and dizziness, reproductive dysfunction. Updated data enable to use EGb761® (tanakan) as a highly-effective cytoprotective agent in treatment of cardiovascular, degenerative and metabolic diseases of the nervous system, inner ear disturbances (tinnitus), dysfunction of reproductive system as well as in prevention and treatment of stress-induced disorders.

PMID: 26978514 [PubMed - indexed for MEDLINE]

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Why Acute Dizziness and Vertigo? Articulating the Emergency Neuro-Otology Imperative.

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Why Acute Dizziness and Vertigo? Articulating the Emergency Neuro-Otology Imperative.

Neurol Clin. 2015 Aug;33(3):xiii-xv

Authors: Newman-Toker DE, Kerber KA, Meurer WJ, Omron R, Edlow JA

PMID: 26231282 [PubMed - indexed for MEDLINE]

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Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

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Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

Neurol Clin. 2015 Aug;33(3):687-98, xi

Authors: Lee SH, Kim JS

Abstract
Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic examination can reliably differentiate acute vestibular syndrome due to stroke from more benign inner ear disease. Sometimes acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Accurate identification of isolated vascular vertigo is very important because misdiagnosis of acute stroke may result in significant morbidity and mortality.

PMID: 26231280 [PubMed - indexed for MEDLINE]

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TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo.

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TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo.

Neurol Clin. 2015 Aug;33(3):577-99, viii

Authors: Newman-Toker DE, Edlow JA

Abstract
Diagnosing dizziness can be challenging, and the consequences of missing dangerous causes, such as stroke, can be substantial. Most physicians use a diagnostic paradigm developed more than 40 years ago that focuses on the type of dizziness, but this approach is flawed. This article proposes a new paradigm based on symptom timing, triggers, and targeted bedside eye examinations (TiTrATE). Patients fall into 1 of 4 major syndrome categories, each with its own differential diagnosis and set of targeted examination techniques that help make a specific diagnosis. Following an evidence-based approach could help reduce the frequency of misdiagnosis of serious causes of dizziness. In the spirit of the flipped classroom, the editors of this Neurologic Clinics issue on emergency neuro-otology have assembled a collection of unknown cases to be accessed electronically in multimedia format. By design, cases are not linked with specific articles, to avoid untoward cueing effects for the learner. The cases are real and are meant to demonstrate and reinforce lessons provided in this and subsequent articles. In addition to pertinent elements of medical history, cases include videos of key examination findings.

PMID: 26231273 [PubMed - indexed for MEDLINE]

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Mandibular melanotic neuroectodermal tumor of infancy: a role for neoadjuvant chemotherapy.

Mandibular melanotic neuroectodermal tumor of infancy: a role for neoadjuvant chemotherapy.

Eur Arch Otorhinolaryngol. 2016 Apr 23;

Authors: Maroun C, Khalifeh I, Alam E, Akl PA, Saab R, Moukarbel RV

Abstract
Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare, locally aggressive neoplasm with a predilection for the head and neck area, most commonly occurring in the maxilla. The vast majority of treatment modalities for all cases of MNTI to date have involved surgical intervention only, with just 9.6 % involving some sort of chemotherapy, radiotherapy, or a combination of the prior mentioned modalities. There is very limited information available regarding the use of neoadjuvant chemotherapy, due to its rare nature. In this report, a 4 month old girl presented to our clinic with a chief complaint of a large oral mass of about 2.5 months in duration. Intraoral examination showed an oral mass arising from the lingual aspect of inferior alveolar ridge with extensive mandibular invasion. The patient received three cycles of vincristine, Adriamycin, and cyclophosphamide as neodajuvant therapy. Upon completion, the tumor had decreased significantly in size. The patient was then scheduled for surgery and underwent surgical resection of the tumor. We were able to obtain adequate shrinkage of the tumor to allow better resectability, easier surgical access and a more minimally invasive approach with no lip split and a smaller neck incision. In conclusion, we have reported an extremely rare case of MNTI of the mandible that was successfully treated with neoadjuvant chemotherapy and surgical resection. This approach was advantageous to minimize the chance of recurrence and improve resectability in particularly large tumors, while maximizing functional outcomes and minimizing deformity.

PMID: 27107579 [PubMed - as supplied by publisher]

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Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

Auris Nasus Larynx. 2016 Apr 20;

Authors: Yasumatsu R, Nakashima T, Sato M, Nakano T, Kogo R, Hashimoto K, Sawatsubashi M, Nakagawa T

Abstract
OBJECTIVE: The aim of this study was to investigate the clinical features and prognosis of patients with squamous cell carcinoma (SCC) associated with sinonasal inverted papilloma (IP).
METHODS: The medical records of 95 patients who were diagnosed with IP or SCC associated with IP were retrospectively reviewed. Out of 95 patients, 15 were diagnosed with SCC associated with IP. The clinical characteristics, treatment modalities, and survival outcomes of the patients were analyzed.
RESULTS: The incidence of SCC associated with IP was 15.8%. Although differential diagnosis between IP and SCC associated with IP is difficult, epistaxis may be the specific symptom in SCC associated with IP cases. The 3-year disease-specific survival rate was higher in cases with T1, 2 and 3 than in cases with T4. There was no significant difference in survival rate between maxillary sinus and other primary sites. On the other hand, there was a significant difference in survival rate between the microscopic SCC with IP cases and the other cases. In addition, the patients with <70 years old better than those with >70 years old with a 3-year disease free survival of 80% versus 0%.
CONCLUSIONS: Some T4 patients were found to have a highly aggressive disease. Therefore, complete surgical resection followed by chemo-radiation therapy is the recommended treatment for patients with T4 disease to control of the primary tumor site.

PMID: 27108101 [PubMed - as supplied by publisher]

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[Acantholytic squamous cell carcinoma of larynx as an uncommon variant of squamous cell carcinoma].

[Acantholytic squamous cell carcinoma of larynx as an uncommon variant of squamous cell carcinoma].

Kulak Burun Bogaz Ihtis Derg. 2016 May-Jun;26(3):176-80

Authors: Tiken EE, Çolpan Öksüz D, Batur Ş, Uzel EK, Öz B, Öz F, Uzel Ö, Turkan S

Abstract
Acantholytic squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. Acantholytic squamous cell carcinoma occurs in the sun-exposed areas of the skin and lip. It is rarely observed in the respiratory and digestive tract and may present more aggressively. The incidence of distant metastases of squamous cell head and neck cancers is low and the lungs are the most common metastatic sites. Metastasis to the soft tissue, skin, and adrenal glands from the laryngeal region is very uncommon. In this article, we report a 58-year-old female case who underwent postoperative radiation therapy with the diagnosis of acantholytic squamous cell carcinoma of the larynx and developed metastasis to the soft tissue and adrenal gland at the early period.

PMID: 27107606 [PubMed - as supplied by publisher]

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[Assessing the risk of falls for the elderly in Basic Health Units].

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[Assessing the risk of falls for the elderly in Basic Health Units].

Rev Esc Enferm USP. 2012 Apr;46(2):320-7

Authors: de Pinho TA, Silva AO, Tura LF, Moreira MA, Gurgel SN, Smith Ade A, Bezerra VP

Abstract
The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.

PMID: 22576534 [PubMed - indexed for MEDLINE]

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[Epidemiological characteristic of the patients presenting with cochleovestibular disorders associated with labyrinthine hydrops].

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[Epidemiological characteristic of the patients presenting with cochleovestibular disorders associated with labyrinthine hydrops].

Vestn Otorinolaringol. 2011;(4):40-2

Authors: Levina IuV, Kunel'skaia NL, Krasiuk AA, Baush IaA

Abstract
A total of 1,067 patients complaining of hearing impairment, dizziness, and tympanophony were admitted for the treatment to the Surdological Department of N.I. Pirogov City Clinical Hospital No 1 during the period from 2000 to 2010. As many as 326 (30.5%) patients were preliminarily diagnosed with Meniere's disease based on their medical histories, clinical condition, and the results of questionnaire studies. All of them were subjected to comprehensive audiologic and vestibulogic examination with the use of up-to-date techniques. The data thus obtained allowed to reveal labyrinthine hydrops in 275 (84%) patients. It is concluded that 101 (9.5%) patients presenting with the typical symptoms of Meniere's disease had labyrinthine hydrops.

PMID: 21983667 [PubMed - indexed for MEDLINE]

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Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences.

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Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences.

World Neurosurg. 2015 Dec;84(6):1726-38

Authors: Zhu Y, Pan J, Shen J, Liu C, Fan Z, Shen Y, Wen L, Tong Y, Zhan R

Abstract
OBJECTIVE: Unruptured paraophthalmic aneurysms present unique challenges, and the ideal management remains unknown.
METHODS: We performed a pooled analysis of single-center experiences to compare the risks and effectiveness involving patients with unruptured paraophthalmic aneurysms treated with clipping, coiling alone, stent-assisted coiling, and flow-diversion. The MEDLINE database was searched and thirty-three series (including our institutional experience) were included.
RESULTS: Clipping caused more intracranial hemorrhage (ICH) and neurologic complications (NCs) than coiling alone (ICH: odds ratio [OR] = 3.058, P = 0.013; NC: OR = 5.809, P < 0.001), stent-assisted coiling (ICH: P = 0.018; NC: OR = 7.367, P < 0.001), and flow-diversion (ICH: P = 0.006; NC: OR = 16.954, P < 0.001). Clipping also caused more unfavorable visual outcomes than both coiling alone (OR = 3.037, P = 0.001) and stent-assisted coiling (OR = 6.055, P = 0.005). Clipping resulted in a lower reoperation rate than coiling alone in large/giant aneurysm group, which approached statistical significance (OR = 0.133, P = 0.057). Clipping, stent-assisted coiling, and flow-diversion all showed higher occlusion rates compared with coiling alone (OR [clipping vs. coiling alone] = 2.852, P ≤ 0.001; OR [coiling alone vs. stent-assisted coiling] = 0.302, P = 0.003; OR [coiling alone vs. flow-diversion] = 0.400, P = 0.013). Flow-diversion showed comparative complication rate, clinical outcomes, and angiographic result compared with stent-assisted coiling. No significant differences were found among all 4 treatment modalities on mortality and poor outcome.
CONCLUSIONS: Endovascular therapies have benefits over surgical clipping in terms of fewer intracranial hemorrhage complications, fewer NCs, and lower unfavorable visual outcome rate. Flow diversion showed comparative safety and effectiveness to stent-assisted coiling, and they both achieved better radiologic results than coiling alone. Further validation by randomized cohort studies is still needed to provide robust evidence.

PMID: 26210711 [PubMed - indexed for MEDLINE]

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Middle ear pain and trauma during air travel.

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Middle ear pain and trauma during air travel.

BMJ Clin Evid. 2007;2007

Authors: Basu A

Abstract
INTRODUCTION: Changes in air pressure during flying can cause ear-drum pain and perforation, vertigo, and hearing loss. It has been estimated that 10% of adults and 22% of children might have damage to the ear drum after a flight, although perforation is rare. Symptoms usually resolve spontaneously.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent middle ear pain during air travel? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 4 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: nasal balloon inflation, oral pseudoephedrine, and topical nasal decongestants.

PMID: 19450303 [PubMed - indexed for MEDLINE]

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[A case-series study on clinical presentation neuroradiological characteristics and outcome of 56 consecutive patients suspected of having spontaneous intracranial hypotension].

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[A case-series study on clinical presentation, neuroradiological characteristics, and outcome of 56 consecutive patients suspected of having spontaneous intracranial hypotension].

Rinsho Shinkeigaku. 2015;55(9):623-9

Authors: Arai M

Abstract
The author reviewed the clinical records and neuroradiologic examinations of 86 consecutive patients with orthostatic headache who visited our clinic between April 1995 and December 2014. Fifty-six patients were suspected to have spontaneous intracranial hypotension (SIH). The baseline characteristics of these patients were essentially similar to those reported in other published case series of SIH: female preponderance, mean age of approximately 40 years, and frequent association with nausea, hearing disturbances, or vertigo. In 43 patients who underwent gadolinium-enhanced MRI, 15 had partial dural enhancement and 15 had diffuse enhancement. Of 13 patients who underwent radionuclide cisternography, a direct finding of cerebrospinal fluid (CSF) leakage was demonstrated in six patients. Ordinal scales were formulated for regression of the extent of dural enhancement on cranial MRI (none: 0, partial: 1, diffuse: 2) and severity of orthostatic headache (not so severe: 1, severe: 2). Ordinal logistic regression analysis demonstrated that the extent of dural enhancement was negatively associated with the severity of orthostatic headache. A possible explanation was that patients suspected of having SIH who showed severe orthostatic headache may lack the ability to compensate for CSF loss. Epidural blood patch (EBP) is targeted at the CSF leak site or at the lumbar level when the site of CSF leak has not been determined. The interval from EBP to disappearance of orthostatic headache did not significantly differ in six patients treated with targeted EBP and five patients with lumbar EBP. Linear regression analysis demonstrated that the duration of orthostatic headache was associated with the interval from onset of headache to initial visit to our clinic, with the slope of the regression line 1.243 and intercept 14.8 days. Thus, early diagnosis of SIH appeared to correlate with earlier disappearance of orthostatic headache. No other factors were found to predict the outcome of SIH.

PMID: 26156257 [PubMed - indexed for MEDLINE]

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Identifying at Diagnosis the Vestibular Schwannomas at Low Risk of Growth in a Long-term Retrospective Cohort.

Identifying at Diagnosis the Vestibular Schwannomas at Low Risk of Growth in a Long-term Retrospective Cohort.

Clin Otolaryngol. 2016 Apr 18;

Authors: Wolbers JG, Dallenga AH, van Linge A, Te West M, Kummer EE, Méndez Romero A, Pauw BK, Wieringa MH

Abstract
OBJECTIVES: Identification at time of diagnosis of those vestibular schwannomas that will not grow.
DESIGN: Retrospective cohort study of consecutive patients diagnosed with a sporadic vestibular schwannoma that were entered in the wait-and-scan protocol.
SETTING: Academic referral centre.
PARTICIPANTS: The study group contained 155 patients with a sporadic vestibular schwannoma first seen in the full 8-year period 2000-2007: continual wait-and-scan (n = 89) and initial wait-and-scan until intervention (n=66).
MAIN OUTCOME MEASURES: Tumour growth, defined as more than 2 mm linear difference in any plane between the diagnostic MRI scan and the last available scan, was related to clinical parameters at diagnosis: localization of the tumour (solely intracanalicular versus cisternal extension), sudden sensorineural hearing loss, sensorineural hearing loss longer than 2 years and vertigo/instability.
RESULTS: Hearing loss longer than 2 years and an entirely intracanalicular localization were associated with no tumour growth by univariate and multivariate Cox analysis. Combining both factors at time of diagnosis resulted in a group with low risk of growth (n=36, median follow-up of 6.2 years) with a Hazard Ratio for growth of 0.37 (95% CI, 0.19-0.69). This subgroup is about 25% of the wait-and-scan population. Thirty-one percent showed growth, while in the remaining higher risk group of 119 patients 62% showed growth. For the growing schwannomas the median time for growth becoming manifest is 1.9 years after diagnostic MRI.
CONCLUSIONS: In this study on vestibular schwannoma patients that start in a wait-and-scan protocol, about a quarter may be set apart having a low risk for growth. These patients at diagnosis combine a history of F hearing loss longer than 2 years and a fully intracanalicular schwannoma. They appear not to need yearly MRI checks. This article is protected by copyright. All rights reserved.

PMID: 27086938 [PubMed - as supplied by publisher]

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STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness.

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STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness.

Behav Neurol. 2015;2015:456850

Authors: Best C, Tschan R, Stieber N, Beutel ME, Eckhardt-Henn A, Dieterich M

Abstract
Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (Q H/V ), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: Q H/V = 0.31 versus controls: Q H/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles.

PMID: 26843786 [PubMed - indexed for MEDLINE]

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Anti-Ri-associated paraneoplastic brainstem cerebellar syndrome with coexisting limbic encephalitis in a patient with mixed large cell neuroendocrine lung carcinoma.

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Anti-Ri-associated paraneoplastic brainstem cerebellar syndrome with coexisting limbic encephalitis in a patient with mixed large cell neuroendocrine lung carcinoma.

J Clin Neurosci. 2015 Feb;22(2):421-3

Authors: Mitchell AN, Bakhos CT, Zimmerman EA

Abstract
Paraneoplastic neurologic syndromes (PNS) can be the first manifestations of occult malignancies. If left untreated, PNS often lead to significant morbidity and mortality. Anti-Ri (anti-neuronal nuclear antibody type 2 [ANNA-2]) autoantibodies are commonly associated with breast and small cell lung cancers. Cases of anti-Ri paraneoplastic cerebellar degeneration are reported, but few describe severe nausea and coexisting limbic encephalitis as the major presenting features. We report a 75-year-old woman with medically-intractable emesis, encephalopathy, diplopia, vertigo, and gait ataxia for 3 months. Examination revealed rotary nystagmus, ocular skew deviation, limb dysmetria, and gait ataxia. After two courses of intravenous immunoglobulin, there was minimal improvement. Anti-Ri antibodies were positive in serum only. CT scan identified a 2.0 cm left lung mass, and histopathology revealed large cell neuroendocrine carcinoma with admixed adenocarcinoma non-small cell lung carcinoma (NCSLC). Though the patient achieved nearly complete clinical recovery after tumor resection, anti-Ri levels remained high at 20 months post-resection. To our knowledge this is the first report of a paraneoplastic brainstem cerebellar syndrome with coexisting limbic encephalitis involving anti-Ri positivity and associated mixed neuroendocrine/NSCLC of the lung with marked improvement after tumor resection.

PMID: 25443085 [PubMed - indexed for MEDLINE]

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Physical functioning in older persons with dizziness: a population-based study.

Physical functioning in older persons with dizziness: a population-based study.

Aging Clin Exp Res. 2016 Apr 16;

Authors: Kollén L, Hörder H, Möller C, Frändin K

Abstract
BACKGROUND: Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.
AIMS: To report physical functioning, health-related aspects and gender differences in elderly persons with and without dizziness in a population-based sample of 75-year-olds.
METHODS: A cross-sectional sample of 75-year-olds from Gothenburg, Sweden (n = 675, 398 women and 277 men) was examined by means of questionnaires and functional tests. The questions concerned dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication. The tests included were self-selected and maximum gait speed, stair climbing capacity, one leg stance and grip strength.
RESULTS: More women than men reported dizziness/imbalance (40 vs 30 %, p < 0.001). Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level (summer: 62 vs 74 %, p < 0.001; winter: 41 vs 51 %, p < 0.001), less often took a daily walk (p < 0.05), had lower scores on the FES(S) (p < 0.001), more often reported general fatigue (p < 0.001), more often had fallen in the previous year (40 vs 23 %, p < 0.001) and had a higher intake of medical drugs (4.6 vs 3.3, p < 0.001). They also performed worse regarding gait speed, stair climbing and one leg stance (p < 0.001), but there was no difference in grip strength.
CONCLUSION: Older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.

PMID: 27086001 [PubMed - as supplied by publisher]

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Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome.

Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome.

J Neurol. 2016 Apr;263(Suppl 1):90-96

Authors: Brandt T, Strupp M, Dieterich M

Abstract
The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute and occur in a series of up to 30 or more per day. VP may manifest when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. The symptoms are usually triggered by direct pulsatile compression with ephaptic discharges, less often by conduction blocks. MR imaging reveals the neurovascular compression of the eighth nerve (3D constructive interference in steady state and 3D time-of-flight sequences) in more than 95 % of cases. A loop of the anterior inferior cerebellar artery seems to be most often involved, less so the posterior inferior cerebellar artery, the vertebral artery, or a vein. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages (200-600 mg/d or 300-900 mg/d, respectively), which have been shown to also be effective in children. Alternative drugs to try are lamotrigine, phenytoin, gabapentin, topiramate or baclofen or other non-antiepileptic drugs used in trigeminal neuralgia. The results of ongoing randomized placebo-controlled treatment studies, however, are not yet available. Surgical microvascular decompression of the eighth nerve is the "ultima ratio" for medically intractable cases or in exceptional cases of non-vascular compression of the eighth nerve by a tumor or cyst. The International Barany Society for Neuro-Otology is currently working on a consensus document on the clinical criteria for establishing a diagnosis of VP as a clinical entity.

PMID: 27083889 [PubMed - as supplied by publisher]

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