The Experts below are selected from a list of 24 Experts worldwide ranked by ideXlab platform
K V Thilo - One of the best experts on this subject based on the ideXlab platform.
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positional down beating nystagmus in 50 patients cerebellar Disorders and possible anterior semicircular canalithiasis
Journal of Neurology Neurosurgery and Psychiatry, 2002Co-Authors: P Bertholon, Adolfo M Bronstein, Rosalyn Davies, Peter Rudge, K V ThiloAbstract:Objectives: To clarify the clinical significance of positional down beat nystagmus (pDBN). Methods: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. Results: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral Labyrinthine Disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral Disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two Conclusion: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
P Bertholon - One of the best experts on this subject based on the ideXlab platform.
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positional down beating nystagmus in 50 patients cerebellar Disorders and possible anterior semicircular canalithiasis
Journal of Neurology Neurosurgery and Psychiatry, 2002Co-Authors: P Bertholon, Adolfo M Bronstein, Rosalyn Davies, Peter Rudge, K V ThiloAbstract:Objectives: To clarify the clinical significance of positional down beat nystagmus (pDBN). Methods: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. Results: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral Labyrinthine Disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral Disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two Conclusion: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
Adolfo M Bronstein - One of the best experts on this subject based on the ideXlab platform.
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screening for depression among neuro otology patients with and without identifiable vestibular lesions
International Journal of Audiology, 2003Co-Authors: Elizabeth A Grunfeld, M A Gresty, Adolfo M Bronstein, Marjan JahanshahiAbstract:The experience of depression and anxiety among a sample of 91 patients with complaints of vertigo or dizziness was assessed using a widely available screening instrument, the Hospital Anxiety and Depression Scale (HADS). Questionnaires to assess reported symptoms, self-esteem and social support were also administered. On the basis of clinical vestibular testing, 53% of participants were classified as having a Labyrinthine Disorder (canal paresis or positional vertigo), 22% as having a vestibular imbalance (spontaneous nystagmus or directional preponderance), and 251% as having no identifiable vestibular abnormality (negative test results). Based on the self-report measures using the screening instrument, 17% of the sample could be classified as depressed, and 29% as anxious. The presence of a vestibular lesion (based on clinical findings) was not associated with reported depression (F (3, 72) = 0.98, p = 0.41). The variables were entered into a hierarchical multiple regression analysis with depression as the dependent variable. A model emerged which accounted for 50% of the variance. Three variables comprised the final model: anxiety (beta = 0.44, p < 0.001), self-esteem (beta = 0.27, p < 0.01), and satisfaction with social support (beta = 0.25, p < 0.01). The results demonstrate the value of identifying psychosocial factors, as well as disease characteristics, among patients presenting at neurootology clinics. In particular, the findings highlight the importance of screening for emotional distress in this patient group, regardless of clinical test results or severity of self-reported symptoms.
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positional down beating nystagmus in 50 patients cerebellar Disorders and possible anterior semicircular canalithiasis
Journal of Neurology Neurosurgery and Psychiatry, 2002Co-Authors: P Bertholon, Adolfo M Bronstein, Rosalyn Davies, Peter Rudge, K V ThiloAbstract:Objectives: To clarify the clinical significance of positional down beat nystagmus (pDBN). Methods: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. Results: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral Labyrinthine Disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral Disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two Conclusion: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
Peter Rudge - One of the best experts on this subject based on the ideXlab platform.
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positional down beating nystagmus in 50 patients cerebellar Disorders and possible anterior semicircular canalithiasis
Journal of Neurology Neurosurgery and Psychiatry, 2002Co-Authors: P Bertholon, Adolfo M Bronstein, Rosalyn Davies, Peter Rudge, K V ThiloAbstract:Objectives: To clarify the clinical significance of positional down beat nystagmus (pDBN). Methods: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. Results: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral Labyrinthine Disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral Disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two Conclusion: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
Rosalyn Davies - One of the best experts on this subject based on the ideXlab platform.
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positional down beating nystagmus in 50 patients cerebellar Disorders and possible anterior semicircular canalithiasis
Journal of Neurology Neurosurgery and Psychiatry, 2002Co-Authors: P Bertholon, Adolfo M Bronstein, Rosalyn Davies, Peter Rudge, K V ThiloAbstract:Objectives: To clarify the clinical significance of positional down beat nystagmus (pDBN). Methods: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. Results: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral Labyrinthine Disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral Disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two Conclusion: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
