Vertigo

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Thomas Lempert - One of the best experts on this subject based on the ideXlab platform.

  • burden of dizziness and Vertigo in the community
    JAMA Internal Medicine, 2008
    Co-Authors: Hannelore Neuhauser, Michael Von Brevern, A Radtke, F Lezius, M Feldmann, Thomas Lempert
    Abstract:

    Background:Dizziness and Vertigo are common, however, the cause often remains unexplained. The percentage of Vertigo of vestibular origin in individuals with unselected dizziness has not been well examined, and its underestimation may lead to diagnostic bias in primary care. The purpose of this study was to reassess the burden of dizziness in the community and to quantify the contribution of Vertigo of vestibular origin. Methods: A nationally representative sample of 4869 adults living in Germany was screened for moderate or severedizziness,and1003individualswithdizzinessunderwent validated neurotologic interviews to differentiate vestibular Vertigo from nonvestibular dizziness according to explicit diagnostic criteria. Results:Dizziness/Vertigo had a prevalence of 22.9% in the last 12 months and an incidence (first episode of dizziness/Vertigo)of3.1%.ForvestibularVertigo,theprevalence was 4.8% and the incidence was 1.4%. A medical consultationbecauseofincidentdizziness/Vertigowasreportedby1.8%ofunselectedadultswhoconsultedaphysician in the last 12 months for incident dizziness/ Vertigo (0.9% for vestibular Vertigo). Compared with nonvestibular dizziness, vestibular Vertigo was more frequently followed by medical consultation (70% vs 54%; P.001), sick leave (41% vs 15%; P.001), interruptionofdailyactivities(40%vs12%;P.001),andavoidance of leaving the house (19% vs 10%; P=.001). However, more than half of the participants with vestibular Vertigo reported nonvestibular diagnoses. Age- and sexadjusted health-related quality of life was lower in individuals with dizziness and Vertigo compared with dizziness-free control subjects. Conclusions: The occurrence of dizziness and Vertigo is frequent and associated with a considerable personal and health care burden. Vestibular Vertigo accounts for a considerable percentage of this burden, which suggests that diagnosis and treatment of frequent vestibular conditions are important issues in primary care.

  • migrainous Vertigo presenting as episodic positional Vertigo
    Neurology, 2004
    Co-Authors: Michael Von Brevern, A Radtke, Andrew H Clarke, Thomas Lempert
    Abstract:

    Migraine can cause vestibular symptoms including positional Vertigo. Of 362 consecutive patients presenting with positional Vertigo, 10 with migrainous Vertigo mimicking benign paroxysmal positional Vertigo (BPPV) were identified. The following factors help to distinguish migrainous positional Vertigo from BPPV: short-duration symptomatic episodes and frequent recurrences, manifestation early in life, migrainous symptoms during episodes with positional Vertigo, and atypical positional nystagmus.

  • Vertigo as a symptom of migraine
    Medizinische Klinik, 2001
    Co-Authors: Thomas Lempert, H. Neuhauser
    Abstract:

    EPIDEMIOLOGY: Since both migraine and Vertigo are common complaints in clinical practice they may coincide in an individual patient just by chance. There are, however, numerous patients with vestibular symptoms caused by migraine, accounting for 6-8% of diagnoses in specialized dizziness clinics. CLINICAL MANIFESTATION: Migraine-associated Vertigo is a vestibular disorder which manifests itself with spontaneous or positional rotational Vertigo or dizziness induced by head motion. The Vertigo may occur without accompanying headache and may last from seconds to several weeks. DIAGNOSIS: Migraine-associated Vertigo can be diagnosed according to the following criteria: 1. recurrent vestibular symptoms, 2. migraine according to the criteria of the International Headache Society, 3. migrainous symptoms during the Vertigo such as headache, photophobia, phonophobia, scintillating scotoma or other auras, 4. exclusion of other causes. PATHOPHYSIOLOGY: The mechanism of migraine-associated Vertigo is still obscure. Several hypotheses relating to the pathophysiology of migraine have been proposed: cortical spreading depression, regional changes in brain perfusion, release of neurotransmitters and paroxysmal dysfunction of ion channels. Clinical findings suggest both central and peripheral vestibular involvement. THERAPY: Treatment is based on the repertoire of acute and prophylactic medications that are used for migrainous headaches. Controlled studies on the treatment of migraine-associated Vertigo are still lacking.

Robert W. Baloh - One of the best experts on this subject based on the ideXlab platform.

  • Migraine associated Vertigo.
    Journal of Clinical Neurology, 2007
    Co-Authors: Robert W. Baloh
    Abstract:

    The interrelations of migraine and Vertigo are complex, eluding a simple localization either centrally or peripherally. Spontaneous episodic Vertigo, benign paroxysmal positional Vertigo, and Meniere's disease all occur more frequently in patients with migraine than in those without. Family studies support a hereditary predisposition to migraine associated Vertigo. In this review, we discuss definitions, epidemiology, associated syndromes, neurootological abnormalities, genetics and treatment for patients with migraine and Vertigo.

  • migraine associated Vertigo
    Acta Oto-laryngologica, 2005
    Co-Authors: Krister Brantberg, Natalie Trees, Robert W. Baloh
    Abstract:

    Conclusions It is probably not wise to demand a temporal relationship between migraine symptoms and Vertigo for the definition of migrainous Vertigo. When recurrent Vertigo attacks begin at an early age in a patient with normal hearing and migraine, there are few diagnoses other than migraine that need to be considered. Objective The clinical association between migraine and vestibular symptoms, such as dizziness, motion intolerance and spontaneous attacks of Vertigo, is well documented. Recently, investigators have attempted to develop diagnostic criteria for this association. We hypothesized that there are multiple migraine-associated vestibular syndromes and studied a more homogenous subset of them (benign recurrent Vertigo). Material and methods A structured interview was conducted over the telephone with 40 patients who presented to our neurotology clinic with benign recurrent Vertigo and met the International Headache Society criteria for migraine. The structured interview was also conducted with 40...

  • differentiating between peripheral and central causes of Vertigo
    Otolaryngology-Head and Neck Surgery, 1998
    Co-Authors: Robert W. Baloh
    Abstract:

    Abstract The history usually provides the key information for distinguishing between peripheral and central causes of Vertigo. Probably the only central lesion that could masquerade as a peripheral vestibular lesion is cerebellar infarction because Vertigo and severe imbalance may be the only presenting features. MRI is indicated in any patient with acute Vertigo and profound imbalance suspected to be the result of cerebellar infarct or hemorrhage. Patients with chronic recurrent attacks of Vertigo often have normal examination results, including normal vestibular function in between attacks. The duration of attacks is most helpful in distinguishing between central and peripheral causes; Vertigo associated with vertebrobasilar insufficiency typically lasts minutes, whereas peripheral inner ear causes of recurrent Vertigo typically last hours. Positional Vertigo nearly always is a benign condition that can be cured easily at the bedside, but in rare cases it can be a symptom of a central lesion, particularly one near the fourth ventricle. Central positional nystagmus is nearly always purely vertical (either upbeating or downbeating), and there are usually associated neurologic findings. (Otolaryngol Head Neck Surg 1998;119:55-9.)

Fikret Bildik - One of the best experts on this subject based on the ideXlab platform.

  • role of c reactive protein d dimer and fibrinogen levels in the differential diagnosis of central and peripheral Vertigo
    Advances in Therapy, 2007
    Co-Authors: Emine Akinci, Gulbin Aygencel, Ayfer Keles, Ahmet Demircan, Fikret Bildik
    Abstract:

    Vertigo is encountered frequently in emergency services. Researchers have explored the role of serologic markers in the differentiation of central and peripheral Vertigo. The study reported here was designed to evaluate the diagnostic efficacy of serologic markers (fibrinogen, D-dimer, and C-reactive protein [CRP]) in the differential diagnosis of peripheral and central Vertigo. A total of 116 patients who sought treatment for Vertigo at Cazi University Hospital Adult Emergency Services during a 3-mo period were included in the study. CRP, fibrinogen, and D-dimer levels were assessed in an effort to differentiate between cases of peripheral and central Vertigo. In all, 65.5% of patients (76 patients) were women. Patients younger than 50 y of age accounted for 60.3% (70 patients). The average D-dimer level for the entire group of patients was 1 81.9±132.2 μg/mL, the average CRP level, 4.2±8.4 mg/L, and the average fibrinogen level, 421.9±176.0 mg/dL. Although serum D-dimer, fibrinogen, and CRP values appeared to be higher in patients with central Vertigo than in those with peripheral Vertigo, no statistically significant differences were noted between the 2 groups in terms of these 3 parameters (P>.05). When 6 mg/L was used as the cutoff point for CRP and 320 mg/dL was used for fibrinogen, the numbers of patients with CRP and fibrinogen levels higher than these values were significantly higher for central Vertigo than for peripheral Vertigo (P<.05). The present study shows that blood D-dimer, fibrinogen, and CRP levels cannot be significant markers for the differentiation of central and peripheral Vertigo.

  • Role of C-reactive protein, D-dimer, and fibrinogen levels in the differential diagnosis of central and peripheral Vertigo
    Advances in Therapy, 2007
    Co-Authors: Emine Akinci, Gulbin Aygencel, Ayfer Keles, Ahmet Demircan, Fikret Bildik
    Abstract:

    Vertigo is encountered frequently in emergency services. Researchers have explored the role of serologic markers in the differentiation of central and peripheral Vertigo. The study reported here was designed to evaluate the diagnostic efficacy of serologic markers (fibrinogen, D-dimer, and C-reactive protein [CRP]) in the differential diagnosis of peripheral and central Vertigo. A total of 116 patients who sought treatment for Vertigo at Cazi University Hospital Adult Emergency Services during a 3-mo period were included in the study. CRP, fibrinogen, and D-dimer levels were assessed in an effort to differentiate between cases of peripheral and central Vertigo. In all, 65.5% of patients (76 patients) were women. Patients younger than 50 y of age accounted for 60.3% (70 patients). The average D-dimer level for the entire group of patients was 1 81.9±132.2 μg/mL, the average CRP level, 4.2±8.4 mg/L, and the average fibrinogen level, 421.9±176.0 mg/dL. Although serum D-dimer, fibrinogen, and CRP values appeared to be higher in patients with central Vertigo than in those with peripheral Vertigo, no statistically significant differences were noted between the 2 groups in terms of these 3 parameters (P>.05). When 6 mg/L was used as the cutoff point for CRP and 320 mg/dL was used for fibrinogen, the numbers of patients with CRP and fibrinogen levels higher than these values were significantly higher for central Vertigo than for peripheral Vertigo (P

Huawei Li - One of the best experts on this subject based on the ideXlab platform.

  • association of Vertigo with hearing outcomes in patients with sudden sensorineural hearing loss a systematic review and meta analysis
    Archives of Otolaryngology-head & Neck Surgery, 2018
    Co-Authors: Huiqian Yu, Huawei Li
    Abstract:

    Importance Sudden sensorineural hearing loss (SSHL) accompanied by Vertigo may portend a negative prognosis in the hearing outcome. Objective To investigate the association of Vertigo with prognosis of hearing variables in SSHL. Data Sources A literature search of eligible studies was performed in PubMed, Web of Science, and Embase from September 26, 1973, through September 26, 2017. Studies published in English were retrieved with no restrictions on the date of publication. References were identified by screening the proceedings of relevant reviews, and annual meeting and other correlative papers were scanned manually for enrollment. Study Selection All original research studies and retrospective or prospective studies focusing on the role of Vertigo in the prognosis for the hearing outcome of SSHL were systematically retrieved. Studies that did not include data regarding the association between the rate of hearing recovery and Vertigo were excluded, as were reviews, comments, case reports, editorials, letters, and practice guidelines. Data Extraction and Synthesis Data were extracted and evaluated by 2 researchers. Data extracted included research type, number of participants with or without Vertigo, treatment regime, definition of pure-tone average, criteria for hearing improvement, and length of follow-up. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (scores range from 0-9, with a score of ≥6 indicating a high-quality study). The data were synthesized in Mantel-Haenszel models; the aggregate results were estimated in forest plots. Main Outcomes and Measures Association of Vertigo with the prognosis for the hearing outcome of SSHL. Results Of the 4814 unique patients identified in 10 studies, 1709 were included in the SSHL group with Vertigo and 3105 were included in SSHL group without Vertigo. The Newcastle-Ottawa Scale score of each study selected was greater than 7. The recovery rate of hearing was 42.13% in the group with Vertigo, compared with 60.29% in the group without Vertigo. Vertigo was significantly associated with a worse hearing recovery (odds ratio, 2.22; 95% CI, 1.54-3.20;I2 = 74%). Similar results were obtained in subgroup analyses of the grading system using the Siegel criteria and systemic corticosteroid therapy. However, no association of Vertigo with the prognosis of SSHL was observed within the subgroup receiving intratympanic corticosteroids (odds ratio, 1.78; 95% CI, 0.64-4.94;I2 = 70%). Conclusions and Relevance Current evidence revealed that Vertigo may be negatively associated with hearing recovery in patients with SSHL, except in a subgroup that received intratympanic corticosteroids. Corticosteroid injection may be more effective for treatment of SSHL accompanied by Vertigo; future studies are needed to determine whether treatment of Vertigo might contribute to the recovery of SSHL.

A Radtke - One of the best experts on this subject based on the ideXlab platform.

  • burden of dizziness and Vertigo in the community
    JAMA Internal Medicine, 2008
    Co-Authors: Hannelore Neuhauser, Michael Von Brevern, A Radtke, F Lezius, M Feldmann, Thomas Lempert
    Abstract:

    Background:Dizziness and Vertigo are common, however, the cause often remains unexplained. The percentage of Vertigo of vestibular origin in individuals with unselected dizziness has not been well examined, and its underestimation may lead to diagnostic bias in primary care. The purpose of this study was to reassess the burden of dizziness in the community and to quantify the contribution of Vertigo of vestibular origin. Methods: A nationally representative sample of 4869 adults living in Germany was screened for moderate or severedizziness,and1003individualswithdizzinessunderwent validated neurotologic interviews to differentiate vestibular Vertigo from nonvestibular dizziness according to explicit diagnostic criteria. Results:Dizziness/Vertigo had a prevalence of 22.9% in the last 12 months and an incidence (first episode of dizziness/Vertigo)of3.1%.ForvestibularVertigo,theprevalence was 4.8% and the incidence was 1.4%. A medical consultationbecauseofincidentdizziness/Vertigowasreportedby1.8%ofunselectedadultswhoconsultedaphysician in the last 12 months for incident dizziness/ Vertigo (0.9% for vestibular Vertigo). Compared with nonvestibular dizziness, vestibular Vertigo was more frequently followed by medical consultation (70% vs 54%; P.001), sick leave (41% vs 15%; P.001), interruptionofdailyactivities(40%vs12%;P.001),andavoidance of leaving the house (19% vs 10%; P=.001). However, more than half of the participants with vestibular Vertigo reported nonvestibular diagnoses. Age- and sexadjusted health-related quality of life was lower in individuals with dizziness and Vertigo compared with dizziness-free control subjects. Conclusions: The occurrence of dizziness and Vertigo is frequent and associated with a considerable personal and health care burden. Vestibular Vertigo accounts for a considerable percentage of this burden, which suggests that diagnosis and treatment of frequent vestibular conditions are important issues in primary care.

  • epidemiology of vestibular Vertigo a neurotologic survey of the general population
    Neurology, 2005
    Co-Authors: Hannelore Neuhauser, A Radtke, F Lezius, M Feldmann, M Von Brevern, T Ziese, T Lempert
    Abstract:

    Objective: The purpose of this study was to determine the prevalence and incidence of vestibular Vertigo in the general population and to describe its clinical characteristics and associated factors. Methods: The neurotologic survey had a two-stage general population sampling design: nationwide modified random digit dialing sampling for participation in the German National Telephone Health Interview Survey 2003 (response rate 52%) with screening of a random sample of 4,869 participants for moderate or severe dizziness or Vertigo, followed by detailed neurotologic interviews developed through piloting and validation (n = 1,003, response rate 87%). Diagnostic criteria for vestibular Vertigo were rotational Vertigo, positional Vertigo, or recurrent dizziness with nausea and oscillopsia or imbalance. Vestibular Vertigo was detected by our interview with a specificity of 94% and a sensitivity of 88% in a concurrent validation study using neurotology clinic diagnoses as an accepted standard (n = 61). Results: The lifetime prevalence of vestibular Vertigo was 7.8%, the 1-year prevalence was 5.2%, and the incidence was 1.5%. In 80% of affected individuals, Vertigo resulted in a medical consultation, interruption of daily activities, or sick leave. Female sex, age, lower educational level, and various comorbid conditions, including tinnitus, depression, and several cardiovascular diseases and risk factors, were associated with vestibular Vertigo in the past year in univariate analysis. In multivariable analysis, only female sex, self-reported depression, tinnitus, hypertension, and dyslipidemia had an independent effect on vestibular Vertigo. Conclusions: Vestibular Vertigo is common in the general population, affecting more than 5% of adults in 1 year. The frequency and health care impact of vestibular symptoms at the population level have been underestimated.

  • migrainous Vertigo presenting as episodic positional Vertigo
    Neurology, 2004
    Co-Authors: Michael Von Brevern, A Radtke, Andrew H Clarke, Thomas Lempert
    Abstract:

    Migraine can cause vestibular symptoms including positional Vertigo. Of 362 consecutive patients presenting with positional Vertigo, 10 with migrainous Vertigo mimicking benign paroxysmal positional Vertigo (BPPV) were identified. The following factors help to distinguish migrainous positional Vertigo from BPPV: short-duration symptomatic episodes and frequent recurrences, manifestation early in life, migrainous symptoms during episodes with positional Vertigo, and atypical positional nystagmus.