Medical treatment of vestibular disorders

Background: The lifelong prevalence of rotatory vertigo is 30%. Despite this high figure, patients with vertigo generally receive either inappropriate or inadequate treatment. However, the majority of vestibular disorders have a benign cause, take a favorable natural course, and respond positively to therapy. Objective: This review puts special emphasis on the medical rather than the physical, operative, or psychotherapeutic treatments available. Methods: A selected review of recent reports and studies on the medical treatment of peripheral and central vestibular disorders. Results/conclusions: In vestibular neuritis, recovery of the peripheral vestibular function can be improved by oral corticosteroids; in Menière's disease, there is first evidence that high-dose, long-term administration of betahistine reduces attack frequency; carbamazepine or oxcarbamazepine is the treatment of first choice in vestibular paroxysmia, a disorder mainly caused by neurovascular cross-compression; the potassium channel blocker aminopyridine provides a new therapeutic principle for treatment of downbeat nystagmus, upbeat nystagmus, and episodic ataxia type 2.     

Dynamic thiol/disulphide homeostasis and ischemic modified albumin levels in isolated oligohydramnios

ObjectiveOligohydramnios is defined as amniotic fluid index in ultrasonographic measurement is less than 5 percentile according to gestational age, the amniotic fluid volume is ≤ 5 cm, or if the single deepest dial is < 2 cm. The condition of oligohydramnios that not with fetal structural/chromosomal abnormalities, intrauterine growth retardation, intrauterine infection and maternal disease is described as isolated oligohydramnios (IO). The aim of this study is to examine whether oxidative stress and reactive oxygen species (ROS) have a place in the pathophysiology of IO.Materials and methodsIn this prospective case–control study, a total of 126 participants were included. The patient group consisted of 65 patients who were diagnosed IO, and the control group consisted of 61 healthy normal pregnants. Native thiol (-SH), total thiol (-SH + -SS), dynamic disulfide (-SS), IMA values from maternal serum were measured and compared between groups.ResultsMaternal serum -SH and -SH + -SS values were significantly lower in the IO group than in the control group (409.47 ± 55.36 μmol/L vs. 437.40 ± 48.68 μmol/L, p = 0.03 and 457.40 ± 63.01 μmol/L vs. 484.59 ± 52.75 μmol/L, p = 0.01). In the IO group when -SS/-SH and -SS/-SH + -SS ratio was found to be statistically significantly higher than control group (5.84 ± 1.1 vs 5.41 ± 0.71, p = 0.01 and 5.2 ± 0.88 vs 4.8 ± 0.58, p = 0.01), -SH/-SH + -SS ratio was significantly lower (89.56 ± 1.7 vs 90.24 ± 1.16, p = 0.01). There was no significant difference in terms of -SS value (p = 0.66). IMA value was significantly higher in the IO group than control group (0.76 ± 0.10 ABSU vs 0.68 ± 0.06, p < 0.01). It is seen as a result of ROC analysis that -SH, -SH + -SS, -SS/-SH, -SS/-SH + -SS, -SH/-SH + -SS and IMA values have a diagnostic value for IO (p < 0.05).ConclusionThe thiol/disulfide balance shifted towards oxidative stress in IO compared to control group. So oxidative stress and ROS have a place in the pathophysiology of IO.     

病程对后半规管良性阵发性位置性眩晕疗效的影响

目的探究病程是否会影响后半规管良性阵发性位置性眩晕（PC BPPV）患者的疗效。方法收集2009年10月~2017年12月确诊的428例原发性PC BPPV，其中男155例，女273例；年龄16~89岁，中位年龄53岁；病程0.5 d至7年，中位病程7 d。按照1周、1个月、半年为时间节点，将患者分为短期组、中期组、中长期组及长期组。并经Epley或李氏复位法治疗的患者，记录患者治疗3 d及治疗1周的疗效，并统计复位治疗的有效率。结果通过手法复位，4组患者治疗后3 d有效率分别为：94.55%（208/220）、90.80%（132/147）、86.27%（44/51）、90.00%（9/10）；治疗1周后有效率分别为：97.73%（215/220）、97.28%（143/147）、96.08%（49/51）、100%（10/10）；两个时间点的治疗效果差异均无统计学意义（P>0.05）。结论BPPV的病程或自愈性并不会引起手法复位的短期疗效，BPPV的自愈性可能与患者的年龄相关。     

Isolated hepatic tuberculosis: An uncommon presentation of a common culprit

Hepatic tuberculosis (HTB) is commonly encountered in patients with widespread miliary disease. Isolated affection of the liver is extremely rare. We present a case of a young woman who presented with a subacute afebrile hepatic failure. Investigations including a liver biopsy proved that the presentation was due to granulomatous hepatitis secondary to mycobacterial infection of the liver. It is important that tuberculosis (TB) be kept in mind especially in endemic areas even in atypical clinical scenarios by clinicians, radiologists, and pathologists. Use of anti-tuberculous drugs in such cases is usually successful and must be instituted early.     

Incidence,predictors, clinical profile,management and outcome of patients with isolated left main coronary artery ostial disease

ObjectivesIsolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease.Methods15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients.ResultsThe mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234).ConclusionIn one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.     

The relevance of migraine in patients with Ménière's disease

Conclusion. Coexistent migraine affects relevant clinical features of patients with Ménière's disease (MD). Objective. Epidemiological studies have shown an association between migraine and MD. We sought to determine whether the coexistence of migraine affects any clinical features in patients with MD. Patients and methods. In this retrospective case-control study of University Neurotology Clinic patients, 50 patients meeting 1995 AAO-HNS criteria for definite MD were compared to 18 patients meeting the same criteria in addition to the 2004 IHS criteria for migraine (MMD). All had typical low frequency sensorineural hearing loss and episodes of rotational vertigo. Outcome measures included: sex, age of onset of episodic vertigo or fluctuating hearing loss, laterality of hearing loss, aural symptoms, caloric responses, severity of hearing loss, and family history of migraine, episodic vertigo or hearing loss. Results. Age of onset of episodic vertigo or fluctuating hearing loss was significantly lower in patients with MMD (mean±1.96*SE=37.2±6.3 years) than in those with MD (mean±1.96*SE=49.3±4.4 years). Concurrent bilateral aural symptoms and hearing loss were seen in 56% of MMD and 4% of MD patients. A family history of episodic vertigo was seen in 39% of MMD and 2% of MD patients.     

耳石复位与药物联合仰卧位摇头法治疗主观性良性阵发性位置性眩晕临床研究

目的:观察耳石复位与药物联合仰卧位摇头法治疗主观性良性阵发性位置性眩晕(S-BPPV)的效果。方法:选取2012年1月至2016年1月期间符合纳入标准的S-BPPV患者186例,采用随机数字表法将患者分为观察组与对照组各93例,对照组采用耳石复位联合药物治疗,观察组在对照组基础上采用仰卧位摇头法治疗。比较两组患者临床疗效、首次治疗成功率、中转手术治疗率、复发率与不良反应发生率的差异。结果:与对照组比较,观察组治疗总有效率、首次治疗成功率明显增高,中转手术治疗率与复发率明显降低,差异具有统计学意义(P0.05);两组中共18例患者经外科手术治疗后症状彻底消失;随访3个月期间,观察组平均复发次数与对照组比较差异具有统计学意义(P0.05);两组患者头晕、恶心呕吐、心律失常、走路不稳与情感障碍等不良反应发生率比较差异无统计学意义(P0.05)。结论:耳石复位与药物联合仰卧位摇头法治疗S-BPPV效果显著,可降低复发率,且未增加不良反应的发生风险。     

整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块43例

目的:观察整脊推拿结合中药化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块的的效果及安全性。方法:伴有颈动脉斑块的颈源性眩晕患者按随机数字表法分为两组,对照组45例采用基础治疗联合中药化痰祛瘀方,观察组43例在对照组基础上结合整脊推拿干预,治疗后统计比较两组眩晕指征和血脂改善情况。结果:治疗后两组患者眩晕、耳鸣、恶心欲呕、头痛、视力障碍、猝倒发作、颈项不适、反应迟钝等症状的恢复率比较,差异有统计学意义(P<0.01);治疗结束后观察组的总有效率为95.35%,明显优于对照组的77.78%,差异有统计学意义(P<0.05);疗程结束后两组患者血脂均较治疗前有所改善(P<0.05),观察组中的总胆固醇(TC)、低密度脂蛋白(LDL)明显低于对照组,高密度脂蛋白(HDL)明显高于对照组,差异均有统计学意义(P<0.05),但三酰甘油(TG)和对照组比较差异无统计学意义(P> 0.05)。结论:整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块,在改善眩晕相关指征和血脂方面疗效较好。     

Intermittent positional downbeat nystagmus of cervical origin

Intermittent positional down beat nystagmus (p-DBN) is rare. We describe an unusual case of intermittent p-DBN which was induced by rotation, anteflexion, and lateral flexion of the neck. A 59-year-old man complained of loss of consciousness and lightheadedness. Positional testing revealed the p-DBN. The evoked p-DBN had latency and the patient had a feeling of passing out while the p-DBN was present. There were no abnormal findings in the vestibular functional examinations. Findings of the MRI were negative. MRA revealed no stenosis of the vertebral artery bilaterally, but there was an anatomical difference. The p-DBN characteristics were documented by electronystagmography during the positional test. The p-DBN lasted intermittently while maintaining the provoking position. It was found that p-DBN occurred with not only the rotation of the neck, but also in the anteflexion and lateral flexion of the neck. There was no stenosis of the vertebral artery (VA) on angiography, but we speculated that the cause of the p-DBN was the VA occlusion due to rotation, anteflexion, and lateral flexion of the neck.     

急诊眩晕症实施不同药物治疗疗效及安全性

目的针对急诊眩晕症患者通过实施不同药物进行治疗,观察及分析临床疗效。方法选取本院收治的急诊眩晕症患者108例,经随机分为对照组、氯丙嗪组、阿托品组、异丙嗪组,分别给不同药治疗后观察4组患者药物在治疗前后阶段的临床效果。结果与对照组相比,其他3组患者其总有效率均出现明显升高,组间差异存在统计学意义(P<0.05)。经治疗后,其他3组发生眩晕的次数改善效果均较好且安全性程度较高。结论对不同药物用于眩晕症稳定型眩晕治疗效果较为明显,不良反应大大降低,安全度高,不仅增强患者生活质量水平,且在急诊科中具有重要参考价值及意义。