Benign paroxysmal positional vertigo in Parkinson's disease

BackgroundDizziness is a frequent complaint of patients with Parkinson's disease (PD), and orthostatic hypotension (OH) is often thought to be the cause. We studied whether benign paroxysmal positional vertigo (BPPV) could also be an explanation.AimTo assess the prevalence of benign paroxysmal positional vertigo in patients with Parkinson's disease, with and without dizziness.Methods305 consecutive outpatients with PD completed the Movement Disorders Society-sponsored revision of the Unified Parkinsons' Disease Rating Scale-motor score, the Dizziness Handicap Inventory, the Dix–Hallpike maneuver and a test for orthostatic hypotension. When positive for benign paroxysmal positional vertigo, a repositioning maneuver was performed. Patients were followed for three months to determine the clinical response.Results305 patients responded (186 men (61%), mean age 70.5 years (Standard Deviation 9.5 years)), of whom 151 (49%) complained of dizziness. 57 (38%) of the dizzy patients appeared to have orthostatic hypotension; 12 patients (8%) had a classical but previously unrecognized benign paroxysmal positional vertigo. A further four patients (3%) had a more atypical presentation of benign paroxysmal positional vertigo. Three months after treatment, 11 (92%) of patients with classical benign paroxysmal positional vertigo were almost or completely without complaints. We found no ‘hidden’ benign paroxysmal positional vertigo among patients without dizziness. The prevalence of benign paroxysmal positional vertigo among all patients with PD was 5.3%.ConclusionAmong Parkinson patients with symptoms of dizziness, up to 11% may have benign paroxysmal positional vertigo, which can be treated easily and successfully.     

Head injury and blast exposure: vestibular consequences

Young adults are more likely to suffer blast injury and traumatic brain injury (TBI) than other age groups. This article reviews the literature on the vestibular?consequences of blast exposure and TBI and concussion. In addition, the vestibular test findings obtained from 31 veterans with a history of blast exposure and/or mild TBI are presented. The authors discuss loss of horizontal semicircular canal function and postural instability related to head injury. Preliminary data suggest the novel theory that otolith organs are uniquely vulnerable to head injury and blast exposure.     

Vestibular neuritis

The epidemiology, diagnostic features, differential diagnosis, and treatment of vestibular neuritis are reviewed. The authors present considerations for physical examination, imaging, and management in both the acute and chronic phases of this disease. The authors also present a dizziness questionnaire in the Appendix of this publication.     

补阳还五汤联合西药治疗脑梗塞后遗症随机平行对照研究

[目的]观察补阳还五汤联合西药治疗脑梗塞后遗症疗效。[方法]使用随机平行对照方法,将104例住院患者按掷骰子法简单随机分为两组。对照组52例阿司匹林,50mg/次,1次/d。治疗组52例补阳还五汤(黄芪30g,当归、赤芍各15g,桃仁、地龙、红花各10g;语言表达障碍加石菖蒲10g;口角歪斜加全蝎、白附子、僵蚕各5g;下肢障碍加天麻10g;上肢偏痪加桂枝10g;便秘加肉苁蓉10g),1剂/d,水煎300m L,早晚口服;西药治疗同对照组。连续治疗14d为1疗程。观测临床症状、偏瘫、眩晕、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组痊愈10例,显效30例,有效9例,无效3例,总有效率94.23%。对照组痊愈5例,显效15例,有效21例,无效11例,总有效率78.84%。治疗组疗效优于对照组(P0.05)。[结论]补阳还五汤联合西药治疗脑梗塞后遗症效果显著,值得推广。     

Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke

Dizzy patients present a significant diagnostic challenge to the emergency clinician. The discrimination between peripheral and central causes is important and will inform subsequent diagnostic evaluation and treatment. Isolated vertigo can be the only initial symptom of a posterior circulation stroke. The sensation of imbalance especially raises this possibility. Research involving strokes of the posterior circulation has lagged behind that of the anterior cerebral circulation. Investigations of the last 20 years, using new technologies in brain imaging in combination with detailed clinical studies, have revolutionized our understanding of the clinical presentation, causes, treatments, and prognosis of posterior circulation ischemia.     

眩晕宁片治疗以单发头晕、眩晕为表现的后循环缺血的临床研究

目的:观察眩晕宁片对以单发头晕、眩晕为表现的后循环缺血的治疗作用。方法:门诊及住院筛选符合入选标准的后循环缺血患者72例,随机分为眩晕宁组和敏使朗组二组,每组36例,分别观察4周。观察两组临床疗效、及不良反应发生情况。结果:4周治疗后,两组均对头晕、眩晕症状的改善均有较好效果,眩晕宁组和敏使朗组治疗的平均起效时间分别为:(3.13±2.15)天、(3.48±2.45)天。平均症状缓解时间分别为:(7.95±2.91)天、(8.62±2.92)天,无统计学差异。两组均无明显不良反应。结论:眩晕宁片治疗以单发头晕/眩晕为表现的后循环缺血,安全、有效。     

Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness

Cervicogenic dizziness is dizziness described as imbalance occurring together with cervical pain or headache. This study aimed to determine the efficacy of sustained natural apophyseal glides (SNAGs) in the treatment of this condition. A double-blind randomised controlled clinical trial was undertaken. Thirty-four participants with cervicogenic dizziness were randomised to receive four to six treatments of SNAGs (n=17) or a placebo of detuned laser (n=17). Participants were assessed by a blinded assistant before treatment, after the final treatment and at 6- and 12-week follow-ups. The primary outcome measures were severity of dizziness, disability, frequency of dizziness, severity of cervical pain, and global perceived effect; balance and cervical range of motion were secondary measures. At post-treatment, 6- and 12-week follow-ups compared to pre-treatment, the SNAG group had less (P<0.05) dizziness, lower (P<0.05) scores on the Dizziness Handicap Inventory (DHI), decreased (P<0.05) frequency of dizziness, and less (P<0.05) cervical pain. The placebo group had significant (P<0.05) changes only at the 12-week follow-up in three outcome measures: severity of dizziness, DHI, and severity of cervical pain. Compared to the placebo group at post-treatment and 6-week follow-up, the SNAG group had less (P<0.05) dizziness, lower (P0.05) scores on DHI, and less (P<0.05) cervical pain. Balance with the neck in extension improved (P0.05) and extension range of motion increased (P<0.05) in the SNAG group. No improvements in balance or range of motion were observed in the placebo group. The SNAG treatment had an immediate clinically and statistically significant sustained effect in reducing dizziness, cervical pain and disability caused by cervical dysfunction.     

平衡针灸治疗眩晕200例疗效总结

目的探讨平衡针灸治疗眩晕的临床疗效。方法针刺头痛穴为主治疗以突发眩晕为主要症状的病人,疗程为1次,观察起效时间及治疗效果。结果针刺后3分钟内起效者占81.50%,总有效率为93.00%。结论平衡针灸治疗眩晕起效时间快,疗效显著。     

脑中风后遗症期头昏重的中西医结合治疗

目的:研究脑中风后遗症期头昏重的证型特点及中西医治疗方法。方法:回顾性分析近5年来诊疗的92例以头昏重为主诉的脑中风后遗症期患者的临床资料,探讨脑中风后遗症期头昏重的证型特点,总结治疗经验。结果:92例患者可辨证分型为气虚血瘀型、肾虚血瘀型、痰湿瘀阻型、肝阳上亢型四个证型。辨证应用补肾平肝益气豁痰逐瘀醒神开窍类中草药,联合应用西药胞二磷胆碱与乙酰谷酰胺针剂、口服心脑健胶囊,有效率高达90.80%。并同时能够不同程度的改善伴发的其他后遗症状。结论:中西医结合治疗能够有效地减轻或消除脑中风后遗症期的头昏重症状,提高患者的生存质量。