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[PMID]:29419660
[Au] Autor:Kim JE; Lee MK; Lee DK; Choi SS; Park JS
[Ad] Endereço:Department of Anesthesiology and Pain medicine, Korea University, Guro Hospital, Seoul, Republic of Korea.
[Ti] Título:Continuous cervical epidural block: Treatment for intractable hiccups.
[So] Source:Medicine (Baltimore);97(6):e9444, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown. This study aimed to evaluate the effectiveness of continuous cervical epidural block in the treatment of intractable hiccups.Records from 28 patients with a history of unsuccessful medical and invasive treatments for hiccups were evaluated. Continuous cervical epidural block was performed with a midline approach at the C7-T1 or T1-T2 intervertebral space with the patient in the prone position. The epidural catheter was advanced through the needle in a cephalad direction to the C3-C5 level. Catheter placement was confirmed using contrast radiography. A 6-mL bolus of 0.25% ropivacaine was injected, and a continuous infusion of 4 mL/h of ropivacaine was administered through the epidural catheter using an infuser containing 0.75% ropivacaine (45 mL ropivacaine and 230 mL normal saline). When the hiccups stopped and did not recur for 48 hours, the catheter was removed.Cumulative complete remission rates were 60.71% after the first cervical epidural block, 92.86% after the second, and 100% after the third. One patient complained of dizziness that subsided. No other adverse effects were reported.Continuous C3-C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups.
[Mh] Termos MeSH primário: Amidas/administração & dosagem
Bloqueio Nervoso Autônomo
Soluço
Injeções Epidurais/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Anestésicos Locais/administração & dosagem
Bloqueio Nervoso Autônomo/efeitos adversos
Bloqueio Nervoso Autônomo/métodos
Cateterismo/métodos
Medula Cervical/efeitos dos fármacos
Medula Cervical/fisiopatologia
Tontura/etiologia
Feminino
Soluço/diagnóstico
Soluço/fisiopatologia
Soluço/terapia
Seres Humanos
Masculino
Meia-Idade
Recidiva
Indução de Remissão/métodos
República da Coreia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009444


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[PMID]:29305455
[Au] Autor:Peng B; Yang L; Yang C; Pang X; Chen X; Wu Y
[Ad] Endereço:General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China.
[Ti] Título:The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study.
[So] Source:Bone Joint J;100-B(1):81-87, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness. PATIENTS AND METHODS: Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain. RESULTS: There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group. CONCLUSION: This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis. Cite this article: 2018;100-B:81-7.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Descompressão Cirúrgica/métodos
Tontura/etiologia
Fusão Vertebral/métodos
Espondilose/complicações
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Discotomia/métodos
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Cervicalgia/etiologia
Estudos Prospectivos
Índice de Gravidade de Doença
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0650.R2


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[PMID]:29020587
[Au] Autor:Pasquier M; Clair M; Pruvot E; Hugli O; Carron PN
[Ad] Endereço:From Lausanne University Hospital, Lausanne, Switzerland.
[Ti] Título:Carotid Sinus Massage.
[So] Source:N Engl J Med;377(15):e21, 2017 Oct 12.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Seio Carotídeo/fisiopatologia
Massagem
Síncope/etiologia
[Mh] Termos MeSH secundário: Tontura/etiologia
Seres Humanos
Taquicardia Supraventricular/diagnóstico
Taquicardia Supraventricular/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMvcm1313338


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[PMID]:28954005
[Au] Autor:Mezzalira R; Bittar RSM; do Carmo Bilécki-Stipsky MM; Brugnera C; Grasel SS
[Ad] Endereço:Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
[Ti] Título:Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints.
[So] Source:Clinics (Sao Paulo);72(8):469-473, 2017 Aug.
[Is] ISSN:1980-5322
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE:: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS:: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS:: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS:: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.
[Mh] Termos MeSH primário: Testes Calóricos/métodos
Tontura/diagnóstico
Tontura/fisiopatologia
Teste do Impulso da Cabeça/métodos
Doenças Vestibulares/diagnóstico
Doenças Vestibulares/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Doença Crônica
Estudos Transversais
Feminino
Seres Humanos
Masculino
Programas de Rastreamento
Meia-Idade
Valores de Referência
Reprodutibilidade dos Testes
Canais Semicirculares/fisiopatologia
Gravação em Vídeo
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE


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[PMID]:28910373
[Au] Autor:Lorbeer R; Hetterich H; Strobl R; Schafnitzel A; Patscheider H; Schindler A; Müller-Peltzer K; Sommer W; Peters A; Meisinger C; Heier M; Rathmann W; Bamberg F; Grill E
[Ad] Endereço:Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
[Ti] Título:Lack of association of MRI determined subclinical cardiovascular disease with dizziness and vertigo in a cross-sectional population-based study.
[So] Source:PLoS One;12(9):e0184858, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We investigated the association between subclinical cardiovascular diseases assessed by MRI examination and symptoms of dizziness and vertigo in participants of a population-based sample. METHODS: Data from 400 participants (169 women) aged from 39 to 73 of a cross-sectional MRI sub-study of the "Kooperative Gesundheitsforschung in der Region Augsburg" (KORA) FF4 study from the south of Germany was used. MRI determined subclinical cardiovascular diseases include left and right ventricular structure and function as well as the presence of carotid plaque and carotid wall thickness. Cerebrum diseases include white matter lesions (WML) and cerebral microbleeds (CMB). The main outcomes of dizziness and vertigo were assessed by standardized interview. Logistic regression models were applied and adjusted odds ratios (OR) with 95% confidence intervals (CI) were provided. RESULTS: Lifetime and 12-month prevalence of dizziness and vertigo were 30% (95%CI 26% to 35%) and 21% (95%CI 17% to 26%) respectively in this sample. On multivariable analysis, cardiac and carotid measurements were not associated with dizziness and vertigo excluding orthostatic vertigo (20%, 95CI 16% to 24%). Only in male participants, there was a significant association between WML and the presence of dizziness and vertigo (OR = 2.95, 95%CI 1.08 to 8.07). There was no significant association of CMB with dizziness and vertigo. However, CMB and WML were tending to associate with a higher risk of dizziness and vertigo in the whole sample (CMB: OR = 1.48, 95%CI 0.70; 3.15; WML: OR = 1.71, 95%CI 0.80 to 3.67;), in persons with prediabetes and diabetes (WML: OR = 2.71, 95%CI 0.89 to 8.23) and in men with normal glucose metabolism (CMB: OR = 2.60, 95%CI 0.56 to 12.0; WML: OR = 3.08, 95%CI 0.58 to 16.5). CONCLUSIONS: In this sample of participants without manifest cardiovascular diseases, subclinical left and right ventricular function and carotid structure were consistently not associated with dizziness and vertigo. Subclinical cerebrum measurements, however, tend to increase the risk for dizziness and vertigo, especially in men and in persons with prediabetes or diabetes.
[Mh] Termos MeSH primário: Encefalopatias/diagnóstico por imagem
Doenças Cardiovasculares/diagnóstico por imagem
Tontura/epidemiologia
Imagem por Ressonância Magnética/métodos
Vertigem/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos Transversais
Feminino
Alemanha/epidemiologia
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Prevalência
Fatores de Risco
Função Ventricular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184858


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[PMID]:28857179
[Au] Autor:Androsova G; Krause R; Borghei M; Wassenaar M; Auce P; Avbersek A; Becker F; Berghuis B; Campbell E; Coppola A; Francis B; Wolking S; Cavalleri GL; Craig J; Delanty N; Koeleman BPC; Kunz WS; Lerche H; Marson AG; Sander JW; Sills GJ; Striano P; Zara F; Sisodiya SM; Depondt C; EpiPGX Consortium
[Ad] Endereço:Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
[Ti] Título:Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.
[So] Source:Epilepsia;58(10):1734-1741, 2017 Oct.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a common epilepsy syndrome that is often poorly controlled by antiepileptic drug (AED) treatment. Comparative AED effectiveness studies in this condition are lacking. We report retention, efficacy, and tolerability in a cohort of patients with MTLE-HS. METHODS: Clinical data were collected from a European database of patients with epilepsy. We estimated retention, 12-month seizure freedom, and adverse drug reaction (ADR) rates for the 10 most commonly used AEDs in patients with MTLE-HS. RESULTS: Seven hundred sixty-seven patients with a total of 3,249 AED trials were included. The highest 12-month retention rates were observed with carbamazepine (85.9%), valproate (85%), and clobazam (79%). Twelve-month seizure freedom rates varied from 1.2% for gabapentin and vigabatrin to 11% for carbamazepine. Response rates were highest for AEDs that were prescribed as initial treatment and lowest for AEDs that were used in a third or higher instance. ADRs were reported in 47.6% of patients, with the highest rates observed with oxcarbazepine (35.7%), topiramate (30.9%), and pregabalin (27.4%), and the lowest rates with clobazam (6.5%), gabapentin (8.9%), and lamotrigine (16.6%). The most commonly reported ADRs were lethargy and drowsiness, dizziness, vertigo and ataxia, and blurred vision and diplopia. SIGNIFICANCE: Our results did not demonstrate any clear advantage of newer versus older AEDs. Our results provide useful insights into AED retention, efficacy, and ADR rates in patients with MTLE-HS.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Epilepsia do Lobo Temporal/tratamento farmacológico
Hipocampo/patologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Aminas/uso terapêutico
Ataxia/induzido quimicamente
Benzodiazepinas/uso terapêutico
Carbamazepina/análogos & derivados
Carbamazepina/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Bases de Dados Factuais
Diplopia/induzido quimicamente
Tontura/induzido quimicamente
Epilepsia do Lobo Temporal/patologia
Epilepsia do Lobo Temporal/fisiopatologia
Feminino
Frutose/análogos & derivados
Frutose/uso terapêutico
Seres Humanos
Letargia/induzido quimicamente
Masculino
Meia-Idade
Pregabalina/uso terapêutico
Estudos Retrospectivos
Esclerose
Resultado do Tratamento
Triazinas/uso terapêutico
Ácido Valproico/uso terapêutico
Vertigem/induzido quimicamente
Vigabatrina/uso terapêutico
Transtornos da Visão/induzido quimicamente
Adulto Jovem
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Anticonvulsants); 0 (Cyclohexanecarboxylic Acids); 0 (Triazines); 0H73WJJ391 (topiramate); 12794-10-4 (Benzodiazepines); 2MRO291B4U (clobazam); 30237-26-4 (Fructose); 33CM23913M (Carbamazepine); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 614OI1Z5WI (Valproic Acid); 6CW7F3G59X (gabapentin); GR120KRT6K (Vigabatrin); U3H27498KS (lamotrigine); VZI5B1W380 (oxcarbazepine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13871


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[PMID]:28738139
[Au] Autor:Juraschek SP; Daya N; Rawlings AM; Appel LJ; Miller ER; Windham BG; Griswold ME; Heiss G; Selvin E
[Ad] Endereço:Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
[Ti] Título:Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults.
[So] Source:JAMA Intern Med;177(9):1316-1323, 2017 Sep 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. It is not known whether measurements performed immediately after standing predict adverse events as strongly as measurements performed closer to 3 minutes. Objective: To compare early vs later OH measurements and their association with history of dizziness and longitudinal adverse outcomes. Design, Setting, and Participants: This was a prospective cohort study of middle-aged (range, 44-66 years) participants in the Atherosclerosis Risk in Communities Study (1987-1989). Exposures: Orthostatic hypotension, defined as a drop in blood pressure (BP) (systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg) from the supine to standing position, was measured up to 5 times at 25-second intervals. Main Outcomes and Measures: We determined the association of each of the 5 OH measurements with history of dizziness on standing (logistic regression) and risk of fall, fracture, syncope, motor vehicle crashes, and all-cause mortality (Cox regression) over a median of 23 years of follow-up (through December 31, 2013). Results: In 11 429 participants (mean age, 54 years; 6220 [54%] were women; 2934 [26%] were black) with at least 4 OH measurements after standing, after adjustment OH assessed at measurement 1 (mean [SD], 28 [5.4] seconds; range, 21-62 seconds) was the only measurement associated with higher odds of dizziness (odds ratio [OR], 1.49; 95% CI, 1.18-1.89). Measurement 1 was associated with the highest rates of fracture, syncope, and death at 18.9, 17.0, and 31.4 per 1000 person-years. Measurement 2 was associated with the highest rate of falls and motor vehicle crashes at 13.2 and 2.5 per 1000 person-years. Furthermore, after adjustment measurement 1 was significantly associated with risk of fall (hazard ratio [HR], 1.22; 95% CI, 1.03-1.44), fracture (HR, 1.16; 95% CI, 1.01-1.34), syncope (HR, 1.40; 95% CI, 1.20-1.63), and mortality (HR, 1.36; 95% CI, 1.23-1.51). Measurement 2 (mean [SD], 53 [7.5] seconds; range, 43-83 seconds) was associated with all long-term outcomes, including motor vehicle crashes (HR, 1.43; 95% CI, 1.04-1.96). Measurements obtained after 1 minute were not associated with dizziness and were inconsistently associated with individual long-term outcomes. Conclusions and Relevance: In contrast with prevailing recommendations, OH measurements performed within 1 minute of standing were the most strongly related to dizziness and individual adverse outcomes, suggesting that OH be assessed within 1 minute of standing.
[Mh] Termos MeSH primário: Acidentes por Quedas
Determinação da Pressão Arterial/métodos
Tontura
Fraturas Ósseas
Hipotensão Ortostática
Síncope
[Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle
Acidentes por Quedas/estatística & dados numéricos
Pressão Sanguínea/fisiologia
Tontura/etiologia
Tontura/fisiopatologia
Feminino
Fraturas Ósseas/epidemiologia
Fraturas Ósseas/etiologia
Fraturas Ósseas/prevenção & controle
Seres Humanos
Hipotensão Ortostática/complicações
Hipotensão Ortostática/diagnóstico
Hipotensão Ortostática/mortalidade
Hipotensão Ortostática/fisiopatologia
Masculino
Meia-Idade
Mortalidade
Medição de Risco/métodos
Síncope/epidemiologia
Síncope/etiologia
Síncope/prevenção & controle
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.2937


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[PMID]:28687453
[Au] Autor:Perloff MD; Patel NS; Kase CS; Oza AU; Voetsch B; Romero JR
[Ad] Endereço:Department of Neurology, Boston University School of Medicine, Boston University Medical Center, 72 E. Concord St, C3, Boston, MA 02118, United States. Electronic address: michael.perloff@bmc.org.
[Ti] Título:Cerebellar stroke presenting with isolated dizziness: Brain MRI in 136 patients.
[So] Source:Am J Emerg Med;35(11):1724-1729, 2017 Nov.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate occurrence of cerebellar stroke in Emergency Department (ED) presentations of isolated dizziness (dizziness with a normal exam and negative neurological review of systems). METHODS: A 5-year retrospective study of ED patients presenting with a chief complaint of "dizziness or vertigo", without other symptoms or signs in narrative history or on exam to suggest a central nervous system lesion, and work-up included a brain MRI within 48h. Patients with symptoms commonly peripheral in etiology (nystagmus, tinnitus, gait instability, etc.) were included in the study. Patient demographics, stroke risk factors, and gait assessments were recorded. RESULTS: One hundred and thirty-six patients, who had a brain MRI for isolated dizziness, were included. There was a low correlation of gait assessment between ED physician and Neurologist (49 patients, Spearman's correlation r =0.17). Based on MRI DWI sequence, 3.7% (5/136 patients) had acute cerebellar strokes, limited to or including, the medial posterior inferior cerebellar artery vascular territory. In the 5 cerebellar stroke patients, mean age, body mass index (BMI), hemoglobin A1c, gender distribution, and prevalence of hypertension were similar to the non-cerebellar stroke patient group. Mean LDL/HDL ratio was 3.63±0.80 and smoking prevalence was 80% in the cerebellar stroke group compared to 2.43±0.79 and 22% (respectively, p values<0.01) in the non-cerebellar stroke group. CONCLUSIONS: Though there was preselection bias for stroke risk factors, our study suggests an important proportion of cerebellar stroke among ED patients with isolated dizziness, considering how common this complaint is.
[Mh] Termos MeSH primário: Cerebelo/irrigação sanguínea
Tontura/etiologia
Acidente Vascular Cerebral/complicações
Vertigem/etiologia
[Mh] Termos MeSH secundário: Adulto
Distribuição por Idade
Idoso
Índice de Massa Corporal
Imagem de Difusão por Ressonância Magnética
Serviço Hospitalar de Emergência
Feminino
Transtornos Neurológicos da Marcha/etiologia
Hemoglobina A Glicada/metabolismo
Seres Humanos
Hipertensão/epidemiologia
Lipoproteínas HDL/sangue
Lipoproteínas LDL/sangue
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Nistagmo Patológico/etiologia
Estudos Retrospectivos
Fatores de Risco
Distribuição por Sexo
Fumar/epidemiologia
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/epidemiologia
Zumbido/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Glycated Hemoglobin A); 0 (Lipoproteins, HDL); 0 (Lipoproteins, LDL); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


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[PMID]:28628235
[Au] Autor:Gadoth A; Pittock SJ; Dubey D; McKeon A; Britton JW; Schmeling JE; Smith A; Kotsenas AL; Watson RE; Lachance DH; Flanagan EP; Lennon VA; Klein CJ
[Ad] Endereço:Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN.
[Ti] Título:Expanded phenotypes and outcomes among 256 LGI1/CASPR2-IgG-positive patients.
[So] Source:Ann Neurol;82(1):79-92, 2017 Jul.
[Is] ISSN:1531-8249
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe an expanded phenotypic spectrum and longitudinal outcome in 256 LGI1-IgG-seropositive and/or CASPR2-IgG-seropositive patients. METHODS: Patients were identified through service neural autoantibody evaluation. Ninety-five had longitudinal follow-up (7-456 months; median = 35). RESULTS: Among 3,910 patients tested, 196 were LGI1-IgG positive, 51 were CASPR2-IgG positive, and 9 were dual positive. Cerebrospinal fluid testing was less sensitive than serum testing, detecting only 24 of 38 (63%) LGI1-IgG-positive and 5 of 6 (83%) CASPR2-IgG-positive patients. LGI1-IgG-positive specimens had higher voltage-gated potassium channel-IgG immunoprecipitation values (0.33nmol/l, range = 0.02-5.14) than CASPR2-IgG-positive specimens (0.10nmol/l, range = 0.00-0.45, p < 0.001). Of patients presenting with pain or peripheral nervous system (PNS) manifestations, 39% were LGI1-IgG seropositive (7% had solely neuropathy or pain). Multivariate analysis identified age as the only significant predictor of central nervous system (CNS) versus PNS involvement (>50 years; odds ratio = 15, p < 0.001). Paroxysmal dizziness spells (PDS), a unique LGI1-IgG accompaniment (14% of patients), frequently delayed the diagnosis. T2-mesiotemporal hyperintensity was more common in LGI1-IgG-positive (41%) than in CASPR2-IgG-positive patients (p = 0.033). T1-bright basal ganglia were confined to LGI1-IgG-positive patients with faciobrachial-dystonic seizures (9 of 39, 31%). Cancer was found in 44% of LGI1-IgG/CASPR2-IgG dual seropositive patients (one-third thymoma). Response to initial immunotherapy was favorable in 97%; mean modified Rankin score was 3 (range = 1-5) at onset and 1.74 (range = 0-6) at last follow-up, with 9% having severe refractory disability, 20% being asymptomatic, 28% receiving immunotherapy, and 58% receiving antiepileptic medication. INTERPRETATION: Older age is a strong predictor of CNS involvement in patients seropositive for CASPR2-IgG or LGI1-IgG. Pain, peripheral manifestations, and stereotypic paroxysmal dizziness spells are common with LGI1-IgG. Response to initial immunotherapy is often favorable, but some patients remain severely disabled, requiring long-term immunotherapy and/or antiepileptic medications. Ann Neurol 2017;82:79-92.
[Mh] Termos MeSH primário: Imunoglobulina G/imunologia
Proteínas de Membrana/imunologia
Proteínas do Tecido Nervoso/imunologia
Proteínas/imunologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Doenças do Sistema Nervoso Central/imunologia
Líquido Cefalorraquidiano/imunologia
Avaliação da Deficiência
Tontura/imunologia
Feminino
Seres Humanos
Imunoterapia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Minnesota/epidemiologia
Neoplasias/imunologia
Neuroimagem
Dor/imunologia
Doenças do Sistema Nervoso Periférico/imunologia
Fenótipo
Canais de Potássio de Abertura Dependente da Tensão da Membrana/imunologia
Convulsões Febris/congênito
Convulsões Febris/imunologia
Estudos Soroepidemiológicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CNTNAP2 protein, human); 0 (Immunoglobulin G); 0 (LGI1 protein, human); 0 (Membrane Proteins); 0 (Nerve Tissue Proteins); 0 (Potassium Channels, Voltage-Gated); 0 (Proteins)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1002/ana.24979


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[PMID]:28623066
[Au] Autor:Tarnutzer AA; Bockisch CJ; Buffone E; Weber KP
[Ad] Endereço:Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland. Electronic address: alexander.tarnutzer@access.uzh.ch.
[Ti] Título:Association of posterior semicircular canal hypofunction on video-head-impulse testing with other vestibulo-cochlear deficits.
[So] Source:Clin Neurophysiol;128(8):1532-1541, 2017 Aug.
[Is] ISSN:1872-8952
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The video-head-impulse test (vHIT) provides a functional assessment of all six semicircular canals (SCC). Occasionally isolated loss of the posterior canal(s) (ILPC) is diagnosed, though this finding is poorly characterized. Here we assessed how accurate that diagnosis is by measuring the co-occurrence of abnormalities on caloric irrigation, vestibular-evoked myogenic-potentials and audiometry. METHODS: We identified 52 patients with ILPC (unilateral=40, bilateral=12). We determined vHIT-gains and saccade-amplitudes and correlated vHIT-findings with other vestibulo-cochlear tests. RESULTS: The most frequent diagnoses were history of vestibular neuritis (13/52), Menière's disease (12/52) and vertigo/dizziness of unclear origin (13/52). Unilateral ILPC on vHIT was accompanied by a deficient horizontal canal on calorics, saccular and/or utricular deficits ipsilesionally in 33/40 (83%), while ipsilesional hearing-loss was noted in 24/40 (60%). Involvement of other sensors was highest for vestibular schwannoma (100%) and history of vestibular neuritis (92%). Bilateral deficits in ≥1 vestibulo-cochlear sensor(s) were noted in 2/12 cases with bilateral ILPC. CONCLUSIONS: >80% of patients with unilateral ILPC had additional deficits of other parts of the vestibular organ, while this rate was ≤20% for patients with bilateral ILPC. SIGNIFICANCE: Dizzy patients should receive testing of the posterior canals and if abnormalities are observed, additional vestibulo-cochlear testing should be obtained.
[Mh] Termos MeSH primário: Cóclea/fisiopatologia
Teste do Impulso da Cabeça/métodos
Canais Semicirculares/fisiopatologia
Vestíbulo do Labirinto/fisiopatologia
Gravação em Vídeo/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Tontura/diagnóstico
Tontura/fisiopatologia
Feminino
Seres Humanos
Masculino
Doença de Meniere/diagnóstico
Doença de Meniere/fisiopatologia
Meia-Idade
Neuroma Acústico/diagnóstico
Neuroma Acústico/fisiopatologia
Estudos Retrospectivos
Neuronite Vestibular/diagnóstico
Neuronite Vestibular/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170618
[St] Status:MEDLINE



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