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Sample records for positional vertigo bppv

  1. Benign Paroxysmal Positional Vertigo (BPPV)

    MedlinePlus

    ... it look like the room is spinning. The eye movement is the clue that something must be happening ... while the practitioner watches for the tell-tale eye movements, or nystagmus. There are two types of BPPV: ...

  2. Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions

    PubMed Central

    Hornibrook, Jeremy

    2011-01-01

    BPPV is the most common cause of vertigo. It most often occurs spontaneously in the 50 to 70 year age group. In younger individuals it is the commonest cause of vertigo following head injury. There is a wide spectrum of severity from inconsistent positional vertigo to continuous vertigo provoked by any head movement. It is likely to be a cause of falls and other morbidity in the elderly. Misdiagnosis can result in unnecessary tests. The cardinal features and a diagnostic test were clarified in 1952 by Dix and Hallpike. Subsequently, it has been established that the symptoms are attributable to detached otoconia in any of the semicircular canals. BPPV symptoms can resolve spontaneously but can last for days, weeks, months, and years. Unusual patterns of nystagmus and nonrepsonse to treatment may suggest central pathology. Diagnostic strategies and the simplest “office” treatment techniques are described. Future directions for research are discussed. PMID:21808648

  3. Benign paroxysmal positional vertigo Part II: A qualitative review of non-pharmacological, conservative treatments and a case report presenting Epley’s “canalith repositioning procedure”, a non-invasive bedside manoeuvre for treating BPPV

    PubMed Central

    van der Velde, Gabrielle M

    1999-01-01

    Purpose: To review the range of treatment interventions for benign paroxysmal positional vertigo (BPPV) with a focus on recent physical treatments (repositioning manoeuvres) inspired by the theoretical pathophysiology canalithiasis. To qualitatively review clinical trials which have examined the efficacy of these repositioning manoeuvres for treating BPPV and present a case report of BPPV treated with a repositioning manoeuvre. Data sources: Relevant studies were identified using the bibliographic database MEDLINE spanning from 1966 to March 1997. Study selection: A total of 21 studies were selected on the basis of their relevance to Part II of this review. Data extraction: The findings and results of relevant studies, and their subsequent conclusions were compared and compiled into a historical summary of the physical treatment of BPPV, focusing on the state of the knowledge regarding the efficacy of repositioning manoeuvres. Results of the data synthesis: The most recent pathophysiological theories for BPPV, cupulolithiasis and canalithiasis, have inspired a number of physical treatments which seek to reverse the pathological mechanisms believed to be responsible for BPPV. The most recent physical treatments, Epley’s canalith repositioning procedure and its variations, are “bedside” procedures which seeks to reverse canalithiasis by the application of a series of positioning manoeuvres. Conclusion: The efficacy of these repositioning manoeuvres has not been satisfactorily determined, but despite this, their popularity is apparently growing. The repositioning manoeuvre can easily be performed in the chiropractic practice setting. However, prior to undertaking these physical treatments, the chiropractor should be confident in the diagnosis of BPPV, given that numerous causes of vertigo are serious and life-threatening.

  4. Benign paroxysmal positional vertigo Part I: Background and clinical presentation

    PubMed Central

    van der Velde, Gabrielle M

    1999-01-01

    Purpose: To review recent theories regarding the aetiology and pathophysiology of benign paroxysmal positional vertigo (BPPV), including its epidemiology, clinical presentation, diagnosis, and differential diagnosis. Data sources: Relevant studies were identified by searching MEDLINE from 1966 - March, 1997. Study selection: A total of 35 studies were selected on the basis of their relevance to Part I of this review. Data extraction: The findings and results of relevant studies and their subsequent theories and conclusions are discussed and compiled into a general overview of BPPV. Results of data synthesis: BPPV is considered the most common cause of vertigo of peripheral origin. A potential causal association has been observed with numerous apparent aetiological factors, all of which may lead to peripheral vestibular trauma. Findings of densities within the posterior semi-circular canal have given rise to the most recent theories regarding the pathophysiology for BPPV, canalithiasis and cupulolithiasis. Conclusions: BPPV is a multiaetiological peripheral vestibular disease whose underlying cause remains an enigma. The existing evidence supports two recent pathophysiological theories, cupulolithiasis and canalithiasis. Two conditions of special concern to the chiropractor, vertebrobasilar insufficiency and cervicogenic vertigo, closely ressemble BPPV, and can be differentiated by certain identifying features. BPPV may be diagnosed clinically, after ruling out conditions in which vertigo is a central feature. A review of the treatment for BPPV, focusing on recent physical treatments will be discussed in Part II of this paper.

  5. [Traumatic benign paroxysmal positional vertigo: diagnosis and treatment].

    PubMed

    Gordon, Carlos R; Joffe, Vitaly; Levite, Ronen; Gadoth, Natan

    2002-11-01

    Although head trauma is the cause of Benign Paroxysmal Positional Vertigo (BPPV) in about 15% of cases, the clinical features and response to treatment in this particular group of patients was not previously evaluated. We present 20 cases of traumatic BPPV: 12 cases identified from 150 consecutive BPPV patients diagnosed in our Dizziness Clinic; and 8 cases diagnosed from 75 consecutive head trauma patients seen in the Emergency Room. In all patients the clinical diagnosis was confirmed by the Dix-Hallpike maneuver and all were treated by the Epley procedure. Treatment results were compared to those of 40 consecutive patients with idiopathic BPPV. There was a wide spectrum and severity of head trauma including road accident (7), different falls (5), blow to the head (5) and miscellaneous (3). Two patients experienced brief loss of consciousness. Only two patients were diagnosed as BPPV before referral to our clinic. When presented to our Dizziness Clinic the patients were diagnosed as follows: unspecified dizziness (7), cervical vertigo (4) and transient ischemic attack (1). Five patients (25%) had bilateral BPPV. Eight patients (40%) had complete resolution of symptoms and signs following a single treatment while 12 patients (60%) required additional physical treatments until complete resolution of BPPV was achieved. During follow-up, 11 patients (55%) had recurrent attacks of BPPV. Thirty-four patients with idiopathic BPPV (85%) had a single successful treatment session while the others required repeated physical treatments until complete resolution of BPPV. We conclude that traumatic BPPV is probably under-recognized or misdiagnosed in clinical practice. Response to a single physical treatment seems to be less favorable than in idiopathic BPPV. The Dix-Hallpike maneuver is mandatory in all patients with dizziness and vertigo following head trauma. PMID:12476625

  6. A Geriatric Perspective on Benign Paroxysmal Positional Vertigo.

    PubMed

    Parham, Kourosh; Kuchel, George A

    2016-02-01

    Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach. PMID:26804483

  7. Benign positional vertigo

    MedlinePlus

    ... Clinical practice guideline: Benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg . 2008;139(5 Suppl 4):S47-S81. ... BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Mosby; 2015: ...

  8. Benign Paroxysmal Positional Vertigo Following Sinus Floor Elevation in Patient with Antecedents of Vertigo.

    PubMed

    Akcay, Huseyin; Ulu, Murat; Kelebek, Seyfi; Aladag, Ibrahim

    2016-07-01

    Benign paroxysmal positional vertigo (BPPV) is an unfamiliar and rare complication occurring following osteotome sinus floor elevation (OSFE) and simultaneous implant placement. Etiology of this disorder is commonly displacement of otoliths by vibratory forces transmitted by osteotomes and mallet along with the hyperextension of the head during the operation, causing them to float around in the endolymph. This report presents a case of protracted BPPV following OSFE and simultaneous implant placement. A 43-year-old female suffered intense vertigo and nausea immediately after implant placement using an OSFE procedure. Upon further questioning after the procedure she gave an account of two times vertigo history within the last 9 years. Despite nootropic drug medication and canalith repositioning procedure applied by a specialist at operation night, the condition did not improve. Patient did not totally recover and was admitted again after 1 month. After repeated maneuvers, nine dosage intravenous serous fluid and piracetam administration the patient recovered. Duration of these procedures took 10 days and the patient was successfully treated with no recurrence of dizziness. Prevention and management of OSFE related BPPV are reviewed especially in patients having prior vertigo history in this report. PMID:27408469

  9. A Case of Labyrinthine Fistula by Cholesteatoma Mimicking Lateral Canal Benign Paroxysmal Positional Vertigo

    PubMed Central

    Shim, Dae Bo; Ko, Kyung Min; Song, Mee Hyun

    2014-01-01

    Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked. PMID:25558413

  10. Investigating the role of Sirt1-modulated oxidative stress in relation to benign paroxysmal positional vertigo and Parkinson's disease.

    PubMed

    Tsai, Kun-Ling; Cheng, Yuan-Yang; Leu, Hsin-Bang; Lee, Yi-Yen; Chen, Tzeng-Ji; Liu, Ding-Hao; Kao, Chung-Lan

    2015-09-01

    Benign paroxysmal positional vertigo (BPPV) is one of the most frequently encountered primary complaints in dizziness clinics. The incidence of BPPV has been proven to increase with age. The relationship between BPPV and another neurodegenerative disease, Parkinson's disease (PD), has not been previously discussed. This study aimed to investigate the relationship of BPPV and PD with oxidative stress. A total of 30,811 subjects participated in our cohort study. The study cohort comprised 5057 BPPV patients and a comparison cohort of 25,754 nonBPPV patients. SIRT1 axis gene expression was investigated in BPPV patient blood samples and a PD cell model of 6-hydroxydopamine (6-OHDA)-treated PC-12 cells to elucidate the potential in vitro and in vivo mechanisms of degeneration in PD and BPPV. Our data suggest that BPPV patients with histories of head injuries show a significantly higher hazard to develop subsequent PD (hazard ratio, 3.942; confidence interval, 1.523-10.205, p = 0.005). We also observed that oxidative status is increased in blood samples from patients with BPPV. Our in vitro study suggests that SIRT1 function is inhibited by oxidative stress, which thereby promotes 6-hydroxydopamine-induced cell death. We conclude that BPPV is independently associated with an increased risk of PD. This finding may be attributed to oxidative stress-mediated inhibition of SIRT1 expression levels. PMID:26130063

  11. Benign positional vertigo

    MedlinePlus

    ... vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you. It may occur when you move ... any of the following: Feeling like you are spinning or moving Feeling like the world is spinning ...

  12. Physical Activity in the Prevention of Benign Paroxysmal Positional Vertigo: Probable Association

    PubMed Central

    Bazoni, Jéssica Aparecida; Mendes, William Siqueira; Meneses-Barriviera, Caroline Luiz; Melo, Juliana Jandre; Costa, Viviane de Souza Pinho; Teixeira, Denilson de Castro; Marchiori, Luciana Lozza de Moraes

    2014-01-01

    Introduction Physical inactivity is an important risk factor for many age-related diseases and symptoms such as dizziness and vertigo. Objective The aim of the study was to investigate the possible association between benign paroxysmal positional vertigo (BPPV) and regular physical activity in elderly subjects. Methods This cross-sectional study included 491 elderly individuals who lived independently. Physical exercise was assessed through a questionnaire and BPPV by history and the Dix-Hallpike maneuver. Results The present study indicates no significant association between BPPV with lack of physical activity in men and in the total population. We have confirmed associations between BPPV with lack of physical activity in women (p = 0.01). Women with a sedentary lifestyle who do not practice physical activity are 2.62 more likely to have BPPV than those with regular physical activity. Conclusion These results highlight the importance of identifying risk factors for BPPV that can be modified through specific interventions. Regular physical activity is a lifestyle with potential to decrease the risk of vertigo in women. PMID:25992128

  13. Increased Risk of Ischemic Stroke in Patients with Benign Paroxysmal Positional Vertigo: A 9-Year Follow-Up Nationwide Population Study in Taiwan

    PubMed Central

    Kao, Chung-Lan; Cheng, Yuan-Yang; Leu, Hsin-Bang; Chen, Tzeng-Ji; Ma, Hsin-I; Chen, Jaw-Wen; Lin, Shing-Jong; Chan, Rai-Chi

    2014-01-01

    Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo and is characterized by episodic dizziness related to changes in head position relative to gravity. BPPV symptoms can be similar to those of central nervous system vascular diseases. The association between BPPV and ischemic stroke has not yet been investigated. The study cohort consisted of patients who were diagnosed with BPPV at least twice in the previous year as an outpatient or for whom BPPV was the primary diagnosis as an inpatient (n = 4104). An age- and gender-matched sample that excluded patients with a diagnosis of any form of vertigo was selected as the comparison cohort (n = 8397). All cases were followed up from January 1, 2000, to December 31, 2008. The demographic characteristics, medical comorbidities, and use of medications in both groups were investigated using chi-square tests. A stratified analysis of stroke risk factors was performed to determine the hazard ratios of BPPV. During the 9-year follow-up period, 185 of the 4104 (4.5%) subjects with BPPV and 240 of the 8379 (2.9%) subjects without BPPV developed ischemic strokes. The crude hazard ratio of BPPV for developing ischemic strokes was 1.708. After adjusting for stroke risk factors, the risk of developing ischemic strokes in BPPV subjects was 1.415-fold higher than the risk among those without BPPV (confidence interval: 1.162–1.732, p = 0.001). After a subgroup analysis stratified according to stroke risk factors, BPPV remained independently associated with a higher risk of developing future ischemic stroke. We conclude that BPPV is independently associated with a risk of subsequent ischemic stroke. More aggressive control of modifiable risk factors for ischemic strokes should be conducted in patients with BPPV. PMID:24917815

  14. Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study

    PubMed Central

    Lin, Yueh-Wen; Sung, Pi-Yu; Chuang, Hsun-Yang; Liao, Wen-Ling

    2016-01-01

    Background Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation. Methods Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls. Results In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27–2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39–2.26). Conclusions Our results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should

  15. Quantitative analysis of benign paroxysmal positional vertigo fatigue under canalithiasis conditions.

    PubMed

    Boselli, F; Kleiser, L; Bockisch, C J; Hegemann, S C A; Obrist, D

    2014-06-01

    In our daily life, small flows in the semicircular canals (SCCs) of the inner ear displace a sensory structure called the cupula which mediates the transduction of head angular velocities to afferent signals. We consider a dysfunction of the SCCs known as canalithiasis. Under this condition, small debris particles disturb the flow in the SCCs and can cause benign paroxysmal positional vertigo (BPPV), arguably the most common form of vertigo in humans. The diagnosis of BPPV is mainly based on the analysis of typical eye movements (positional nystagmus) following provocative head maneuvers that are known to lead to vertigo in BPPV patients. These eye movements are triggered by the vestibulo-ocular reflex, and their velocity provides an indirect measurement of the cupula displacement. An attenuation of the vertigo and the nystagmus is often observed when the provocative maneuver is repeated. This attenuation is known as BPPV fatigue. It was not quantitatively described so far, and the mechanisms causing it remain unknown. We quantify fatigue by eye velocity measurements and propose a fluid dynamic interpretation of our results based on a computational model for the fluid-particle dynamics of a SCC with canalithiasis. Our model suggests that the particles may not go back to their initial position after a first head maneuver such that a second head maneuver leads to different particle trajectories causing smaller cupula displacements. PMID:24720888

  16. Gender-Based Comorbidity in Benign Paroxysmal Positional Vertigo

    PubMed Central

    Ogun, Oluwaseye Ayoola; Janky, Kristen L.; Cohn, Edward S.; Büki, Bela; Lundberg, Yunxia Wang

    2014-01-01

    It has been noted that benign paroxysmal positional vertigo (BPPV) may be associated with certain disorders and medical procedures. However, most studies to date were done in Europe, and epidemiological data on the United States (US) population are scarce. Gender-based information is even rarer. Furthermore, it is difficult to assess the relative prevalence of each type of association based solely on literature data, because different comorbidities were reported by various groups from different countries using different patient populations and possibly different inclusion/exclusion criteria. In this study, we surveyed and analyzed a large adult BPPV population (n = 1,360 surveyed, 227 completed, most of which were recurrent BPPV cases) from Omaha, NE, US, and its vicinity, all diagnosed at Boys Town National Research Hospital (BTNRH) over the past decade using established and consistent diagnostic criteria. In addition, we performed a retrospective analysis of patients’ diagnostic records (n = 1,377, with 1,360 adults and 17 children). The following comorbidities were found to be significantly more prevalent in the BPPV population when compared to the age- and gender-matched general population: ear/hearing problems, head injury, thyroid problems, allergies, high cholesterol, headaches, and numbness/paralysis. There were gender differences in the comorbidities. In addition, familial predisposition was fairly common among the participants. Thus, the data confirm some previously reported comorbidities, identify new ones (hearing loss, thyroid problems, high cholesterol, and numbness/paralysis), and suggest possible predisposing and triggering factors and events for BPPV. PMID:25187992

  17. Severe hydrocephalus complicated with benign paroxysmal positional vertigo: one case report

    PubMed Central

    Chen, Jian Jun; Cheng, Wei Jin; Rao, Jie; Lu, Ye Fen; Qiu, Wei Wen

    2015-01-01

    In this study, we reported one female patient diagnosed with severe hydrocephalus who presented with benign paroxysmal positional vertigo (BPPV). She presented with progressive headache and dizziness prior to hospitalization as chief complaints. She received Diagnostic Dix-Hallpike and Roll tests to make a definite diagnosis. The patient was cured after Gufoni maneuver and did not recur after 6-month follow-up. The diagnostic procedures of this female case prompted that prior to formal treatment, patients developing severe hydrocephalus complicated with BPPV should receive provocative test for positional dizziness, performed by experienced physicians from the Department of neurology and otolaryngology. PMID:26885146

  18. Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome.

    PubMed

    West, Niels; Hansen, Søren; Møller, Martin Nue; Bloch, Sune Land; Klokker, Mads

    2016-03-01

    The objective was to evaluate the clinical value of repositioning chairs in management of refractory benign paroxysmal positional vertigo (BPPV) and to study how different BPPV subtypes respond to treatment. We performed a retrospective chart review of 150 consecutive cases with refractory vertigo referred to our clinic within a 10-month period. The BPPV patients were managed with classical manual manoeuvres, the Epley Omniax(®) rotator (EO) or the TRV chair (TRV). In addition, a comprehensive review of the literature was performed. BPPV was identified in 95 cases. The number of needed treatments for posterior canalolithiasis versus posterior cupulolithiasis, horizontal cupulolithiasis and multi-canal affection was significant (p < 0.01). Thirty-seven (38 %) patients required only one repositioning manoeuvre and the overall symptom relief was 91.7-100 % after 3 treatments. Eleven patients (12 %) experienced relapse within the ½-year follow-up period. Horizontal cupulolithiasis and multi-canal affection constituted the most resilient cases. The literature search identified 9 repositioning chair studies. The EO and the TRV are highly valuable assets in diagnosis and management of BPPV of particularly complex and refractory cases. However, further validation is anticipated through controlled clinical trials. PMID:25749489

  19. Image-based computer-assisted diagnosis system for benign paroxysmal positional vertigo

    NASA Astrophysics Data System (ADS)

    Kohigashi, Satoru; Nakamae, Koji; Fujioka, Hiromu

    2005-04-01

    We develop the image based computer assisted diagnosis system for benign paroxysmal positional vertigo (BPPV) that consists of the balance control system simulator, the 3D eye movement simulator, and the extraction method of nystagmus response directly from an eye movement image sequence. In the system, the causes and conditions of BPPV are estimated by searching the database for record matching with the nystagmus response for the observed eye image sequence of the patient with BPPV. The database includes the nystagmus responses for simulated eye movement sequences. The eye movement velocity is obtained by using the balance control system simulator that allows us to simulate BPPV under various conditions such as canalithiasis, cupulolithiasis, number of otoconia, otoconium size, and so on. Then the eye movement image sequence is displayed on the CRT by the 3D eye movement simulator. The nystagmus responses are extracted from the image sequence by the proposed method and are stored in the database. In order to enhance the diagnosis accuracy, the nystagmus response for a newly simulated sequence is matched with that for the observed sequence. From the matched simulation conditions, the causes and conditions of BPPV are estimated. We apply our image based computer assisted diagnosis system to two real eye movement image sequences for patients with BPPV to show its validity.

  20. Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study

    PubMed Central

    Sheikhzadeh, Mahboobeh; Lotfi, Yones; Mousavi, Abdollah; Heidari, Behzad; Monadi, Mohsen; Bakhshi, Enayatollah

    2016-01-01

    Background: Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV. Methods: The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels < 20 ng/ml was considered a deficiency. All patients received rehabilitation treatment using Epley's maneuver one time per week for one month. Serum 25-OHD deficient patients were classified as treated and non-treated groups (rehabilitation with or without 50.000 IU cholecalciferol weekly for two months).The results of treatment were compared with vitamin D sufficient group as control. All patients were followed-up for 6 months. Results: After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period. Conclusion: This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV. PMID:27386060

  1. Benign paroxysmal positional vertigo in the first acute attack of Ménière's disease.

    PubMed

    Psillas, G; Triaridis, S; Markou, K; Tsalighopoulos, M; Vital, V

    2011-01-01

    A 69-year-old woman, with no history of vertigo attacks, presented with the classical triad of symptoms for Ménière's disease in the right ear (vertigo, tinnitus, fullness). Upon admission, the patient had a third-degree horizontal nystagmus beating to the right, after beating towards the left ear a few hours earlier. Audiometry confirmed a severe sensorineural hearing loss in the right ear, especially at low and high frequencies. The following day, the patient complained of short episodes of vertigo linked to head movement, and the Hallpike test was compatible with benign paroxysmal positional vertigo (BPPV) in the right ear. To our knowledge this is the first description of BPPV of the posterior semicircular canal manifesting during the first vertiginous attack of Ménière's disease in the same ear. It was possible that the hydropic distension or rupture damaged the otolithic apparatus, leading to the release of otoconia debris which migrated to the posterior semicircular canal where it resulted in BPPV. PMID:21838099

  2. Benign paroxysmal positional vertigo and head position during sleep.

    PubMed

    Shigeno, Kohichiro; Ogita, Hideaki; Funabiki, Kazuo

    2012-01-01

    To determine whether any particular head positions during sleep are associated with BPPV, head position during sleep was monitored for 3 days in 50 BPPV patients after the disappearance of positional nystagmus and in 25 normal control subjects. A gravity sensor was attached to the center of the subject's forehead at home. The positional angle of the head was measured at 5-second intervals during sleep. In BPPV, the posterior semicircular canal was involved in 40 patients and the lateral semicircular canal in 10 patients. Recurrence was found in 22 of 50 BPPV patients. BPPV patients with recurrence were significantly more likely to sleep in the affected-ear-down 45-degree head position than were patients with no history of recurrence (P< 0.02). When the head is in the affected-ear-down 45-degree head position, the non-ampullated half of the posterior semicircular canal and the non-ampullated half of the lateral semicircular canal are nearly in the earth-vertical position, making it easier for detached otoconia to fall into the posterior or lateral semicircular canal and to agglomerate and attain a certain size in the lowest portion of each semicircular canal. Our findings showed that the affected-ear-down 45-degree head position during sleep could be an etiological factor of BPPV, more particularly in patients with recurrent BPPV. PMID:23142834

  3. Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients.

    PubMed

    Maranhão, Eliana Teixeira; Maranhão Filho, Péricles

    2015-06-01

    Benign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit. PMID:26083883

  4. Is There a Possible Association between Dietary Habits and Benign Paroxysmal Positional Vertigo in the Elderly? The Importance of Diet and Counseling

    PubMed Central

    Schultz, Adriane Rocha; Neves-Souza, Rejane Dias; Costa, Viviane de Souza Pinho; Meneses-Barriviera, Caroline Luiz; Franco, Pricila Perini Rigotti; Marchiori, Luciana Lozza de Moraes

    2015-01-01

    Introduction Poor diet habits and inadequate intake of nutrients are a concern in the elderly. Nutritional education with guidance may improve the results of the treatment of vertigo. Objective Evaluate the presence of benign paroxysmal positional vertigo (BPPV) associated with feeding habits. Methods Cross-sectional study with elderly people living independently. We evaluated nutritional habits through the method of dietary 24-hour recall and manipulation of Dix-Hallpike. Results Based on a sample of 487 individuals, 117 had BPPV. Among the 117 elderly patients with BPPV, 37 (31.62%) had inadequate feeding. From those 370 individuals without BPPV, 97 (26.21%) had inappropriate feeding. No significant association between nutritional habits and BPPV in the total population was observed (p = 0.3064). However, there was significant relation between BPPV and inadequate carbohydrate intake (p = 0.0419) and insufficient fiber intake (p = 0.03), and the diet of these subjects was rich in polyunsaturated fatty acids (p = 0.0084). Conclusion These data correlate with the dyslipidemia and hypertriglyceridemia status, making it extremely important to reduce the intake of fats and carbohydrates and increase the fiber intake to stabilize triglycerides and thus minimize harmful effects on the inner ear. Food readjustment is suggested in patients with BPPV, along with the work of a multidisciplinary team to improve the quality of the elderly. PMID:26491473

  5. [Peripheral, central and functional vertigo syndromes].

    PubMed

    Strupp, M; Dieterich, M; Zwergal, A; Brandt, T

    2015-12-01

    Depending on the temporal course, three forms of vertigo syndrome can be differentiated: 1) vertigo attacks, e.g. benign paroxysmal positional vertigo (BPPV), Menière's disease and vestibular migraine, 2) acute spontaneous vertigo lasting for days, e.g. acute unilateral vestibulopathy, brainstem or cerebellar infarction and 3) symptoms lasting for months or years, e.g. bilateral vestibulopathy and functional vertigo. The specific therapy of the various syndromes is based on three principles: 1) physical treatment with liberatory maneuvers for BPPV and balance training for vestibular deficits, 2) pharmacotherapy, e.g. for acute unilateral vestibulopathy (corticosteroids) and Menière's disease (transtympanic administration of gentamicin or steroids and high-dose betahistine therapy); placebo-controlled pharmacotherapy studies are currently being carried out for acute unilateral vestibulopathy, vestibular paroxysmia, prophylaxis of BPPV, vestibular migraine, episodic ataxia type 2 and cerebellar ataxia; 3) psychotherapy for functional dizziness. PMID:26643594

  6. Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital.

    PubMed

    Abbott, Joel; Tomassen, Sylvia; Lane, Laura; Bishop, Katie; Thomas, Nibu

    2016-08-01

    Having benign paroxysmal positional vertigo (BPPV) puts patients at a significantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients.For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identified, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre.Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identified with standard practice. PMID:27481376

  7. Validation of 5-item and 2-item questionnaires in Chinese version of Dizziness Handicap Inventory for screening objective benign paroxysmal positional vertigo.

    PubMed

    Chen, Wei; Shu, Liang; Wang, Qian; Pan, Hui; Wu, Jing; Fang, Jie; Sun, Xu-Hong; Zhai, Yu; Dong, You-Rong; Liu, Jian-Ren

    2016-08-01

    As possible candidate screening instruments for benign paroxysmal positional vertigo (BPPV), studies to validate the Dizziness Handicap Inventory (DHI) sub-scale (5-item and 2-item) and total scores are rare in China. From May 2014 to December 2014, 108(55 with and 53 without BPPV) patients complaining of episodic vertigo in the past week from a vertigo outpatient clinic were enrolled for DHI evaluation, as well as demographic and other clinical data. Objective BPPV was subsequently determined by positional evoking maneuvers under the record of optical Frenzel glasses. Cronbach's coefficient α was used to evaluate the reliability of psychometric scales. The validity of DHI total, 5-item and 2-item questionnaires to screen for BPPV was assessed by receiver operating characteristic (ROC) curves. It revealed that the DHI 5-item questionnaire had good internal consistency (Cronbach's coefficient α = 0.72). Area under the curve of total DHI, 5-item and 2-item scores for discriminating BPPV from those without was 0.678 (95 % CI 0.578-0.778), 0.873(95 % CI 0.807-0.940) and 0.895(95 % CI 0.836-0.953), respectively. It revealed 74.5 % sensitivity and 88.7 % specificity in separating BPPV and those without, with a cutoff value of 12 in the 5-item questionnaire. The corresponding rate of sensitivity and specificity was 78.2 and 88.7 %, respectively, with a cutoff value of 6 in 2-item questionnaire. The present study indicated that both 5-item and 2-item questionnaires in the Chinese version of DHI may be more valid than DHI total score for screening objective BPPV and merit further application in clinical practice in China. PMID:27071688

  8. Recognition and management of BPPV for an elderly female patient referred for low back pain: a resident's case study.

    PubMed

    Massey, B James; Osborne, Raine; Beneciuk, Jason M; Rowe, Robert H

    2014-08-01

    Benign paroxysmal positional vertigo (BPPV) is common among older adults and frequently misdiagnosed or unidentified. Undiagnosed BPPV has been associated with depression, falls and ADL limitations. This case study describes the diagnostic process and management of BPPV for a 65-year-old patient with a primary complaint of chronic low back pain (LBP) in an outpatient orthopedic physical therapy setting. Following routine screening performed on initial evaluation, the patient was educated about examination findings that indicated the potential for BPPV and given the option to proceed with further assessment or defer until LBP was under control. The patient attended 16 visits over the course of care and the complaint of vertigo, described as a true spinning sensation, was assessed further on the visit 5. Continued assessment confirmed BPPV and the canalith repositioning procedure was administered. Following positive response to this intervention, the maneuver was re-administered on visit 6. Complete resolution of symptoms was reported on visit 7 and for the remainder of physical therapy services over the following month. Physical therapists may play a vital role in reducing healthcare expenses associated with cost to arrive at the diagnosis of BPPV, as well as improving the quality of life and safety of the older adult population affected by BPPV. PMID:24597728

  9. Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.

    PubMed

    Singh, Niraj Kumar; Apeksha, Kumari

    2016-09-01

    Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV. PMID:26718546

  10. Impaired mental rotation in benign paroxysmal positional vertigo and acute vestibular neuritis

    PubMed Central

    Candidi, Matteo; Micarelli, Alessandro; Viziano, Andrea; Aglioti, Salvatore M.; Minio-Paluello, Ilaria; Alessandrini, Marco

    2013-01-01

    Vestibular processing is fundamental to our sense of orientation in space which is a core aspect of the representation of the self. Vestibular information is processed in a large subcortical–cortical neural network. Tasks requiring mental rotations of human bodies in space are known to activate neural regions within this network suggesting that vestibular processing is involved in the control of mental rotation. We studied whether mental rotation is impaired in patients suffering from two different forms of unilateral vestibular disorders (vestibular neuritis – VN – and Benign Paroxysmal positional VertigoBPPV) with respect to healthy matched controls (C). We used two mental rotation tasks in which participants were required to: (i) mentally rotate their own body in space (egocentric rotation) thus using vestibular processing to a large extent and (ii) mentally rotate human figures (allocentric rotation) thus using own body representations to a smaller degree. Reaction times and accuracy of responses showed that VN and BPPV patients were impaired in both tasks with respect to C. Significantly, the pattern of results was similar in the three groups suggesting that patients were actually performing the mental rotation without using a different strategy from the control individuals. These results show that dysfunctional vestibular inflow impairs mental rotation of both own body and human figures suggesting that unilateral acute disorders of the peripheral vestibular input massively affect the cerebral processes underlying mental rotations. PMID:24324422

  11. The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo: a meta-analytic study.

    PubMed

    Mostafa, Badr E; Youssef, Tamer Ali; Hamad, Ahmed S

    2013-03-01

    The objective of this article is to verify the role of postural restrictions after repositioning maneuvers in treating patients with benign paroxysmal positional vertigo (BPPV). The study included published articles yielded by a Pubmed search concerning post-maneuver postural restriction in treating BPPV. The search was limited to articles published in English language in the last three decades. The search was done on 1/11/2011. For the 18 relevant articles, we applied our inclusion and exclusion criteria and only 9 articles were included. The data collected from each article were statistically analyzed utilizing meta-analytic Review Manager (RevMan 5.1) software. (Version: 5.1.0.0). There were no significant differences between patients instructed with postural restriction after undergoing repositioning maneuver and patients left free to move after undergoing repositioning maneuver with regard to the presence or absence of post-maneuver symptoms. In conclusion, post-maneuver restrictions do not add to the success of the treatment of BPPV and there is no reason to submit patients to these impractical instructions. PMID:22588196

  12. Evaluation of quality of life pre- and post-vestibular rehabilitation in patients with benign paroxysmal positional vertigo associated with Meniere's disease

    PubMed Central

    Socher, Dayra Dill; Socher, Jan Alessandro; Azzi, Viviane Jacintha Bolfe

    2012-01-01

    Summary Introduction: Vertigo is a symptom that impacts the patients' quality of life and may force them to cease performing activities of daily living. Here, we discuss benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD), which show exacerbated symptoms when they appear in association. Vestibular rehabilitation (VR) is an effective treatment in reducing vertigo, especially in conjunction with other therapies. Aim: To evaluate the quality of life of patients with BPPV and MD before and after VR. Method: We conducted a descriptive observational qualitative and quantitative case study with 12 patients aged 35 to 86 years. All patients diagnosed with BPPV and MD received treatment in the ENT clinic. The Brazilian DHI questionnaire, which assesses the quality of life with a focus on physical, emotional, and functional aspects, was used for data collection, and was completed by patients before the first session and after the fifth session of VR. Data were tested using the Shapiro-Wilk normality test, followed by Wilcoxon, Friedman, and Spearman correlation tests (p < 0.05). Results: There were significant improvements in scores for all aspects, with median changes ranging from 12 to 0 in the physical, 6 to 1 in the emotional, and 11 to 1 in the functional aspect. There were no correlations between the scores and sample characteristics. Conclusion: VR was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender. PMID:25991970

  13. New Analyses of the Sensory Organization Test Compared to the Clinical Test of Sensory Integration and Balance in Patients with Benign Paroxysmal Positional Vertigo

    PubMed Central

    Mulavara, Ajitkumar P.; Cohen, Helen S.; Peters, Brian T.; Sangi-Haghpeykar, Haleh; Bloomberg, Jacob J.

    2013-01-01

    Objective To determine whether the Sensory Organization Test (SOT) of the computerized dynamic posturography battery or the Clinical Test of Sensory Integration and Balance (CTSIB) is more likely to indicate balance disorders in people with benign paroxysmal positional vertigo. Study design Normal controls were compared to patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV). Methods Subjects performed tests with eyes open or closed on stable and unstable surfaces, with head still or with head moving at 0.33 Hz in pitch or yaw. Dependent variables were the percent time of the standard duration each subject could perform the task, the number of head motions made, and kinematic variables measured with head- and torso-mounted inertial motion units. Results Because equilibrium scores of normals improved significantly over repeated trials on SOT patients were given only 1 trial per condition. For percent time between-group differences were found on CTSIB with eyes closed, on foam, head moving in yaw showing significantly reduced performance by BPPV subjects compared to controls. Compared to controls patients made significantly fewer head movements on CTSIB, eyes closed, on foam, head still, pitch and yaw. Kinematic data also differed between the groups on tests with eyes closed, unstable surfaces with different head movement combinations, indicating increased instability in BPPV patients. Conclusion For screening, CTSIB with head movements is more likely than SOT to indicate balance deficits, especially when dependent measures include percent time as well as head movement counts and kinematic measures. PMID:23553110

  14. Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design This study is a randomized clinical trial conducted in the primary care setting. The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. Discussion Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and

  15. Pharmacological treatment of vertigo.

    PubMed

    Hain, Timothy C; Uddin, Mohammed

    2003-01-01

    This review discusses the physiology and pharmacological treatment of vertigo and related disorders. Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists and dopamine receptor antagonists. These medications often have multiple actions. They may modify the intensity of symptoms (e.g. vestibular suppressants) or they may affect the underlying disease process (e.g. calcium channel antagonists in the case of vestibular migraine). Most of these agents, particularly those that are sedating, also have a potential to modulate the rate of compensation for vestibular damage. This consideration has become more relevant in recent years, as vestibular rehabilitation physical therapy is now often recommended in an attempt to promote compensation. Accordingly, therapy of vertigo is optimised when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. In both Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used. In Ménière's disease, salt restriction and diuretics are used in an attempt to prevent flare-ups. In vestibular neuritis, only brief use of vestibular suppressants is now recommended. Drug treatments are not presently recommended for BPPV and bilateral vestibular paresis, but physical therapy treatment can be very useful in both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment

  16. The fluid mechanics of the inner-ear disorder BPPV

    NASA Astrophysics Data System (ADS)

    Weidman, Michael; Squires, Todd; Stone, Howard

    2001-11-01

    The inner ear of mammals contains fluid-filled semi-circular canals with a flexible sensory membrane (called a cupula) which detects rotational acceleration. Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common disorders of this system diagnosed today, and is characterized by symptoms of dizziness and nausea brought on by sudden changes in head orientation. BPPV is believed to have a mechanical (rather than nervous) origin, in which dense particles called otoconia settle into the canals and trigger false sensations of rotational acceleration. Several qualitative mechanisms have been proposed by the medical community, which we examine from a fluid mechanical standpoint. Traditionally, the semicircular canal and the cupula are modeled as an over-damped torsional pendulum with a driving force provided by rotational acceleration. We extend this model to include the time-dependent mechanical response owing to sedimentation of the otoconia. We make qualitative and quantitative predictions associated with the proposed mechanisms, with an eye towards differentiating between them and perhaps towards more effective diagnostic and therapeutic methods.

  17. Vertiginous Symptoms and Objective Measures of Postural Balance in Elderly People with Benign Paroxysmal Positional Vertigo Submitted to the Epley Maneuver.

    PubMed

    Silva, Camila Nicácio da; Ribeiro, Karyna Myrelly O B de Figueiredo; Freitas, Raysa Vanessa de Medeiros; Ferreira, Lidiane Maria de Britho Macedo; Guerra, Ricardo Oliveira

    2016-01-01

    Introduction Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common and treatable causes of peripheral vestibular vertigo in adults. Its incidence increases with age, eventually leading to disability and a decreased quality of life. Objective The research aims to assess short-term effects of Otolith Repositioning Maneuver (ORM) on dizziness symptoms, quality of life, and postural balance in elderly people with Benign Paroxysmal Positional Vertigo. Methods A quasi-experimental study, which evaluated 14 elderly people that underwent the Otolith Repositioning Maneuver and reevaluation after one week. The authors performed statistical analysis by descriptive analysis of central tendency and dispersion; for pre- and post-treatment conditions, the authors used the Wilcoxon test. Results All aspects of the Dizziness Handicap Inventory (physical, functional, emotional, and total scores) as well as the Visual Analogue Scale (VAS) decreased after therapy (p < 0.05 and p = 0.001, respectively). However, more than half of the elderly participants did not achieve negative Dix-Hallpike. Regarding static and dynamic balance, there were significant differences in some parameters of the modified Clinical Test of Sensory Interaction and Balance, Limits of Stability and gait assessment measured by the Dizziness Gait Index (p < 0.05). Conclusion Results reveal clinical and functional benefits in elderly people with Benign Paroxysmal Positional Vertigo submitted to Otolith Repositioning Maneuver. However, most of the participants did not overcome Benign Paroxysmal Positional Vertigo and not all aspects of postural balance improved. Therefore, a longer follow-up period and a multidisciplinary team are required to establish comprehensive care for elderly patients with dizziness complaints. PMID:26722348

  18. Vertiginous Symptoms and Objective Measures of Postural Balance in Elderly People with Benign Paroxysmal Positional Vertigo Submitted to the Epley Maneuver

    PubMed Central

    Silva, Camila Nicácio da; Ribeiro, Karyna Myrelly O. B. de Figueiredo; Freitas, Raysa Vanessa de Medeiros; Ferreira, Lidiane Maria de Britho Macedo; Guerra, Ricardo Oliveira

    2015-01-01

    Introduction Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common and treatable causes of peripheral vestibular vertigo in adults. Its incidence increases with age, eventually leading to disability and a decreased quality of life. Objective The research aims to assess short-term effects of Otolith Repositioning Maneuver (ORM) on dizziness symptoms, quality of life, and postural balance in elderly people with Benign Paroxysmal Positional Vertigo. Methods A quasi-experimental study, which evaluated 14 elderly people that underwent the Otolith Repositioning Maneuver and reevaluation after one week. The authors performed statistical analysis by descriptive analysis of central tendency and dispersion; for pre- and post-treatment conditions, the authors used the Wilcoxon test. Results All aspects of the Dizziness Handicap Inventory (physical, functional, emotional, and total scores) as well as the Visual Analogue Scale (VAS) decreased after therapy (p < 0.05 and p = 0.001, respectively). However, more than half of the elderly participants did not achieve negative Dix-Hallpike. Regarding static and dynamic balance, there were significant differences in some parameters of the modified Clinical Test of Sensory Interaction and Balance, Limits of Stability and gait assessment measured by the Dizziness Gait Index (p < 0.05). Conclusion Results reveal clinical and functional benefits in elderly people with Benign Paroxysmal Positional Vertigo submitted to Otolith Repositioning Maneuver. However, most of the participants did not overcome Benign Paroxysmal Positional Vertigo and not all aspects of postural balance improved. Therefore, a longer follow-up period and a multidisciplinary team are required to establish comprehensive care for elderly patients with dizziness complaints. PMID:26722348

  19. Clinical management of a patient with chronic recurrent vertigo following a mild traumatic brain injury.

    PubMed

    Johnson, Eric G

    2009-01-01

    Vertigo, was provoked and right torsional up-beat nystagmus was observed in a 47-year-old patient when she was placed into the right Hallpike-Dix test position using infrared goggle technology. The clinical diagnosis was benign paroxysmal positional vertigo (BPPV), specifically right posterior canalithiasis, resulting from a mild traumatic brain injury (TBI) suffered approximately six-months earlier. Previous medical consultations did not include vestibular system examination, and Meclizine was prescribed to suppress her chief complaint of vertigo. Ultimately, the patient was successfully managed by performing two canalith repositioning maneuvers during a single clinical session. The patient reported 100% resolution of symptoms upon reexamination the following day, and the Hallpike-Dix test was negative. Continued symptom resolution was subjectively reported 10 days postintervention via telephone consultation. This case report supports previous publications concerning the presence of BPPV following TBI and the need for inclusion of vestibular system examination during medical consultation. PMID:19826635

  20. Paroxysmal positional vertigo in skeet shooters and hunters.

    PubMed

    Bruno, Ernesto; Napolitano, Bianca; Di Girolamo, Stefano; De Padova, Alessandro; Alessandrini, Marco

    2007-04-01

    Paroxysmal positional vertigo (PPV) is a high prevalence vestibular end organ disorder due to the detachment of the utricular otoconia floating in the posterior or lateral semicircular canal. In the majority of cases the etiology of PPV is unknown and it may follow viral infections, vascular disorders and head trauma. This report presents six cases (out of 520 diagnoses of PPV) of PPV following repeated training sessions of skeet shooting or gun shooting during animal hunting. The transmission of impulsive and vibratory energy from the shoulder to the cervical spine and the subsequent minimal whiplash injury ipsilateral to the side where the gun is placed on the shoulder may be considered to be responsible of the otoconia detachment. PMID:17242916

  1. Health services utilization of patients with vertigo in primary care: a retrospective cohort study.

    PubMed

    Grill, Eva; Strupp, Michael; Müller, Martin; Jahn, Klaus

    2014-08-01

    Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often under- and misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Menière's disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 % BPPV, 12.7 % MD, 5.8 % VP, 7.2 % BVP, 14.1 % VM, 40.6 % PSY), 61.3 % with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 %, 71 % in BPPV) and electrocardiography (53.5 %). Most frequent therapies were medication (61.0 %) and physical therapy (41.3 %). 37.3 % had received homoeopathic medication (39 % in BPPV), and 25.9 % were treated with betahistine (20 % in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients. PMID:24817192

  2. Apogeotropic central positional nystagmus as a sole sign of nodular infarction.

    PubMed

    Kim, Hyun-Ah; Yi, Hyon-Ah; Lee, Hyung

    2012-10-01

    Positional vertigo and nystagmus without associated neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). Although positional nystagmus may occur with caudal cerebellar infarction including the nodulus, positional nystagmus is usually associated with other neurological signs such as spontaneous or gaze-evoked nystagmus, perverted head-shaking nystagmus, cerebellar dysmetria, or severe gait ataxia with falling. We present a patient with nodular infarction who had positional vertigo with nystagmus as a sole manifestation. Video-oculography showed apogeotropic positional horizontal nystagmus during head turning while supine, which was consistent with apogeotropic BPPV involving the horizontal canal. MRI disclosed acute infarct in the nodulus. Nodulus infarction should be considered in a patient with positional nystagmus, especially when the presenting symptoms and signs are consistent with BPPV involving the horizontal canal. PMID:22187336

  3. Dizziness and vertigo - aftercare

    MedlinePlus

    Meniere disease - aftercare; Benign positional vertigo - aftercare ... Dizziness can describe two different symptoms: lightheadedness and vertigo. Lightheadedness means you feel like you might faint. ...

  4. Efficacy of Epley's Maneuver in Treating BPPV Patients: A Prospective Observational Study

    PubMed Central

    Gaur, Sushil; Awasthi, Sanjeev Kumar; Bhadouriya, Sunil Kumar Singh; Saxena, Rohit; Pathak, Vivek Kumar; Bisht, Mamta

    2015-01-01

    Vertigo and balance disorders are among the most common symptoms encountered in patients who visit ENT outpatient department. This is associated with risk of falling and is compounded in elderly persons with other neurologic deficits and chronic medical problems. BPPV is the most common cause of peripheral vertigo. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact, and medical costs. The objective of Epley's maneuver, which is noninvasive, inexpensive, and easily administered, is to move the canaliths out of the canal to the utricle where they no longer affect the canal dynamics. Our study aims to analyze the response to Epley's maneuver in a series of patients with posterior canal BPPV and compares the results with those treated exclusively by medical management alone. Even though many studies have been conducted to prove the efficacy of this maneuver, this study reinforces the validity of Epley's maneuver by comparison with the medical management. PMID:26495002

  5. Particle sedimentation in curved tubes: A 3D simulation and optimization for treatment of vestibular vertigo

    NASA Astrophysics Data System (ADS)

    White, Brian; Squires, Todd M.; Hain, Timothy C.; Stone, Howard A.

    2003-11-01

    Benign paroxysmal positional vertigo (BPPV) is a mechanical disorder of the vestibular system where micron-size crystals abnormally drift into the semicircular canals of the inner ear that sense angular motion of the head. Sedimentation of these crystals causes sensation of motion after true head motion has stopped: vertigo results. The usual clinical treatment is through a series of head maneuvers designed to move the particles into a less sensitive region of the canal system. We present a three-dimensional model to simulate treatment of BPPV by determining the complete hydrodynamic motion of the particles through the course of a therapeutic maneuver while using a realistic representation of the actual geometry. Analyses of clinical maneuvers show the parameter range for which they are effective, and indicate inefficiencies in current practice. In addition, an optimization process determines the most effective head maneuver, which significantly differs from those currently in practice.

  6. [Vertigo and dizziness: the neurologist's perspective].

    PubMed

    Strupp, M

    2013-01-01

    The spectrum of diagnoses of patients with dizziness as the leading symptom who consult a neurologist does not differ greatly from the spectrum of those who consult ear nose and throat (ENT) specialists or general practitioners (GP). The most frequent forms are benign paroxysmal positioning vertigo (BPPV), phobic postural vertigo, central vertigo disorders, Menière's disease, vestibular neuritis and bilateral vestibulopathy. However, the first and most important question that is posed to neurologists is whether it is a central or peripheral syndrome. In more than 90 % of cases this differentiation is possible by taking the patient history (asking about the type of vertigo, the duration, triggers and accompanying symptoms) and conducting a physical examination of the patient. In the case of acute vertigo disorders in particular, a five-step procedure has proved to be helpful: the cover test to look for skew deviation as the central sign and component of the ocular tilt reaction, an examination with and without Frenzel's goggles to differentiate between peripheral vestibular spontaneous nystagmus and central fixation nystagmus, an examination of smooth pursuit and gaze-holding function and finally the head-impulse test to look for a deficit in the vestibulo-ocular reflex (VOR). Considerable advances have been made in the treatment of vertigo disorders in the last 10 years, e.g., cortisone for the treatment of acute vestibular neuritis, betahistine as a high-dosage, long-term treatment for Menière's disease, carbamazepine to treat vestibular paroxysmia and aminopyridine for downbeat nystagmus and episodic ataxia type 2. PMID:23288313

  7. Should the clinician do the tests for benign paroxysmal positional vertigo even in the presence of spontaneous nystagmus at primary gaze?

    PubMed

    Yetiser, Sertac

    2016-07-01

    Different balance problems may occur in the same patient simultaneously, and the other problem may be overlooked if the clinician does not pay much attention. Spontaneous nystagmus of Meniere's disease and positional nystagmus of posterior canal BPPV in the same patient is presented. Positional tests must always be considered even in the presence of spontaneous nystagmus. PMID:27386136

  8. [Benign paroxysmal positional vertigo. Differential diagnosis of posterior, horizontal and anterior canalolithiasis].

    PubMed

    Steddin, S; Brandt, T

    1994-08-01

    Evidence is presented that all typical features of benign paroxysmal positioning vertigo can be explained by canalolithiasis rather than by cupulolithiasis. A free floating clot of "heavy" inorganic particles gravitates to the most dependent part of the canal as soon as the patient's head is moved in a way that alters the angle between the canal's plane and the gravity vector. Based on the canalolithiasis mechanism we describe how characteristics of the thus elicited nystagmus differ if the posterior, the horizontal or the anterior semicircular canal is causative. PMID:7969646

  9. Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo Presenting with Torsional Downbeating Nystagmus: An Apogeotropic Variant

    PubMed Central

    Vannucchi, Paolo; Pecci, Rudi; Giannoni, Beatrice

    2012-01-01

    The aim of this study is to verify the hypothesis that free-floating particles could sometimes localize into the distal portion of the non ampullary arm of the posterior semicircular canal (PSC) so that assuming the Dix-Hallpike's positions, the clot could move towards the ampulla eliciting a inhibitory torsional-down beating paroxysmal positional nystagmus (PPNy), instead of typical excitatory torsional-up beating PPNy. Among 45 patients with vestibular signs suggesting anterior semicircular canal paroxysmal positional vertigo (PPV), collected from February 2003 to August 2006, we detected a group of 6 subjects whose clinical findings showed a singular behaviour during follow-up. At the first check-up, all patients were submitted to different types of physical manoeuvres for ASC canalolithiasis. Patients were controlled during the same session and after one week. When we found that nystagmus was qualitatively changed we adopted the appropriate physical therapies for that sign. At a next check-up, after having performed some physical therapies, all patients had a typical PSC PPNy of the opposite side, with respect to that of the ASC initially diagnosed. Basing on these observations we conclude that PSC PPV, similarly to lateral semicircular canal PPV, could manifests in a apogeotropic variant. PMID:22969807

  10. Immunogold TEM of otoconin 90 and otolin - relevance to mineralization of otoconia, and pathogenesis of benign positional vertigo.

    PubMed

    Andrade, Leonardo R; Lins, Ulysses; Farina, Marcos; Kachar, Bechara; Thalmann, Ruediger

    2012-10-01

    interconnecting otoconia. Consequently, otoconia detached from each other may be released into the endolymphatic space by minor mechanical disturbances. In humans, benign positional vertigo (BPV) is believed to result from translocation of otoconia from the endolymphatic space into the semi-circular canals rendering their receptors susceptible to stimulation by gravity causing severe attacks of vertigo. The combinations of these observations in humans, together with the presented animal experiments, provide a tentative pathogenetic basis of the early stage of BPV. PMID:22841569

  11. Drug treatment of vertigo in neurological disorders.

    PubMed

    Berisavac, Ivana I; Pavlović, Aleksandra M; Trajković, Jasna J Zidverc; Šternić, Nadežda M Čovičković; Bumbaširević, Ljiljana G Beslać

    2015-01-01

    Vertigo is a common symptom in everyday clinical practice. The treatment depends on the specific etiology. Vertigo may be secondary to inner ear pathology, or any existing brainstem or cerebellar lesion but may also be psychogenic. Central vertigo is a consequence of a central nervous system lesion. It is often associated with a focal neurological deficit. Peripheral vertigo is secondary to dysfunction of the peripheral vestibular system and is usually characterized by an acute vertigo with loss of balance, sensation of spinning in the space or around self, and is exaggerated with changes of the head and body position; no other neurological deficit is present. Some medications may also cause vertigo. Depending on the cause of the vertigo, drugs with different mechanisms of action, physical therapy, psychotherapy, as well as surgery may be used to combat this disabling malady. Symptomatic treatment has a particularly important role, regardless of the etiology of vertigo. We reviewed the current medications recommended for patients with vertigo, their mechanisms of action and their most frequent side effects. PMID:26588629

  12. Benign positional vertigo -- aftercare

    MedlinePlus

    ... make symptoms worse. Avoid activities such as driving, operating heavy machinery, and climbing while you are having ... member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www. ...

  13. Vertigo-associated disorders

    MedlinePlus

    ... you have vertigo due to problems in the brain (central vertigo), you may have other symptoms, including: Difficulty swallowing Double vision Eye movement problems Facial paralysis Slurred speech Weakness of the limbs

  14. Dizziness and Vertigo (Beyond the Basics)

    MedlinePlus

    ... and certain infections can cause problems in the vestibular system. The vestibular system includes parts of the inner ear and ... 1 ). Benign paroxysmal positional vertigo, Meniere disease, and vestibular neuritis are three of the most common types ...

  15. Evaluation of the vertical semicircular canal function by the pendular rotation test: a study on patients with benign paroxysmal positional vertigo.

    PubMed

    Iida, M; Igarashi, M; Naitoh, A; Ishida, K; Endo, K; Nomura, K; Sakai, M

    1997-01-01

    The pendular rotation test (non-damped) in a head-tilted position, 60 degrees backward and then rotated 45 degrees either to the right or left, was performed in 6 patients with benign paroxysmal positional vertigo. The stimulus mode was amplitude = 360 degrees, frequency = 0.1 Hz, and the maximal speed = 114 degrees/s. By this test procedure, it was possible to evaluate the excitability of vertical semicircular canals. Using an infra-red CCD camera and a personal computer system, the evoked nystagmus was analysed. A statistically significant difference (p < 0.05) in the maximal slow-phase eye velocity of vertical nystagmus was found between those from the anterior semicircular canal and those from the posterior semicircular canal. The excitability of the posterior semicircular canal in the affected ear was found to be lower than that of the anterior semicircular canal. PMID:9279865

  16. Dizziness, Vertigo, and Disequilibrium

    MedlinePlus

    ... has a rotational, spinning component, and is the perception of movement, either of the self or surrounding ... to help maintain posture and balance. Vertigo: the perception of movement or whirling - either of the self ...

  17. [Clinical examination of vertigo].

    PubMed

    Topka, Helge Roland

    2016-07-01

    Acute vertigo may originate from peripheral or central vestibular disorders. As central vestibular symptoms may indicate severe brainstem or cerebellar ischemia, rapid clinical differentiation is required. To this end, evaluation of spontaneous or gaze-evoked nystagm, head-impulse test as well identification of skew deviation are most helpful. PMID:27464281

  18. DISCUSSION ON VERTIGO

    PubMed Central

    1929-01-01

    Symptoms revealing a state of consciousness, attributable to incoördination of afferent impulses connected with the vestibular system—disturbances of muscle-sense—vestibular ocular tracks—vestibular-spinal tracks. Different Vertigo-Complexes. Destructive lesions of labyrinth, or of vestibular tracks, partial or complete.—Heterogeneous stimulations of the paired intact vestibular-end organs.—The hypersensitive labyrinth.—Clinical manifestations of vertigo, associated with nausea, headache, visual disturbances, nystagmus, diplopia, staggering gait, vasomotor and cardio-vascular symptoms, pallor, flushing, sweating, dyspnœa, fainting, vomiting and diarrhœa. Objective Examination. The tympanic membrane.—Middle-ear track.—Upper air passages.—Hearing tests.—Oculomotor tests.—Labyrinthine reactions.—Postural, caloric, galvanic tests.—Differentiation between destructive and non-destructive disturbances of labyrinth.—Discrimination between peripheral and central lesions.—Vertigo associated with acute, non-perforative otitis media, with chronic otitis media, with labyrinthine fistula, with otosclerosis, post-suppurative adhesions; with peripheral nerve deafness, gun deafness; with rhinitis, ethmoiditis, sinusitis, nasal polypi, postnasal catarrh and dental infections.—Influence of general health on recurrent vertigo and vice versa.—Other factors. Syphilis, malaria, etc. Principles of Treatment. Seek the cause, which, if peripheral, may be removed by operations on the ear, nose, throat, or even by extraction of dead teeth.—If central, by intracranial surgery, decompression, or by neuropathic medical treatment. Controversial Problems. (1) Medicinal treatment: Iodide, bromides, atropine, quinine. (2) Attention to upper air-passages. (3) Fenestration of tympanic membrane. (4) Possible value of Küster's operation in certain cases. (5) Exploration of the saccus-endolymphaticus. (6) Fenestration of the external semicircular canal. (7

  19. Vertigo and Dizziness in the Elderly

    PubMed Central

    Fernández, Lara; Breinbauer, Hayo A.; Delano, Paul Hinckley

    2015-01-01

    The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years. Balance disorders in the elderly constitute a major public health problem, and require an adequate diagnosis and management by trained physicians. In the elderly, common causes of vertigo may manifest differently, as patients tend to report less rotatory vertigo and more non-specific dizziness and instability than younger patients, making diagnosis more complex. In this mini review, age-related degenerative processes that affect balance are presented. Diagnostic and therapeutic approaches oriented to the specific impaired system, including visual, proprioceptive, and vestibular pathways, are proposed. In addition, presbystasis – the loss of vestibular and balance functions associated with aging – benign paroxysmal positional vertigo, and stroke (in acute syndromes) should always be considered. PMID:26167157

  20. [Vascular vertigo syndromes].

    PubMed

    Dieterich, M

    2002-12-01

    Ischemia,hemorrhages, and other vascular disorders can result in various central or peripheral vestibular syndromes with vertigo, oculomotor/balance disturbances, and nausea. The vascular vertigo syndromes listed in Table 1 can however be brought about by other causes such as demyelitizing focuses in multiple sclerosis or space-occupying lesions, so that not only localization of the damaged structure but also the various etiologies are decisive for the choice of therapy. Occasionally, combined functional disturbances of the peripheral and central vestibular system appear, such as an infarction of the inferior anterior cerebellar artery, which supplies the labyrinth and parts of the brainstem and cerebellum. In rare cases, a central lesion can have the same signs as a peripheral-vertibular disturbance: a lacunar infarct at the root entry zone of the eighth nerve can mimic a unilateral partial loss of labyrinth function as it occurs in vestibular neuritis, thus named "pseudoneuritis". Differential diagnosis between vestibular migraine, vestibular paroxysmia, transient ischemic brainstem attacks, and Meniere's disease is sometimes so difficult that only trial therapies such as prophylaxis with beta blockers, carbamazepine, thrombocyte aggregation inhibitors, antiplatelet drugs, or betahistin can clarify the issue. PMID:12486562

  1. Vertigo and hearing loss.

    PubMed

    Newman-Toker, David E; Della Santina, Charles C; Blitz, Ari M

    2016-01-01

    Symptoms referable to disorders affecting the inner ear and vestibulocochlear nerve (eighth cranial nerve) include dizziness, vertigo, tinnitus, and hearing loss, in various combinations. Similar symptoms may occur with involvement of the central nervous system, principally the brainstem and cerebellum, to which the vestibular and auditory systems are connected. Imaging choices should be tailored to patient symptoms and the clinical context. Computed tomography (CT) should be used primarily to assess bony structures. Magnetic resonance imaging (MRI) should be used primarily to assess soft-tissue structures. Vascular imaging by angiography or venography should be obtained when vascular lesions are suspected. No imaging should be obtained in patients with typical presentations of common peripheral vestibular or auditory disorders. In current clinical practice, neuroimaging is often overused, especially CT in the assessment of acute dizziness and vertigo in the emergency department. Despite low sensitivity for ischemic strokes, CT is often used to rule out neurologic causes. When ischemic stroke is the principal concern in acute vestibular presentations, imaging should almost always be by MRI with diffusion-weighted images, rather than CT. In this chapter, we describe recommended strategies for audiovestibular imaging based on patient symptoms and signs. PMID:27430449

  2. Associations between peripheral vertigo and gastroesophageal reflux disease.

    PubMed

    Viliušytė, Edita; Macaitytė, Raminta; Vaitkus, Antanas; Rastenytė, Daiva

    2015-09-01

    We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered – gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis. PMID:26115947

  3. Alternobaric vertigo in professional divers.

    PubMed

    Molvaer, O I; Albrektsen, G

    1988-07-01

    The present investigation was part of a project performed to detect possible effects of diving on the cochleovestibular system. A group of 194 professional divers were interviewed, examined otologically, and their hearing was tested audiometrically. Caloric vestibular tests were performed in 48 subjects. The interview reviewed age, diving experience, previous ear disease or injury, head trauma, noise exposure during diving and during spare-time activities, eye color, tobacco habits, and the occurrence of vertigo during diving. Useful information regarding vertigo was obtained from 193. Of the 76 (39%) who had experienced vertigo, 64 (33%) were classified as alternobaric vertigo (AV), a type of vertigo caused by asymmetric middle ear pressure. A stepwise multiple logistic regression analysis was performed to detect variables contributing to the presence of AV. Variables having a statistically significant association with AV were previous barotrauma of the ear (P less than 0.05) and noise exposure during diving (less than 0.05). AV was most frequently encountered when diving during a common cold. In this sample of divers, AV did not lead to any serious or critical situations. PMID:3212844

  4. Evaluation and Treatment of the Patient with Vertigo.

    ERIC Educational Resources Information Center

    Glasscock, Michael E. III; Haynes, David S.

    1997-01-01

    The sensation of vertigo is a complex symptom that patients find difficult to describe, and physicians often find evaluating and treating patients with the vertigo a difficult task. This article outlines types and causes of vertigo and the work up, evaluation, and treatment of a patient with vertigo. (Contains references.) (Author/CR)

  5. Vertigo

    MedlinePlus

    ... decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. FreeMD.com is powered by a computer program that performs symptom triage. The goal of ...

  6. Importance of spontaneous nystagmus detection in the differential diagnosis of acute vertigo.

    PubMed

    Pavlin-Premrl, Davor; Waterston, John; McGuigan, Sean; Infeld, Bernard; Sultana, Ron; O'Sullivan, Richard; Gerraty, Richard P

    2015-03-01

    Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. We enrolled consecutive consenting patients arriving at a single emergency department with acute vertigo. There was no declared protocol for the emergency department staff. A standardized history and examination was conducted by the investigators. Observation for spontaneous nystagmus, its response to visual fixation, and testing the vestibulo-ocular reflex with the horizontal head impulse test were the chief examination components. MRI was obtained within 24 hours. Clinical criteria and MRI were used to reach the final diagnosis. The investigators' physical findings and final neurological diagnosis were compared with the initial emergency department examination findings and the referral diagnosis. There were 28 patients, 15 with vestibular neuritis, six with benign paroxysmal positional vertigo, one with stroke, suspected clinically, and three with migraine. In three the diagnosis remained uncertain. Spontaneous nystagmus was seen in all 15 patients with vestibular neuritis, fixation-suppressed in eight of 11 tested for this. The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo. PMID:25537400

  7. Vertigo as a Predominant Manifestation of Neurosarcoidosis

    PubMed Central

    Imran, Tasnim F.; Eyzner, Igor; Mirani, Neena; Hossain, Tanzib; Fede, Robert; Capitle, Eugenio

    2015-01-01

    Sarcoidosis is a granulomatous disease of unknown etiology that affects multiple organ systems. Neurological manifestations of sarcoidosis are less common and can include cranial neuropathies and intracranial lesions. We report the case of a 21-year-old man who presented with vertigo and uveitis. Extensive workup including brain imaging revealed enhancing focal lesions. A lacrimal gland biopsy confirmed the diagnosis of sarcoidosis. The patient was initially treated with prednisone, which did not adequately control his symptoms, and then was switched to methotrexate with moderate symptomatic improvement. Our patient had an atypical presentation with vertigo as the predominant manifestation of sarcoidosis. Patients with neurosarcoidosis typically present with systemic involvement of sarcoidosis followed by neurologic involvement. Vertigo is rarely reported as an initial manifestation. This case highlights the importance of consideration of neurosarcoidosis as an entity even in patients that may not have a typical presentation or systemic involvement of disease. PMID:25922606

  8. La Mettrie's soul: vertigo, fever, massacre, and The Natural History.

    PubMed

    Hacking, Ian

    2009-01-01

    La Mettrie's materialist and monistic philosophy is that of a military doctor, knowing what dysentery did to his own mind, watching his regiment destroyed at Fontenoy, running French field hospitals in Flanders. He learned brain science in the injuries of his fellows. He knew pain and that man's main positive drive was sex. He despised the prudish hypocrisies of feeble materialists like Diderot and Voltaire. His brutal military life and his hedonism made him the most coherent monist against Cartesian dualism. His study of vertigo is sound clinical medicine, which well accords with one trend in today's medical practice. PMID:19831303

  9. Mastication-induced vertigo and nystagmus.

    PubMed

    Park, Seong-Ho; Kim, Hyo-Jung; Kim, Ji-Soo; Koo, Ja-Won; Oh, Seo Won; Kim, Dong-Uk; Kim, Joon-Tae; Welgampola, Miriam; Deriu, Franca

    2014-03-01

    Even though trigeminovestibular connections are well established in animals, mastication-induced dizziness has been described only as a vascular steal phenomenon in humans. We determined induction or modulation of nystagmus in two index patients with mastication-induced vertigo, 12 normal controls, and 52 additional patients with peripheral (n = 38, 26 with vestibular neuritis/labyrinthitis and 12 with Meniere's disease) or central (n = 14, 11 with Wallenberg syndrome, two with cerebellar infarction, and one with pontine infarction) vestibulopathy during their acute or compensated phase. Both index patients developed mastication-induced vertigo after near complete resolution of the spontaneous vertigo from presumed acute unilateral peripheral vestibulopathy. The nystagmus and vertigo gradually built up during mastication and dissipated slowly after cessation of mastication. Brain MRI and cerebral angiography were normal in these patients. Mastication did not induce nystagmus in normal controls. However, mastication induced nystagmus in five (24 %) of the 21 patients without spontaneous nystagmus (SN) but with a previous history of a vestibular syndrome, and either increased (21/31, 68 %) or decreased (7/31, 23 %) the SN in almost all the patients (28/31, 90 %) with SN. Mastication may induce significant vertigo and nystagmus in patients with a prior history of acute vestibulopathy. The induction or modulation of nystagmus by mastication in both peripheral and central vestibulopathies supports trigeminal modulation of the vestibular system in human. The gradual build-up and dissipation suggest a role of the velocity storage mechanism in the generation of mastication-induced vertigo and nystagmus. PMID:24379040

  10. [Cardinal symptom vertigo from the neurologist's perspective].

    PubMed

    Strupp, M; Muth, C; Böttcher, N; Bayer, O; Teufel, J; Feil, K; Bremova, T; Kremmyda, O; Fischer, C S

    2013-09-01

    In most patients with vertigo, the first and clinically most important question posed to neurologists is whether it is a central or a peripheral syndrome. In more than 90 % of cases, this differentiation is made possible by systematically recording the patient history (asking about the type of vertigo, the duration, triggers and accompanying symptoms) and conducting a physical examination. Particularly in the case of acute vertigo disorders, a five-step procedure has proven useful: 1. A cover test to look for vertical divergence (skew deviation) as a central sign and component of the ocular tilt reaction (OTR); 2. Examination with and without Frenzel goggles to differentiate between peripheral vestibular spontaneous nystagmus and central fixation nystagmus; 3. Examination of smooth pursuit; 4. Examination of the gaze-holding function (particularly gaze-evoked nystagmus beating in the opposite direction to spontaneous nystagmus); 5. The head impulse test to look for a deficit in the vestibulo-ocular reflex (VOR). Considerable advances have been made in the pharmacotherapy of vertigo disorders during the last 10 years, including cortisone for the treatment of acute vestibular neuritis, betahistine as a high-dose long-term treatment for Menière's disease, carbamazepine to treat vestibular paroxysmia and aminopyridine for down- and upbeat nystagmus and episodic ataxia type 2. PMID:23979117

  11. Migraine-associated vertigo: diagnosis and treatment.

    PubMed

    Cha, Yoon-Hee

    2010-04-01

    Migraine-associated vertigo has become a well-recognized disease entity diagnosed based on a clinical history of recurrent vertigo attacks unexplained by other central or peripheral otologic abnormalities, which occurs in the patient with a history of migraine headaches. There is no international agreement on what spectrum of symptoms should be covered under this diagnosis, or what terminology should be used. The headaches and vestibular symptoms of migraine-associated vertigo may not be temporally associated, which often obscures the association. Diagnostic tests usually show nonspecific abnormalities that are also seen in patients with migraine who do not experience vestibular symptoms. Management generally follows the recommended treatment of migraine headaches, and includes dietary and lifestyle modifications and medical treatment with beta blockers, calcium channel blockers, and tricyclic amines. Small case series show that acetazolamide and lamotrigine appear to be more effective for the vertigo attacks than headaches. Vestibular rehabilitation has also been shown to be helpful in several studies. In this review, the epidemiologic and clinical features of the disorder, as well as the current state of knowledge on pathophysiology, diagnostic testing, and treatment are described. PMID:20352586

  12. Vertigo in downhill mountain biking and road cycling.

    PubMed

    Lion, Alexis; Vibert, Dominique; Bosser, Gilles; Gauchard, Gérome C; Perrin, Philippe P

    2016-01-01

    Vertigo has been described after the practice of mountain bike. This study aimed to investigate the prevalence of vertigo following competitions or training sessions of downhill mountain biking (DMB) or road cycling (RC). One hundred and two DMB riders, 79 road cyclists and 73 control participants filled in a survey intended to evaluate the prevalence of vertigo in daily living activities and following competitions or training sessions. Vertigo causal factors (crashes, head trauma, fatigue, characteristics of the path/road ridden) were recorded. DMB riders and road cyclists did not report more vertigo during daily living activities than controls. But DMB riders older than 30 had more risk to report vertigo than age-matched road cyclists (OR: 5.06, 95% CI: 1.23-20.62). Road cyclists aged between 20 and 29 were 2.59-fold (95% CI: 1.06-6.27) more likely to report vertigo than controls. After competitions and training sessions, DMB riders were 2.33-fold (95% CI: 1.22-4.41) more likely to report vertigo than road cyclists. Vertigo causal factors were crash with head trauma in DMB riders and fatigue in road cyclists. Vertigo during daily living activities may be of concern for cyclists, particularly older DMB riders. The accumulation of impacts (crashes, vibrations) during the career of a DMB rider may generate micro-traumatisms of the central nervous system and/or peripheral vestibular structures, particularly the otolith organs. In RC, the pathophysiological mechanisms generating vertigo might be effort-related disturbance of homeostasis. To avoid injuries, DMB riders should be aware that vertigo may occur at the end of training sessions or competitions. PMID:25495238

  13. The Neural Correlates of Chronic Symptoms of Vertigo Proneness in Humans

    PubMed Central

    Alsalman, Ola; Ost, Jan; Vanspauwen, Robby; Blaivie, Catherine; De Ridder, Dirk; Vanneste, Sven

    2016-01-01

    Vestibular signals are of significant importance for variable functions including gaze stabilization, spatial perception, navigation, cognition, and bodily self-consciousness. The vestibular network governs functions that might be impaired in patients affected with vestibular dysfunction. It is currently unclear how different brain regions/networks process vestibular information and integrate the information into a unified spatial percept related to somatosensory awareness and whether people with recurrent balance complaints have a neural signature as a trait affecting their development of chronic symptoms of vertigo. Pivotal evidence points to a vestibular-related brain network in humans that is widely distributed in nature. By using resting state source localized electroencephalography in non-vertiginous state, electrophysiological changes in activity and functional connectivity of 23 patients with balance complaints where chronic symptoms of vertigo and dizziness are among the most common reported complaints are analyzed and compared to healthy subjects. The analyses showed increased alpha2 activity within the posterior cingulate cortex and the precuneues/cuneus and reduced beta3 and gamma activity within the pregenual and subgenual anterior cingulate cortex for the subjects with balance complaints. These electrophysiological variations were correlated with reported chronic symptoms of vertigo intensity. A region of interest analysis found reduced functional connectivity for gamma activity within the vestibular cortex, precuneus, frontal eye field, intra-parietal sulcus, orbitofrontal cortex, and the dorsal anterior cingulate cortex. In addition, there was a positive correlation between chronic symptoms of vertigo intensity and increased alpha-gamma nesting in the left frontal eye field. When compared to healthy subjects, there is evidence of electrophysiological changes in the brain of patients with balance complaints even outside chronic symptoms of vertigo

  14. Relationship of the changes of cervical MRI, TCD and BAEP in patients with “isolated” vertigo

    PubMed Central

    Ji, Wenzhen; Zhang, Xueqing

    2014-01-01

    Objective: To study the relationship and changes of cervical MRI, TCD and BAEP in patients with “isolated” vertigo. Methods: The relationship and changes of cervical MRI, TCD and BAEP were investigated respectively in 125 patients with “isolated” vertigo and 100 healthy controls. Results: There were statistically significant differences between two groups for overall abnormalities of TCD (X2 = 61.96, P<0.01), BAEP (X2 = 97.99, P<0.01), and cervical MRI severity scale (Z = -8.71, P<0.01). In vertigo group, results showed significant correlations between TCD and cervical MRI, TCD and BAEP as well. And analysis on TCD PI and some items of BAEP demonstrated positive linear correlations. There were no statistical differences or correlations in control group. Conclusions: TCD is a sensitive method of “isolated” vertigo screening. A combined test protocol of cervical MRI, TCD and BAEP has superiorities to assess “isolated” vertigo. PMID:25197392

  15. Did Vertigo Kill America's Forgotten Astronaut?

    NASA Technical Reports Server (NTRS)

    Bendrick, Gregg A.; Merlin, Peter W.

    2007-01-01

    On November 15, 1967, U.S. Air Force test pilot Major Michael J. Adams was killed while flying the X-15 rocket-propelled research vehicle in a parabolic spaceflight profile. This flight was part of a joint effort with NASA. An electrical short in one of the experiments aboard the vehicle caused electrical transients, resulting in excessive workload by the pilot. At altitude Major Adams inappropriately initiated a flat spin that led to a series of unusual aircraft attitudes upon atmospheric re-entry, ultimately causing structural failure of the airframe. Major Adams was known to experience vertigo (i.e. spatial disorientation) while flying the X-15, but all X-15 pilots most likely experienced vertigo (i.e. somatogravic, or "Pitch-Up", illusion) as a normal physiologic response to the accelerative forces involved. Major Adams probably experienced vertigo to a greater degree than did others, since prior aeromedical testing for astronaut selection at Brooks AFB revealed that he had an unusually high degree of labyrinthine sensitivity. Subsequent analysis reveals that after engine burnout, and through the zenith of the flight profile, he likely experienced the oculoagravic ("Elevator") illusion. Nonetheless, painstaking investigation after the mishap revealed that spatial disorientation (Type II, Recognized) was NOT the cause, but rather, a contributing factor. The cause was in fact the misinterpretation of a dual-use flight instrument (i.e. Loss of Mode Awareness), resulting in confusion between yaw and roll indications, with subsequent flight control input that was inappropriate. Because of the altitude achieved on this flight, Major Adams was awarded Astronaut wings posthumously. Understanding the potential for spatial disorientation, particularly the oculoagravic illusion, associated with parabolic spaceflight profiles, and understanding the importance of maintaining mode awareness in the context of automated cockpit design, are two lessons that have direct

  16. Probable Correlation between Temporomandibular Dysfunction and Vertigo in the Elderly

    PubMed Central

    Marchiori, Luciana Lozza de Moraes; Oltramari-Navarro, Paula Vanessa Pedron; Meneses-Barrivieira, Caroline Luiz; Melo, Juliana Jandre; Macedo, Julya; Bruniera, Juliana Ribeiro Zuculin; Gorres, Vanessa Cristina; Navarro, Ricardo de Lima

    2013-01-01

    Introduction Temporomandibular disorder (TMD) covers a variety of clinical problems, and some epidemiologic studies have tried to indicate mechanisms of interaction and association between vertigo and TMD, but this topic still is controversial. Objective To assess the presence of vertigo in elderly patients associated with TMD. Methods A cross-sectional study was conducted with the inclusion of elderly individuals who lived independently. TMD was assessed by dental evaluation and vertigo was verified by medical history. Statistical analysis was performed using the chi-square and relative risk. Results There was a significant association (p = 0.0256) between the TMD and vertigo (odds ratio = 2.3793). Conclusion These results highlighted the importance of identifying risk factors for vertigo that can be modified through specific interventions, which is essential to prevent future episodes, as well as managing the process of rehabilitation of elderly patients in general. PMID:25992063

  17. True Vertigo Patients in Emergency Department; an Epidemiologic Study

    PubMed Central

    Shahrami, Ali; Norouzi, Mehdi; Kariman, Hamid; Hatamabadi, Hamid Reza; Arhami Dolatabadi, Ali

    2016-01-01

    Introduction: Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient’s quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED). Methods: In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined. Results: 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86) were enrolled (58.13% female). There was no sex difference in vertigo incidence (p = 0.756). A significant correlation existed between older age and increase in frequency of central cases (p < 0.001). No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72). There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist’s final opinion (p < 0.001). In the end, 361 (95.3%) patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported. Conclusion: Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99) and 99 (95% CI: 97-99), respectively PMID:26862546

  18. Jugulotympanic Paraganglioma: A Rare Cause of Vertigo

    PubMed Central

    Jehangir, Asad; Pathak, Ranjan; Shaikh, Bilal; Salman, Ahmed; Fareedy, Shoaib Bilal; Qureshi, Anam; Jehangir, Qasim; Alweis, Richard

    2015-01-01

    Patient: Female, 83 Final Diagnosis: Jugulotympanic paraganglioma Symptoms: Dizziness • tinnitus Medication: — Clinical Procedure: — Specialty: Oncology Objective: Rare disease Background: Jugulotympanic paraganglioma generally presents in the 5th or 6th decades of life with tinnitus and hearing loss. In this manuscript, we present a rare case of jugulotympanic paraganglioma presenting in the 9th decade with vertigo as the most bothersome symptom. Case Report: An 83-year-old woman presented with worsening episodes of dizziness of a few months duration. She also complained of tinnitus and hearing loss, more severe on the left side. Examination revealed a red bulging left-sided tympanic membrane, conductive hearing loss, and a bruit at the base of the skull. Dix-Hallpike test was negative. CT head and MRI brain revealed findings consistent with a large left-sided jugulotympanic paraganglioma, which was found to be hormonally inactive on laboratory tests. The patient underwent treatment with radiotherapy, which resulted in partial improvement of symptoms. Conclusions: Jugulotympanic paraganglioma may manifest in the elderly with the chief complaint of intermittent vertigo, as in our case. A red bulging mass on otoscopy raises the suspicion, necessitating further investigations, including CT and MRI. PMID:25889842

  19. Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery

    PubMed Central

    Parthasarathy, Rajsrinivas; Derksen, Carol; Saqqur, Maher; Khan, Khurshid

    2016-01-01

    Embryonic carotid – basilar anastomosis when persistent in adult life can present with a variety of neurological symptoms. We present a patient with isolated intermittent vertigo attributable to the embryonic anastomosis and describe the different types of persistent trigeminal artery. A 76-year-old Caucasian man presented with isolated intermittent vertigo and symptoms suggestive of anterior and posterior circulation strokes. Impaired vasomotor reactivity was demonstrated on insonation of the anterior and posterior cerebral arteries in this patient with a persistent left trigeminal artery and 75% stenosis of the left internal carotid artery (ICA). The symptom of intermittent vertigo resolved with carotid endarterectomy. Decreased flow across the stenotic segment of the ICA which subserved the posterior circulation resulted in basilar insufficiency. Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is a likely cause for the intermittent vertigo. PMID:26933370

  20. Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery.

    PubMed

    Parthasarathy, Rajsrinivas; Derksen, Carol; Saqqur, Maher; Khan, Khurshid

    2016-01-01

    Embryonic carotid - basilar anastomosis when persistent in adult life can present with a variety of neurological symptoms. We present a patient with isolated intermittent vertigo attributable to the embryonic anastomosis and describe the different types of persistent trigeminal artery. A 76-year-old Caucasian man presented with isolated intermittent vertigo and symptoms suggestive of anterior and posterior circulation strokes. Impaired vasomotor reactivity was demonstrated on insonation of the anterior and posterior cerebral arteries in this patient with a persistent left trigeminal artery and 75% stenosis of the left internal carotid artery (ICA). The symptom of intermittent vertigo resolved with carotid endarterectomy. Decreased flow across the stenotic segment of the ICA which subserved the posterior circulation resulted in basilar insufficiency. Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is a likely cause for the intermittent vertigo. PMID:26933370

  1. The efficacy of Arlevert therapy for vertigo and tinnitus.

    PubMed

    Novotný, M; Kostrica, R; Círek, Z

    1999-01-01

    We were interested in determining the efficacy of Arlevert therapy in vertigo and tinnitus patients, especially as it compared to the efficacy of the drug's two component agents, dimenhydrinate and cinnarizine. We conducted a comparative, randomized, double blind, multicenter, parallel group study involving a group of patients (n = 122) with vertigo and tinnitus of peripheral or central origin. The three test groups, nearly equal in size, were administered three times daily for 4 weeks one of the three agents being evaluated. To evaluate therapeutic success, we studied patients' vertigo symptoms, concomitant vegetative symptoms, CCG parameters, and electronystagmographic and audiometric parameters. We also obtained subjective assessments of outcomes from the test patients. Our results led us to conclude that Arlevert is more effective than either of its component drugs alone in treating vertigo and tinnitus. The drug also was well tolerated. PMID:10753423

  2. Some Considerations of Vertigo based on Experience

    PubMed Central

    Müller, Isidore

    1928-01-01

    Our only direct intimation of the existence of space is the sensation of vertigo, when through our cortical centres we become conscious of the fact that we are surrounded by a “blank” space in which motion is apparent, i.e., the relative condition of our body to the things around us seems to be altered. A precise account of the “nerve-cycle” and of its exact relation to the sympathic and parasympathic—in a word, to the autonomous vegetative—system and to the endocrine system, is at present impossible. We have known since the time of the classic investigations of Flourens, Breuer, Mach, Crum Brown, and their followers—especially Sherrington—that the nature of these things is highly complicated. Simple mechanical theories are useless, even for teaching purposes, as they are more or less fictitious and often incomplete. The path of nervous action is through the ear, cerebellum, brain stem, cerebrum, medulla oblongata, spinal cord, and autonomous nervous system, to the different parts of the periphery, and there are also mutual connexions with the endocrine glands. Mention is made of the influence of constitution (i.e., inheritance, “the natural endowment”), and also of the conditional disposition, temper, training, in a word all external and internal stimuli. Again, the various reflexes, the numerous aggregations of ganglia, indicating a certain autonomy of function, constitute a great problem for future clinical observation. The mechanism of adaptation and compensation by which extensive injury may sometimes be counterbalanced, also enters into the question, as do the varying collateral paths, the synergetic action of different and sometimes very distant organs and so forth. Again, we have to think of the ratio of irritability and fatiguability, a significant factor in causation. Syphilis, arthritis, alcoholism, nicotine-poisoning, anæmia, leukæmia, tumours, and—especially—catarrh, are most important causes. PMID:19986527

  3. Wallenberg Syndrome: An Exceptional Cause of Acute Vertigo in Children.

    PubMed

    Ehresmann, Aude Ménétrey; Van, Hélène Cao; Merlini, Laura; Fluss, Joel

    2016-01-01

    The assessment of acute vertigo in childhood is often challenging, but fortunately a central cause is rarely identified. We present the case of a 7-year-old boy who developed, after a mild head trauma, a rotary vertigo associated with nausea and vomiting. A posttraumatic peripheral vestibular dysfunction was first suspected but not confirmed by an otoneurological evaluation. When subtle neurological signs were elicited, a brain magnetic resonance imaging was promptly requested. This showed a small infarct on the lateral posterior left part of the medulla oblongata of the brainstem, typical of Wallenberg syndrome. Vascular imaging was normal and no defined etiology was found. The child was started on prophylactic acetylsalicylic acid. The rapid disappearance of vertigo was noted. On follow-up at 6 months, there has been no recurrence and neurological examination was fully normal. Our case extends the differential diagnosis of acute vertigo in childhood that rarely includes the possibility of a brainstem infarct whose recognition through appropriate clinical examination is nevertheless capital for appropriate investigations and management. PMID:26569158

  4. Clinical and electrographic findings in epileptic vertigo and dizziness

    PubMed Central

    Lee, Seung-Han; Robinson, Karen A.; Kaplan, Peter W.; Newman-Toker, David E.

    2015-01-01

    Objective: Seizures can cause vestibular symptoms, even without obvious epileptic features. We sought to characterize epileptic vertigo or dizziness (EVD) to improve differentiation from nonepileptic causes, particularly when vestibular symptoms are the sole manifestation. Methods: We conducted a systematic review with electronic (Medline) and manual search for English-language studies (1955–2014). Two independent reviewers selected studies. Study/patient characteristics were abstracted. We defined 3 study population types: (1) seizures, some experiencing vertigo/dizziness (disease cohort); (2) vertigo/dizziness, some due to seizures (symptom cohort); (3) vertigo/dizziness due to seizures in all patients (EVD-only cohort). Results: We identified 84 studies describing 11,354 patients (disease cohort = 8,129; symptom cohort = 2,965; EVD-only cohort = 260). Among 1,055 EVD patients in whom a distinction could be made, non-isolated EVD was present in 8.5%, isolated EVD in 0.8%. Thorough diagnostic workups (ictal EEG, vestibular testing, and brain MRI to exclude other causes) were rare (<0.1%). Ictal EEG was reported in 487 (4.3%), formal neuro-otologic assessment in 1,107 (9.7%). Localized EEG abnormalities (n = 350) were most frequently temporal (79.8%) and uncommonly parietal (11.8%). Duration of episodic vestibular symptoms varied, but was very brief (<30 seconds) in 69.6% of isolated EVD and 6.9% of non-isolated EVD. Conclusions: Non-isolated EVD is much more prevalent than isolated EVD, which appears to be rare. Diagnostic evaluations for EVD are often incomplete. EVD is primarily associated with temporal lobe seizures; whether this reflects greater epidemiologic prevalence of temporal lobe seizures or a tighter association with dizziness/vertigo presentations than with other brain regions remains unknown. Consistent with clinical wisdom, isolated EVD spells often last just seconds, although many patients experience longer spells. PMID:25795644

  5. [The specific clinical features of acute sensorineural loss of hearing associated with vertigo].

    PubMed

    Pal'chun, V T; Guseva, A L; Levina, Yu V; Chistov, S D

    2016-01-01

    The objective of the present study was to estimate the prevalence of vertigo and to determine the type of the lesion of the vestibular analyzer in the patients presenting with acute sensorineural loss of hearing (ASNLH). The secondary objective was to evaluate the possibility of the restoration of the auditory thresholds. The results of the examination and treatment of 94 patients suffering from ASNLH are presented. It was shown that the development of acute sensorineural loss of hearing was accompanied by unilateral peripheral vestibulopathy in 22.3% of the patients. In 5.3% of these cases, dizziness could be attributed to benign paroxysmal positional vertigo and canalolythias is of the posterior semicircular canal on the side of hearing impairment. It is concluded that the presence of the clinical signs of lesions of the vestibular analyzer and peripheral vestibular dysfunction in the form of latent spontaneous nystagmus without gaze fixation and/or asymmetric nystagmus with unilateral weakness in the caloric test is a negative prognostic factor for the restoration of the auditory thresholds in the patients presenting with acute sensorineural loss of hearing. PMID:26977560

  6. Dizziness Handicap Inventory and Visual Vertigo Analog Scale in Vestibular Dysfunction

    PubMed Central

    Grigol, Thaís Alvares de Abreu e Silva; Silva, Adriana Marques; Ferreira, Maristela Mian; Manso, Andrea; Ganança, Maurício Malavasi; Caovilla, Heloisa Helena

    2015-01-01

    Introduction  Dizziness is one of the most common symptoms among the population, producing numerous consequences for individual's quality of life. There are some questionnaires that can trace the patient's profile and quality of life impairment from dizziness, including the Dizziness Handicap Inventory (DHI) and the Visual Vertigo Analogue Scale (VVAS). Objective  This study aims to correlate the results of the DHI and VVAS in patients with vestibular dysfunction. Methods  This is a retrospective study of medical records of patients treated in a medical school between 2006 and 2012. Results of the DHI and EVA were collected and subjected to statistical analysis using Pearson's correlation test with p < 0.001. The significance level adopted for the statistical tests was p ≤ 0.05. Results  A total of 91 records were included in this study, 72 (79.1%) from female and 19 (20.9%) from male patients, aged 23 to 86 years, with a mean age of 52.5 years. The mean score on the DHI total was 43.9 and 5.2 points for the EVA. The result of Pearson's correlation test was 0.54. Conclusion  Self-perceived dizziness measured with the Dizziness Handicap Inventory has a regular and positive correlation with the Visual Vertigo Analog Scale in patients with vestibular dysfunction. The clinical trial is registered under number UTN U1111–1170–5065. PMID:27413406

  7. Persistent vertigo and dizziness after mild traumatic brain injury.

    PubMed

    Fife, Terry D; Kalra, Deepak

    2015-04-01

    Vertigo, dizziness, and disequilibrium are common symptoms following concussion or mild traumatic brain injury (mTBI). Dizziness and vertigo may be the result of trauma to the peripheral vestibular system or the central nervous system, or, in some cases, may be due to anxiety, depression, or posttraumatic stress disorder; these mechanisms are not mutually exclusive. While most peripheral vestibular disorders can be identified by testing and examination, those without inner-ear causes that have persisting complaints of dizziness and motion sickness are more difficult to understand and to manage. Some of these patients exhibit features compatible with vestibular migraine and may be treated successfully with migraine-preventative medications. This paper reviews the nonotogenic causes of persisting dizziness, the possible mechanisms, and the pathophysiology, as a framework for patient management and for future research. PMID:25728715

  8. On the Vertigo Due to Static Magnetic Fields

    PubMed Central

    Mian, Omar S.; Li, Yan; Antunes, Andre; Glover, Paul M.; Day, Brian L.

    2013-01-01

    Vertigo is sometimes experienced in and around MRI scanners. Mechanisms involving stimulation of the vestibular system by movement in magnetic fields or magnetic field spatial gradients have been proposed. However, it was recently shown that vestibular-dependent ocular nystagmus is evoked when stationary in homogenous static magnetic fields. The proposed mechanism involves Lorentz forces acting on endolymph to deflect semicircular canal (SCC) cupulae. To investigate whether vertigo arises from a similar mechanism we recorded qualitative and quantitative aspects of vertigo and 2D eye movements from supine healthy adults (n = 25) deprived of vision while pushed into the 7T static field of an MRI scanner. Exposures were variable and included up to 135s stationary at 7T. Nystagmus was mainly horizontal, persisted during long-exposures with partial decline, and reversed upon withdrawal. The dominant vertiginous perception with the head facing up was rotation in the horizontal plane (85% incidence) with a consistent direction across participants. With the head turned 90 degrees in yaw the perception did not transform into equivalent vertical plane rotation, indicating a context-dependency of the perception. During long exposures, illusory rotation lasted on average 50 s, including 42 s whilst stationary at 7T. Upon withdrawal, perception re-emerged and reversed, lasting on average 30 s. Onset fields for nystagmus and perception were significantly correlated (p<.05). Although perception did not persist as long as nystagmus, this is a known feature of continuous SSC stimulation. These observations, and others in the paper, are compatible with magnetic-field evoked-vertigo and nystagmus sharing a common mechanism. With this interpretation, response decay and reversal upon withdrawal from the field, are due to adaptation to continuous vestibular input. Although the study does not entirely exclude the possibility of mechanisms involving transient vestibular stimulation

  9. Differential diagnosis of vertigo--combined galvanic test and MRI.

    PubMed

    Sekitani, T

    1988-01-01

    Differential diagnosis of the disease entities of vertigo are important in clinical investigations. Many concepts and procedures have been proposed for available diagnostic tests. Recent basic and clinical studies proved the efficacy and reliability of galvanic tests, including galvanic nystagmus test (GNT) and galvanic body sway test (GBST), emphasizing that the effects of galvanization are: 1) on the action potential in vestibular nerve and 2) on the resting discharge of the vestibular nerve. These suggest further that galvanic nystagmus reaction (GNT) is mainly a manifested reaction of the semicircular canal system, while galvanic body sway such as spinal reflexes (includ. GBST) are mainly a reaction of the otolithic system. The purpose of this paper is to review briefly the previous results of GBST in our laboratory; and to introduce a newly devised combined galvanic test, simultaneous recording of both GBST and GNT; and also introduce magnetic resonance imaging (MRI) of the brain including the cerebrum, cerebellum with brainstem relating the central vestibular system, both of which help us to make a more defined diagnosis of the central origin vertigo. On CGT of a normal subject, galvanic eye movements are constantly induced showing the initial eye deviation and the following main deviation during galvanization, on both eyes, which are almost similar and occur synchronously. Galvanic body sway is also induced well with individual components, as described in the previous papers. CGT of the cases with vertigo revealed abnormal response patterns in each disease. PMID:3245417

  10. Betahistine treatment in managing vertigo and improving vestibular compensation: clarification.

    PubMed

    Lacour, Michel

    2013-01-01

    Betahistine dihydrochloride (betahistine) is currently used in the management of vertigo and vestibular pathologies with different aetiologies. The main goal of this review is to clarify the mechanisms of action of this drug, responsible for the symptomatic relief of vertigo and the improvement of vestibular compensation. The review starts with a brief summary recalling the role of histamine as a neuromodulator/neurotransmitter in the control of the vestibular functions, and the role of the histaminergic system in vestibular compensation. Then are presented data recorded in animal models demonstrating that betahistine efficacy can be explained by mechanisms targeting the histamine receptors (HRs) at three different levels: the vascular tree, with an increase of cochlear and vestibular blood flow involving the H1R; the central nervous system, with an increase of histamine turnover implicating the H3R, and the peripheral labyrinth, with a decrease of vestibular input implying the H3R/H4R. Clinical data from vestibular loss patients show the impact of betahistine treatment for the long-term control of vertigo, improvement of balance and quality of life that can be explained by these mechanisms of action. However, two conditions, at least, are required for reaching the betahistine therapeutic effect: the dose and the duration of treatment. Experimental and clinical data supporting these requirements are exposed in the last part of this review. PMID:24177346

  11. Vertigo in virtual reality with haptics: case report.

    PubMed

    Viirre, Erik; Ellisman, Mark

    2003-08-01

    A researcher was working with a desktop virtual environment system. The system was displaying vector fields of a cyclonic weather system, and the system incorporated a haptic display of the forces in the cyclonic field. As the subject viewed the rotating cyclone field, they would move a handle "through" the representation of the moving winds and "feel" the forces buffeting the handle as it moved. Stopping after using the system for about 10 min, the user experienced an immediate sensation of postural instability for several minutes. Several hours later, there was the onset of vertigo with head turns. This vertigo lasted several hours and was accompanied with nausea and motion illusions that exacerbated by head movements. Symptoms persisted mildly the next day and were still present the third and fourth day, but by then were only provoked by head movements. There were no accompanying symptoms or history to suggest an inner ear disorder. Physical examination of inner ear and associated neurologic function was normal. No other users of this system have reported similar symptoms. This case suggests that some individuals may be susceptible to the interaction of displays with motion and movement forces and as a result experience motion illusions. Operators of such systems should be aware of this potential and minimize exposure if vertigo occurs. PMID:14511456

  12. Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo.

    PubMed

    Kim, Hyun-Ah; Yi, Hyon-Ah; Lee, Hyung

    2015-11-01

    Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be the most common symptom of OH. However, recent studies have demonstrated that 30-39 % of patients with OH experienced rotatory vertigo during upright posture (i.e., orthostatic vertigo, OV), which challenges the dogma that OH induces dizziness and not vertigo. A recent population-based study on spontaneously occurring OD across a wide age range showed that the one-year and lifetime prevalence of OD was 10.9 and 12.5 %, respectively. Approximately 83 % of patients with OD had at least one abnormal autonomic function test result. So far, 11 subtypes of OD have been proposed according to the pattern of autonomic dysfunction, and generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions was the most common type. Four different patterns of OH, such as classic, delayed, early, and transient type have been found in patients with OD. The head-up tilt test and Valsalva maneuver should be performed for a comprehensive evaluation of sympathetic adrenergic failure in patients with OD/OV. This review summarizes current advances in OH presenting OD/OV, with a particular focus on the autonomic dysfunction associated with OD. PMID:26292788

  13. Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease.

    PubMed

    Seemungal, Barry; Kaski, Diego; Lopez-Escamez, Jose Antonio

    2015-08-01

    Vestibular migraine is the most common cause of acute episodic vestibular symptoms after benign paroxysmal positional vertigo. In contrast, Ménière's disease is an uncommon disorder. For both conditions, early and accurate diagnosis (or its exclusion) enables the correct management of patients with acute episodic vestibular symptoms. Long-term management of migraine requires changes in lifestyle to avoid triggers of migraine and/or prophylactic drugs if attacks become too frequent. The long-term management of Ménière's disease also involves lifestyle changes (low salt diet), medications (betahistine, steroids), and ablative therapy applied to the diseased ear (eg, intratympanic gentamicin). PMID:26231275

  14. Cervicogenic vertigo treated by c1 transverse foramen decompression : a case report.

    PubMed

    Park, Junhee; Lee, Chulkyu; You, Namkyu; Kim, Sanghyun; Cho, Kihong

    2014-09-01

    Cervicogenic vertigo was known as Bow hunter's syndrome. Occlusion of vertebral artery causes vertebrobasilar insufficiency and we reported cervicogenic vertigo case which was treated by simple decompression of transverse foramen of C1. The patient was 48 years old female who had left side dominant vertebral artery and vertigo was provoked when she rotated her head to right side. Angiography showed complete obliteration of blood flow of left vertebral artery when her head was rotated to right side. The operation was decompression of left vertebral artery at C1 level. Posterior wall of transverse foramen was resected and vertebral artery was exposed and decompressed. After surgery, vertigo of the patient was disappeared, and angiography showed patent left vertebral artery when her head was rotated to right side. Vertigo caused by compression of cervical vertebral artery could be treated by decompression without fusion or instrumentation, especially in C1 transverse foramen. PMID:25346772

  15. The RAVE/VERTIGO vertex reconstruction toolkit and framework

    NASA Astrophysics Data System (ADS)

    Waltenberger, W.; Mitaroff, W.; Moser, F.; Pflugfelder, B.; Riedel, H. V.

    2008-07-01

    A detector-independent toolkit for vertex reconstruction (RAVE1) is being developed, along with a standalone framework (VERTIGO2) for testing, analyzing and debugging. The core algorithms represent state-of-the-art for geometric vertex finding and fitting by both linear (Kalman filter) and robust estimation methods. Main design goals are ease of use, flexibility for embedding into existing software frameworks, extensibility, and openness. The implementation is based on modern object-oriented techniques, is coded in C++ with interfaces for Java and Python, and follows an open-source approach. A beta release is available.

  16. Is Vestibular Neuritis an Immune Related Vestibular Neuropathy Inducing Vertigo?

    PubMed Central

    Greco, A.; Macri, G. F.; Gallo, A.; Fusconi, M.; De Virgilio, A.; Pagliuca, G.; Marinelli, C.; de Vincentiis, M.

    2014-01-01

    Objectives. To review the current knowledge of the aetiology of vestibular neuritis including viral infections, vascular occlusion, and immunomediated mechanisms and to discuss the pathogenesis with relevance to pharmacotherapy. Systematic Review Methodology. Relevant publications on the aetiology and treatment of vestibular neuritis from 1909 to 2013 were analysed. Results and Conclusions. Vestibular neuritis is the second most common cause of peripheral vestibular vertigo and is due to a sudden unilateral loss of vestibular function. Vestibular neuronitis is a disorder thought to represent the vestibular-nerve equivalent of sudden sensorineural hearing loss. Histopathological studies of patients who died from unrelated clinical problems have demonstrated degeneration of the superior vestibular nerve. The characteristic signs and symptoms include sudden and prolonged vertigo, the absence of auditory symptoms, and the absence of other neurological symptoms. The aetiology and pathogenesis of the condition remain unknown. Proposed theories of causation include viral infections, vascular occlusion, and immunomediated mechanisms. The management of vestibular neuritis involves symptomatic treatment with antivertiginous drugs, causal treatment with corticosteroids, and physical therapy. Antiviral agents did not improve the outcomes. PMID:24741601

  17. Consumer Demand for Online Dizziness Information: If You Build it, They may Come

    PubMed Central

    Kerber, Kevin A.; Skolarus, Lesli E.; Callaghan, Brian C.; Zheng, Kai; Zhang, Yuhao; An, Lawrence C.; Burke, James F.

    2014-01-01

    Objective: Dizziness is a common reason patients present to doctors, but effective diagnostic tests and treatments for dizziness are underused. The internet is a way to disseminate medical information and is emerging as an intervention platform. The objective of this study was to describe internet searches for dizziness terms to assess the possible consumer demand for internet-based dizziness diagnostic and treatment tools. Study Design/Methods: Google AdWords and Google Insights for Search were used for keyword search data on the following generic terms: vertigo, dizzy, dizziness, lightheaded, and lightheadedness. Data collected included keyword ideas (i.e., additional keywords identified by Google as being related search terms), global and US only monthly search frequencies, as well as trends in top searches related to dizziness terms from 2004 to 2012. Keywords suggestive of benign paroxysmal positional vertigo (BPPV) or BPPV processes were identified. Results: Of the five generic dizziness terms, vertigo had the most global searches per month (1.83 million) and lightheadedness had the least (90,500). Four BPPV-specific terms had more than 100,000 global searches per month. Three BPPV terms (“positional vertigo,” “benign vertigo,” and “benign positional vertigo”) have been in the list of top searches related to vertigo every quarter since 2004. Conclusion: Substantial demand exists for dizziness information via the internet. Future studies should seek to better characterize the population seeking this information. The magnitude of this potential demand suggests that validated and tested diagnostic and treatment tools could contribute to healthcare efficiencies and patient outcomes. PMID:24795690

  18. Positioning.

    ERIC Educational Resources Information Center

    Conone, Ruth M.

    The key to positioning is the creation of a clear benefit image in the consumer's mind. One positioning strategy is creating in the prospect's mind a position that takes into consideration the company's or agency's strengths and weaknesses as well as those of its competitors. Another strategy is to gain entry into a position ladder owned by…

  19. Acute vertigo in an anesthesia provider during exposure to a 3T MRI scanner

    PubMed Central

    Gorlin, Andrew; Hoxworth, Joseph M; Pavlicek, William; Thunberg, Christopher A; Seamans, David

    2015-01-01

    Vertigo induced by exposure to the magnetic field of a magnetic resonance imaging (MRI) scanner is a well-known phenomenon within the radiology community but is not widely appreciated by other clinical specialists. Here, we describe a case of an anesthetist experiencing acute vertigo while providing sedation to a patient undergoing a 3 Tesla MRI scan. After discussing previous reports, and the evidence surrounding MRI-induced vertigo, we review potential etiologies that include the effects of both static and time-varying magnetic fields on the vestibular apparatus. We conclude our review by discussing the occupational standards that exist for MRI exposure and methods to minimize the risks of MRI-induced vertigo for clinicians working in the MRI environment. PMID:25792858

  20. Vestibular Migraine (a.k.a.Migraine Associated Vertigo or [MAV])

    MedlinePlus

    ... is a Top Rated Nonprofit! Volunteer. Donate. Review. Vestibular Migraine (a.k.a. Migraine Associated Vertigo or ... Wackym on his You Tube Channel. Migraine and vestibular dysfunction Approximately 40% of migraine patients have some ...

  1. The clinical efficacy of Vertigoheel in the treatment of vertigo of various etiology.

    PubMed

    Morawiec-Bajda, A; Lukomski, M; Latkowski, B

    1993-06-01

    In this paper the authors describe the clinical efficacy in treatment of vertigo of various etiology. A group of 31 patients were treated with Vertigoheel medication: 14 patients suffered from vertebrobasilar arterial insufficiency, 8 patients were diagnosed as Meniere's disease, 5 patients complained of vertigo of traumatic origin and 4 patients suffered from neuronitis vestibularis. The authors found regression of clinical symptoms in the majority of cases in the investigated group who were treated with Vertigoheel. PMID:8414621

  2. DIZZYNET-a European network initiative for vertigo and balance research: visions and aims.

    PubMed

    Zwergal, Andreas; Brandt, Thomas; Magnusson, Mans; Kennard, Christopher

    2016-04-01

    Vertigo is one of the most common complaints in medicine. Despite its high prevalence, patients with vertigo often receive either inappropriate or inadequate treatment. The most important reasons for this deplorable situation are insufficient interdisciplinary cooperation, nonexistent standards in diagnostics and therapy, the relatively rare translations of basic science findings to clinical applications, and the scarcity of prospective controlled multicenter clinical trials. To overcome these problems, the German Center for Vertigo and Balance Disorders (DSGZ) started an initiative to establish a European Network for Vertigo and Balance Research called DIZZYNET. The central aim is to create a platform for collaboration and exchange among scientists, physicians, technicians, and physiotherapists in the fields of basic and translational research, clinical management, clinical trials, rehabilitation, and epidemiology. The network will also promote public awareness and help establish educational standards in the field. The DIZZYNET has the following objectives as regards structure and content: to focus on multidisciplinary translational research in vertigo and balance disorders, to develop interdisciplinary longitudinal and transversal networks for patient care by standardizing and personalizing the management of patients, to increase methodological competence by implementing common standards of practice and quality management, to internationalize the infrastructure for prospective multicenter clinical trials, to increase recruitment capacity for clinical trials, to create a common data base for patients with vertigo and balance disorders, to offer and promote attractive educational and career paths in a network of cooperating institutions. In the long term, the DIZZYNET should serve as an internationally visible network for interdisciplinary and multiprofessional research on vertigo and balance disorders. It ideally should equally attract the afflicted patients and

  3. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study.

    PubMed

    Obermann, Mark; Bock, Eva; Sabev, Nikolay; Lehmann, Nils; Weber, Ralph; Gerwig, Marcus; Frings, Markus; Arweiler-Harbeck, Diana; Lang, Stephan; Diener, Hans-Christoph

    2015-09-01

    To investigate the long-term outcome of interdisciplinary treatment in a tertiary care neuro-otology institution after 2 years as part of the Dizziness and Vertigo Registry study. Risk factors associated with unfavourable outcome were assessed. 3113 consecutive patients with disorders of vertigo and dizziness were recruited prospectively between March 2010 and February 2012. Patients were clinically assessed and treated according to their diagnosis. Standardized instruments were used at baseline and at 2-year follow-up [Dizziness Handicap Inventory (DHI), Quality of Life Questionnaire, General Depression Scale, Stait-Trait Anxiety Index], as well as a custom health-related questionnaire. The primary outcome variable of this observational study was the change in DHI after 2 years. Patients suffered from phobic postural vertigo (23%), benign peripheral paroxysmal vertigo (14.4%), unilateral vestibulopathy (10.5%), central vestibular disorders (8%), Menière's disease (9.8%), vestibular migraine (6.9%), bilateral vestibulopathy (5.5%), and vestibular paroxysmia (3.1%). Mean disease duration was 4.6 ± 6.3 years. 1272 patients were available for follow-up, 1159 completed the DHI score. 72.1% of patients improved in DHI score from baseline to 2 years follow-up. Mean reduction in DHI score was 14 points (p = 0.02). Long-term outcome following diagnosis and treatment in a specialized tertiary care centre is good and persistent after 2 years. Risk factors for an unfavourable outcome were advanced age, severe disability, constant vertigo or dizziness, and concomitant back pain, while depression and anxiety did not contribute to this risk considerably. PMID:26092518

  4. Flunarizine in the prophylaxis of migrainous vertigo: a randomized controlled trial.

    PubMed

    Lepcha, Anjali; Amalanathan, Sophia; Augustine, Ann Mary; Tyagi, Amit Kumar; Balraj, Achamma

    2014-11-01

    Migrainous vertigo is a common cause of dizziness presenting to an otorhinolaryngology/otoneurology clinic. Although it causes a substantial burden to the individual and society there are no randomized controlled trails on prophylactic medication for this condition. Flunarizine, a calcium channel blocker has been used effectively in both migraine and vestibular conditions. This randomized control trial was undertaken in a tertiary academic referral center to evaluate the efficacy of flunarizine in patients with migrainous vertigo when compared to non-specific vestibular treatment of betahistine and vestibular exercises. The effect of flunarizine on two particularly disabling symptoms of vertigo and headache was studied. A total of 48 patients who were diagnosed with definitive migrainous vertigo completed the study of 12 weeks duration. Patients in arm A received 10-mg flunarizine daily along with betahistine 16 mg and paracetamol 1 gm during episodes, and arm B received only betahistine and paracetamol during episodes. Symptom scores were noted at the start of the study and at the end of 12 weeks. Analysis of the frequency of vertiginous episodes showed a significant difference between arm A and arm B (p = 0.010) and improvement in severity of vertigo between the two groups (p = 0.046). Headache frequency and severity did not improve to a significant degree in arm A as compared to arm B. The main side effects were weight gain and somnolence and this was not significantly different between the two groups. Flunarizine (10 mg) is effective in patients with migrainous vertigo who suffer from considerable vestibular symptoms. PMID:24166742

  5. [Characteristics and drug analysis associated with vertigo disease in real world].

    PubMed

    Xie, Qian; Li, Yuan-Yuan; Xie, Yan-Ming; Yang, Wei; Zhao, Wei; Zhuang, Yan; Wang, Yong-Yan

    2014-09-01

    To explore the characteristics and influenced factors associated with the onset of vertigo disease, analysis of 3 719 cases of hospitalized patients with vertigo disease from the real world. Analysis the date of patients diagnosed with vertigo disease from the hospital information system of 19 grade-III class-A hospital from 2004 to 2011, include general information, the doctor's advice, other diseases combined, diagnostic information and the relationship with the onset of 24 solar terms, and the treatment drugs. The median age of hospitalized patients with vertigo disease was 59, the number of women (65.91%) was more than men (34.09%), manual workers (85.32%) were the majority career, most patients (81.63%) condition were general by the time they were hospital admission, patients more like admitted to neurologist (70.34%) when they first time to outpatient serves, hospitalization days were in 8-14 days (46.65%), 46.04% of the patients in the hospital total cost is in 5 000 RMB to 10 000 RMB, 73.86% of patients paid by National Health Medical Insurance. Hypertension (20.79%) was the most common underlying health problems, The most common syndromes was deficiency of liver-Yin and kidney-Yin(44. 21%) , followed by hyperactivity of liver-yang, disease of phlegm turbidity in mongolia and deficiency of Qi and blood. There were more deficiency syndrome and less excess syndrome. The highest rate of hospital admission solar terms in 2009 was the insects awaken throttle (5.21%), In 2010, the highest rate solar terms of hospital admission was the rain throttle (6.14%). The most frequently used traditional Chinese medicine was gastrodine injection (20.55%), the most frequently used western medicine for betahistine (10.19%), gastrodine injection was the most traditional Chinese medicine that combination with other western medicine. Hypertension was the most underlying health problems in the patients with vertigo disease in the real world, although the mental factors should

  6. The rationale and technique of head exercises in the treatment of vertigo.

    PubMed

    Dix, M R

    1979-01-01

    The central compensation mechanisms for vertigo resulting from vestibular lesions are described together with the scientific basis for head exercises in vestibular rehabilitation. The indications and contra-indications for head exercises are discussed and the Cawthorne-Cooksey regime of exercises illustrated. PMID:314722

  7. The methodology of Dynamic Uncertain Causality Graph for intelligent diagnosis of vertigo.

    PubMed

    Dong, Chunling; Wang, Yanjun; Zhang, Qin; Wang, Ningyu

    2014-01-01

    Vertigo is a common complaint with many potential causes involving otology, neurology and general medicine, and it is fairly difficult to distinguish the vertiginous disorders from each other accurately even for experienced physicians. Based on comprehensive investigations to relevant characteristics of vertigo, we propose a diagnostic modeling and reasoning methodology using Dynamic Uncertain Causality Graph. The symptoms, signs, findings of examinations, medical histories, etiology and pathogenesis, and so on, are incorporated in the diagnostic model. A modularized modeling scheme is presented to reduce the difficulty in model construction, providing multiple perspectives and arbitrary granularity for disease causality representations. We resort to the "chaining" inference algorithm and weighted logic operation mechanism, which guarantee the exactness and efficiency of diagnostic reasoning under situations of incomplete and uncertain information. Moreover, the causal insights into underlying interactions among diseases and symptoms intuitively demonstrate the reasoning process in a graphical manner. These solutions make the conclusions and advices more explicable and convincing, further increasing the objectivity of clinical decision-making. Verification experiments and empirical evaluations are performed with clinical vertigo cases. The results reveal that, even with incomplete observations, this methodology achieves encouraging diagnostic accuracy and effectiveness. This study provides a promising assistance tool for physicians in diagnosis of vertigo. PMID:24176413

  8. [Characteristics of acupoint selection of acupuncture-moxibustion for vertigo in history: a data mining research].

    PubMed

    Li, Xiang; Shou, Yi-Xia; Ren, Yu-Lan; Liang, Fan-Rong

    2014-05-01

    The data mining technique is adopted to analyze characteristics and rules of acupoint and meridian selection of acupuncture-moxibustion for treatment of vertigo at different time periods in the ancient. The data is collected from literature regarding acupuncture-moxibustion from the pre-Qin period to the end of Qing Dynasty, so as to establish a clinical literature database of ancient acupuncture-moxibustion for treatment of vertigo. Data mining method is applied to analyze the commonly used meridians, acupoints and special acupoints in different dynasties, also possible rules are explored. Totally 82 pieces of prescription of acupuncture-moxibustion for treatment of vertigo are included. In the history the leading selection of acupoitns are Fengchi (GB 20), Hegu (LI 4), Shangxing (GV 23) and Jiexi (ST 41) while that of meridians are mainly three yang meridians of foot and the Governor Vessel, especially the acupoints on the Bladder Meridian of foot yangming had the highest utilization rate, accounting for 23.04%. The acupoint selection is characterized by special acupoint, accounting for 80.6%, among which the crossing points are the most common choice. Distal-proximal acupoints combination is the most frequent method. The results indicate that the ancient acupuncture-moxibustion for treatment of vertigo focused on acupoints in the yang meridians, and the specific acupoints play an essential role in prescription; also the principle of syndrome differentiation and selecting acupoints along the meridians could be seen. PMID:25022134

  9. [Height-induced vertigo and its medical interpretation: Goethe and the Strassburger Münster].

    PubMed

    Jagella, C

    2000-02-19

    An analysis combining medicine and literature challenges the methodology of both disciplines. This essay on the vertigo Goethe suffered on the tower of the Strasbourg Minster attempts to trace the vicissitudes of interpreting an emblem, like vertigo, burdened by cultural meaning and implications. Thus, Goethe's own report of this event 40 years after the fact, in his "Dichtung und Wahrheit", has to be related to another, hidden chronology of vertigo and fear in his account which, at first glance, conveys quite different implications. The first part of this paper refers to a medical interpretation of Goethe's dread of high places and his way of coping with it which, today, could be defined as a typical example of a behaviourist approach. In the second part, Goethe's vertigo is linked to psychoanalytic, literary, and historical reflections on the meanings of symptoms we connect today with medical terms like anxiety, phobia, and vertigo. Goethe's vertigo is shown as a complex problem--not only for himself but also for its interpreters: on the one hand, it tells its own story-within-a-story; on the other, it depends on the tools it was written with. Traditional approaches of medical history try to find symptoms and traces of diseases known to us today in literary texts, an approach which is as dubious as taking today's tools of medical analysis, such as psychoanalytic terms and concepts, to explain specific phenomena in literature without first carefully analysing these methods themselves, and only then subjecting the text to an analysis based on them. Nevertheless, this essay does not contest the justification of interpreting literary texts in the light of today's medical knowledge, but postulates that it should be clear which type of medical knowledge is applied. It is quite possible to read Goethe's account only as an old tale of acrophobia, but how will this help us? It seems more interesting to look at the link between the feeling of dizziness he experienced on

  10. Puerarin and betahistine treatment of vertebrobasilar ischemia vertigo: A meta-analysis of randomized controlled trials

    PubMed Central

    CHEN, YAN-YAN; CHEN, WEN; ZHANG, QING; LI, HUI; ZHANG, YE-WEN; KANG, QIAN; LAN, YI; WU, QING

    2016-01-01

    The present meta-analysis aimed to evaluate the effectiveness and safety of puerarin co-treatment with betahistine in treating vertebrobasilar ischemia (VBI) vertigo. A total of 6 medical databases were searched, identifying randomized controlled trials (RCTs) of VBI vertigo performed until August 2014 that investigated a combined treatment of puerarin with betahistine or with other conventional drugs. The quality of the literature was evaluated using the Cochrane Collaboration's tool for assessing risk of bias, and Rev Man 5.0 software was used for statistical analysis and evaluation. The present study included 7 RCTs, involving a total of 664 subjects, and revealed a statistically significant increase in efficacy between the control and the experimental group (odds ratio [OR], 4.99; 95% confidence interval [CI], 3.05 to 8.15). The average blood flow velocity within the vertebrobasilar arteries increased following treatment with puerarin and betahistine compared with that of the control groups (OR, 7.59; 95% CI, 6.19 to 9.00); however, no difference was detected between these groups in the average flow velocity within the left vertebral artery (OR, 6.17; 95% CI, 5.22 to 7.13). The frequency of adverse reactions in the experimental group was lower (OR, 0.75; 95% CI, 0.32 to 1.77) compared with the control group. Combined puerarin and betahistine regimens were more effective in treating VBI vertigo compared with other, conventional drugs; effectively alleviating the associated symptoms, including dizziness and increased average blood flow velocity within the vertebrobasilar arteries, without causing an increased number of serious side effects. However, the efficacy and safety of puerarin and betahistine use in treating VBI vertigo requires additional investigation. PMID:26998036

  11. The Epidemiology of Vertigo, Dizziness, and Unsteadiness and Its Links to Co-Morbidities

    PubMed Central

    Bisdorff, Alexandre; Bosser, Gilles; Gueguen, René; Perrin, Philippe

    2012-01-01

    Vertigo, dizziness, and unsteadiness (VDU) are common symptoms traditionally considered to result from different kinds of vestibular and non-vestibular dysfunctions. The epidemiology of each symptom and how they relate to each other and to migraine, agoraphobia, motion sickness susceptibility (MSS), vaso-vagal episodes (VVE), and anxiety-depression was the object of this population-based study in north-eastern France. A self-administered questionnaire was returned by 2987 adults (age span 18–86 years, 1471 women). The 1-year prevalence for vertigo was 48.3%, for unsteadiness 39.1%, and for dizziness 35.6%. The three symptoms were correlated with each other, occurred mostly (69.4%) in various combinations rather than in isolation, less than once per month, and 90% of episodes lasted ≤2 min. The three symptoms were similar in terms of female predominance, temporary profile of the episodes, and their link to falls and nausea. Symptom episodes of >1 h increase the risk of falls. VDU are much more common than the known prevalence of vestibular disorders. The number of drugs taken increase VDU even when controlling for age. Each VDU symptom was correlated with each co-morbidity in Chi-squared tests. The data suggest that the three symptoms are more likely to represent a spectrum resulting from a range of similar – rather than from different, unrelated – mechanisms or disorders. Logistic regressions controlling for each vestibular symptom showed that vertigo correlated with each co-morbidity but dizziness and unsteadiness did not, suggesting that vertigo is certainly not a more specific symptom than the other two. A logistic regression using a composite score of VDU, controlling for each co-morbidity showed a correlation of VDU to migraine and VVE but not to MSS and not to agoraphobia in men, only in women. PMID:23526567

  12. Outbreak of vertigo in Wyoming: possible role of an enterovirus infection.

    PubMed

    Simonsen, L; Khan, A S; Gary, H E; Hanson, C; Pallansch, M A; Music, S; Holman, R C; Stewart, J A; Erdman, D D; Arden, N H; Arenberg, I K; Schonberger, L B

    1996-08-01

    An epidemiologic investigation was conducted to characterize and evaluate the possibility of a viral aetiology of an outbreak of acute vertigo in Hot Springs Country, Wyoming, during autumn 1992. Case-finding identified Hot Springs County residents who sought medical attention for new onset vertigo during 1 August, 1992-31 January 1993. Thirty-five case-patients and 61 matched controls were interviewed and serum specimens were obtained during January 1993. Case-patients were more likely than controls to report symptoms (e.g. fatigue, sore throat, fever, diarrhoea) of antecedent acute illness. Case-patients did not have a significantly greater prevalence or mean titre of IgG antibodies to respiratory syncytial virus, parainfluenza viruses, Epstein-Barr virus, and cytomegalovirus than controls. Serologic evidence of recent enterovirus infection (IgM antibodies) was found for 74% of case-patients compared with 54% of controls (P < 0.05), suggesting a possible association between vertigo and enterovirus infection. Future studies are needed to define the role of enteroviruses in innerear diseases. PMID:8760963

  13. AICA syndrome with facial palsy following vertigo and acute sensorineural hearing loss.

    PubMed

    Ikegami-Takada, Tomoko; Izumikawa, Masahiko; Doi, Tadashi; Takada, Yohei; Tomoda, Koichi

    2012-04-01

    We report a case of infarction of the anterior inferior cerebellar artery (AICA) with peripheral facial palsy following vertigo and acute sensorineural hearing loss. A 39-year-old female presented with vertigo and sudden hearing loss, tinnitus, and aural fullness of the right ear. An audiogram revealed a severe hearing loss at all tested frequencies in the right ear. Spontaneous nystagmus toward the left side was also observed. Otoneurological examinations showed sensorineural hearing loss of the right ear and horizontal and rotatory gaze nystagmus toward the left side, and a caloric reflex test demonstrated canal paresis. Initially, we diagnosed the patient for sudden deafness with vertigo. However, right peripheral facial palsy appeared 2 days later. An eye tracking test (ETT) and optokinetic pattern test (OKP) showed centralis abnormality. The patient's brain was examined by magnetic resonance imaging (MRI) and magnetic resonance angioglaphy (MRA) and showed an infarction localized in the pons and cerebellum. MRI and MRA revealed infarction of the right cerebellar hemisphere indicating occlusion of the AICA. Consequently, the patient was diagnosed with AICA syndrome but demonstrated regression following steroid and edaravone treatment. We suggest that performing MRI and MRA in the early stage of AICA syndrome is important for distinguishing cerebellar infarction resulting from vestibular disease. PMID:21862260

  14. [Study on rules of acupoints selection for vertigo in ancient acupuncture].

    PubMed

    Zhan, Qiana; Chen, Hua-De

    2014-04-01

    The characteristics of selection and matching acupoint and application rules of meridians in ancient acupuncture literature for vertigo were explored. The data were collected from literature regarding acupuncture for vertigo from the pre-Qin period to Qing dynasty and then database was established. Frequency statistics method and comparison of support degree were applied to analyze and explore application rules of acupoints and meridians, while association rules in data mining was used to extract combinations of acupoints. As a result, for treatment of vertigo, according to frequency of use and support degree, generally the most selected acupoints, in turn, were Fengchi (GB 20), Shangxing (GV 23), Yanggu (SI 5), Jiexi (ST 41), Zulinqi (GB 41) and Shenting (GV 24), etc.; the most methods for matching acupoint were combination of adjacent acupoints, combination of same-meridian acupoints, combination of the superior-inferior acupoints, combination of yang-meridian and yang-meridian acupoints and combination of child-mother meridians acupoints; the most selected meridians were bladder meridian of foot-taiyang, gallbladder meridian of foot-shaoyang and governor vessel. Compared between the ancient and modern literature, it was found out that the ancient and modern clinic has same points in selection of acupoint-meridian and matching acupoints methods. However, the use of Yanggu (SI 5), Jiexi (ST 41) and Feiyang (BL 58) as well as combination of child-mother meridians acupoints were less seen in modern clinic, which could provide new reference. PMID:24946637

  15. [Vertigo and peripheral ischemic cochleovestibular syndrome caused by circulatory insufficiency in the vertebrobasilar system].

    PubMed

    Alekseeva, N S; Kirichenko, I M

    2006-01-01

    We studied characteristics of vestibular and acoustic disorders in patients with arterial hypertension, atherosclerosis and vascular dystonia; correlation between peripheral cochleovestibular syndromes (PCVS) and circulation in the major and intracranial arteries, central hemodynamics, organic changes in the brain. We discovered that anomalies and asymmetry in vertebral arteries diameters, stenoses, reduced stroke and minute blood volumes play an essential role in development of PCVS. The latter are rarely accompanied with ischemic foci in the brain. Medication of vascular vertigo consists in administration of an adequate drug. We believe that betaserk is most effective. PMID:16710175

  16. Meta-analysis of clinical studies with betahistine in Ménière's disease and vestibular vertigo.

    PubMed

    Nauta, Jozef J P

    2014-05-01

    We present a meta-analysis of 12 double-blind, randomized, placebo-controlled clinical studies with betahistine in patients suffering from vestibular vertigo or Ménière's disease, based on both published and unpublished data. The clinical endpoint we used was the investigator's overall opinion on the response to treatment of the vertigo symptoms, after at least 1 month of treatment. We introduce a new effect parameter, the odds of a favorable treatment outcome, with the odds ratio as measure to compare the responses of betahistine and placebo patients. For each study a separate odds ratio was estimated (the study-specific odds ratio). All but one of the study-specific odds ratios were >1.0, meaning that with the new effect parameter there was evidence of an effect of betahistine on vertigo symptoms in 11 of the 12 studies. Four of the 12 studies showed a statistically significant effect in favor of betahistine compared to placebo. The meta-analytical (i.e., average) odds ratio was 2.58 (95% confidence interval 1.67-3.99), a statistically significant result. This means that on average, the likelihood of a favorable outcome is almost two times higher for patients treated with betahistine than for placebo-treated patients. Sub-analyses conducted for patients with Ménière's disease on one hand and with vestibular vertigo on the other hand also yielded statistically significant results. For Ménière's disease, the meta-analytical odds ratio was 3.37 (95% CI 2.14-5.29); for vestibular vertigo, the odds ratio was 2.23 (95% CI 1.20-4.14). Our meta-analysis supports the therapeutic benefit of betahistine on vertiginous symptoms in both Ménière's disease and vestibular vertigo. PMID:23778722

  17. [Pharmacokinetics and pharmacodynamics of flunarizine in multimorbid, geriatric patients with vertigo].

    PubMed

    Rolzhäuser, H P; Oestreich, W; Seiler, K U; Peters, T; Platt, D; Jorisch, D

    1991-02-01

    Ten multimorbid, geriatric, hospitalised patients, mean age 76 years, were treated for vertigo and received 10 mg flunarizine (CAS 52468-60-7; Sibelium) daily for 3 weeks. The study of the pharmacokinetics and pharmacodynamics of this dosage scheme revealed that the kinetics did not change during the three weeks of therapy. The terminal half-life is 7.3 +/- 3.3 days. Since a steady state concentration is only to be expected after about 5 half-lives, this condition was not fully met yet in most patients after three weeks. The data obtained from the patients examined are essentially identical with those in young and old healthy subjects. The unchanged kinetics during long-term treatment prevent side-effects due to cumulation on the one hand or the decrease of plasma levels to inactive concentrations resulting from enzyme induction. There was not measurable anti-aggregator effect on thrombocytes or erythrocytes. The effectiveness in connection with vertigo seems to be due to a direct labyrinth depressor activity and/or to a selective vasospecific action. No side-effects were observed during the three weeks of therapy. PMID:2043170

  18. STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness

    PubMed Central

    Best, Christoph; Tschan, Regine; Stieber, Nikola; Beutel, Manfred E.; Eckhardt-Henn, Annegret; Dieterich, Marianne

    2015-01-01

    Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (QH/V), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: QH/V = 0.31 versus controls: QH/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles. PMID:26843786

  19. STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness.

    PubMed

    Best, Christoph; Tschan, Regine; Stieber, Nikola; Beutel, Manfred E; Eckhardt-Henn, Annegret; Dieterich, Marianne

    2015-01-01

    Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (Q H/V ), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: Q H/V = 0.31 versus controls: Q H/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles. PMID:26843786

  20. [The role of neurovisualization methods in diagnosis and verification of vertigo etiology].

    PubMed

    Alekseeva, N S; Krotenkova, M V; Konovalov, R N; Kirichenko, I M; Baev, A A; Petrova, E I

    2006-01-01

    Roentgen computed tomography (RCT) and MR-imaging (MRI) were used in investigation of vertigo etiology and affection of the cochleovestibular analyzer in 130 patients aged 28 to 74 years with recurrent systemic rotatory vertigo or its other symptoms. All the patients have undergone comprehensive otoneurological examination, RCT and MRI which showed that peripheral cochleovestibular syndromes (PCVS) caused by arterial hypertension (AH), atherosclerosis (AS), vascular dystonia (VD) are rarely characterized by focal alterations in the brain. PCVS comparison with blood flow in the vertebral arteries (VA) detected most frequently anomalies and asymmetries of the diameters. MR-angiography plays an important role in verification of pathology of intracranial VA. In central cochleovestibular syndrome (CCVS) with AH, AS, VD, principal pathological changes were registered in the brain trunk and cerebellum by MRI. Vestibulometry and otoneurological method detect not only vascular cochleovestibular peripheral and central syndromes but also to make differential diagnosis. RCT and MRI verify cochleovestibular syndromes in patients with multiple encephalomyelitis, VIII nerve neurinoma and tumors of the posterior cranial fossa. PMID:16482004

  1. Microcirculatory effects of a homeopathic preparation in patients with mild vertigo: an intravital microscopic study.

    PubMed

    Klopp, R; Niemer, W; Weiser, M

    2005-01-01

    The effects of the homeopathic preparation Vertigoheel on variables related to microcirculation were investigated using vital microscopy techniques in patients with vestibular vertigo. In a non-randomized, open study, 16 patients given Vertigoheel were compared with 16 untreated patients. Measurements were carried out in two areas (defined by selecting 60 blood-cell perfused nodal points of arterioles, venules, and capillaries with a mean diameter > or = 40 microm): the cuticulum/subcuticulum of the inside left lower arm and an area 5 mm behind the left earlobe. After 12 weeks of treatment, patients receiving the homeopathic preparation exhibited an increased number of nodal points, increased flow rates of erythrocytes in both arterioles and venules, increased vasomotion, and a slight reduction in hematocrit vs. baseline. None of these changes were observed in the control group and the differences between treatment groups were statistically significant. Partial oxygen pressure increased significantly in the Vertigoheel group compared with the control group. In addition, in Vertigoheel patients, significantly increased numbers of cell-wall adhering leucocytes were observed, accompanied by increased local concentrations of the adhesion molecules ICAM-1. The microcirculatory changes were associated with a reduction in the severity of vertigo in the actively treated patients, both as assessed by the treating physician and by the patients themselves. The data support a pharmacological effect on microcirculation from the treatment. PMID:15797255

  2. Mechanical versus CO2 laser occlusion of the posterior semicircular canal in humans.

    PubMed

    Antonelli, P J; Lundy, L B; Kartush, J M; Burgio, D L; Graham, M D

    1996-05-01

    The purpose of this study was to compare the effectiveness of mechanical and laser-assisted posterior semicircular canal occlusion (PCO) for the treatment of intractable benign paroxysmal positional vertigo (BPPV). Twelve consecutive patients with intractable BPPV underwent PCO by three surgeons, six with mechanical PCO and six with CO2 laser-assisted PCO. PCO eliminated positional vertigo in all patients treated with the laser and five of six patients treated without the laser. Dysequilibrium was present in all patients immediately postoperatively. This resolved in all patients treated with the CO2 laser but in only two of six patients treated without the laser (p = 0.03). Patients were hospitalized for dysequilibrium for an average of 5.2 and 2.8 days for the mechanical and laser-assisted groups, respectively. Preoperative and postoperative hearing was not significantly different between the groups. No clinically significant postoperative hearing loss was encountered in either group. These results suggest that PCO is an effective treatment for intractable BPPV. The incidence of dysequilibrium that persists following PCO may be reduced by using the CO2 laser to seal the membranous canal prior to occluding the bony canal. PMID:8817019

  3. The Use of Release-Active Antibody-Based Preparations for Vertigo Prevention in Adults.

    PubMed

    Barchukov, V V; Zhavbert, E S; Dugina, Yu L; Epstein, O I

    2015-11-01

    The effectiveness of antibody-based release-active preparations Impaza (antibodies to eNOS), Tenoten (antibodies to brain-specific protein S-100), Dietressa (antibodies to type 1 cannabinoid receptor), Brizantin (combined preparation, antibodies to brain-specific protein S-100 and type 1 cannabinoid receptor), and Divaza (combined preparation, antibodies to brain-specific protein S-100 and eNOS) in the prevention of vertigo was studied on the model of intermittent accumulation of Coriolis accelerations (ICCA). Modification of activity of vestibular receptors and signal systems by release-active preparations contributed to an increase in ICCA tolerance time. Combined preparation Impaza possessed the most significant antinaupathic properties. Brizantin was less potent in this respect. PMID:26608378

  4. Behavior of the Posterior Semicircular Canal After Dix-Hallpike Maneuver

    PubMed Central

    e Maia, Francisco Carlos Zuma; Albernaz, Pedro Luiz Mangabeira; Cal, Renato Valério

    2016-01-01

    The objective of the present study is to analyze the quantitative vestibulo-ocular responses in a group of patients with benign paroxysmal positional vertigo (BPPV) canalolithiasis and compare these data with the data of the tridimensional biomechanical model. This study was conducted on 70 patients that presented idiopathic posterior semicircular canal canalolithiasis. The diagnosis was obtained by Dix-Hallpike maneuvers recorded by videonystagmograph. The present study demonstrates that there is a significant correlation between the intensity of the nystagmus and its latency in cases of BPPV-idiopathic posterior semicircular canal canalolithiasis type. These findings are in agreement with those obtained in a tridimensional biomechanical model and are not related to the patients’ age. PMID:27588161

  5. Behavior of the Posterior Semicircular Canal After Dix-Hallpike Maneuver.

    PubMed

    E Maia, Francisco Carlos Zuma; Albernaz, Pedro Luiz Mangabeira; Cal, Renato Valério

    2016-04-20

    The objective of the present study is to analyze the quantitative vestibulo-ocular responses in a group of patients with benign paroxysmal positional vertigo (BPPV) canalolithiasis and compare these data with the data of the tridimensional biomechanical model. This study was conducted on 70 patients that presented idiopathic posterior semicircular canal canalolithiasis. The diagnosis was obtained by Dix-Hallpike maneuvers recorded by videonystagmograph. The present study demonstrates that there is a significant correlation between the intensity of the nystagmus and its latency in cases of BPPV-idiopathic posterior semicircular canal canalolithiasis type. These findings are in agreement with those obtained in a tridimensional biomechanical model and are not related to the patients' age. PMID:27588161

  6. An attempt to understand flicker vertigo: changes in pupil size and choroidal blood flow under flickering conditions

    NASA Astrophysics Data System (ADS)

    Masi, Maria Gabriella; Peretto, Lorenzo; Rovati, Luigi; Ansari, Rafat R.

    2010-02-01

    Light flickering at a rate of 4- 20 cycles per second can produce unpleasant reactions such as nausea and vertigo. In this paper, the possibility of achieving an objective evaluation/prediction of the physiological effects induced by flicker is investigated using a new imaging method based on the pupil size determination. This method is also compared with the blood flow analysis in the choroid.

  7. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness

    PubMed Central

    Chau, Allan T.; Menant, Jasmine C.; Hübner, Patrick P.; Lord, Stephen R.; Migliaccio, Americo A.

    2015-01-01

    Dizziness and imbalance are clinically poorly defined terms, which affect ~30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51–92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1–2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s2 to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of ~25%. Our results indicate that htDVA, sinusoidal (particularly 0.5–1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction. PMID:26733940

  8. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness.

    PubMed

    Chau, Allan T; Menant, Jasmine C; Hübner, Patrick P; Lord, Stephen R; Migliaccio, Americo A

    2015-01-01

    Dizziness and imbalance are clinically poorly defined terms, which affect ~30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51-92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1-2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s(2) to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of ~25%. Our results indicate that htDVA, sinusoidal (particularly 0.5-1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction. PMID:26733940

  9. Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health

    PubMed Central

    2012-01-01

    Purpose Aims of this study were to identify aspects of functioning and health relevant to patients with vertigo expressed by ICF categories and to explore the potential of the ICF to describe the patient perspective in vertigo. Methods We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF). Results From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor. Conclusions From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo. PMID:22738067

  10. Particulate matter chemistry and dynamics in the Twilight Zone at VERTIGO ALOHA and K2 Sites

    SciTech Connect

    Bishop, James K.B.; Wood, T.J.

    2008-03-25

    Understanding particle dynamics in the 'Twilight Zone' is critical to prediction of the ocean's carbon cycle. As part of the VERTIGO (VERtical Transformations In the Global Ocean) project, this rarely sampled regime extending from the base of the euphotic layer to 1000 m, was characterized by double-paired day/night Multiple Unit Large Volume in-situ Filtration System (MULVFS) deployments and by {approx}100 high-frequency CTD/transmissometer/turbidity sensor profiles. VERTIGO studies lasting three weeks, contrasted oligotrophic station ALOHA (22.75{sup o}N 158{sup o}W), sampled in June-July 2004, with a biologically productive location (47{sup o}N 161{sup o}E) near station K2 in the Oyashio, occupied July-August 2005. Profiles of major and minor particulate components (C{sub org}, N, P, Ca, Si, Sr, Ba, Mn) in <1, 1-51, and >51 {micro}m size fractions, in-water optics, neutrally buoyant sediment trap (NBST) fluxes, and zooplankton data were intercompared. MULVFS total C{sub org} and C-Star particle beam attenuation coefficient (C{sub P}) were consistently related at both sites with a 27 {micro}M m{sup -1} conversion factor. 26 At K2, C{sub P} profiles further showed a multitude of transient spikes throughout the water column and spike abundance profiles closely paralleled the double peaked abundance profiles of zooplankton. Also at K2, copepods contributed {approx}40% and 10%, night and day, respectively to >51 {micro}m C{sub org} of MULVFS samples in the mixed layer, but few copepods were collected in deeper waters; however, non-swimming radiolarians were quantitatively sampled. A recent hypothesis regarding POC differences between pumps and bottles is examined in light of these results. Particulate >51 {micro}m C{sub org}, N, and P at both ALOHA and K2 showed strong attenuation with depth at both sites. Notable at ALOHA were unusually high levels of >51 {micro}m Sr (up to 4 nM) in the mixed layer, a reflection of high abundances of SrSO{sub 4} precipitating

  11. Particulate matter chemistry and dynamics in the twilight zone at VERTIGO ALOHA and K2 sites

    NASA Astrophysics Data System (ADS)

    Bishop, James K. B.; Wood, T. J.

    2008-12-01

    Understanding particle dynamics in the 'Twilight Zone' is critical to prediction of the ocean's carbon cycle. As part of the VERtical Transport In the Global Ocean (VERTIGO) project, this rarely sampled regime extending from the base of the euphotic layer to 1000 m, was characterized by double-paired day/night Multiple Unit Large Volume in-situ Filtration System (MULVFS) deployments and by ˜100 high-frequency CTD/transmissometer/turbidity sensor profiles. VERTIGO studies lasting 3 weeks, contrasted oligotrophic station ALOHA (22.75°N 158°W), sampled in June-July 2004, with a biologically productive location (47 °N 161°E) near station K2 in the Oyashio, occupied July-August 2005. Profiles of major and minor particulate components (C org, N, P, Ca, Si, Sr, Ba, Mn) in <1, 1-51, and >51 μm size fractions, in-water optics, neutrally buoyant sediment trap (NBST) fluxes, and zooplankton data were intercompared. MULVFS total C org and C-Star particle beam attenuation coefficient ( C P) were consistently related at both sites with a 27 μM m -1 conversion factor. At K2, C P profiles further showed a multitude of transient spikes throughout the water column and spike abundance profiles closely paralleled the double peaked abundance profiles of zooplankton. Also at K2, copepods contributed ˜40% and 10%, night and day, respectively to >51 μm C org of MULVFS samples in the mixed layer, but few copepods were collected in deeper waters; however, non-swimming radiolarians were quantitatively sampled. A recent hypothesis regarding POC differences between pumps and bottles is examined in light of these results. Particulate >51 μm C org, N, and P at both ALOHA and K2 showed strong attenuation with depth at both sites. Notable at ALOHA were unusually high levels of >51 μm Sr (up to 4 nM) in the mixed layer, a reflection of high abundances of SrSO 4 precipitating Acantharia. Notable at K2 were major changes in water column inventories of many particulate components to 700 m

  12. VERTIGO (VERtical Transport In the Global Ocean): A study of particle sources and flux attenuation in the North Pacific

    NASA Astrophysics Data System (ADS)

    Buesseler, K. O.; Trull, T. W.; Steinberg, D. K.; Silver, M. W.; Siegel, D. A.; Saitoh, S.-I.; Lamborg, C. H.; Lam, P. J.; Karl, D. M.; Jiao, N. Z.; Honda, M. C.; Elskens, M.; Dehairs, F.; Brown, S. L.; Boyd, P. W.; Bishop, J. K. B.; Bidigare, R. R.

    2008-07-01

    The VERtical Transport In the Global Ocean (VERTIGO) study examined particle sources and fluxes through the ocean's "twilight zone" (defined here as depths below the euphotic zone to 1000 m). Interdisciplinary process studies were conducted at contrasting sites off Hawaii (ALOHA) and in the NW Pacific (K2) during 3-week occupations in 2004 and 2005, respectively. We examine in this overview paper the contrasting physical, chemical and biological settings and how these conditions impact the source characteristics of the sinking material and the transport efficiency through the twilight zone. A major finding in VERTIGO is the considerably lower transfer efficiency ( Teff) of particulate organic carbon (POC), POC flux 500/150 m, at ALOHA (20%) vs. K2 (50%). This efficiency is higher in the diatom-dominated setting at K2 where silica-rich particles dominate the flux at the end of a diatom bloom, and where zooplankton and their pellets are larger. At K2, the drawdown of macronutrients is used to assess export and suggests that shallow remineralization above our 150-m trap is significant, especially for N relative to Si. We explore here also surface export ratios (POC flux/primary production) and possible reasons why this ratio is higher at K2, especially during the first trap deployment. When we compare the 500-m fluxes to deep moored traps, both sites lose about half of the sinking POC by >4000 m, but this comparison is limited in that fluxes at depth may have both a local and distant component. Certainly, the greatest difference in particle flux attenuation is in the mesopelagic, and we highlight other VERTIGO papers that provide a more detailed examination of the particle sources, flux and processes that attenuate the flux of sinking particles. Ultimately, we contend that at least three types of processes need to be considered: heterotrophic degradation of sinking particles, zooplankton migration and surface feeding, and lateral sources of suspended and sinking

  13. VERTIGO (VERtical Transport In the Global Ocean): A study of particle sources and flux attenuation in the North Pacific

    SciTech Connect

    Buesseler, K.O.; Trull, T.W.; Steinberg, D.K.; Silver, M.W.; Siegel, D.A.; Saitoh, S.-I.; Lamborg, C.H.; Lam, P.J.; Karl, D.M.; Jiao, N.Z.; Honda, M.C.; Elskens, M.; Dehairs, F.; Brown, S.L.; Boyd, P.W.; Bishop, J.K.B.; Bidigare, R.R.

    2008-06-10

    The VERtical Transport In the Global Ocean (VERTIGO) study examined particle sources and fluxes through the ocean's 'twilight zone' (defined here as depths below the euphotic zone to 1000 m). Interdisciplinary process studies were conducted at contrasting sites off Hawaii (ALOHA) and in the NW Pacific (K2) during 3 week occupations in 2004 and 2005, respectively. We examine in this overview paper the contrasting physical, chemical and biological settings and how these conditions impact the source characteristics of the sinking material and the transport efficiency through the twilight zone. A major finding in VERTIGO is the considerably lower transfer efficiency (T{sub eff}) of particulate organic carbon (POC), POC flux 500/150 m, at ALOHA (20%) vs. K2 (50%). This efficiency is higher in the diatom-dominated setting at K2 where silica-rich particles dominate the flux at the end of a diatom bloom, and where zooplankton and their pellets are larger. At K2, the drawdown of macronutrients is used to assess export and suggests that shallow remineralization above our 150 m trap is significant, especially for N relative to Si. We explore here also surface export ratios (POC flux/primary production) and possible reasons why this ratio is higher at K2, especially during the first trap deployment. When we compare the 500 m fluxes to deep moored traps, both sites lose about half of the sinking POC by >4000 m, but this comparison is limited in that fluxes at depth may have both a local and distant component. Certainly, the greatest difference in particle flux attenuation is in the mesopelagic, and we highlight other VERTIGO papers that provide a more detailed examination of the particle sources, flux and processes that attenuate the flux of sinking particles. Ultimately, we contend that at least three types of processes need to be considered: heterotrophic degradation of sinking particles, zooplankton migration and surface feeding, and lateral sources of suspended and sinking

  14. Evolutionary Pattern and Process within the Vertigo gouldii (Mollusca: Pulmonata, Pupillidae) group of minute North American Land Snails

    PubMed Central

    Nekola, Jeffrey C.; Coles, Brian F.; Bergthorsson, Ulfar

    2010-01-01

    A phylogenetic analysis of 19 sibling taxa in the Vertigo gouldii group was conducted on 73 individuals sampled across North America using DNA sequence data of the mitochondrial genes cytochrome oxidase subunit 1 (CO1) and 16S ribosomal RNA (16S), and the internal transcribed spacer-2 of the nuclear ribosomal RNA (ITS-2) gene. The results of these analyses were found incongruent with previous taxonomic concepts used to define the V. gouldii group and its composite taxa that were based entirely on conchological features. The mtDNA sequence data suggest that some previous members of the traditional V. gouldii group may be more closely related to V. modesta. They also suggest that V. gouldii may itself consist of seven species-level branches spread across two deeply rooted clades. Revision of geographical distributions on the basis of these analyses suggests that these Vertigo species may commonly possess continental-sized ranges in spite of their minute size and limited active dispersal ability. High levels of sympatry within the group are also confirmed, with up to four species being known to co-occur within single microsites. These data also suggest that rates of diversification have been non-constant. Assuming a 1%/my rate of base pair substitution, a 10-fold diversification pulse is indicated from 6.7-7.0 myBP, which would be co-incident with known mid-late Miocene global climate changes. PMID:19766197

  15. Quantifying the surface-subsurface biogeochemical coupling during the VERTIGO ALOHA and K2 studies

    SciTech Connect

    Boyd, P.W.; Gall, M.P.; Silver, M.W.; Bishop, J.K.B.; Coale, Susan L.; Bidigare, Robert R.

    2008-02-25

    A central question addressed by the VERTIGO (VERtical Transport In the Global Ocean) study was 'What controls the efficiency of particle export between the surface and subsurface ocean'? Here, we present data from sites at ALOHA (N Central Pacific Gyre) and K2 (NW subarctic Pacific) on phytoplankton processes, and relate them via a simple planktonic foodweb model, to subsurface particle export (150-500 m). Three key factors enable quantification of the surface-subsurface coupling: a sampling design to overcome the temporal lag and spatial displacement between surface and subsurface processes; data on the size-partitioning of Net Primary Production (NPP) and subsequent transformations prior to export; estimates of the ratio of algal- to faecal-mediated vertical export flux. At ALOHA, phytoplankton were characterized by low stocks, NPP, F{sub v}/F{sub m} (N-limited), and were dominated by picoplankton. The HNLC waters at K2 were characterized by both two-fold changes in NPP and floristic shifts (high to low proportion of diatoms) between deployment 1 and 2. Prediction of export exiting the euphotic zone was based on size-partitioning of NPP, a copepod-dominated foodweb and a ratio of 0.2 (ALOHA) and 0.1 (K2) for algal:faecal particle flux. Predicted export was 20-22 mg POC m{sup -2} d{sup -1} at ALOHA (i.e. 10-11% NPP (0-125 m); 1.1-1.2 x export flux at 150 m (E{sub 150}). At K2, export was 111 mg C m{sup -2} d{sup -1} (21% NPP (0-50 m); 1.8 x E{sub 150}) and 33 mg POC m{sup -2} d{sup -1} (11% NPP, 0-55 m); 1.4 x E{sub 150}) for deployments 1 and 2, respectively. This decrease in predicted export at K2 matches the observed trend for E{sub 150}. Also, the low attenuation of export flux from 60 to 150 m is consistent with that between 150 to 500 m. This strong surface-subsurface coupling suggests that phytoplankton productivity and floristics play a key role at K2 in setting export flux, and moreover that pelagic particle transformations by grazers strongly influence

  16. Quantifying the surface subsurface biogeochemical coupling during the VERTIGO ALOHA and K2 studies

    NASA Astrophysics Data System (ADS)

    Boyd, Philip W.; Gall, Mark P.; Silver, Mary W.; Coale, Susan L.; Bidigare, Robert R.; Bishop, James L. K. B.

    2008-07-01

    A central question addressed by the VERtical Transport In the Global Ocean (VERTIGO) study was 'What controls the efficiency of particle export between the surface and subsurface ocean'? Here, we present data from sites at ALOHA (N Central Pacific Gyre) and K2 (NW subarctic Pacific) on phytoplankton processes, and relate them via a simple planktonic foodweb model, to subsurface particle export (150-500 m). Three key factors enable quantification of the surface-subsurface coupling: a sampling design to overcome the temporal lag and spatial displacement between surface and subsurface processes; data on the size partitioning of net primary production (NPP) and subsequent transformations prior to export; estimates of the ratio of algal- to faecal-mediated vertical export flux. At ALOHA, phytoplankton were characterized by low stocks, NPP, Fv/ Fm (N-limited), and were dominated by picoplankton. The HNLC waters at K2 were characterized by both two-fold changes in NPP and floristic shifts (high to low proportion of diatoms) between deployment 1 and 2. Prediction of export exiting the euphotic zone was based on size partitioning of NPP, a copepod-dominated foodweb and a ratio of 0.2 (ALOHA) and 0.1 (K2) for algal:faecal particle flux. Predicted export was 20-22 mg POC m -2 d -1 at ALOHA (i.e. 10-11% NPP (0-125 m); 1.1-1.2×export flux at 150 m ( E150). At K2, export was 111 mg C m -2 d -1 (21% NPP (0-50 m); 1.8× E150) and 33 mg POC m -2 d -1 (11% NPP, 0-55 m); 1.4× E150) for deployments 1 and 2, respectively. This decrease in predicted export at K2 matches the observed trend for E150. Also, the low attenuation of export flux from 60 to 150 m is consistent with that between 150 and 500 m. This strong surface-subsurface coupling suggests that phytoplankton productivity and floristics play a key role at K2 in setting export flux, and moreover that pelagic particle transformations by grazers strongly influence to what extent sinking particles are further broken down in the

  17. 75 FR 21050 - V-GPO, Inc., Valesc Holdings, Inc., Venture Stores, Inc., Vertigo Theme Parks, Inc. (f/k/a Snap2...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-22

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION V-GPO, Inc., Valesc Holdings, Inc., Venture Stores, Inc., Vertigo Theme Parks, Inc. (f/k/a Snap2 Corp.), Videolan Technologies, Inc., VisionGateway, Inc., Vital Health Technologies, Inc. (n/k/a Caribbean American Health Resorts), and...

  18. Role of orientation reference selection in motion sickness

    NASA Technical Reports Server (NTRS)

    Peterka, Robert J.; Black, F. Owen

    1988-01-01

    Previous experiments with moving platform posturography have shown that different people have varying abilities to resolve conflicts among vestibular, visual, and proprioceptive sensory signals used to control upright posture. In particular, there is one class of subjects with a vestibular disorder known as benign paroxysmal positional vertigo (BPPV) who often are particularly sensitive to inaccurate visual information. That is, they will use visual sensory information for the control of their posture even when that visual information is inaccurate and is in conflict with accurate proprioceptive and vestibular sensory signals. BPPV has been associated with disorders of both posterior semicircular canal function and possibly otolith function. The present proposal hopes to take advantage of the similarities between the space motion sickness problem and the sensory orientation reference selection problems associated with the BPPV syndrome. These similarities include both etiology related to abnormal vertical canal-otolith function, and motion sickness initiating events provoked by pitch and roll head movements. The objectives of this proposal are to explore and quantify the orientation reference selection abilities of subjects and the relation of this selection to motion sickness in humans.

  19. Removal of vertigo blue dyes from Batik textile wastewater by adsorption onto activated carbon and coal bottom ash

    NASA Astrophysics Data System (ADS)

    Kusmiyati, L., Puspita Adi; Deni, V.; Robi Indra, S.; Islamica, Dlia; Fuadi, M.

    2016-04-01

    Removal of vertigo blue dye from batik textile wastewater was studied by adsorptionprocess onto activated carbon (AC) and coal bottom ash (CBA).The influence of experimental conditions (pH solution, dye concentration, and contact time) were studied on the both adsorbents. At equilibrium conditions, the data were fitted to Langmuir and Freundlich adsorption models. The maximum adsorption capacity calculated from the Langmuir model for carbon active was 6.29mg/g at pH that found to be considerably higher than that obtained for coal bottom ash 3.72mg/g pH 9. From Freundlich model, the maximum adsorption capacity is less for coal bottom ash (pH 9) than that for carbon active (pH4).

  20. Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the "Eye ECG".

    PubMed

    Newman-Toker, David E; Curthoys, Ian S; Halmagyi, G Michael

    2015-10-01

    Patients who present to the emergency department with symptoms of acute vertigo or dizziness are frequently misdiagnosed. Missed opportunities to promptly treat dangerous strokes can result in poor clinical outcomes. Inappropriate testing and incorrect treatments for those with benign peripheral vestibular disorders leads to patient harm and unnecessary costs. Over the past decade, novel bedside approaches to diagnose patients with the acute vestibular syndrome have been developed and refined. A battery of three bedside tests of ocular motor physiology known as "HINTS" (head impulse, nystagmus, test of skew) has been shown to identify acute strokes more accurately than even magnetic resonance imaging with diffusion-weighted imaging (MRI-DWI) when applied in the early acute period by eye-movement specialists. Recent advances in lightweight, high-speed video-oculography (VOG) technology have made possible a future in which HINTS might be applied by nonspecialists in frontline care settings using portable VOG. Use of technology to measure eye movements (VOG-HINTS) to diagnose stroke in the acute vestibular syndrome is analogous to the use of electrocardiography (ECG) to diagnose myocardial infarction in acute chest pain. This "eye ECG" approach could transform care for patients with acute vertigo and dizziness around the world. In the United States alone, successful implementation would likely result in improved quality of emergency care for hundreds of thousands of peripheral vestibular patients and tens of thousands of stroke patients, as well as an estimated national health care savings of roughly $1 billion per year. In this article, the authors review the origins of the HINTS approach, empiric evidence and pathophysiologic principles supporting its use, and possible uses for the eye ECG in teleconsultation, teaching, and triage. PMID:26444396

  1. Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine.

    PubMed

    Sokolova, Larysa; Hoerr, Robert; Mishchenko, Tamara

    2014-01-01

    A multicenter clinical trial was performed to compare the efficacy and safety of Ginkgo biloba extract EGb 761 and betahistine at recommended doses in patients with vertigo. One hundred and sixty patients (mean age 58 years) were randomly assigned to double-blind treatment with EGb 761 (240 mg per day) or betahistine (32 mg per day) for 12 weeks. An 11-point numeric analogue scale, the Vertigo Symptom Scale-short form, the Clinical Global Impression Scales and the Sheehan Disability Scale were used as outcome measures. Both treatment groups were comparable at baseline and improved in all outcome measures during the course of treatment. There was no significant intergroup difference with regard to changes in any outcome measure. Numerically, improvements of patients receiving EGb 761 were slightly more pronounced on all scales. Clinical global impression was rated "very much improved" or "much improved" in 79% of patients treated with EGb 761 and in 70% receiving betahistine. With 27 adverse events in 19 patients, EGb 761 showed better tolerability than betahistine with 39 adverse events in 31 patients. In conclusion, the two drugs were similarly effective in the treatment of vertigo, but EGb 761 was better tolerated. This trial is registered with controlled-trials.com ISRCTN02262139. PMID:25057270

  2. Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine

    PubMed Central

    Sokolova, Larysa; Mishchenko, Tamara

    2014-01-01

    A multicenter clinical trial was performed to compare the efficacy and safety of Ginkgo biloba extract EGb 761 and betahistine at recommended doses in patients with vertigo. One hundred and sixty patients (mean age 58 years) were randomly assigned to double-blind treatment with EGb 761 (240 mg per day) or betahistine (32 mg per day) for 12 weeks. An 11-point numeric analogue scale, the Vertigo Symptom Scale—short form, the Clinical Global Impression Scales and the Sheehan Disability Scale were used as outcome measures. Both treatment groups were comparable at baseline and improved in all outcome measures during the course of treatment. There was no significant intergroup difference with regard to changes in any outcome measure. Numerically, improvements of patients receiving EGb 761 were slightly more pronounced on all scales. Clinical global impression was rated “very much improved” or “much improved” in 79% of patients treated with EGb 761 and in 70% receiving betahistine. With 27 adverse events in 19 patients, EGb 761 showed better tolerability than betahistine with 39 adverse events in 31 patients. In conclusion, the two drugs were similarly effective in the treatment of vertigo, but EGb 761 was better tolerated. This trial is registered with controlled-trials.com ISRCTN02262139. PMID:25057270

  3. Sinking fluxes of minor and trace elements in the North Pacific Ocean measured during the VERTIGO program

    NASA Astrophysics Data System (ADS)

    Lamborg, C. H.; Buesseler, K. O.; Lam, P. J.

    2008-07-01

    As part of the Vertical Transport in the Global Ocean (VERTIGO) program, we collected and analyzed sinking particles using sediment traps at three depths in the oceanic mesopelagic zone and at two biogeochemically contrasting sites (N. Central Pacific at ALOHA; N. Pacific Western Subarctic Gyre at K2). In this paper, we present the results of minor and trace element determinations made on these samples. Minor and trace elements in the sinking material showed 2 trends in flux with depth: increasing and constant. The sinking particulate phase of some elements (Al, Fe, Mn) was dominated by material of lithogenic origin and exhibited flux that was constant with depth and consistent with eolian dust inputs (ALOHA), or increasing in flux with depth as a result of lateral inputs from a shelf (K2). This shelf-derived material also appears to have been confined to very small particles, whose inherent sinking rates are slow, and residence time within the mesopelagic "twilight zone" would be consequently long. Furthermore, the flux of this material did not change with substantial changes in the rain of biogenic material from the surface (K2), suggesting mechanistic decoupling from the flux of organic carbon and macronutrients. Micronutrient (Fe, Co, Zn and Cu) fluxes examined in a 1-D mass balance suggest widely differing sources and sinks in the water column as well as impacts from biological uptake and regeneration. For example, total Fe fluxes into and out of the euphotic zone appeared to be dominated by lithogenic material and far exceed biological requirements. The export flux of Fe, however, appeared to be balanced by the eolian input of soluble Fe. For Zn and Cu, the situation is reversed, with atmospheric inputs insufficient to support fluxes, and the cycling therefore dominated by the draw down of an internal pool. For Co, the situation lies in between, with important, but ultimately insufficient atmospheric inputs.

  4. Gait characteristics of patients with phobic postural vertigo: effects of fear of falling, attention, and visual input.

    PubMed

    Schniepp, Roman; Wuehr, Max; Huth, Sabrina; Pradhan, Cauchy; Brandt, Thomas; Jahn, Klaus

    2014-04-01

    Phobic postural vertigo (PPV) is the most common cause of chronic dizziness in middle-aged patients. Many patients report symptoms involving gait. We investigated the gait performance and its relationship to the fear of falling and attention of PPV patients in a prospective study of 24 patients with PPV and 24 healthy subjects (HS) using a pressure-sensitive mat (GAITRite(®)). Subjects walked at three different speeds (slow, preferred, fast), both during cognitive dual tasks (DTc) and with eyes closed (EC). Falls efficacy and balance confidence were rated by the Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance Confidence Scale (ABC). PPV patients walked slower, with reduced cadence (all p < 0.01), stride length (p < 0.05), and increased double support (p < 0.01) compared to HS. These changes correlated with FES-I (R = -0.528, p < 0.001) and ABC (R = 0.481, p < 0.01). Walking deterioration under DTc did not differ between PPV patients and HS, but patients showed a reduced cognitive processing speed (p < 0.05). When walking with EC, gait speed decreased more in PPV patients compared to HS (p < 0.05). Patients with PPV show gait changes which correlate with their fear of falling and balance confidence. Absent visual feedback leads to more pronounced gait deteriorations in PPV patients than in HS, indicating a higher reliance of patients on visual information during walking. These findings support the view that the gait characteristics of PPV can be attributed to an inadequate, cautious gait control. PMID:24519356

  5. Effects and tolerability of betahistine in patients with vestibular vertigo: results from the Romanian contingent of the OSVaLD study

    PubMed Central

    Băjenaru, Ovidiu; Roceanu, Adina Maria; Albu, Silviu; Zainea, Viorel; Pascu, Alexandru; Georgescu, Mădălina Gabriela; Cozma, Sebastian; Mărceanu, Luigi; Mureşanu, Dafin Fior

    2014-01-01

    Background and methods An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD). Endpoints were changes in the Dizziness Handicap Index (primary endpoint), Medical Outcome Study Short-Form 36 (SF-36v2®), and the Hospital Anxiety and Depression Scale. Results During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale). Statistically significant improvements of 12–14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001). Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001) and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001). Betahistine was well tolerated, with only one suspected adverse drug reaction recorded in the Romanian safety population (n=259). Conclusion Betahistine 48 mg/day was associated with improvements in multiple measures of health-related quality of life and had a good tolerability profile in these Romanian patients with recurrent peripheral vestibular vertigo. PMID:25506241

  6. Causes and characteristics of horizontal positional nystagmus.

    PubMed

    Lechner, Corinna; Taylor, Rachael L; Todd, Chris; Macdougall, Hamish; Yavor, Robbie; Halmagyi, G Michael; Welgampola, Miriam S

    2014-05-01

    Direction changing horizontal positional nystagmus can be observed in a variety of central and peripheral vestibular disorders. We tested sixty subjects with horizontal positional nystagmus and vertigo on the Epley Omniax(®) rotator. Monocular video recordings were performed with the right or left ear down, in the supine and prone positions. Nystagmus slow-phase velocity (SPV) was plotted as a function of time. Thirty-one subjects diagnosed with horizontal canalolithiasis had paroxysmal horizontal geotropic nystagmus with the affected ear down (onset 0.8 ± 1 s, range 0-4.9 s, duration 11.7-47.9 s, peak SPV 79 ± 67°/s). The SPV peaked at 5-20 s and declined to 0 by 60 s; at 40 s from onset, the average SPV was 1.8 % of the peak. Nine subjects diagnosed with cupulolithiasis had persistent apogeotropic horizontal nystagmus (onset 0.7 ± 1.4 s, range 0-4.3 s). Peak SPV was 54.2 ± 31.8°/s and 26.6 ± 12.2°/s with unaffected and affected ears down, respectively. At 40 s, the average SPV had decayed to only 81 % (unaffected ear down) and 65 % (affected ear down) of the peak. Twenty subjects were diagnosed with disorders other than benign positional vertigo (BPV) [vestibular migraine (VM), Ménière's Disease, vestibular schwannoma, unilateral or bilateral peripheral vestibular loss]. Subjects with VM (n = 13) had persistent geotropic or apogeotropic horizontal nystagmus. On average, at 40 s from nystagmus onset, the SPV was 61 % of the peak. Two patients with Ménière's Disease had persistent apogeotropic horizontal nystagmus; the peak SPV at 40 s ranged between 28.6 and 49.5 % of the peak. Symptomatic horizontal positional nystagmus can be observed in canalolithiasis, cupulolithiasis and diverse central and peripheral vestibulopathies; its temporal and intensity profile could be helpful in the separation of these entities. PMID:24676938

  7. [Therapy of vestibular vertigo].

    PubMed

    Hamann, K F

    1993-05-01

    The non-surgical treatment of vestibular disorders must be based on current knowledge of vestibular pathophysiology. It is generally accepted that after vestibular lesions a self-repair mechanism exists that allows a more or less complete recovery. In cases of persisting vestibular complaints the physician's duty consists in stimulation of these pre-existing mechanisms. This can be done by physical exercises, as has been recommended since the work of Cawthorne and Cooksey in 1946. This concept is meanwhile supported by modern neurophysiological research. This article describes a short training program consisting of exercises for fixation during rotations, smooth pursuit, optokinetic nystagmus and motor learning mechanisms. Physical exercises can be reinforced by nootropic drugs. PMID:8335490

  8. Vertigo-associated disorders

    MedlinePlus

    ... Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 19. Crane BT, Minor LB. ... Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 165. Furman JK, Mccall AA. ...

  9. Principles of Calcite Dissolution in Human and Artificial Otoconia

    PubMed Central

    Walther, Leif Erik; Blödow, Alexander; Buder, Jana; Kniep, Rüdiger

    2014-01-01

    Human otoconia provide mechanical stimuli to deflect hair cells of the vestibular sensory epithelium for purposes of detecting linear acceleration and head tilts. During lifetime, the volume and number of otoconia are gradually reduced. In a process of degeneration morphological changes occur. Structural changes in human otoconia are assumed to cause vertigo and balance disorders such as benign paroxysmal positional vertigo (BPPV). The aim of this study was to investigate the main principles of morphological changes in human otoconia in dissolution experiments by exposure to hydrochloric acid, EDTA, demineralized water and completely purified water respectively. For comparison reasons artificial (biomimetic) otoconia (calcite gelatin nanocomposits) and natural calcite were used. Morphological changes were detected in time steps by the use of environmental scanning electron microscopy (ESEM). Under in vitro conditions three main dissolution mechanisms were identified as causing characteristic morphological changes of the specimen under consideration: pH drops in the acidic range, complex formation with calcium ions and changes of ion concentrations in the vicinity of otoconia. Shifts in pH cause a more uniform reduction of otoconia size (isotropic dissolution) whereas complexation reactions and changes of the ionic concentrations within the surrounding medium bring about preferred attacks at specific areas (anisotropic dissolution) of human and artificial otoconia. Owing to successive reduction of material, all the dissolution mechanisms finally produce fragments and remnants of otoconia. It can be assumed that the organic component of otoconia is not significantly attacked under the given conditions. Artificial otoconia serve as a suitable model system mimicking chemical attacks on biogenic specimens. The underlying principles of calcite dissolution under in vitro conditions may play a role in otoconia degeneration processes such as BPPV. PMID:25048115

  10. [Clinical experimental test and equilibrimetric measurements of the therapeutic action of a homeopathic drug consisting of ambra, cocculus, Conium and mineral oil in the diagnosis of vertigo and nausea].

    PubMed

    Claussen, C F; Bergmann, J; Bertora, G; Claussen, E

    1984-01-01

    This paper presents a study by means of a modern neurotological technique for investigating the action and the site of action of an antivertiginous drug. The sensory motor tests are able to discriminate the sites of the lesions in the equilibrium regulating system, i.e., peripheral vestibular system, lower brainstem regulating system, upper brainstem nystagmus generating system and supratentorial system. Acoustic brainstem evoked potentials add information. A sample of 40 vertigo and nausea patients was treated by a combined drug, containing cocculus D4 210 mg, conium D3 30 mg, ambra D6 30 mg, mineral oil D8 30 mg (Vertigo-heel). The patients received 3 tablets 3 times per day during 14 days. An initial investigation was performed just before starting the treatment. A second directly followed the therapy. By subjective self-rating 57.5% of the patients reported on an improvement after the intake of Vertigoheel. Statistical evaluations showed that the different vertigo and nausea symptoms as well as the trigger mechanisms of vertigo and nausea (i.e. getting up, turning the head or gazing aside), highly significantly improved due to the therapy. The objective sensory motor tests showed a highly significant improvement in the monaural caloric butterfly chart as well as in the vestibulospinal head and body sway. The site of the action of Vertigoheel is in the brainstem and the Medulla oblongata, especially the middle longitudinal fascicle (MLF). The localisation in this area can be stressed by the investigation with acoustically brainstem evoked potentials (ABEP).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6543316

  11. Nursing Positions

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy Nursing Positions KidsHealth > For Parents > Nursing Positions Print A ... and actually needs to feed. Getting Comfortable With Breastfeeding Nursing can be one of the most challenging ...

  12. Positive Psychology

    ERIC Educational Resources Information Center

    Peterson, Christopher

    2009-01-01

    Positive psychology is a deliberate correction to the focus of psychology on problems. Positive psychology does not deny the difficulties that people may experience but does suggest that sole attention to disorder leads to an incomplete view of the human condition. Positive psychologists concern themselves with four major topics: (1) positive…

  13. Positional plagiocephaly

    PubMed Central

    Cummings, Carl

    2011-01-01

    Cranial asymmetry occurring as a result of forces that deform skull shape in the supine position is known as deformational plagiocephaly. The risk of plagiocephaly may be modified by positioning the baby on alternate days with the head to the right or the left side, and by increasing time spent in the prone position during awake periods. When deformational plagiocephaly is already present, physiotherapy (including positioning equivalent to the preventive positioning, and exercises as needed for torticollis and positional preference) has been shown to be superior to counselling about preventive positioning only. Helmet therapy (moulding therapy) to reduce skull asymmetry has some drawbacks: it is expensive, significantly inconvenient due to the long hours of use per day and associated with skin complications. There is evidence that helmet therapy may increase the initial rate of improvement of asymmetry, but there is no evidence that it improves the final outcome for patients with moderate or severe plagiocephaly. PMID:23024590

  14. Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo

    PubMed Central

    Tsukamoto, Heloísa Freiria; Costa, Viviane de Souza Pinho; Silva, Rubens Alexandre da; Pelosi, Gislaine Garcia; Marchiori, Luciana Lozza de Moraes; Vaz, Cláudia Regina Sanches; Fernandes, Karen Barros Parron

    2015-01-01

    Introduction Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment. Objective Analyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs. Methods A nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a custom protocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs. Results There was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session. Conclusion Quality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment. PMID:26157499

  15. Effects and safety profile of betahistine in patients in the Russian contingent of OSVaLD, an open-label observational study in vestibular vertigo

    PubMed Central

    Morozova, Svetlana Vyacheslavovna; Alekseeva, Natalia Stepanovna; Lilenko, Sergey Vasilyevich; Matsnev, Eduard Ivanovich; Melnikov, Oleg Anatol’evich

    2015-01-01

    Background We report here data from the >200 patients recruited in Russia to take part in OSVaLD, a 12-week, open-label, post-marketing surveillance study of the response to betahistine 48 mg/day in vertigo of peripheral vestibular origin carried out in a total of 13 countries. Methods The primary efficacy endpoint was change in the Dizziness Handicap Inventory (DHI; 100-point scale). Changes in Hospital Anxiety and Depression Scale (HADS) and Medical Outcomes Study Short-Form 36, version 2 (SF-36v2®) scores were a priori secondary Outcomes. Results Total DHI score improved by 43 points during betahistine treatment. This aggregate improvement was equally distributed across the three domains of the DHI (physical, emotional, and functional; P<0.0001 for main and subscore changes from baseline). Statistically significant improvements versus baseline were also observed in mean HADS scores for anxiety and depression (both P<0.0001), and in the Physical Component Summary and Mental Component Summary scores of the SF-36v2 (both P<0.0001 versus baseline). Only one suspected adverse drug reaction was recorded in the Russian safety population (n=204), indicating that betahistine was well tolerated in those patients. Conclusion Betahistine 48 mg/day was associated with clear improvements in well-configured and widely validated measures of health-related quality of life and an encouraging tolerability profile in patients in Russia who took part in OSVaLD. PMID:25653552

  16. Positive Psychotherapy

    ERIC Educational Resources Information Center

    Seligman, Martin E. P.; Rashid, Tayyab; Parks, Acacia C.

    2006-01-01

    Positive psychotherapy (PPT) contrasts with standard interventions for depression by increasing positive emotion, engagement, and meaning rather than directly targeting depressive symptoms. The authors have tested the effects of these interventions in a variety of settings. In informal student and clinical settings, people not uncommonly reported…

  17. Positive Proof.

    ERIC Educational Resources Information Center

    Auty, Geoffrey

    1988-01-01

    Presents experiments which show that in electrostatics there are logical reasons for describing charged materials as positive or negative. Indicates that static and current electricity are not separate areas of physics. Diagrams of experiments and circuits are included. (RT)

  18. Nucleosome Positioning

    PubMed Central

    Nishida, Hiromi

    2012-01-01

    Nucleosome positioning is not only related to genomic DNA compaction but also to other biological functions. After the chromatin is digested by micrococcal nuclease, nucleosomal (nucleosome-bound) DNA fragments can be sequenced and mapped on the genomic DNA sequence. Due to the development of modern DNA sequencing technology, genome-wide nucleosome mapping has been performed in a wide range of eukaryotic species. Comparative analyses of the nucleosome positions have revealed that the nucleosome is more frequently formed in exonic than intronic regions, and that most of transcription start and translation (or transcription) end sites are located in nucleosome linker DNA regions, indicating that nucleosome positioning influences transcription initiation, transcription termination, and gene splicing. In addition, nucleosomal DNA contains guanine and cytosine (G + C)-rich sequences and a high level of cytosine methylation. Thus, the nucleosome positioning system has been conserved during eukaryotic evolution.

  19. Position indicator

    DOEpatents

    Tanner, David E.

    1981-01-01

    A nuclear reactor system is described in which a position indicator is provided for detecting and indicating the position of a movable element inside a pressure vessel. The movable element may be a valve element or similar device which moves about an axis. Light from a light source is transmitted from a source outside the pressure vessel to a first region inside the pressure vessel in alignment with the axis of the movable element. The light is redirected by a reflector prism to a second region displaced radially from the first region. The reflector prism moves in response to movement of the movable element about its axis such that the second region moves arcuately with respect to the first region. Sensors are arrayed in an arc corresponding to the arc of movement of the second region and signals are transmitted from the sensors to the exterior of the reactor vessel to provide indication of the position of the movable element.

  20. [Positive psychiatry].

    PubMed

    Timmerby, Nina; Austin, Stephen; Bech, Per

    2016-02-01

    Positive psychiatry (PP) is a field within psychiatry with a particular focus on promoting well-being in people who already have or are at high risk of developing mental or physical illness. PP should be considered a supplement to trad-tional psychiatry and a call for therapists in psychiatry to focus on the person as a whole rather than just as a patient. PP is in line with current national and international health policy focus on promoting positive mental health. PMID:26857411

  1. Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research.

    PubMed

    Strupp, Michael; Zwergal, Andreas; Feil, Katharina; Bremova, Tatiana; Brandt, Thomas

    2015-04-01

    There are currently eight groups of drugs for the pharmacotherapy of vertigo, nystagmus, and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications; antidepressants, anticonvulsants, aminopyridines, and acetyl-DL-leucine ("the eight A's"). In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but there is not sufficient current evidence for a general recommendation. There is also insufficient evidence that 48 or 144 mg/day betahistine has an effect in Ménière's disease. Therefore, higher dosages are currently recommended; in animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one yet not randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There are so far no RCTs on vestibular migraine, so currently no treatment can be recommended. Acetyl-dl-leucine improves cerebellar ataxia (three observational studies); it also accelerates central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT). PMID:25903394

  2. [Pharmacotherapy of Vestibular Disorders, Nystagmus and Cerebellar Disorders].

    PubMed

    Feil, K; Böttcher, N; Kremmyda, O; Muth, C; Teufel, J; Zwergal, A; Brandt, T; Strupp, M

    2015-09-01

    There are currently different groups of drugs for the pharmacotherapy of vertigo, nystagmus and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications and antidepressants, anticonvulsants, aminopyridines as well as acetyl-DL-leucine. In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but currently there is not sufficient evidence for a general recommendation. There is insufficient evidence to support the view that 16 mg t. i. d. or 48 mg t. i. d. betahistine has an effect in Menière's disease. Therefore, higher dosages are recommended. In animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There has been no RCT on the efficacy of beta-blockers or topiramate but one RCT on flunarizine in vestibular migraine. Based on clinical experience, a treatment analogous to that for migraine without aura can be recommended. Acetyl-DL-leucine improved cerebellar ataxia (two observational studies); it also accelerated central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on treatment of vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT). PMID:26421856

  3. Positive psychotherapy.

    PubMed

    Seligman, Martin E P; Rashid, Tayyab; Parks, Acacia C

    2006-11-01

    Positive psychotherapy (PPT) contrasts with standard interventions for depression by increasing positive emotion, engagement, and meaning rather than directly targeting depressive symptoms. The authors have tested the effects of these interventions in a variety of settings. In informal student and clinical settings, people not uncommonly reported them to be "life-changing." Delivered on the Web, positive psychology exercises relieved depressive symptoms for at least 6 months compared with placebo interventions, the effects of which lasted less than a week. In severe depression, the effects of these Web exercises were particularly striking. This address reports two preliminary studies: In the first, PPT delivered to groups significantly decreased levels of mild-to-moderate depression through 1-year follow-up. In the second, PPT delivered to individuals produced higher remission rates than did treatment as usual and treatment as usual plus medication among outpatients with major depressive disorder. Together, these studies suggest that treatments for depression may usefully be supplemented by exercises that explicitly increase positive emotion, engagement, and meaning. ((c) 2006 APA, all rights reserved). PMID:17115810

  4. Position sensor

    NASA Technical Reports Server (NTRS)

    Auer, Siegfried (Inventor)

    1988-01-01

    A radiant energy angle sensor is provided wherein the sensitive portion thereof comprises a pair of linear array detectors with each detector mounted normal to the other to provide X and Y channels and a pair of slits spaced from the pair of linear arrays with each of the slits positioned normal to its associated linear array. There is also provided electrical circuit means connected to the pair of linear array detectors and to separate X and Y axes outputs.

  5. Positive Psychologists on Positive Constructs

    ERIC Educational Resources Information Center

    Lyubomirsky, Sonja

    2012-01-01

    Comments on the original article by McNulty and Fincham (see record 2011-15476-001). In their article, the authors offered compelling evidence that constructs such as forgiveness and optimism can have both beneficial and adverse consequences, depending on the context. Their caution about labeling particular psychological processes as "positive" is…

  6. Living positively as HIV positive.

    PubMed

    Garraty, Sarah J

    2011-01-01

    A nursing student records a brief biography of a Zambian nurse and certified midwife living with HIV/AIDS while shadowing the nurse during an undergraduate cross-cultural course in Macha, Zambia in January 2009. The nurse strives to live positively, educating, encouraging, and empowering others. PMID:21294466

  7. Positioning apparatus

    DOEpatents

    Vogel, M.A.; Alter, P.

    1983-07-07

    An apparatus is provided for precisely adjusting the position of an article relative to a beam emerging from a neutron source disposed in a housing. The apparatus includes a support pivotably mounted on a movable base plate and freely suspended therefrom. The support is gravity biased toward the housing and carries an article holder movable in a first direction longitudinally of the axis of said beam and normally urged into engagement against said housing. Means are provided for moving the base plate in two directions to effect movement of the suspended holder in two mutually perpendicular directions, respectively, normal to the axis of the beam.

  8. Positioning apparatus

    DOEpatents

    Vogel, Max A.; Alter, Paul

    1986-05-06

    An apparatus for precisely positioning materials test specimens within the optimum neutron flux path emerging from a neutron source located in a housing. The test specimens are retained in a holder mounted on the free end of a support pivotably mounted and suspended from a movable base plate. The support is gravity biased to urge the holder in a direction longitudinally of the flux path against the housing. Means are provided for moving the base plate in two directions to effect movement of the holder in two mutually perpendicular directions normal to the axis of the flux path.

  9. Positioning apparatus

    DOEpatents

    Vogel, Max A.; Alter, Paul

    1986-01-01

    An apparatus for precisely positioning materials test specimens within the optimum neutron flux path emerging from a neutron source located in a housing. The test specimens are retained in a holder mounted on the free end of a support pivotably mounted and suspended from a movable base plate. The support is gravity biased to urge the holder in a direction longitudinally of the flux path against the housing. Means are provided for moving the base plate in two directions to effect movement of the holder in two mutually perpendicular directions normal to the axis of the flux path.

  10. POSITIONING DEVICE

    DOEpatents

    Wall, R.R.; Peterson, D.L.

    1959-09-15

    A positioner is described for a vertical reactor-control rod. The positioner comprises four grooved friction rotatable members that engage the control rod on all sides and shift it longitudinally. The four friction members are drivingly interconnected for conjoint rotation and comprise two pairs of coaxial members. The members of each pair are urged toward one another by hydraulic or pneumatic pressure and thus grip the control rod so as to hold it in any position or adjust it. Release of the by-draulic or pneumatic pressure permits springs between the friction members of each pair to force them apart, whereby the control rod moves quickly by gravity into the reactor.

  11. Lateralization of horizontal semicircular canal canalolithiasis and cupulopathy using bow and lean test and head-roll test.

    PubMed

    Kim, Chang-Hee; Kim, Yong Gyu; Shin, Jung Eun; Yang, Young Soo; Im, Donghyuk

    2016-10-01

    Accurate lateralization is important to improve treatment outcomes in horizontal semicircular canal (HSCC) benign paroxysmal positional vertigo (BPPV). To determine the involved side in HSCC-BPPV, the intensity of nystagmus has been compared in a head-roll test (HRT) and the direction of nystagmus was evaluated in a bow and lean test (BLT). The aim of this study is to compare the results of a BLT with those of a HRT for lateralization of HSCC-canalolithiasis and cupulopathy (heavy cupula and light cupula), and evaluate treatment outcomes in patients with HSCC-canalolithiasis. We conducted retrospective case reviews in 66 patients with HSCC-canalolithiasis and 63 patients with HSCC-cupulopathy. The affected side was identified as the direction of bowing nystagmus on BLT in 55 % (36 of 66) of patients with canalolithiasis, which was concordant with the HRT result in 67 % (24 of 36) of cases (concordant group). Lateralization was determined by comparison of nystagmus intensity during HRT in 30 patients who did not show bowing or leaning nystagmus. The remission rate after the first treatment was 71 % (17 of 24) in the concordant group and 45 % (5 of 11) in the discordant group. Both bowing and leaning nystagmus were observed in all patients with cupulopathy, and the side of the null plane was identified as the affected side. In conclusion, bowing and/or leaning nystagmus were observed in only 55 % of patients with HSCC-canalolithiasis, and the first treatment based on the result of BLT alone was effective in only 45 % of the patients in whom the BLT and HRT were discordant, which may suggest that the usefulness of BLT in lateralizing the HSCC-canalolithiasis may be limited. PMID:26758464

  12. Positive position control of robotic manipulators

    NASA Technical Reports Server (NTRS)

    Baz, A.; Gumusel, L.

    1989-01-01

    The present, simple and accurate position-control algorithm, which is applicable to fast-moving and lightly damped robot arms, is based on the positive position feedback (PPF) strategy and relies solely on position sensors to monitor joint angles of robotic arms to furnish stable position control. The optimized tuned filters, in the form of a set of difference equations, manipulate position signals for robotic system performance. Attention is given to comparisons between this PPF-algorithm controller's experimentally ascertained performance characteristics and those of a conventional proportional controller.

  13. Positional Plagiocephaly (Flattened Head)

    MedlinePlus

    ... Simple practices like changing a baby's sleep position, holding your baby, and providing lots of "tummy time" ... devices to keep your baby in one position. Alternate positions in the crib. Consider how you lay ...

  14. Want Positive Behavior? Use Positive Language

    ERIC Educational Resources Information Center

    Wood, Chip; Freeman-Loftis, Babs

    2012-01-01

    Positive adult language is the professional use of words and tone of voice to enable students to learn in an engaged, active way. This includes learning social skills. To guide children toward choosing and maintaining positive behaviors, adults need to carefully choose the words and tone of voice used when speaking to them. Learning to use…

  15. Positive Education: Positive Psychology and Classroom Interventions

    ERIC Educational Resources Information Center

    Seligman, Martin E. P.; Ernst, Randal M.; Gillham, Jane; Reivich, Karen; Linkins, Mark

    2009-01-01

    Positive education is defined as education for both traditional skills and for happiness. The high prevalence worldwide of depression among young people, the small rise in life satisfaction, and the synergy between learning and positive emotion all argue that the skills for happiness should be taught in school. There is substantial evidence from…

  16. Positive Classroom Environments = Positive Academic Results

    ERIC Educational Resources Information Center

    Wilson-Fleming, LaTerra; Wilson-Younger, Dylinda

    2012-01-01

    This article discusses the effects of a positive classroom environment and its impact on student behavior and achievement. It also provides strategies for developing expectations for student achievement and the importance of parental involvement. A positive classroom environment is essential in keeping behavior problems to a minimum. There are a…

  17. Mammalian Otolin: A Multimeric Glycoprotein Specific to the Inner Ear that Interacts with Otoconial Matrix Protein Otoconin-90 and Cerebellin-1

    PubMed Central

    Deans, Michael R.; Peterson, Jonathan M.; Wong, G. William

    2010-01-01

    Background The mammalian otoconial membrane is a dense extracellular matrix containing bio-mineralized otoconia. This structure provides the mechanical stimulus necessary for hair cells of the vestibular maculae to respond to linear accelerations and gravity. In teleosts, Otolin is required for the proper anchoring of otolith crystals to the sensory maculae. Otoconia detachment and subsequent entrapment in the semicircular canals can result in benign paroxysmal positional vertigo (BPPV), a common form of vertigo for which the molecular basis is unknown. Several cDNAs encoding protein components of the mammalian otoconia and otoconial membrane have recently been identified, and mutations in these genes result in abnormal otoconia formation and balance deficits. Principal Findings Here we describe the cloning and characterization of mammalian Otolin, a protein constituent of otoconia and the otoconial membrane. Otolin is a secreted glycoprotein of ∼70 kDa, with a C-terminal globular domain that is homologous to the immune complement C1q, and contains extensive posttranslational modifications including hydroxylated prolines and glycosylated lysines. Like all C1q/TNF family members, Otolin multimerizes into higher order oligomeric complexes. The expression of otolin mRNA is restricted to the inner ear, and immunohistochemical analysis identified Otolin protein in support cells of the vestibular maculae and semi-circular canal cristae. Additionally, Otolin forms protein complexes with Cerebellin-1 and Otoconin-90, two protein constituents of the otoconia, when expressed in vitro. Otolin was also found in subsets of support cells and non-sensory cells of the cochlea, suggesting that Otolin is also a component of the tectorial membrane. Conclusion Given the importance of Otolin in lower organisms, the molecular cloning and biochemical characterization of the mammalian Otolin protein may lead to a better understanding of otoconial development and vestibular dysfunction

  18. Role of orientation reference selection in motion sickness, supplement 2S

    NASA Technical Reports Server (NTRS)

    Peterka, Robert J.; Black, F. Owen

    1987-01-01

    Previous experiments with moving platform posturography have shown that different people have varying abilities to resolve conflicts among vestibular, visual, and proprioceptive sensory signals. The conceptual basis of the present proposal hinges on the similarities between the space motion sickness problem and the sensory orientation reference selection problems associated with benign paroxysmal positional vertigo (BPPV) syndrome. These similarities include both etiology related to abnormal vertical canal-otolith function, and motion sickness initiating events provoked by pitch and roll head movements. The objectives are to explore and quantify the orientation reference selection abilities of subjects and the relation of this selection to motion sickness in humans. The overall objectives are to determine: if motion sickness susceptibility is related to sensory orientation reference selection abilities of subjects; if abnormal vertical canal-otolith function is the source of abnormal posture control strategies and if it can be quantified by vestibular and oculomotor reflex measurements, and if it can be quantified by vestibular and oculomotor reflex measurements; and quantifiable measures of perception of vestibular and visual motion cues can be related to motion sickness susceptibility and to orientation reference selection ability.

  19. Otopetrin 1 is required for otolith formation in the zebrafish Danio rerio.

    PubMed

    Hughes, Inna; Blasiole, Brian; Huss, David; Warchol, Mark E; Rath, Nigam P; Hurle, Belen; Ignatova, Elena; Dickman, J David; Thalmann, Ruediger; Levenson, Robert; Ornitz, David M

    2004-12-15

    Orientation with respect to gravity is essential for the survival of complex organisms. The gravity receptor is one of the phylogenetically oldest sensory systems, and special adaptations that enhance sensitivity to gravity are highly conserved. The fish inner ear contains three large extracellular biomineral particles, otoliths, which have evolved to transduce the force of gravity into neuronal signals. Mammalian ears contain thousands of small particles called otoconia that serve a similar function. Loss or displacement of these structures can be lethal for fish and is responsible for benign paroxysmal positional vertigo (BPPV) in humans. The distinct morphologies of otoconial particles and otoliths suggest divergent developmental mechanisms. Mutations in a novel gene Otopetrin 1 (Otop1), encoding multi-transmembrane domain protein, result in nonsyndromic otoconial agenesis and a severe balance disorder in mice. Here we show that the zebrafish, Danio rerio, contains a highly conserved gene, otop1, that is essential for otolith formation. Morpholino-mediated knockdown of zebrafish Otop1 leads to otolith agenesis without affecting the sensory epithelium or other structures within the inner ear. Despite lack of otoliths in early development, otolith formation partially recovers in some fish after 2 days. However, the otoliths are malformed, misplaced, lack an organic matrix, and often consist of inorganic calcite crystals. These studies demonstrate that Otop1 has an essential and conserved role in the timing of formation and the size and shape of the developing otolith. PMID:15581873

  20. Sharing a Faculty Position.

    ERIC Educational Resources Information Center

    O'Kane, Patricia K.; Meyer, Mary

    1982-01-01

    Describes the experience of two nursing faculty members who shared an assistant professor of nursing position. Discusses positive and negative aspects of the experience and notes that a unified and creative approach must be taken for it to succeed. (JOW)

  1. Positive battery plate

    NASA Technical Reports Server (NTRS)

    Rowlette, John R. (Inventor)

    1985-01-01

    The power characteristics of a lead acid battery are improved by incorporating a dispersion of 1 to 10% by weight of a thermodynamically stable conductivity additive, such as conductive tin oxide coated glass fibers (34) of filamentary glass wool (42) in the positive active layer (32) carried on the grid (30) of the positive plate (16). Positive plate potential must be kept high enough to prevent reduction of the tin oxide to tin by utilizing an oversized, precharged positive paste.

  2. Prone positioning for surgery.

    PubMed

    Bowers, Mark

    2012-05-01

    The role of the registered perioperative practitioner (Operating Department Practitioner or Registered Nurse) includes the responsibility for safely positioning patients for surgery. The prone position is in common use for a variety of surgical procedures. The formal term for this surgical position is ventral decubitus (meaning laying face down). PMID:22720505

  3. The Positivity Scale

    ERIC Educational Resources Information Center

    Caprara, Gian Vittorio; Alessandri, Guido; Eisenberg, Nancy; Kupfer, A.; Steca, Patrizia; Caprara, Maria Giovanna; Yamaguchi, Susumu; Fukuzawa, Ai; Abela, John

    2012-01-01

    Five studies document the validity of a new 8-item scale designed to measure "positivity," defined as the tendency to view life and experiences with a positive outlook. In the first study (N = 372), the psychometric properties of Positivity Scale (P Scale) were examined in accordance with classical test theory using a large number of college…

  4. Interval polynomial positivity

    NASA Technical Reports Server (NTRS)

    Bose, N. K.; Kim, K. D.

    1989-01-01

    It is shown that a univariate interval polynomial is globally positive if and only if two extreme polynomials are globally positive. It is shown that the global positivity property of a bivariate interval polynomial is completely determined by four extreme bivariate polynomials. The cardinality of the determining set for k-variate interval polynomials is 2k. One of many possible generalizations, where vertex implication for global positivity holds, is made by considering the parameter space to be the set dual of a boxed domain.

  5. Beam position monitor

    DOEpatents

    Alkire, Randy W.; Rosenbaum, Gerold; Evans, Gwyndaf

    2003-07-22

    An apparatus for determining the position of an x-ray beam relative to a desired beam axis. Where the apparatus is positioned along the beam path so that a thin metal foil target intersects the x-ray beam generating fluorescent radiation. A PIN diode array is positioned so that a portion of the fluorescent radiation is intercepted by the array resulting in an a series of electrical signals from the PIN diodes making up the array. The signals are then analyzed and the position of the x-ray beam is determined relative to the desired beam path.

  6. Positioning and locking apparatus

    DOEpatents

    Hayward, M.L.; Harper, W.H.

    1987-06-30

    A positioning and locking apparatus are disclosed including a fixture having a rotatable torque ring provided with a plurality of cam segments for automatically guiding a container into a desired location within the fixture. Rotation of the ring turns the container into a final position in pressure sealing relation against a hatch member. 6 figs.

  7. "Positive Discipline": Beginnings Workshop.

    ERIC Educational Resources Information Center

    Stephens, Karen; And Others

    1992-01-01

    Four articles in this special section discuss (1) ideas for making discipline a positive experience for child care staff and children (Karen Stephens); (2) scenarios illustrating the power of adult messages to children (Karen Stephens); (3) classroom environments that facilitate positive discipline (Marjorie K. Kostelnik); and (4) strategies for…

  8. Positioning and locking apparatus

    DOEpatents

    Hayward, Milton L.; Harper, William H.

    1987-01-01

    A positioning and locking apparatus including a fixture having a rotatable torque ring provided with a plurality of cam segments for automatically guiding a container into a desired location within the fixture. Rotation of the ring turns the container into a final position in pressure sealing relation against a hatch member.

  9. Positioning and locking apparatus

    DOEpatents

    Hayward, M.L.; Harper, W.H.

    1985-06-19

    A positioning and locking apparatus including a fixture having a rotatable torque ring provided with a plurality of cam segments for automatically guiding a container into a desired location within the fixture. Rotation of the ring turns the container into a final position in pressure sealing relation against a hatch member.

  10. CRANE POSITIONING APPARATUS

    DOEpatents

    Landsiedel, F.W.; Wolff, H.

    1960-06-28

    An apparatus is described for automatically accomplishing the final accurate horizontal positioning of a crane after the latter has been placed to within 1/8 in. of its selected position. For this purpose there is provided a tiltable member on the crane mast for lowering into contact with a stationary probe. Misalignment of the tiltable member, with respect to the probe as the member is lowered, causes tilting of the latter to actuate appropriate switches that energize motors for bringing the mast into proper position. When properly aligned the member is not tilted and a central switch is actuated to indicate the final alignment of the crane.

  11. Fluorescent optical position sensor

    DOEpatents

    Weiss, Jonathan D.

    2005-11-15

    A fluorescent optical position sensor and method of operation. A small excitation source side-pumps a localized region of fluorescence at an unknown position along a fluorescent waveguide. As the fluorescent light travels down the waveguide, the intensity of fluorescent light decreases due to absorption. By measuring with one (or two) photodetectors the attenuated intensity of fluorescent light emitted from one (or both) ends of the waveguide, the position of the excitation source relative to the waveguide can be determined by comparing the measured light intensity to a calibrated response curve or mathematical model. Alternatively, excitation light can be pumped into an end of the waveguide, which generates an exponentially-decaying continuous source of fluorescent light along the length of the waveguide. The position of a photodetector oriented to view the side of the waveguide can be uniquely determined by measuring the intensity of the fluorescent light emitted radially at that location.

  12. Video image position determination

    DOEpatents

    Christensen, Wynn; Anderson, Forrest L.; Kortegaard, Birchard L.

    1991-01-01

    An optical beam position controller in which a video camera captures an image of the beam in its video frames, and conveys those images to a processing board which calculates the centroid coordinates for the image. The image coordinates are used by motor controllers and stepper motors to position the beam in a predetermined alignment. In one embodiment, system noise, used in conjunction with Bernoulli trials, yields higher resolution centroid coordinates.

  13. Optimal Centroid Position Estimation

    SciTech Connect

    Candy, J V; McClay, W A; Awwal, A S; Ferguson, S W

    2004-07-23

    The alignment of high energy laser beams for potential fusion experiments demand high precision and accuracy by the underlying positioning algorithms. This paper discusses the feasibility of employing online optimal position estimators in the form of model-based processors to achieve the desired results. Here we discuss the modeling, development, implementation and processing of model-based processors applied to both simulated and actual beam line data.

  14. Electronystagmography

    MedlinePlus

    ... movements. Any disease or injury that damages the acoustic nerve can cause vertigo. This may include: Blood ... conditions under which the test may be performed: Acoustic neuroma Benign positional vertigo Labyrinthitis Meniere disease Risks ...

  15. Electronystagmography

    MedlinePlus

    ... movements. Any disease or injury that damages the acoustic nerve can cause vertigo. This may include: Blood ... conditions under which the test may be performed: Acoustic neuroma Benign positional vertigo Labyrinthitis Meniere disease

  16. Vertigo in America: A Social Comment.

    ERIC Educational Resources Information Center

    Donnelly, Peter

    1977-01-01

    Participation in high-risk sports appears to have increased in the 1970s. This article analyzes this trend from a sociological perspective, citing examples from a number of commercial and noncommercial sports. (DS)

  17. The positivity scale.

    PubMed

    Caprara, Gian Vittorio; Alessandri, Guido; Eisenberg, Nancy; Kupfer, A; Steca, Patrizia; Caprara, Maria Giovanna; Yamaguchi, Susumu; Fukuzawa, Ai; Abela, John

    2012-09-01

    Five studies document the validity of a new 8-item scale designed to measure positivity, defined as the tendency to view life and experiences with a positive outlook. In the first study (N = 372), the psychometric properties of Positivity Scale (P Scale) were examined in accordance with classical test theory using a large number of college participants. In Study 2, the unidimensionality of the P Scale was corroborated with confirmatory factor analysis in 2 independent samples (N₁ = 322; N₂ = 457). In Study 3, P Scale invariance across sexes and its relations with self-esteem, life satisfaction, optimism, positive negative affect, depression, and the Big Five provided further evidence of the internal and construct validity of the new measure in a large community sample (N = 3,589). In Study 4, test-retest reliability of the P Scale was found in a sample of college students (N = 262) who were readministered the scale after 5 weeks. In Study 5, measurement invariance and construct validity of P Scale were further supported across samples in different countries and cultures, including Italy (N = 689), the United States (N = 1,187), Japan (N = 281), and Spain (N = 302). Psychometric findings across diverse cultural context attest to the robustness of the P Scale and to positivity as a basic disposition. PMID:22250591

  18. Local positioning system

    SciTech Connect

    Kyker, R.

    1995-07-25

    Navigation systems have been vital to transportation ever since man took to the air and sea. Early navigation systems utilized the sextant to navigate by starlight as well as the magnetic needle compass. As electronics and communication technologies improved, inertial navigation systems were developed for use in ships and missile delivery. These systems consisted of electronic compasses, gyro-compasses, accelerometers, and various other sensors. Recently, systems such as LORAN and the Global Positioning System (GPS) have utilized the properties of radio wave propagation to triangulate position. The Local Positioning System (LPS), described in this paper, is an implementation of a limited inertial navigation system designed to be used on a bicycle. LPS displays a cyclist`s current position relative to a starting location. This information is displayed in Cartesian-like coordinates. To accomplish this, LPS relies upon two sensors, an electronic compass sensor and a distance sensor. The compass sensor provides directional information while the distance sensor provides the distance traveled. This information yields a distance vector for each point in time which when summed produces the cyclist`s current position. LPS is microprocessor controlled and is designed for a range of less than 90 miles.

  19. Beyond Positive Psychology?

    PubMed Central

    McNulty, James K.; Fincham, Frank D.

    2014-01-01

    The field of positive psychology rests on the assumption that certain psychological traits and processes are inherently beneficial for well-being. We review evidence that challenges this assumption. First, we review data from 4 independent longitudinal studies of marriage revealing that 4 ostensibly positive processes—forgiveness, optimistic expectations, positive thoughts, and kindness—can either benefit or harm well-being depending on the context in which they operate. Although all 4 processes predicted better relationship well-being among spouses in healthy marriages, they predicted worse relationship well-being in more troubled marriages. Then, we review evidence from other research that reveals that whether ostensibly positive psychological traits and processes benefit or harm well-being depends on the context of various noninterpersonal domains as well. Finally, we conclude by arguing that any movement to promote well-being may be most successful to the extent that it (a) examines the conditions under which the same traits and processes may promote versus threaten well-being, (b) examines both healthy and unhealthy people, (c) examines well-being over substantial periods of time, and (d) avoids labeling psychological traits and processes as positive or negative. PMID:21787036

  20. Positive quadrature formulas III

    NASA Astrophysics Data System (ADS)

    Peherstorfer, Franz

    2008-12-01

    First we discuss briefly our former characterization theorem for positive interpolation quadrature formulas (abbreviated qf), provide an equivalent characterization in terms of Jacobi matrices, and give links and applications to other qf, in particular to Gauss-Kronrod quadratures and recent rediscoveries. Then for any polynomial t_n which generates a positive qf, a weight function (depending on n ) is given with respect to which t_n is orthogonal to mathbb{P}_{n-1} . With the help of this result an asymptotic representation of the quadrature weights is derived. In general the asymptotic behaviour is different from that of the Gaussian weights. Only under additional conditions do the quadrature weights satisfy the so-called circle law. Corresponding results are obtained for positive qf of Radau and Lobatto type.

  1. Uncharged positive electrode composition

    DOEpatents

    Kaun, Thomas D.; Vissers, Donald R.; Shimotake, Hiroshi

    1977-03-08

    An uncharged positive-electrode composition contains particulate lithium sulfide, another alkali metal or alkaline earth metal compound other than sulfide, e.g., lithium carbide, and a transition metal powder. The composition along with a binder, such as electrolytic salt or a thermosetting resin is applied onto an electrically conductive substrate to form a plaque. The plaque is assembled as a positive electrode within an electrochemical cell opposite to a negative electrode containing a material such as aluminum or silicon for alloying with lithium. During charging, lithium alloy is formed within the negative electrode and transition metal sulfide such as iron sulfide is produced within the positive electrode. Excess negative electrode capacity over that from the transition metal sulfide is provided due to the electrochemical reaction of the other than sulfide alkali metal or alkaline earth metal compound.

  2. Automated stereotactic positioning system.

    PubMed

    Goerss, S J; Kelly, P J; Kall, B A

    1987-01-01

    An automated stereotactic machine has been interfaced to a surgical computer to complete a totally interactive surgical system capable of locating tumor volumes. Stepper motors, activated by the host computer, drive a three-dimensional slide to position the patient's head with respect to a fixed arc, locating the surgical target. Linear encoders on each axis create a closed-loop positioning system and a digital display for visual inspection of the slide's position. The 160-mm arc directs all instrumentation to its isocenter, regardless of the two angular settings, providing maximum freedom in selecting a safe trajectory to the target. Phantom test points compatible with computerized tomographic and magnetic resonance imaging were repeatedly scanned to determine the overall system accuracy, which approached 0.6 mm, depending on the spatial resolution of the image. This stereotactic device may be used to perform stereotactic laser craniotomies, biopsies, 192Ir implants for interstitial radiation, third ventriculostomies and functional procedures. PMID:3329830

  3. Taking a Position

    NASA Technical Reports Server (NTRS)

    1999-01-01

    "TerrAvoid" and "Position Integrity" combine Global Positioning Satellite (GPS) data with high-resolution maps of the Earth's topography. Dubbs & Severino, Inc., based in Irvine, California, has developed software that allows the system to be run on a battery-powered laptop in the cockpit. The packages, designed primarily for military sponsors and now positioned to hit the consumer market in coming months, came about as the result of the Jet Propulsion Laboratory's Technology Affiliates Program. Intended to give American industry assistance from NASA experts and to facilitate business use of intellectual property developed for the space program, the Technology Affiliates Program introduced the start-up company of Dubbs & Severino to JPL's Dr. Nevin Bryant four years ago. GeoTIFF is now in the public domain, and its use for commercial product development has evolved into an industry standard over the last year.

  4. [Mammaplasty: the "love position"].

    PubMed

    Petit, F; Paraskevas, A; Lantieri, L

    2004-02-01

    The authors describe a new position of the patient that enables the surgeon to perform a bilateral and synchronous mammaplasty, without switching sides. The patient is first raised in the sitting position, then the thigh and leg holders of the operating table are spread out to a 45-60 degrees angle. The surgeon stands in between the thighs, where he faces the chest and can operate on the breasts. The entire operation is performed by the surgeon, approaching both breasts simultaneously without the need for switching positions. The direct and central access, along with the continuing visual control of the shaping, turns the operation into a simple and faster one with better control of the cosmetic result. PMID:15013529

  5. Turbine nozzle positioning system

    DOEpatents

    Norton, Paul F.; Shaffer, James E.

    1996-01-30

    A nozzle guide vane assembly having a preestablished rate of thermal expansion is positioned in a gas turbine engine and being attached to conventional metallic components. The nozzle guide vane assembly includes an outer shroud having a mounting leg with an opening defined therein, a tip shoe ring having a mounting member with an opening defined therein, a nozzle support ring having a plurality of holes therein and a pin positioned in the corresponding opening in the outer shroud, opening in the tip shoe ring and the hole in the nozzle support ring. A rolling joint is provided between metallic components of the gas turbine engine and the nozzle guide vane assembly. The nozzle guide vane assembly is positioned radially about a central axis of the gas turbine engine and axially aligned with a combustor of the gas turbine engine.

  6. Turbine nozzle positioning system

    DOEpatents

    Norton, P.F.; Shaffer, J.E.

    1996-01-30

    A nozzle guide vane assembly having a preestablished rate of thermal expansion is positioned in a gas turbine engine and being attached to conventional metallic components. The nozzle guide vane assembly includes an outer shroud having a mounting leg with an opening defined therein, a tip shoe ring having a mounting member with an opening defined therein, a nozzle support ring having a plurality of holes therein and a pin positioned in the corresponding opening in the outer shroud, opening in the tip shoe ring and the hole in the nozzle support ring. A rolling joint is provided between metallic components of the gas turbine engine and the nozzle guide vane assembly. The nozzle guide vane assembly is positioned radially about a central axis of the gas turbine engine and axially aligned with a combustor of the gas turbine engine. 9 figs.

  7. Bayesian model selection techniques as decision support for shaping a statistical analysis plan of a clinical trial: An example from a vertigo phase III study with longitudinal count data as primary endpoint

    PubMed Central

    2012-01-01

    Background A statistical analysis plan (SAP) is a critical link between how a clinical trial is conducted and the clinical study report. To secure objective study results, regulatory bodies expect that the SAP will meet requirements in pre-specifying inferential analyses and other important statistical techniques. To write a good SAP for model-based sensitivity and ancillary analyses involves non-trivial decisions on and justification of many aspects of the chosen setting. In particular, trials with longitudinal count data as primary endpoints pose challenges for model choice and model validation. In the random effects setting, frequentist strategies for model assessment and model diagnosis are complex and not easily implemented and have several limitations. Therefore, it is of interest to explore Bayesian alternatives which provide the needed decision support to finalize a SAP. Methods We focus on generalized linear mixed models (GLMMs) for the analysis of longitudinal count data. A series of distributions with over- and under-dispersion is considered. Additionally, the structure of the variance components is modified. We perform a simulation study to investigate the discriminatory power of Bayesian tools for model criticism in different scenarios derived from the model setting. We apply the findings to the data from an open clinical trial on vertigo attacks. These data are seen as pilot data for an ongoing phase III trial. To fit GLMMs we use a novel Bayesian computational approach based on integrated nested Laplace approximations (INLAs). The INLA methodology enables the direct computation of leave-one-out predictive distributions. These distributions are crucial for Bayesian model assessment. We evaluate competing GLMMs for longitudinal count data according to the deviance information criterion (DIC) or probability integral transform (PIT), and by using proper scoring rules (e.g. the logarithmic score). Results The instruments under study provide excellent

  8. In situ measurement of mesopelagic particle sinking rates and the control of carbon transfer to the ocean interior during the Vertical Flux in the Global Ocean (VERTIGO) voyages in the North Pacific

    NASA Astrophysics Data System (ADS)

    Trull, T. W.; Bray, S. G.; Buesseler, K. O.; Lamborg, C. H.; Manganini, S.; Moy, C.; Valdes, J.

    2008-07-01

    sinking slower than 137 m d -1. At K2, less than 1% of the POC flux sank at >820 m d -1, but a large fraction (˜15-45%) of the flux was contributed by other fast-sinking classes (410 and 205 m d -1). PIC and BSi minerals were not present in higher proportions in the faster sinking fractions, but the observations were too limited to rule out a ballasting contribution to the control of sinking rates. Photographic evidence for a wide range of particle types within individual sinking-rate fractions suggests that biological processes that set the porosity and shape of particles are also important and may mask the role of minerals. Comparing the spectrum of sinking rates observed at K2 with the power-law profile of flux attenuation with depth obtained from other VERTIGO sediment traps deployed at multiple depths [Buesseler, K.O., Lamborg, C.H., Boyd, P.W., Lam, P.J., Trull, T.W., Bidigare, R.R., Bishop, J.K.B., Casciotti, K.L., Dehairs, F., Elskens, M., Honda, M., Karl, D.M., Siegel, D., Silver, M., Steinberg, D., Valdes, J., Van Mooy, B., Wilson, S.E., 2007b. Revisiting carbon flux through the Ocean's twilight zone. Science 316(5824), 567-570, doi: 10.1126/science.1137959] emphasizes the importance of particle transformations within the mesopelagic zone in the control of carbon transport to the ocean interior.

  9. Nucleosome Positioning and Epigenetics

    NASA Astrophysics Data System (ADS)

    Schwab, David; Bruinsma, Robijn

    2008-03-01

    The role of chromatin structure in gene regulation has recently taken center stage in the field of epigenetics, phenomena that change the phenotype without changing the DNA sequence. Recent work has also shown that nucleosomes, a complex of DNA wrapped around a histone octamer, experience a sequence dependent energy landscape due to the variation in DNA bend stiffness with sequence composition. In this talk, we consider the role nucleosome positioning might play in the formation of heterochromatin, a compact form of DNA generically responsible for gene silencing. In particular, we discuss how different patterns of nucleosome positions, periodic or random, could either facilitate or suppress heterochromatin stability and formation.

  10. Delegation. Position Statement. Revised

    ERIC Educational Resources Information Center

    Board, Connie; Bushmiaer, Margo; Davis-Alldritt, Linda; Fekaris, Nina; Morgitan, Judith; Murphy, M. Kathleen; Yow, Barbara

    2010-01-01

    It is the position of the National Association of School Nurses (NASN) that the delegation of nursing tasks in the school setting can be a valuable tool for the school nurse, when based on the nursing definition of delegation and in compliance with state nursing regulations and guidance. Delegation in school nursing is a complex process in which…

  11. Schoolwide Positive Behavior Supports

    ERIC Educational Resources Information Center

    Flannery, K. Brigid; Guest, Elise M.; Horner, Robert H.

    2010-01-01

    Schools are complex communities that play a major role in the social fabric of culture. Effective schools provide access to both good instruction and a social culture that supports engagement, community, and success. Over the past 10 years, more than 11,000 elementary, middle level, and high schools have adopted schoolwide positive behavior…

  12. The Teacher's Social Position.

    ERIC Educational Resources Information Center

    Ziiatdinova, Fliura Gazizovna

    1990-01-01

    Discusses a survey conducted in the Tatar Republic of the Soviet Union involving over 800 teachers, students, and parents. Reports that the study investigated opinions about teachers' social position. Indicates widespread agreement concerning the teaching profession's low prestige. Explores reasons for the profession's low prestige through an…

  13. Positive Attitude Toward Learning.

    ERIC Educational Resources Information Center

    Bethalto Community Unit District 8, IL.

    Project Positive Attitude Toward Learning (PATL) grew out of an identified need by the Bethalto Community Unit No. 8 schools to improve student self-concept and attitudes toward school. The basic approach used in project PATL is to change teacher behavior which, in turn, causes change to take place in student behavior. The mechanism for affecting…

  14. Positive Discipline. (Revised Edition).

    ERIC Educational Resources Information Center

    Nelsen, Jane

    Understanding why children do not behave the way they used to, and why both controlling and overly-permissive discipline styles are ineffective, is the first step for parents and teachers who are facing child-discipline problems. This book describes a program of positive discipline principles aimed at assisting parents and teachers in…

  15. A Positive Report Card.

    ERIC Educational Resources Information Center

    Hellman, Sally G.

    A high school English teacher found that one easy way to keep the idea of positive reinforcement foremost in her mind when she works with students was to use writing portfolios. A Portfolio Assessment project was designed in which portfolios were used in two sophomore and two junior regular English classes. A flexible plan was developed for using…

  16. Positive: HIV Affirmative Counseling.

    ERIC Educational Resources Information Center

    Kain, Craig D.

    At the end of the 1980s, counselors largely lacked an integrated approach to counseling people living with HIV disease. This book describes the experience of counseling this group of persons. The major premise here is that counselors who counsel HIV-positive clients must come to understand and affirm their clients' experiences. The text defines a…

  17. Nursing Research: Position Statement.

    ERIC Educational Resources Information Center

    Copp, Laurel; And Others

    The role of the American Association of Colleges of Nursing (AACN) in encouraging research through the programs and activities of the member schools is discussed. It is suggested that the dean or administrative head of a college of nursing is in a position to influence nursing research activities. The principal role of the academic dean in…

  18. Creating Positive Task Constraints

    ERIC Educational Resources Information Center

    Mally, Kristi K.

    2006-01-01

    Constraints are characteristics of the individual, the task, or the environment that mold and shape movement choices and performances. Constraints can be positive--encouraging proficient movements or negative--discouraging movement or promoting ineffective movements. Physical educators must analyze, evaluate, and determine the effect various…

  19. Positions of minor planets

    NASA Astrophysics Data System (ADS)

    Gressmann, M.

    A continuation of Gressman's (1980) observations is given using the Schmidt-camera 34/40 cm, f = 76. Topocentric positions of several minor planets are presented, and reference stars are obtained from the AGK(3), and applied to the two-star method to avoid any major errors. Parallax constants are also given, along with coordinates for the epoch 1950.0.

  20. Magnetic beam position monitor

    SciTech Connect

    Varfolomeev, A.A.; Ivanchenkov, S.N.; Khlebnikov, A.S.

    1995-12-31

    Many nondestructive beam position monitors are known. However, these devices can not be used for DC particle beam diagnostics. We investigated a method of beam diagnostics applicable for the operative control of DC high power e-beam inside closed waveguide. A design of the detector for determination of{open_quote} center of mass {close_quote} position of DC particle beam was developed. It was shown that the monitor can be used as a nondestructive method for the beam position control in resonators. Magnetic field of the particle beam outside a resonator is used. The detector consists of the steel yokes and magnetic field sensors. The sensors measure magnetic fluxes in the steel yokes fixed outside the resonator. When the particle beam changes its position, these magnetic fluxes also change. Beam displacement sensitivity of the monitor depends on the steel yoke dimensions. The detector sensitivity is equal to 1 Gauss/mm for the conditions adequate to the FOM-FEM project.

  1. Review of HRP Positions

    SciTech Connect

    Center for Reliability Studies

    2007-01-01

    The Department of Energy (DOE) Human Reliability Program (HRP), published as 10 CFR Part 712, is currently being reviewed and revised to address concerns identified during its implementation. Although these ''page changes'' primarily incorporate clarification of terms and language, the following discussion relates to broadening the definition of positions that require HRP certification that is found in {section}712.10.

  2. Immunizations. Position Statement. Revised

    ERIC Educational Resources Information Center

    Bobo, Nichole; Garrett, Jennifer; Teskey, Carmen; Duncan, Kay; Strasser, Kathy; Burrows-Mezu, Alicia L.

    2015-01-01

    It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood. Promotion of immunizations by the registered professional school nurse (hereinafter referred to as school nurse) is central to the public health focus of school nursing practice…

  3. Position feedback control system

    DOEpatents

    Bieg, Lothar F.; Jokiel, Jr., Bernhard; Ensz, Mark T.; Watson, Robert D.

    2003-01-01

    Disclosed is a system and method for independently evaluating the spatial positional performance of a machine having a movable member, comprising an articulated coordinate measuring machine comprising: a first revolute joint; a probe arm, having a proximal end rigidly attached to the first joint, and having a distal end with a probe tip attached thereto, wherein the probe tip is pivotally mounted to the movable machine member; a second revolute joint; a first support arm serially connecting the first joint to the second joint; and coordinate processing means, operatively connected to the first and second revolute joints, for calculating the spatial coordinates of the probe tip; means for kinematically constraining the articulated coordinate measuring machine to a working surface; and comparator means, in operative association with the coordinate processing means and with the movable machine, for comparing the true position of the movable machine member, as measured by the true position of the probe tip, with the desired position of the movable machine member.

  4. INTERMITTENT POSITIVE PRESSURE BREATHING

    EPA Science Inventory

    Efficacy of long-term intermittent positive pressure breathing (IPPB) treatment when used as an adjunct to the overall care of ambulatory outpatients with chronic obstructive pulmonary disease. The evaluation compared the use of IPPB with use of a powered nebulizer.

  5. Positive isolation disconnect

    NASA Technical Reports Server (NTRS)

    Rosener, A. A.; Jonkoniec, T. G.

    1975-01-01

    A positive isolation disconnect was developed for component replacement in serviced liquid and gaseous spacecraft systems. Initially a survey of feasible concepts was made to determine the optimum method for fluid isolation, sealing techniques, coupling concepts, and foolproofing techniques. The top concepts were then further evaluated, including the fabrication of a semifunctional model. After all tradeoff analyses were made, a final configuration was designed and fabricated for development testing. This resulted in a 6.35 mm (1/4 inch) line and 12.7 mm (1/2 inch) line positive isolation disconnect, each unit consisting of two coupled disconnect halves, each capable of fluid isolation with essentially zero clearance between them for zero leakage upon disconnect half disengagement. An interlocking foolproofing technique was incorporated that prevents uncoupling of disconnect halves prior to fluid isolation.

  6. Video image position determination

    NASA Astrophysics Data System (ADS)

    Christensen, W.; Anderson, F. L.; Kortegaard, B. L.

    1990-04-01

    The present invention generally relates to the control of video and optical information and, more specifically, to control systems utilizing video images to provide control. Accurate control of video images and laser beams is becoming increasingly important as the use of lasers for machine, medical, and experimental processes escalates. In AURORA, an installation at Los Alamos National Laboratory dedicated to laser fusion research, it is necessary to precisely control the path and angle of up to 96 laser beams. This invention is comprised of an optical beam position controller in which a video camera captures an image of the beam in its video frames, and conveys those images to a processing board which calculates the centroid coordinates for the image. The image coordinates are used by motor controllers and stepper motors to position the beam in a predetermined alignment. In one embodiment, system noise, used in conjunction with Bernoulli trials, yields higher resolution centroid coordinates.

  7. Position Sensitive Microcalorimeters

    NASA Technical Reports Server (NTRS)

    Sadleir, J. E.; Hammock, C.; Figueroa-Feliciano, E.; Stahle, C. K.; Bandler, S.; Saab, T.; Lindeman, M.; Porter, F. S.; Chervenak, J.; Brown, G.

    2004-01-01

    A Position Sensitive Transition-Edge Sensor (PoST) is a microcalorimeter device capable of one-dimensional imaging spectroscopy. The device consists of two Transition-Edge Sensors (TESs) connected to the ends of a long X-ray absorbing strip. The energy of a photon hitting the absorber and the position of the absorption event along the strip is measured from the response in the two sensors by analyzing the relative signal sizes, pulse rise times, and the sum of the pulses measured at each sensor, We report on the recent PoST effort at Goddard for applications to large field of view, high-energy- resolution, X-ray astrophysics.

  8. SPA: Solar Position Algorithm

    NASA Astrophysics Data System (ADS)

    Reda, Ibrahim; Andreas, Afshin

    2015-04-01

    The Solar Position Algorithm (SPA) calculates the solar zenith and azimuth angles in the period from the year -2000 to 6000, with uncertainties of +/- 0.0003 degrees based on the date, time, and location on Earth. SPA is implemented in C; in addition to being available for download, an online calculator using this code is available at http://www.nrel.gov/midc/solpos/spa.html.

  9. Mapping your competitive position.

    PubMed

    D'Aveni, Richard A

    2007-11-01

    A price-benefit positioning map helps you see, through your customers' eyes, how your product compares with all its competitors in a market. You can draw such a map quickly and objectively, without having to resort to costly, time-consuming consumer surveys or subjective estimates of the excellence of your product and the shortcomings of all the others. Creating a positioning map involves three steps: First, define your market to include everything your customers might consider to be your product's competitors or substitutes. Second, track the price your customers actually pay (wholesale or retail? bundled or unbundled?) and identify what your customers see as your offering's primary benefit. This is done through regression analysis, determining which of the product's attributes (as described objectively by rating services, government agencies, R&D departments, and the like) explains most of the variance in its price. Third, draw the map by plotting on a graph the position of every product in the market you've selected according to its price and its level of primary benefit, and draw a line that runs through the middle of the points. What you get is a picture of the competitive landscape of your market, where all the products above the line command a price premium owing to some secondary benefit customers value, and all those below the line are positioned to earn market share through lower prices and reduced secondary benefits. Using examples as varied as Harley-Davidson motorcycles, Motorola cell phones, and the New York restaurant market, Tuck professor D'Aveni demonstrates some of the many ways the maps can be used: to locate unoccupied or less-crowded spaces in highly competitive markets, for instance, or to identify opportunities created through changes in the relationship between the primary benefit and prices. The maps even allow companies to anticipate--and counter-- rivals' strategies. R eprint RO711G PMID:18159791

  10. Nuclear core positioning system

    DOEpatents

    Garkisch, Hans D.; Yant, Howard W.; Patterson, John F.

    1979-01-01

    A structural support system for the core of a nuclear reactor which achieves relatively restricted clearances at operating conditions and yet allows sufficient clearance between fuel assemblies at refueling temperatures. Axially displaced spacer pads having variable between pad spacing and a temperature compensated radial restraint system are utilized to maintain clearances between the fuel elements. The core support plates are constructed of metals specially chosen such that differential thermal expansion produces positive restraint at operating temperatures.

  11. Aircraft control position indicator

    NASA Technical Reports Server (NTRS)

    Dennis, Dale V. (Inventor)

    1987-01-01

    An aircraft control position indicator was provided that displayed the degree of deflection of the primary flight control surfaces and the manner in which the aircraft responded. The display included a vertical elevator dot/bar graph meter display for indication whether the aircraft will pitch up or down, a horizontal aileron dot/bar graph meter display for indicating whether the aircraft will roll to the left or to the right, and a horizontal dot/bar graph meter display for indicating whether the aircraft will turn left or right. The vertical and horizontal display or displays intersect to form an up/down, left/right type display. Internal electronic display driver means received signals from transducers measuring the control surface deflections and determined the position of the meter indicators on each dot/bar graph meter display. The device allows readability at a glance, easy visual perception in sunlight or shade, near-zero lag in displaying flight control position, and is not affected by gravitational or centrifugal forces.

  12. Alignment positioning mechanism

    NASA Technical Reports Server (NTRS)

    Fantasia, Peter M. (Inventor)

    1991-01-01

    An alignment positioning mechanism for correcting and compensating for misalignment of structures to be coupled is disclosed. The mechanism comprises a power screw with a base portion and a threaded shank portion. A mounting fixture is provided for rigidly coupling said base portion to the mounting interface of a supporting structure with the axis of the screw perpendicular thereto. A traveling ball nut threaded on the power screw is formed with an external annular arcuate surface configured in the form of a spherical segment and enclosed by a ball nut housing with a conforming arcuate surface for permitting gimballed motion thereon. The ball nut housing is provided with a mounting surface which is positionable in cooperable engagement with the mounting interface of a primary structure to be coupled to the supporting structure. Cooperative means are provided on the ball nut and ball nut housing, respectively, for positioning the ball nut and ball nut housing in relative gimballed position within a predetermined range of relative angular relationship whereby severe structural stresses due to unequal loadings and undesirable bending moments on the mechanism are avoided.

  13. Welding nozzle position manipulator

    NASA Technical Reports Server (NTRS)

    Gilbert, Jeffrey L. (Inventor); Gutow, David A. (Inventor)

    1994-01-01

    The present invention is directed to a welding nozzle position manipulator. The manipulator consists of an angle support to which the remaining components of the device are attached either directly or indirectly. A pair of pivotal connections attach a weld nozzle holding link to the angle support and provide a two axis freedom of movement of the holding link with respect to the support angle. The manipulator is actuated by a pair of adjusting screws angularly mounted to the angle support. These screws contact a pair of tapered friction surfaces formed on the upper portion of the welding nozzle holding link. A spring positioned between the upper portions of the support angle and the holding link provides a constant bias engagement between the friction surfaces of the holding link and the adjustment screws, so as to firmly hold the link in position and to eliminate any free play in the adjustment mechanism. The angular relationships between the adjustment screws, the angle support and the tapered friction surfaces of the weld nozzle holding link provide a geometric arrangement which permits precision adjustment of the holding link with respect to the angle support and also provides a solid holding link mount which is resistant to movement from outside forces.

  14. Positional information, in bits

    PubMed Central

    Dubuis, Julien O.; Tkačik, Gašper; Wieschaus, Eric F.; Gregor, Thomas; Bialek, William

    2013-01-01

    Cells in a developing embryo have no direct way of “measuring” their physical position. Through a variety of processes, however, the expression levels of multiple genes come to be correlated with position, and these expression levels thus form a code for “positional information.” We show how to measure this information, in bits, using the gap genes in the Drosophila embryo as an example. Individual genes carry nearly two bits of information, twice as much as would be expected if the expression patterns consisted only of on/off domains separated by sharp boundaries. Taken together, four gap genes carry enough information to define a cell’s location with an error bar of along the anterior/posterior axis of the embryo. This precision is nearly enough for each cell to have a unique identity, which is the maximum information the system can use, and is nearly constant along the length of the embryo. We argue that this constancy is a signature of optimality in the transmission of information from primary morphogen inputs to the output of the gap gene network. PMID:24089448

  15. Photon beam position monitor

    DOEpatents

    Kuzay, Tuncer M.; Shu, Deming

    1995-01-01

    A photon beam position monitor for use in the front end of a beamline of a high heat flux and high energy photon source such as a synchrotron radiation storage ring detects and measures the position and, when a pair of such monitors are used in tandem, the slope of a photon beam emanating from an insertion device such as a wiggler or an undulator inserted in the straight sections of the ring. The photon beam position monitor includes a plurality of spaced blades for precisely locating the photon beam, with each blade comprised of chemical vapor deposition (CVD) diamond with an outer metal coating of a photon sensitive metal such as tungsten, molybdenum, etc., which combination emits electrons when a high energy photon beam is incident upon the blade. Two such monitors are contemplated for use in the front end of the beamline, with the two monitors having vertically and horizontally offset detector blades to avoid blade "shadowing". Provision is made for aligning the detector blades with the photon beam and limiting detector blade temperature during operation.

  16. Photon beam position monitor

    DOEpatents

    Kuzay, T.M.; Shu, D.

    1995-02-07

    A photon beam position monitor is disclosed for use in the front end of a beamline of a high heat flux and high energy photon source such as a synchrotron radiation storage ring detects and measures the position and, when a pair of such monitors are used in tandem, the slope of a photon beam emanating from an insertion device such as a wiggler or an undulator inserted in the straight sections of the ring. The photon beam position monitor includes a plurality of spaced blades for precisely locating the photon beam, with each blade comprised of chemical vapor deposition (CVD) diamond with an outer metal coating of a photon sensitive metal such as tungsten, molybdenum, etc., which combination emits electrons when a high energy photon beam is incident upon the blade. Two such monitors are contemplated for use in the front end of the beamline, with the two monitors having vertically and horizontally offset detector blades to avoid blade ''shadowing''. Provision is made for aligning the detector blades with the photon beam and limiting detector blade temperature during operation. 18 figs.

  17. Position from gravity

    NASA Technical Reports Server (NTRS)

    Mather, R. S.

    1973-01-01

    Procedures for obtaining position from surface gravity observations are reviewed and their relevance assessed in the context of the application of modern geodetic techniques to programs of Earth and ocean physics. Solutions based on the use of surface layer techniques, the discrete value approach, and the development from Green's theorem are stated in summary, the latter being extended to order e cubed in the height anomaly. The representation of the surface gravity field which is required in order that this accuracy may be achieved is discussed. Interim techniques which could be used in the absence of such a representation are also outlined.

  18. Position statement on cannabis.

    PubMed

    Stein For The Executive Committee Of The Central Drug Authority, Dan Joseph

    2016-01-01

    There is an ongoing national debate around cannabis policy. This brief position statement by the Executive Committee of the Central Drug Authorityoutlines some of the factors that have contributed to this debate, delineates reduction strategies, summarises the harms and benefits ofmarijuana, and provides recommendations. These recommendations emphasise an integrated and evidence-based approach, the need forresources to implement harm reduction strategies against continued and chronic use of alcohol and cannabis, and the potential value of afocus on decriminalisation rather than the legalisation of cannabis. PMID:27245718

  19. Deep Space Positioning System

    NASA Technical Reports Server (NTRS)

    Vaughan, Andrew T. (Inventor); Riedel, Joseph E. (Inventor)

    2016-01-01

    A single, compact, lower power deep space positioning system (DPS) configured to determine a location of a spacecraft anywhere in the solar system, and provide state information relative to Earth, Sun, or any remote object. For example, the DPS includes a first camera and, possibly, a second camera configured to capture a plurality of navigation images to determine a state of a spacecraft in a solar system. The second camera is located behind, or adjacent to, a secondary reflector of a first camera in a body of a telescope.

  20. Global Positioning Satellite Recorder

    Energy Science and Technology Software Center (ESTSC)

    1997-11-10

    The GPS Tracker is a device (automotive unit) that records position (latitude and longitude), date, and time autonomously with time. The data from the GPS Tracker can be used offline with a personal computer and map data base to plot the track of where a vehicle or other mobile battery powered object has been. The invention simplifies field operations for recording location autonomously by obviating the need to execute a set of detailed instructions priormore » to operation. The vehicle combines GPS technology and a cpu with custom software to accomplish the task.« less

  1. Positive lubrication system

    NASA Technical Reports Server (NTRS)

    Smith, Dennis W.; Hooper, Fred L.

    1990-01-01

    As part of the development of an autonomous lubrication system for spin bearings, a system was developed to deliver oil to grease-lubricated bearings upon demand. This positive oil delivery system (PLUS) consists of a pressurized reservoir with a built-in solenoid valve that delivers a predictable quantity of oil to the spin bearing through a system of stainless steel tubes. Considerable testing was performed on the PLUS to characterize its performance and verify its effectiveness, along with qualifying it for flight. Additional development is underway that will lead to the fully autonomous active lubrication system.

  2. A cutaneous positioning system.

    PubMed

    Martin, Bernard J; Lee, Beom-Chan; Sienko, Kathleen H

    2015-04-01

    Our previous work revealed that torso cutaneous information contributes to the internal representation of the torso and plays a role in postural control. Hence, the aims of this study were to assess whether posture could be manipulated by patterns of vibrotactile stimulation and to determine whether resulting modified postures were associated with specific and consistent spatial attitudes. Ten healthy young adults stood in normal and Romberg stances with six vibrating actuators positioned on the torso in contact with the skin over the anatomical locations corresponding to left and right external oblique, internal oblique and erector spinae muscles at the L4/L5 vertebrae level. A 250-Hz tactile vibration was applied for 5 s either at a single location or consecutively at each location in clockwise or counterclockwise sequences. Kinematic analysis of the body segments indicated that postural responses observed in response to single and sequential stimulation patterns were similar, while the center of pressure remained unaltered in any situations. Moreover, torso inclinations followed rectilinear-like path segments chartered by stimuli loci during sequential stimulations. Comparison of torso attitudes with previous results obtained with co-vibration patterns of the same duration showed that torso inclination amplitudes are equivalent for single (one location) and co-vibration (pairs of locations) patterns inducing the same directional effect. Hence, torso cutaneous information exhibits kinesthetic properties, appears to provide a map of upper body spatial configuration, and could assume the role of an internal positioning system for the upper body. PMID:25600816

  3. Positional Information, in bits

    NASA Astrophysics Data System (ADS)

    Dubuis, Julien; Bialek, William; Wieschaus, Eric; Gregor, Thomas

    2010-03-01

    Pattern formation in early embryonic development provides an important testing ground for ideas about the structure and dynamics of genetic regulatory networks. Spatial variations in the concentration of particular transcription factors act as ``morphogens,'' driving more complex patterns of gene expression that in turn define cell fates, which must be appropriate to the physical location of the cells in the embryo. Thus, in these networks, the regulation of gene expression serves to transmit and process ``positional information.'' Here, using the early Drosophila embryo as a model system, we measure the amount of positional information carried by a group of four genes (the gap genes Hunchback, Kr"uppel, Giant and Knirps) that respond directly to the primary maternal morphogen gradients. We find that the information carried by individual gap genes is much larger than one bit, so that their spatial patterns provide much more than the location of an ``expression boundary.'' Preliminary data indicate that, taken together these genes provide enough information to specify the location of every row of cells along the embryo's anterior-posterior axis.

  4. Government Positions for Physicists.

    NASA Astrophysics Data System (ADS)

    Seiler, David

    2006-03-01

    There are a number of government agencies that employ physicists in a wide variety of jobs -- from student internships to post docs to full time staff positions. You can do real, creative, fore-front physics or pursue a wide range of leadership positions. The possibilities are almost unlimited and so is the impact your work can have on the government, academia, and industry. So how do you go about finding a government job? What qualities or abilities are deemed valuable? What are the advantages and disadvantages to working in the government? I will bring some personal experiences and observations from working in the government (one year as a rotator at the National Science Foundation in the Division of Materials Research and almost 18 years at the National Institute of Standards and Technology, both as a Group Leader and a Division Chief) to bear on these questions and more. Prior to my government career I was a physics professor pursuing research and teaching in academia.

  5. The Global Positioning System

    USGS Publications Warehouse

    U.S. Geological Survey

    1999-01-01

    The Global Positioning System (GPS) is a constellation of navigation satellites called Navigation Satellite Timing And Ranging (NAVSTAR), maintained by the U.S. Department of Defense. Many outdoor enthusiasts recognize that a handheld GPS receiver can be an accurate tool for determining their location on the terrain. The GPS receiver helps determine locations on the Earth's surface by collecting signals from three or more satellites through a process called triangulation. Identifying a location on the Earth is more useful if you also know about the surrounding topographic conditions. Using a topographic map with the GPS receiver provides important information about features of the surrounding terrain and can help you plot an effective route from one location to another.

  6. Metallic positive expulsion diaphragms

    NASA Technical Reports Server (NTRS)

    Gleich, D.

    1972-01-01

    High-cycle life ring-reinforced hemispherical type positive expulsion diaphragm performance was demonstrated by room temperature fluid expulsion tests of 13" diameter, 8 mil thick stainless steel configurations. A maximum of eleven (11) leak-free, fluid expulsions were achieved by a 25 deg cone angle diaphragm hoop-reinforced with .110-inch cross-sectional diameter wires. This represents a 70% improvement in diaphragm reversal cycle life compared to results previously obtained. The reversal tests confirmed analytic predictions for diaphragm cycle life increases due to increasing values of diaphragm cone angle, radius to thickness ratio and material strain to necking capacity. Practical fabrication techniques were demonstrated for forming close-tolerance, thin corrugated shells and for obtaining closely controlled reinforcing ring stiffness required to maximize diaphragm cycle life. A non-destructive inspection technique for monitoring large local shell bending strains was developed.

  7. Position paper on mesotherapy.

    PubMed

    Sarkar, Rashmi; Garg, Vijay Kumar; Mysore, Venkataram

    2011-01-01

    Mesotherapy is a controversial cosmetic procedure which has received publicity among the lay people, in the internet and in the media. It refers to minimally invasive techniques which consist of the use of intra- or subcutaneous injections containing liquid mixture of compounds (pharmaceutical and homeopathic medications, plant extracts, vitamins and other ingredients) to treat local medical and cosmetic conditions. This position paper has examined the available evidence and finds that acceptable scientific evidence for its effectiveness and safety is lacking. IADVL taskforce, therefore would like to state that the use of this technique remains controversial at present. Further research and well-designed controlled scientific studies are required to substantiate the claims of benefit of this mode of therapy. PMID:21393967

  8. Beyond complete positivity

    NASA Astrophysics Data System (ADS)

    Dominy, Jason M.; Lidar, Daniel A.

    2016-04-01

    We provide a general and consistent formulation for linear subsystem quantum dynamical maps, developed from a minimal set of postulates, primary among which is a relaxation of the usual, restrictive assumption of uncorrelated initial system-bath states. We describe the space of possibilities admitted by this formulation, namely that, far from being limited to only completely positive (CP) maps, essentially any C-linear, Hermiticity-preserving, trace-preserving map can arise as a legitimate subsystem dynamical map from a joint unitary evolution of a system coupled to a bath. The price paid for this added generality is a trade-off between the set of admissible initial states and the allowed set of joint system-bath unitary evolutions. As an application, we present a simple example of a non-CP map constructed as a subsystem dynamical map that violates some fundamental inequalities in quantum information theory, such as the quantum data processing inequality.

  9. Shaft Position Optical Sensor

    NASA Technical Reports Server (NTRS)

    Blumenstock, Kenneth A. (Inventor); Hakum, Claef F. (Inventor); Johnson, Clarence S. (Inventor)

    2001-01-01

    The present invention is an optical sensor that senses the movement of a shaft. Detection of radial movement is made when a portion of light incident on the shaft sensor-target is blocked. For detection of axial movement, a disk with flat surface is mounted and used to block a portion of light. The variation in the amount of light allowed to pass through is a measure of the position of the shaft. As proposed by this invention, significant improvement is made with respect to sensitivity and linearity of the system when the light is permanently partially blocked. To accomplish this goal this invention adds a boss to the system. To eliminate possible drift of system performance due to LED degradation or temperature variation, a feedback feature is added to the system.

  10. A POSITIONAL DATA SYSTEM

    DOEpatents

    Forster, G.A.

    1963-09-24

    between master and slave synchros is described. A threephase a-c power source is connected to the stators of the synchros and an error detector is connected to the rotors of the synchros to measure the phasor difference therebetween. A phase shift network shifts the phase of one of the rotors 90 degrees and a demodulator responsive thereto causes the phasor difference signal of the rotors to shift phase 180 degrees whenever the 90 degree phase shifted signal goes negative. The phase shifted difference signal has a waveform which, with the addition of small values of resistance and capacitance, gives a substantially pure d-c output whose amplitude and polarity is proportional to the magnitude and direction of the difference in the angular positions of the synchro's rotors. (AEC)