Neurological Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Blackouts are transient attacks of loss of consciousness during attacks. Dizziness can mean light-headedness, or vertigo, or a general feeling of unsteadiness. Labyrinthine disorders cause only vertigo, nausea and nystagmus.Brainstem lesions cause diplopia, dysarthria, dysphagia, blurred vision, quadriparesis or cranial nerve palsies in addition to vertigo.Cerebellar lesions may cause unsteadiness, imbalance or ‘walking as if drunk’, but not vertigo.Presyncope comprises light-headedness, faintness, sweating and pallor, which may be relieved by lying flat.Complex partial seizures may be accompanied by déjà vu, altered smell and/or taste, and vivid memories. Stereotyped movements (e.g. lip smacking), automatisms and an open-eyed trance-like state last a few minutes.Absence seizures may be accompanied by fluttering of the eyelids.
Vertigo
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Dizziness is frequently encountered in both neurologic practice and in the acute setting. For example, approximately 3.3% of visits to US emergency departments relate to dizziness/vertigo, with 5% of these related to acute vestibular neuritis or labyrinthitis.3,4 Alternatively, approximately 30% of patients who seek medical attention have vestibular vertigo with an otoneurologic cause, most commonly paroxysmal positional vertigo (33%), Ménière's syndrome (1%), or vestibular migraine (14%).3,5 Vertigo may occasionally relate to cerebrovascular disease, primarily transient ischemia (TIA), or infarction affecting brainstem or cerebellar territories. The other common etiology for acute presentation of dizziness (which represents the majority) is cardiovascular disease. Other causes for dizziness include nonorganic (psychogenic) etiologies, and side effects of medications.
Chronic Fatigue: The Fatigue Neurosis
Francis X. Dercum in Rest, Suggestion, 2019
By other patients, a feeling of uncertainty in moving about is complained of. Sometimes they complain of being giddy, but actual, i.e., objective, vertigo is rarely, if ever, observed. The giddiness appears to be due to lessened vasomotor control of the cerebral vessels, so that slight motion or change of posture influence the intracranial circulation. Rarely the sense of uncertainty is so great that the patient grasps at surrounding objects when in reality there is no danger of falling. True staggering and incoórdination of movement are rarely observed and being due to weakness they are merely transitory symptoms and not persistent as in organic disease. Dizziness may, however, be very pronounced and continuous and in such case is a very distressing symptom. It may be excited by mental or physical effort, such as reading and writing, by such slight causes as motion in bed or the taking of food.
Implementation of a municipality-based rehabilitation program for patients with neuritis vestibularis: lessons learned and derived snowball effects
Published in Physiotherapy Theory and Practice, 2023
Morten Villumsen, Anna Emilie Livbjerg, Bo Grarup, Christine Kjeldal Skram, Uffe Laessoe
The number of exercise repetitions would depend on the patient’s condition. As a guideline, the duration of each of the exercises was one minute and could be increased to two minutes. An exercise session would usually last five to six minutes, and the exercises should be repeated five times a day. The velocity and duration of the exercises could be adjusted progressively. For further progression, the visual disturbance from the surroundings could be increased by using a checkered background. The balance demands during the exercises could be increased by going from a sitting to a standing position and going from a standing position with a large and stable support surface to more dynamic conditions during locomotion. Potential fall risk should be avoided by providing balance support or by performing the exercises while standing in a corner or at a table. The progression and regression of the exercises should follow the patient´s response to the exercises. Short-term increase in dizziness symptoms, as well as fatigue, was acceptable, but symptoms should not be aggravated for more than an hour. The instructions for the designated physiotherapist included suggestions for progression and regression of the exercises as well as practical guidelines for safe conduction of the exercises.
Outcome for dizzy patients in a physiotherapy practice: an observational study
Published in Annals of Medicine, 2022
Willem De Hertogh, René Castien, Laura Jacxsens, Joke De Pauw, Luc Vereeck
Dizziness (including vertigo) is a common complaint. It affects about 15% to over 20% of adults yearly in large population-based studies [1]. The most common causes are cardiovascular and peripheral vestibular conditions [2]. The diagnosis is made based on thorough patient history and a clinical examination. Nevertheless, in a substantial part of patients, no specific cause can be determined [3]. In that sense, obtaining or just failing to obtain a therapeutic effect can assist the diagnostic process. Vestibular vertigo is believed to account for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. It is an important reason for patients to contact a physician such as a general practitioner (GP), neurologist or an Ear-Nose-Throat (ENT) specialist [4].
Is COVID-19 associated with self-reported audio-vestibular symptoms?
Published in International Journal of Audiology, 2022
Arwa AlJasser, Walid Alkeridy, Kevin J. Munro, Christopher J. Plack
The main section was designed with a five-point Likert scale to assess any self-reported change over time in nine symptoms under four categories.Olfactory and gustatory abnormalities which included disturbances in sense of smell and taste.Auditory symptoms which included hearing abilities (changes assessed for four variables: sense of hearing, ease of conversing by telephone, ability to follow a conversation with background noise, and preferred volume while listening to various media); non-pulsatile tinnitus; and hyperacusis (i.e. stress, irritation or sensitivity caused by noise and environmental sounds).Dizziness which included rotatory vertigo (the feeling that the person, or things around person, are spinning or moving); and stability (unsteadiness/light-headedness, losing balance or feeling unsteady when walking, climbing stairs, or picking something up off the floor).Ear symptoms which included ear pressure; and otalgia (ear pain).