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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Circulatory regulation in response to postural changes follows mechanical rules, whereby the shifts in volume in the various organs of the body play an essential role. The change from the horizontal to the vertical position is accompanied by a decrease in pressure above the hydrostatic neutral point, i.e. in the cephalic vessels, whereas the capacious vessels in the caudal region are dilated and the venous return becomes sluggish. As a consequence of the different time courses followed by the various circulatory parameters in the wake of counter-regulatory measures, a distinction can be made between an early orthostatic instant regulatory response and a late orthostatic response. Prominent clinical features do not necessarily always consist of non-systemic dizziness, tinnitus, pallor cold sweat and, finally, orthostatic collapse, but general subjective symptoms such as deafness and tingling of the extremities, a chilly sensation and cardiac symptoms may frequently predominante. In the case of development of an autonomic neurotic symptom complex, psychoautonomic symptoms such as general sleep disturbance are observed. Apart from investigations carried out on a surgical tilting table in general practice, other procedures such as the Valsalva manoeuvre, the squatting test and, in most cases, the erect test are performed. Broadly speaking four different reaction types can be distinguished amongst cases of postural hypotension. Drugs with different therapeutic actions are selectively administered according to the pathophysiological characteristics of the individual patient and the sympathetic adrenal counter-regulatory response. Medico-mechanical measures and physical training should not be neglected.
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PMID:[Postural hypotension: pathophysiology and clinical features (author's transl)]. 1 41

Most of the previous literature concerning otologic problems in compressed gas environments has emphasized middle ear barotrauma. With recent increases in commercial, military, and sport diving to deeper depths, inner ear disturbances during these exposures have been noted more frequently. Studies of inner ear physiology and pathology during diving indicate that the causes and treatment of these problems differ depending upon the phase and type of diving. Humans exposed to simulated depths of up to 305 meters without barotrauma or decompression sickness develop transient, conductive hearing losses with no audiometric evidence of cochlear dysfunction. Transient vertigo and nystagmus during diving have been noted with caloric stimulation, resulting from the unequal entry of cold water into the external auditory canals, and with asymmetric middle ear pressure equilibration during ascent and descent (alternobaric vertigo). Equilibrium disturbances noted with nitrogen narcosis, oxygen toxicity, hypercarbia, or hypoxia appear primarily related to the effects of these conditions upon the central nervous system and not to specific vestibular end-organ dysfunction. Compression of humans in helium-oxygen at depths greater than 152.4 meters results in transient symptoms of tremor, dizziness, and nausea plus decrements in postural equilibrium and psychomotor performance, the high pressure nervous syndrome. Vestibular function studies during these conditions indicate that these problems are due to central dysfunction and not to vestibular end-organ dysfunction. Persistent inner ear injuries have been noted during several phases of diving: 1) Such injuries during compression (inner ear barotrauma) have been related to round window ruptures occurring with straining, or a Valsalva's maneuver during inadequate middle ear pressure equilibration. Divers who develop cochlear and/or vestibular symptoms during shallow diving in which decompression sickness is unlikely or during compression in deeper diving, should be placed on bed rest with head elevation and avoidance of maneuvers which result in increased cerebrospinal fluid and intralabyrinthine pressure. With no improvement in symptoms after 48 hours, exploratory tympanotomy and repair of a possible labyrinthine window fistula should be considered. Recompression therapy is contraindicated in these cases...
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PMID:Diving injuries to the inner ear. 40 82

To our knowledge there is no study that answers the question, whether low blood pressure itself or the fall of blood pressure during standing have a negative effect on pregnant women. These patients suffer from signs of reduced central and/or peripheral blood flow like fatigue, headache, cold extremities, paresthesia, flickering, black outs and dizziness. In addition, it is of interest whether frequency, occurrence and intensity of these hypotensive symptoms alter during pregnancy. In a longitudinal study 12 hypotensive pregnant women were compared with 13 normotensive and later on in a randomized study 102 clinical healthy pregnant women were tested with a modified orthostatic test over defined time periods during pregnancy. Blood pressure and heart rate were registered in one minute intervals over 30 minute period with an automatic Dinamap measuring device. This period was subdivided in a 10 minutes lying period, 10 minutes standing period followed by a 10 minutes lying period. In addition, the pregnant women were asked about frequency, occurrence and intensity of typical hypotensive symptoms. The frequency of subjective symptoms were related to low blood pressure (p less than 0.001) but not to the fall in blood pressure during standing. The occurrence of different hypotensive symptoms (p less than 0.05) and their intensity (p less than 0.01) were most often in early pregnancy and decreased until term. We conclude that the subjective symptoms were twice as much during early pregnancy than during late pregnancy and were more often in patients with low blood pressure. Furthermore, fatigue, headache and cold extremities occur frequently during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hypotonic symptoms and pregnancy]. 149 47

Iloprost, a stable prostacyclin analog, was evaluated clinically for its ability to ameliorate the symptoms of peripheral neuropathy associated with diabetes. In an open, nonrandomized trial, 13 diabetic patients with neuropathy but without proliferative retinopathy received an intravenous infusion of Iloprost at a dose of 10 micrograms, at a rate of 0.1 micrograms/kg/h, twice daily for two weeks. The administration of Iloprost relieved the majority of such subjective symptoms as pain, numbness or sensation of cold and to a lesser extent, such autonomic symptoms as dizziness. In contrast, there was little evidence of objective improvement, e.g., in motor nerve conduction velocity. Iloprost treatment significantly inhibited the platelet aggregation rate stimulated by collagen in vitro. In the one patient tested, thermography revealed an increase in skin temperature by more than 2 degrees C. Side effects associated with Iloprost included headache (3 patients) or aggravation of pain in the extremities (2 patients) and could be ameliorated by slowing the infusion rate or by discontinuing the drug (one patient). Iloprost appears to be safe and effective for relieving the symptoms of diabetic neuropathy. Our results provide the rationale for a double-blind, clinical trial in larger populations of diabetics with peripheral neuropathy.
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PMID:Clinical efficacy of a stable prostacyclin analog, iloprost, in diabetic neuropathy. 170 9

Orthostatic dysregulation (OD), originally a German-Scandinavian term partially corresponding to an Anglo-American concept of sympathotonic orthostatic hypotension, is characterised by altered cardiovascular control on standing, and its clinical features include dizziness, palpitation and, occasionally, orthostatic hypotension. The symptomatology suggests presence of cardiovascular adrenoceptor dysfunction, although the aetiology of OD has not been elucidated. The above situation prompted us to investigate autonomic nervous function in OD. The subjects were 8 patients with OD (20 +/- 2 years old; mean +/- SD), all of them fulfilled the diagnostic criteria accepted in Japan, and 6 healthy controls (17 +/- 3 years old). Noradrenaline and isoproterenol infusion tests and conventional haemodynamic functional tests (70 degrees passive head-up tilt, cold pressor test, Valsalva manoeuvre and Aschner's eye-ball pressure test) were carried out upon the subjects under the continuous measurement of blood pressure, pulse rate and respiration. Plasma vasoactive substances (noradrenaline, adrenaline, arginine-vasopressin and renin activity) were also determined in supine position and at 15 minutes after the 70 degrees passive head-up tilt. In noradrenaline infusion test, different doses (0.01 microgram/kg, 0.02 microgram/kg, 0.05 microgram/kg and 0.1 microgram/kg) of noradrenaline were administered by means of intravenous bolus injection, and a degree of subsequent rise in blood pressure was used as an index for the cardiovascular alpha-adrenoceptor sensitivity. In isoproterenol infusion tests cardiovascular beta 1- and beta 2-adrenoceptor sensitivities were assessed, respectively, by a degree of an increase in pulse rate and a degree of a fall in blood pressure following bolus injection of the drug (0.001 microgram/kg, 0.002 microgram/kg, 0.005 microgram/kg and 0.01 microgram/kg).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiovascular alpha- and beta-adrenoceptor sensitivities in orthostatic dysregulation]. 216 87

One year after head trauma, 23 patients with post-traumatic headache entered a prospective clinical controlled trial to find out if specific manual therapy on the neck could reduce the headache. The study was completed by 19 patients (83%). Ten patients were treated twice with manual therapy and nine patients were treated twice with cold packs on the neck. The pain index was calculated blindly. Two weeks after the last treatment the mean pain index was significantly reduced to 43% in the group treated with manual therapy compared with the pretreatment level. At follow-up five weeks later, the pain index was still lower in this group compared with the group treated with cold packs, but this difference was not statistically significant. The pain index for all 19 patients was significantly correlated to the use of analgesics as well as to the frequency of associated symptoms (number of days per week with dizziness, visual disturbances and ear symptoms). It is concluded that the type of manual therapy used in this study seems to have a specific effect in reducing post-traumatic headache. The result supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome.
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PMID:An open study comparing manual therapy with the use of cold packs in the treatment of post-traumatic headache. 227 94

The aim of this work was the results comparison in Proctor-Dix and Fitzgerald-Hallpike tests. The examinations were performed in 22 normal and in 34 patients with vestibular syndromes. In ENG recordings the symetricity was evaluated as well as the feeling of dizziness and vegetative symptoms. The pendular trial was made during the caloric nystagmus in two above mentioned methods. The sinusoidal Proctor-Dix test was more sensible than classic test and easy for patients. In some instances the cold excitation fails to provoke the reaction in sinusoidal test in spite of reaction in classic test. The pendular trial in Proctor-Dix test is difficult to obtain.
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PMID:[Clinical evaluation of the sinusoidal caloric test]. 264 Apr 97

The side-effect profile of labetalol was assessed in 34 patients with mild to moderate essential hypertension who had previously experienced side effects during beta-blocker therapy. The most frequently reported beta-blocker side effects were fatigue, impotence, cold extremities, and depression. After discontinuing their previous beta-blocker for 4 weeks, labetalol was titrated (100-400 mg b.i.d.) to achieve blood pressure control. Twenty-seven of 34 patients did not have a recurrence of a beta-blocker related side effect while receiving labetalol. The most common new side effect with labetalol was dizziness (3 patients). As judged by the attending physician and the patient, labetalol was better tolerated than conventional beta-blocker therapy in 30 of 34 patients (88%). Twenty-four of 34 patients (71%) preferred labetalol over previous therapy. Labetalol controlled blood pressure in 30 of 34 patients (88%). At equal antihypertensive doses, some side effects common to beta-blockers are seen less frequently with labetalol.
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PMID:Comparative tolerability of labetalol versus propranolol, atenolol, pindolol, metoprolol, and nadolol. 287 65

Effects of smoking are highlighted in a posthoc analysis of this randomized, double-blind International Prospective Primary Prevention Study in Hypertension (IPPPSH). At the time of entry, 37% of the men and 23% of the women were smoking cigarettes, and only 537 patients changed their smoking status during the trial. In men and women, smoking doubled cardiac and cerebrovascular event rates. Nonsmoking men had fewer myocardial infarctions and sudden deaths when treated with oxprenolol. Smoking status did not affect in-study blood pressure control, the type of drugs, or the combinations used, but smokers were given higher doses of oxprenolol. For a given blood pressure during antihypertensive treatment, rates for cardiac and cerebrovascular events were higher in smokers. Heart rates were higher in both oxprenolol and non-beta-blocker-treated smokers. Smoking dose dependently increased hematocrit level. Among physician-elicited symptoms, dyspnea and cold extremities were more frequent in smokers, whereas dyspnea, headaches, impotence, dizziness, and anxiety states were common, with unsatisfactory blood pressure control (diastolic blood pressure greater than 95 mm Hg). Quality of life may be more jeopardized by smoking, poor blood pressure control, or diuretic use than by beta-blocker-based therapy. In the IPPPSH, the patient who smoked had double the cardiovascular complication rates without cardiac benefit from the beta-blocker despite higher doses given; the higher heart rate and hematocrit level may have been contributing factors.
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PMID:Impact of smoking on heart attacks, strokes, blood pressure control, drug dose, and quality of life aspects in the International Prospective Primary Prevention Study in Hypertension. 289 88

The long-term treatment of essential hypertension with terazosin, a new once-a-day alpha 1-adrenergic blocking agent, was evaluated in 364 hypertensive patients who received total daily doses of 1 to 40 mg for 3 weeks to 56 months. Consistent mean decreases in supine and standing systolic and diastolic blood pressures were observed throughout the study for patients treated with terazosin as monotherapy (supine, 9 to 12/10 to 13 mm Hg; and standing, 12 to 18/11 to 14 mm Hg) or in combination with other antihypertensive agents (supine, 12 to 16/12 to 15 mm Hg; and standing, 16 to 22/13 to 19 mm Hg). The most commonly reported adverse experiences were dizziness, headache, asthenia, cold symptoms, and nasal congestion. Adverse effects and metabolic disorders often associated with diuretics and beta blockers such as sexual dysfunction, hyperglycemia, hyperuricemia, hypokalemia, or adverse lipid effects were seen infrequently during long-term treatment with terazosin as monotherapy. Overall, terazosin was shown to be effective, safe, and well tolerated by most patients.
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PMID:Terazosin, a new selective alpha 1-adrenergic blocking agent. Results of long-term treatment in patients with essential hypertension. 290 Dec 67


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