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

Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5+/-2.5 cm/s in the control group and 6.1+/-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.
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PMID:Cervical vertigo and dizziness after whiplash injury. 1643 49

Carbon monoxide is an insidious poison that accounts for thousands of deaths each year in North America. Clinical effects maybe diverse and include headache, dizziness, nausea, vomiting,syn-cope, seizures, coma, dysrhythmias, and cardiac ischemia. Children, pregnant women, and patients who have underlying cardiovascular disease are particularly at risk for adverse out-comes. Treatment consists of oxygen therapy, supportive care, and, in selected cases, hyperbaric oxygen therapy.
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PMID:Toxicity associated with carbon monoxide. 1656 27

The diabetic patient poses special problems in the primary care setting. Symptoms that are relatively unimpressive on initial presentation, such as polyuria or dizziness, may actually be the beginning of serious medical complications. With careful evaluation and follow-up, some patients, such as those who have mild hypo- and hyperglycemia and certain infections, can be managed as an outpatients; however, many cardiovascular conditions, such as cardiac ischemia or limb-threatening peripheral vascular disease, require immediate transfer to an acute care facility. In all situations, close monitoring of glucose levels during all phases of care--in the office, in the hospital and at home--is essential to achieving target glycemic control and rapid detection of clinical conditions that often first manifest as alterations in glycemic control.
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PMID:Emergencies in diabetic patients in the primary care setting. 1708 57

Intracranial dural arteriovenous fistulas (AVFs) are potentially at risk for hemorrhage, and their symptoms and prognosis are highly variable. We present 7 surgical cases with the initial symptoms of venous ischemia by dural AVF. The series comprises 3 male and 4 female, ranging in age from 37 to 76 years (mean age, 61.1 years). Initial symptoms were dizziness in 3 cases, headache in 2 cases, unconsciousness in 1 case, and hemiparesis in 1 case. The locations included the superior sagittal sinus in 3 cases and the transverse-sigmoid sinus in 4 cases. Computed tomography with contrast media and magnetic resonance imaging revealed abnormal vessels. In all cases, retrograde feeding into the cortical veins was observed. On angiography, multiple retrograde venous drainage into the cortical veins were observed in all cases. Single photon emission computed tomography (SPECT) demonstrated apparent hypoperfusion in all 7 cases and further decrease by diamox challenging test in 4 cases. The dural AVFs were removed, and the symptoms disappeared in all cases, although transient aphasia was observed in a single case postoperatively. Postoperative SPECT showed improvement of cerebral blood flow in 4 and no change in 2 of 6 follow-up cases. Cerebral ischemia was induced by venous hypertension, and the hypoperfused brain improved immediately after the operation. Cerebral venous ischemia is a reversible condition that can be improved by appropriate early-stage treatment.
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PMID:Cerebral venous ischemia by dural arteriovenous fistulas. 1790 17

We report the case of a 32-year-old man who presented at the emergency department with severe chest pressure, left arm pain, and dizziness. These symptoms were described as intermittent, occurring after exercise and at rest. He had undergone several stress tests during the past 8 years, but no objective evidence of ischemia was produced. His history of hyperlipidemia and increasing frequency of symptoms prompted us to perform coronary angiography, which showed a single coronary artery with an ostium at the right sinus of Valsalva. The vessel had an initial, mixed common trunk that gave rise to both the right coronary artery proper and to the left coronary artery. The left main trunk followed a prepulmonic course. The anatomic features were eventually confirmed by computed tomographic angiography. The left main stem had a fixed 50% to 60% area narrowing, at baseline study. A treadmill stress myocardial perfusion study showed no evidence of ischemia. The patient was referred to a 2nd facility, where intravascular ultrasonography, at baseline, revealed 63% left main narrowing without evidence of atherosclerosis. Acetylcholine provocation demonstrated worsening of the stenosis to about 80%, with reproduction of angina and ST-segment depression, which indicated that medical management of spasm might provide symptomatic relief.
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PMID:Single coronary artery with prepulmonic coursing left main coronary artery manifesting as prinzmetal's angina. 1817 28

We report a 40-year-old female patient who was on maintenance hemodialysis for end-stage renal disease. She was initially noted to have severe hypertension necessitating use of four anti-hypertensive drugs. Gradually, and with regular dialysis, her blood pressure normalized without any medications, and subsequently she was noted to have pre- and post-dialysis blood pressure respectively of 90/60 mm Hg and 70/40 mm Hg which was asymptomatic. Following one session of dialysis during which she had severe hypotension associated with dizziness and headache, corrected by saline infusion, she noticed loss of vision affecting both eyes. Detailed evaluation including fundoscopy, magnetic resonance imaging, fluorescein angiography, color doppler and electroretinogram was performed. Empirical treatment with pulse methyl prednisolone and plasma exchange did not help. A diagnosis of anterior ischemia optic neuropathy due to hypotension was arrived at. Our case suggests that intra-dialytic hypotension can be problematic and should be treated aggressively.
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PMID:Visual loss in uremic patients on dialysis: a case report and review of literature. 1820 12

We present a 46-year-old patient who suffered from cardiac arrest and subsequently underwent placement of an implantable cardioverter defibrillator (ICD). The patient underwent a cardiac catheterization which revealed no significant coronary artery disease. About 1 year later he experienced appropriated and frequent ICD discharges due to monomorphic ventricular tachycardia (VT) with left bundle branch block morphology. His prodromal symptoms were mild dizziness and lightheadedness with no chest pain. Amiodarone, mexiletine, sotalol and dofetilide as well as ablation of two inducible ventricular tachycardias in the electrophysiology studies were unsuccessful in controlling the arrhythmias and ICD discharges. During the last episode, he experienced a mild burning sensation in his chest and was given nitroglycerin 0.4 mg sublingually, which relived his symptoms and aborted the VT. This led to a second cardiac catheterization to investigate whether the VT was being induced by myocardial ischemia. This second coronary angiogram spontaneously revealed significant coronary vasospasm and simultaneously, the patient's cardiac rhythm showed short runs of VT with left bundle branch block morphology. Intracoronary nitroglycerine relieved the coronary vasospasm and terminated the arrhythmia. The patient was treated with isosorbide mononitrate and diltiazem. He remained symptom free with no ICD discharges and no VT in ICD interrogations for more than 2 years. Coronary vasospasm may be silent and with no chest pain which creates a difficult clinical situation particularly if it is associated with ventricular tachycardia and sudden cardiac death. The mechanisms of VT in the setting of coronary vasospasm are not known and increased automaticity, focal discharges, functional unidirectional block with reentry, or a combination of these mechanisms may contribute to inducing the VT during the transient ischemia or rarely in the reperfusion phase. It is important to perform provocative tests to diagnose silent coronary vasospasm in unexplained sudden cardiac arrests.
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PMID:Multiple episodes of ventricular tachycardia induced by silent coronary vasospasm. 1829 82

Cerebellar infarctions often go unrecognized and misdiagnosed. Easily confused with peripheral vestibular system dysfunction, physicians often miss the cardinal symptoms of dizziness and an abnormal gait. If not treated appropriately and quickly, cerebellar infarcts can lead to coma and death. This review discusses the key features of cerebellar infarction, including the anatomical origination and clinical symptomology of the infarcts. Evaluation recommendations include neuroimaging analysis, which can help clarify the etiology and aid in making therapeutic decisions. Management of patients with cerebellar infarcts is similar to that of patients with posterior circulation ischemia. Antithrombotic drugs, thrombolytics, surgery, and angioplasty/stenting are options.
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PMID:Cerebellar infarcts: key features. 1981 98

Dizziness, vertigo, and imbalance are likely the most common presenting complaints among patients 75 years and older in office practices. Although the cause of falls among the aging population is multifactorial, several studies have implicated senescence of the vestibular periphery. It is imperative that clinicians correctly diagnose and treat dizziness and vertigo in the geriatric population, as vestibular impairment is quite responsive to specifically designed rehabilitation. One of the most common causes of vertigo in older adults is benign positional vertigo. The aging otolithic membrane, alterations in calcium metabolism, and microvascular ischemia may all play a role. An age-related deterioration of vestibular function on quantitative testing has been documented, and the age of onset correlates with the age-related cellular loss in the vestibular periphery. Furthermore, longitudinal tests of decline in vestibular function correlate with decline in gait and balance on testing. It is likely that senescence of both the central and peripheral vestibular pathways plays a role in age-related decline in balance. Vestibular disorders in the older patient are associated with a diminished level of independent activities, an increased incidence of falls, and possibly also clinical depression. The author's laboratory is delineating the immunohistochemical expression of proteins in the basement membrane of the vestibular system in older adults as a potential cause of the age-related decline in sensory cell and neuronal number.
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PMID:Imbalance and vertigo: the aging human vestibular periphery. 1983 60

Subclavian steal syndrome (SSS) is caused by hypoplasia of a vertebral artery or stenosis or occlusion of the subclavian artery or the brachiocephalic artery with subsequent retrograde filling of the subclavian artery via the contralateral vertebral artery. Symptoms of SSS are due to vertbrobasilar insufficiency or ischemia of the ipsilateral upper extremity, and they may include dizziness, syncope, ataxia, arm claudication, hand numbness or a decrease in brachial blood pressure on the affected side. However, most SSS cases are asymptomatic and they are classified as subclavian steal phenomenon (SSP). Atherosclerosis is the common cause of SSS, and Takayasu arteritis, neurofibromatosis, trauma, embolization, congenital vascular anomalies and surgical interruption of the subclavian artery can be identified among the other causes. We describe a rare case of hypervascular thyroid nodule presenting with features of SSP. The patient was hospitalized with acute cerebral infarction due to middle cerebral artery (MCA) severe stenosis. The patient had conservative therapy in the acute stage, and underwent STA-MCA anastomosis for MCA stenosis in the chronic stage. SSS was asymptomatic although there was laterality in blood pressure in the patient's bilateral upper limbs. Thyroid tumor was regarded as benign by radiological findings, laboratory data, and physical examination. If SSS becomes symptomatic, removal of the thyroid tumor may be indicated.
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PMID:[Subclavian steal phenomenon associated with hypervascular thyroid tumor]. 2052 19


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