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

The management of patients with cerebral transient ischemic attacks and carotid artery stenosis remains controversial. Noninvasive techniques help to determine which patients require surgical intervention without exposing the majority of patients to the risk and discomfort of invasive procedures. Measurement of ophthalmic artery pressure by ophthalmodynamometry or oculoplethysmography gives a representation of perfusion pressure in the internal carotid artery circulation. Doppler ultrasound studies can define the extent of obstruction to flow at the carotid artery bifurcation and assess collateral flow from the external carotid artery. Real time B-mode ultrasonography can detect nonobstructive ulcerated plaque in the carotid artery bifurcation. Employing these examinations in a test battery can identify hemodynamically significant lesions, which are more likely to precipitate a stroke. The information obtained from these studies can be utilized in patients with episodes of cerebral transient ischemic attacks, asymptomatic carotid artery bruits and vertebrobasilar insufficiency. Noninvasive carotid artery testing is also useful in screening patients with nonspecific symptoms, such as dizziness or light-headedness, which may be related to decreased flow in the carotid circulation. Noninvasive carotid artery testing can provide valuable anatomic and physiologic information required in the appropriate management of patients with cerebrovascular disease. It is of particular value in managing patients with heart disease who are at high risk for complications from invasive procedures.
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PMID:Clinical applications of noninvasive carotid artery testing. 388 May 66

The authors have reviewed their experience in the management of 55 patients admitted to Henry Ford Hospital with symptoms of vertebrobasilar insufficiency and associated proximal vertebral artery stenosis or occlusion. In 48 patients, the symptoms occurred as multiple repeated events, five of which resulted in permanent deficits. The remaining seven patients had single events, four of which caused permanent deficit. These patients had been treated unsuccessfully with antiplatelet agents (37 cases) and with anticoagulant drugs (15 cases) before surgery. Most patients had multiple angiographic abnormalities, including bilateral vertebral stenosis in 19 cases, unilateral vertebral stenosis and contralateral occlusion in 18, unilateral vertebral hypoplasia and contralateral stenosis in 10, subclavian artery stenosis with steal in seven, and bilateral vertebral artery occlusion in one case. Posterior communicating arteries could not be demonstrated angiographically in 18 patients. Thirty-four patients had associated stenotic or occlusive lesions of the internal carotid artery. Forty-eight underwent a vertebral-to-carotid artery transposition. Of these, 18 had an associated carotid endarterectomy and seven had a vertebral artery endarterectomy immediately before the transposition. Two patients had saphenous vein grafts, one from the subclavian and one from the common carotid artery to the vertebral artery. Other surgical procedures included vertebral artery ligation in one case, transposition of the vertebral artery to the thyrocervical trunk in two cases and to the subclavian artery in one case, and endarterectomy of the origin of the vertebral artery in one case. All but two patients had complete resolution of their symptoms: one had persistent dizziness and the other had syncopal episodes. Complications included transient Horner's syndrome (30 cases) which became permanent in four cases, vocal cord paralysis (three cases), elevated hemidiaphragm without respiratory difficulty (two cases), and superficial would infection (one case). There were no deaths. Although the presentation of patients with vertebrobasilar insufficiency is generally characteristic, we believe that a specific diagnosis can be established only by angiographic means. Anticoagulants have been used to alleviate symptoms in some cases but are ineffective in solving the primary hemodynamic problem. Surgical reconstruction of the affected area deserves further evaluation in the management of these patients.
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PMID:Surgical reconstruction of the proximal vertebral artery. 649 33

Eight patients were evaluated for severe vertebrobasilar insufficiency (VBI). There were five males and three females, with an average age of 60.2 years (range 42 to 67 years). Three were diabetic and five hypertensive, including two patients who had both diseases. Seven of the eight had ongoing episodes of VBI refractory to anticoagulant and/or antiplatelet agents. Symptoms included two or more of the following in all patients: dizziness, diplopia, hemiparesis, hemihypesthesia, perioral numbness, bilateral visual blurring, dysarthria, and ataxia. Angiography revealed severe atherosclerotic stenosis of the proximal or midsection of the basilar artery in all patients. A 10-cm segment of the anterior or posterior division of the superficial temporal artery (STA) was anastomosed to a proximal segment of the superior cerebellar artery (SCA) through a right subtemporal approach. Seven of eight (87%) postoperative angiograms demonstrated patency as evidenced by filling of the SCA and, in most cases, of the basilar artery. Six of the eight patients were improved or asymptomatic after the operation, one was unchanged, and one died. The average follow-up period was 14 months, with a range of 4 to 23 months. Transient morbidity included temporal lobe swelling in four patients and a subdural hematoma in one. Anastomosis of the STA to the SCA is a feasible therapeutic option in the patient with VBI secondary to stenosis of the proximal or midsection of the basilar artery.
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PMID:Posterior circulation revascularization. Superficial temporal artery to superior cerebellar artery anastomosis. 707 75

Twenty-four hour ambulatory ECG records were obtained from 163 patients attending a general medical unit of a district general hospital. The main indications for recording were palpitations, syncope and dizziness and 262 tapes were suitable for analysis. Problems and benefits of the system were discussed. Abnormalities detected were supraventricular tachycardia, ventricular tachycardia, atrial fibrillation, intermittent heart block, sinoatrial disease and pacemaker malfunction. Sixty-one patients were reassured and in 78 patients an alteration in drug regime was advised with clinical improvement in 63 cases. Vertebrobasilar insufficiency was diagnosed in 14 patients, 4 patients were referred for further cardiac investigations, 4 required insertion or replacement of a pacemaker, 1 was referred for psychiatric opinion, and 1 patient died. Selected 24-hour ambulatory ECG monitoring in a district general hospital provides a valuable service for investigation of symptoms that may be caused by cardiac arrhythmias. The question of local or centralised analysis of recordings should be decided on the grounds of time and staff available and the capital cost of equipment.
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PMID:The contribution of 24-hour ambulatory ECG monitoring in a general medical unit. 719 16

One hundred and one consecutive patients complaining of dizziness were assessed by noninvasive carotid-artery testing, including oculoplethysmography, supraorbital directional Doppler and direct carotid flow Doppler. Hemodynamically significant carotid disease was found in 8 of 34 patients with the nonspecific complaint of "lightheadedness," in 4 of 21 patients with syncope, in 3 of 12 patients with vertebrobasilar insufficiency, and in 7 of 27 patients with associated focal cerebral signs or symptoms. None of 7 patients with vertigo alone were affected. In summary, 21 of the 101 patients with dizziness had hemodynamically significant obstruction to flow in the carotid-artery circulation. These findings suggest that in a fairly large proportion of patients complaining of dizziness, the symptoms may be the result of decreased cerebral perfusion due to carotid-artery occlusive disease. In these patients, noninvasive carotid-artery testing appears to be useful in identifying those with significant obstruction to blood flow in the carotid-artery circulation.
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PMID:Hemodynamics of the carotid-artery circulation in the elderly "dizzy" patient. 726 32

Drop attacks are sudden, unexpected, nonsyncopal falls, which are not preceded or accompanied by loss of consciousness, dizziness, lightheadedness, or loss of balance. They can be a manifestation of epilepsy, brain stem tumors, and a variety of other conditions. In the elderly, they have been associated with vertebrobasilar insufficiency, cervical spondylosis, or both. However, the specificity and etiology of drop attacks have come under some scrutiny in recent years. The patient described in this case report experienced frequent drop attacks that were effectively prevented with nifedipine. Possible pathophysiologic mechanisms are discussed and the relevant literature is reviewed.
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PMID:Treatment of drop attacks with nifedipine: a case report. 779 70

In order to evaluate diagnostic usefulness of MRI in vertebrobasilar insufficiency (VBI), we performed magnetic resonance imaging (MRI) and MR angiography (MRA) in 90 patients presenting vertigo and dizziness as an initial and cardinal complaint. High signals observed by T2-weighted imaging in the basal ganglia (44.4%) or pontine base (48.9%) were more frequently seen in the possible VBI group than in the controls (p < 0.001). The electronystagmographical abnormalities were commonly observed in the patients with a high signal in the pontine base, reflecting diffuse ischemic lesion in the territory of the vertebrobasilar system. Vertebral artery asymmetry (45.6%) or basilar artery twisting (41.1%) as shown by MRA was also significantly more frequent in the patients than in the controls (p < 0.05). In conclusion, MRI and MRA were considered to be useful in making a clinical diagnosis of VBI in such patients.
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PMID:[MRI findings in patients with vertigo and dizziness possibly arising from vertebrobasilar insufficiency]. 815 8

Atherosclerotic change is the main reason for vertebrobasilar insufficiency. However, if clinical symptoms such as vertigo happen transiently and repeatedly with head movement, vascular insufficiency due to mechanical compression of the vertebral artery must be kept in mind as its cause. The patient was a 54-year-old male complaining of recurrent vertigo which occurred during head rotation. He had been treated medically before he came to our hospital. Right compressed vertebral angiogram with head turned to the right and left compressed vertebral angiogram with head turned to the left were obtained at the first segment. Unilateral decompression of the vertebral artery was performed. At surgery it was found that the right vertebral artery was compressed by a stellate ganglion. After cutting of the sympathetic chains, the stellate ganglion was detached from the vertebral artery. The patient's intractable vertigo immediately disappeared after this procedure. It is concluded that if severe vertigo or dizziness is repeated under certain conditions, we must perform a bilateral vertebral angiogram and differentiate whether it is a case of decompression or not and then take measures to bring about decompression effectively.
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PMID:[A case of effective decompression at the first segment of the vertebral artery for intractable vertigo]. 874 13

Complaints of vertigo and dizziness are common problems referred to otolaryngologists for evaluation. Awareness of uncommon causes of dizziness increases the physician's ability to diagnose and treat these patients. We present the case of a middle-aged woman who presented with episodes of vertigo and symptoms suggestive of vertebrobasilar insufficiency. These symptoms were the result of a persistent trigeminal artery (PTA) and occlusive carotid artery disease. A PTA is a carotid-basilar anastomosis that has been reported to be demonstrated on 0.1% to 0.6% of all cerebral angiograms. Persistence of this vessel usually leads to hypoplasia or agenesis of the ipsilateral posterior communicating artery, and leaves the internal carotid artery as the main source of blood supply to the region of the upper brainstem. The appearance and clinical significance of this unusual condition will be discussed.
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PMID:Persistent trigeminal artery as a cause of dizziness. 901 36

Vertebrobasilar insufficiency is a very imprecise and much too frequently applied diagnostic term, usually used to classify uncharacteristic intermittent symptoms such as dizziness or visual blurring. Detailed history may make it possible to identify more specific details. Diagnostic attempts nowadays should aim at identifying underlying pathophysiologic mechanisms: intrinsic vessel disease (e.g. atherosclerosis), extrinsic vessel compression (e.g. cervical spondylarthrosis), systemic affections (e.g. anemia, hypotension), or combined etiologies. Accordingly, various therapeutic options exist. Ultrasound examination of the vertebrobasilar system is a reliable screening method in skilled hands, though its sensitivity is lower than in carotid artery disease. To identify the site and nature of the underlying pathology, digital angiography and, probably soon, magnetic resonance angiography (MRA) are available.
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PMID:[Vertebrobasilar insufficiency]. 941 87


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