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

Stimulated by the widespread use of head-up tilt testing, transient episodes of neurocardiogenically mediated hypotension and bradycardia have become a well recognized cause of recurrent syncope and near syncope (generally referred to as neurally mediated syncope). On the other hand, a large subgroup of patients was identified, who appeared to have a less severe hypotension and orthostatic intolerance that is characterized by postural tachycardia, exercise intolerance, disabling fatigue, lightheadedness and dizziness. This form of disability has been recognized as postural orthostatic tachycardia syndrome (POTS). While the etiology of POTS is still unclear, a mild form of idiopathic peripheral autonomic neuropathy (partial dysautonomia) or beta-receptor hypersensitivity has been suggested for the pathophysiology of this disorder. A detailed history and physical examination that includes a careful neurologic examination are essential for diagnosis. Head-up tilt testing is often useful as a standardized measure of response to postural change. This review summarizes the history, current knowledge of clinical features, diagnosis and therapeutic strategies.
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PMID:[Idiopathic postural orthostatic tachycardia syndrome] 1101 90

It is a well-known fact, and there are several publications on this matter, the links between panic attacks, simulation, anxiety, depression and lightheadedness or imbalance, but in our perusal of the related literature no connection between pathological mourning, dizziness and imbalance was found. In this paper are reported the outcomes of a prospective study of 58 patients suffering vertigo and imbalance as well and psychiatrically assessed. Pathologic mourning shows its predominance among otic vertiginous. This feature, we think, should be investigated when collecting the anamnesis of patients complaining of dizziness and/or imbalance in order to planning the appropriate treatment.
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PMID:[Vertigo, imbalance and mourning]. 1107 77

To dissociate the sensorimotor aspects of cigarette smoking from the pharmacologic effects of nicotine, smokers rated the subjective effects of nicotine-containing or denicotinized cigarettes, and intravenous (IV) nicotine or saline infusions. Three groups of participants (n=20 per group) received either: (1) continuous nicotine, (2) pulsed nicotine, or (3) saline. Each group was exposed to an IV condition once while smoking a denicotinized cigarette and once while not smoking, in a 3x2 mixed design. A fourth group (n=20) received saline while smoking their usual brand of cigarette. The dose and rate of nicotine administration were individualized based on previous measures of ad lib smoke intake. Denicotinized cigarette smoke significantly reduced craving and was rated significantly more satisfying and rewarding than the no-smoking conditions. IV nicotine reduced craving for cigarettes, and increased ratings of lightheadedness and dizziness. However, no significant satisfaction or reward was reported after IV nicotine. The combination of IV nicotine and denicotinized cigarette smoke produced effects similar to those of smoking the usual brand of cigarette. The results suggest that sensorimotor factors are critical in mediating the immediate subjective response to smoking, and that the immediate subjective effects of nicotine administered in doses obtained from cigarette smoking are subtle. Thus, addressing smokers' needs for both for the sensorimotor aspects of smoking as well as for the direct CNS effects of nicotine may be critical in enhancing smoking cessation treatment outcome.
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PMID:Dissociating nicotine and nonnicotine components of cigarette smoking. 1111 86

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, interactions, and dosage of nateglinide are reviewed. Nateglinide is an oral hypoglycemic agent approved for use alone or in combination with metformin as an adjunct to diet and exercise for the treatment of type 2 diabetes mellitus. Nateglinide, an amino acid derivative of D-phenylalanine, stimulates the secretion of insulin by binding to the ATP potassium channels in pancreatic beta cells. The result is an increase in beta-cell calcium influx, which leads to rapid, short-lived insulin release. The drug is rapidly and completely absorbed in the small intestine. The estimated bioavailability is 72%. Nateglinide is highly bound to plasma proteins, is metabolized extensively by the liver, and has an elimination half-life of 1.4 hours. Several clinical trials of nateglinide, alone and in combination with other oral hypoglycemic agents, have found the drug to be safe, effective, and well tolerated. The most common adverse effects are nausea, diarrhea, dizziness, and lightheadedness. There is a potential for interactions between nateglinide and medications affected by the cytochrome P-450 isoenzyme system. Dosage regimens ranging from 60 to 240 mg have been evaluated. The maximum effective dosage is 120 mg taken 10 minutes before meals three times a day. Nateglinide is an alternative to second-generation sulfonylureas for the treatment of type 2 diabetes mellitus. Additional comparative trials are needed to fully elucidate nateglinide's role.
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PMID:Nateglinide. 1144 77

The general public, the mass media, and many government officials believe that the use of weapons of mass destruction (WMD) will inevitably lead to mass panic and/or mass hysteria. However, studies of disasters and wars show that disorganized flight in the presence of a real or perceived danger (i.e., mass panic) is rare. On the other hand, in a real or perceived WMD scenario, outbreaks of multiple unexplained symptoms (i.e., mass psychogenic illness, mass sociogenic illness, mass hysteria, or epidemic hysteria) may be prevalent. Many of the symptoms (fatigue, nausea, vomiting, headache, dizziness/lightheadedness, and anorexia) are common in combat and after toxic chemical exposure, chemical weapon exposure, prodromal infectious illness, and acute radiation sickness.
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PMID:Collective behaviors: mass panic and outbreaks of multiple unexplained symptoms. 1177 31

Dizziness is a frequent complaint in elderly people, and is a broad term used to explain various abnormal sensations related to the perception of the body's relationship to space. Classically, four subtypes are described: vertigo, pre-syncopal lightheadedness, disequilibrium, and other dizziness. Dizziness is often a chronic complaint in elderly people and may lead to dramatic worsened functional and psychosocial outcomes. Dizziness should be approached as a symptom and as a syndrome. In fact, physicians should exclude potential curable causes of dizziness, considering dizziness as a symptom of specific diseases. As dizziness is often multifactorial, it should also be treated as a geriatric syndrome. Physicians should, thus, identify risk factors of recurrent dizziness. The "Dizziness Handicap Inventory Scale" may assist the clinician to establish the extent of the "dizziness" problem. Specific causes of dizziness should be addressed as well as contributive factors (i.e., medications). Vestibular and balance rehabilitation with an interdisciplinary collaboration should start rapidly to avoid psycho-social complications, such as fear of falling.
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PMID:Management of chronic dizziness in elderly people. 1261 2

In the Dutch College of General Practitioners' practice guideline entitled 'Dizziness', a distinction is made between two types of dizziness. The first is vertigo which is characterised by a sense of spinning or movement and which is caused by problems with the vestibular organ. The second is lightheadedness or the feeling that one is going to faint; the cause of this problem is found outside the vestibular organ. In making the diagnosis, history-taking and a limited physical examination is usually sufficient. Providing the patient with information plays an important role in the treatment. Medication for dizziness is not advised. In case of nausea and vomiting, specific medication can be prescribed to treat these symptoms. Referral to secondary care is indicated if there are signs of a serious condition or if additional investigations are required.
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PMID:[Summary of the Dutch College of General Practitioners' practice guideline 'Dizziness']. 1274 Nov 74

Of almost 8,000 patients referred for neurological consultation, 6.1 per cent had "dizziness" as a presenting complaint. Dizziness is a nonspecific complaint, used loosely to describe funny feelings in the head or lightheadedness by anxious or depressed patients; or it may mean vertigo-a hallucination of movement of self or surroundings in horizontal, rotatory or vertical direction. An analysis of 400 cases showed the complaint "dizziness" to be functional in about 25 per cent of patients. The cause in the remaining cases varied from epilepsy from cortical lesions, to lesion of the brain stem, such as tumors, vascular insufficiency, and multiple sclerosis, or to the peripheral neurone from Meniere's disease, and vestibular neuritis. Leading the patient out in a description of the kind of dizziness he feels may give clues that will help differentiate between true vertigo and functional disorder, particularly when considered against the information that is obtained in neurological examination.
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PMID:The neurologic aspects of vertigo: analysis of 400 cases. 1441 39

A 63-year-old man presented with subclavian steal syndrome associated with left internal mammary artery (IMA) bypass graft to a coronary artery. He was admitted with a history of oppressive sensation in the chest, dizziness, and light headedness on exertion for 2 weeks in March 2002. He had undergone myocardial revascularization consisting of a left IMA-to-left anterior descending coronary artery graft in April 1988. His blood pressure was 140/70 mmHg in the right arm and 80/64 mmHg in the left arm. Aortic arch arteriography revealed complete occlusion of the left subclavian artery proximal to the left IMA takeoff and subclavian steal with anterograde flow of the left IMA. Percutaneous angioplasty and stent placement with protection of the left IMA bypass graft using a balloon catheter was successfully performed without complication by cerebral or myocardial ischemia. Complete recanalization of the occluded left subclavian artery and anterograde flow of the left vertebral artery were achieved. His symptoms disappeared and blood pressure in the left arm recovered. This variant of coronary subclavian steal might require protection of the left IMA during angioplasty and stent placement.
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PMID:Percutaneous transluminal angioplasty and stent placement for subclavian steal syndrome with concomitant anterograde flow in the left internal mammary artery graft for coronary artery bypass--case report. 1462 Feb

The purpose of this research trial is to assess the effectiveness and tolerability of tizanidine in neuropathic pain. In an open-label study, patients with neuropathic pain received 1 to 4 mg of tizanidine once daily for 7 days, followed by weekly dose escalation of 2 to 8 mg to his/her effective or maximum tolerated dose or a maximum of 36 mg over an 8-week period. Treatment effects were assessed, using average weekly pain scores as well as biweekly scores for patient global assessment of pain relief, the neuropathic pain scale, and wisconsin brief pain inventory. Frequency and severity of adverse events were examined also. Twenty-three patients were enrolled. The mean average weekly pain score at baseline was 6.9, which decreased by 1.7 points at the end of week 8 to 5.2 (p < or =.01). A total of 15 patients (68%) reported that their pain relief was improved or much improved with tizanidine therapy, and 2 of these patients became completely pain-free. The following neuropathic pain qualities were significantly lower at week 8 compared with baseline: intense, sharp, hot, dull, cold, sensitive, unpleasant, and deep pain. There was a significant decline in pain quantity and interference of pain on quality of life from baseline to week 8. The mean effective or maximum tolerated dose was 23 mg/day (range 6 to 36 mg/day). Side effects consisted primarily of dizziness/lightheadedness (52%), drowsiness (48%), fatigue/weakness (43%), dry mouth (39%), gastrointestinal upset (30%), and sleep difficulty (22%). One patient developed significant elevation in liver function tests (LFTS) With symptoms at week 4. Tizanidine therapy was discontinued. LFTS returned to normal in 3 weeks. Tizanidine might be an effective treatment for neuropathic pain, offering an alternative for patients poorly responsive to other medications. A larger, randomized placebo-controlled trial is recommended. In addition, comparative studies with alternative agents should be sought.
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PMID:Effectiveness of tizanidine in neuropathic pain: an open-label study. 1462 12


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