Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 68-year-old man with disturbed consciousness had repeatedly developed light-headedness and dizziness since the summer of 1996 and was admitted to a hospital for detailed examinations on October 8, 1996. On admission, he weighed 49 kg and showed subclinical hypothyroidism with low T3 syndrome. The adrenal function and serum electrolytes were normal. Since the stool samples were positive for occult blood, gastroscopy was performed. Examination of the biopsy specimens demonstrated gastric cancer. On October 21, blood examination showed hyponatremia (127 mEq/l). On October 22, marked disturbance of consciousness developed. On October 24, the serum Na level further decreased to 116 mEq/l. On November 8, he was referred to our hospital. On admission, his skin and tongue showed marked dehydration, and severe disturbance of consciousness and neck stiffness were observed. The central venous pressure was 4 cmH2O. In the cerebrospinal fluid, atypical cells were observed, and a diagnosis of meningeal carcinomatosis was made. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was excluded because of marked dehydration, a normal blood ADH level, and because plasma osmotic pressure was greater than urinary osmotic pressure. Considering the possibility of cerebral salt wasting syndrome (CSWS) or hypoadrenocorticism, Na supplementation and drip infusion of prednisolone (20 mg/day) were performed. The serum Na has normalized (140.1 mEq/l), and his consciousness improved. He died of aggravation of the general condition on December 16. Pathological examination demonstrated a small metastatic lesion in the infundibular part of the pituitary gland and a small metastatic lesion in the parenchyma of the bilateral adrenal glands. However, since neither hypotension nor hypoglycemia was observed before treatment, and the blood cortisol level and the serum K level were normal, hypoadrenocorticism was excluded. Hypoaldosteronism was also excluded because of a normal serum K level. CSWS has been reported to be caused by head trauma, subarachnoid hemorrhage, or trans-sphenoidal pituitary operation. This patient is a rare case of CSWS developed in the presence of meningeal carcinomatosis accompanied by a small pituitary metastatic lesion from gastric cancer. The aged with decreased ability to retain water and sodium in the body are more susceptible to CSWS than the young. In the aged with central hyponatremia, the possibility of CSWS should be considered, and early diagnosis and treatment are necessary.
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PMID:[A patient with meningeal carcinomatosis accompanied by a small pituitary metastatic lesion from gastric cancer who developed cerebral salt wasting syndrome]. 1057 52

Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or of the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed by caloric irrigation and has been interpreted (sometimes falsely) as demonstrating a vestibular nerve lesion. The vertical semicircular canals are not assessed easily. Caloric testing with the head in various positions is not very helpful, but the canals may be tested in pairs using specific rotational techniques. Often, the otolith organs, detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. The extent of otolith involvement in Meniere's disease is not well understood. The tested subject is seated eccentrically in a rotatory chair and faces the direction of rotation. Thus, the otolith organs are stimulated in steady-state rotation. The subject experiences a lateral tilt and, in darkness, is instructed to point a short light bar in the position that he or she thinks a water surface would have (identical to the perceived tilt). Patients with conservatively treated unilateral Meniere's disease were tested. In the eccentric rotation test, the patients with unilateral Meniere's disease showed highly variable, sometimes even paradoxical, responses. No correlation was noted between the eccentric otolith test and pure-tone audiometry or the side difference of the caloric responses. Otolith and lateral semicircular canal functions may differ in patients with Meniere's disease, the nature of which remains to be elucidated in further studies.
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PMID:Subjective Visual Horizontal Determination During Otolith Stimulation by Eccentric Rotation in Conservatively Treated Meniere's Disease. 1075 91

Angiotensin II receptor blockers (ARBs) represent a new class of effective and well tolerated orally active antihypertensive agents. Recent clinical trials have shown the added benefits of ARBs in hypertensive patients (reduction in left ventricular hypertrophy, improvement in diastolic function, decrease in ventricular arrhythmias, reduction in microalbuminuria, and improvement in renal function), and cardioprotective effect in patients with heart failure. Several large long-term studies are in progress to assess the beneficial effects of ARBs on cardiac hypertrophy, renal function, and cardiovascular and cerebrovascular morbidity and mortality in hypertensive patients with or without diabetes mellitus, and the value of these drugs in patients with heart disease and diabetic nephropathy. The ARBs specifically block the interaction of angiotensin II at the AT1 receptor, thereby relaxing smooth muscle, increasing salt and water excretion, reducing plasma volume, and decreasing cellular hypertrophy. These agents exert their blood pressure-lowering effect mainly by reducing peripheral vascular resistance usually without a rise in heart rate. Most of the commercially available ARBs control blood pressure for 24 h after once daily dosing. Sustained efficacy of blood pressure control, without any evidence of tachyphylaxis, has been demonstrated after long-term administration (3 years) of some of the ARBs. The efficacy of ARBs is similar to that of thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors or calcium channel blockers in patients with similar degree of hypertension. Higher daily doses, dietary salt restriction, and concomitant diuretic or ACE inhibitor administration amplify the antihypertensive effect of ARBs. The ARBs have a low incidence of adverse effects (headache, upper respiratory infection, back pain, muscle cramps, fatigue and dizziness), even in the elderly patients. After the approval of losartan, five other ARBs (candesartan cilexetil, eprosartan, irbesartan, telmisartan, and valsartan) and three combinations with hydrochlorothiazide (irbesartan, losartan and valsartan) have been approved as antihypertensive agents, and some 28 compounds are in various stages of development. The ARBs are non-peptide compounds with varied structures; some (candesartan, losartan, irbesartan, and valsartan) have a common tetrazolo-biphenyl structure. Except for irbesartan, all active ARBs have a carboxylic acid group. Candesartan cilexetil is a prodrug, while losartan has a metabolite (EXP3174) which is more active than the parent drug. No other metabolites of ARBs contribute significantly to the antihypertensive effect. The variation in the molecular structure of the ARBs results in differences in the binding affinity to the receptor and pharmacokinetic profiles. The differences observed in lipid solubility, absorption/distribution, plasma protein binding, bioavailability, biotransformation, plasma half-life, and systemic elimination influence the time of onset, duration of action, and efficacy of the ARBs. On the basis of the daily mg dose, the antihypertensive potency of the ARBs follows the sequence: candesartan cilexetil > telmisartan approximately = losartan > irbesartan approximately = valsartan > eprosartan. After oral administration, the ARBs are rapidly absorbed (time for peak plasma levels = 0.5-4 h) but they have a wide range of bioavailability (from a low of 13% for eprosartan to a high of 60-80% for irbesartan); food does not influence the bioavailability, except for valsartan (a reduction of 40-50%) and eprosartan (increase). A limited dose-peak plasma levels/areas under the plasma level-time curve proportionality is observed for some of the ARBs. Most of these drugs have high plasma protein binding (95-100%); irbesartan has the lowest binding among the group (90%). The steady-state volumes of distribution vary from a low of 9 L (candesartan) to a high of 500 L (telmisartan). (ABSTRACT TRUNCATE
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PMID:Clinical pharmacokinetics of angiotensin II (AT1) receptor blockers in hypertension. 1085 85

We investigated the effect of vestibular stimulation on the lateralization of dichotic sound by cold-water irrigation of the external auditory canal in human subjects. Subjects adjusted the interaural level difference of the auditory stimulus to the subjective median plane of the head. In those subjects in whom dizziness and nystagmus indicated sufficient vestibular stimulation, these adjustments were significantly shifted toward the cooled ear compared with the control condition (irrigation with water at body temperature); i.e., vestibular stimulation induced a shift of the sound image toward the nonstimulated side. The mean magnitude of the shift was 7.3 dB immediately after vestibular stimulation and decreased to 2.5 dB after 5 min. As shown by an additional control experiment, this effect cannot be attributed to a unilateral hearing loss induced by cooling of the auditory periphery. The results indicate the involvement of vestibular afferent information in the perception of sound location during movements of the head and/or the whole body. We thus hypothesize that vestibular information is used by central-nervous mechanisms generating a world-centered representation of auditory space.
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PMID:Vestibular influence on human auditory space perception. 1093 34

The CSF-pressure-lowering effects of indomethacin in seven patients with idiopathic intracranial hypertension and one patient with symptomatic intracranial hypertension due to a non-space-occupying meningioma are reported. CSF opening pressure between 350 and 500 mm H2O (mean 400 mm H2O) was promptly reduced by 80 to 200 mm H2O (mean reduction, 139 mm H2O) for at least 10 minutes in all patients after IV administration of 50 mg indomethacin. Four patients had mild and transient side effects (dizziness). Indomethacin might be an alternative drug for treatment of intracranial hypertension.
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PMID:Indomethacin reduces CSF pressure in intracranial hypertension. 1106 Dec 68

The safety and efficacy of Trigonella foenum-graecum extract was investigated using 20 male volunteers aged 20-30 years. They were randomly treated with either 40 mg/kg aqueous extract powder in 10 mL distilled water or 10 mL distilled water in which coffee simulated the extract. The extract significantly lowered blood glucose level by 13.4% 4 hours after ingestion. A significant change of 14.1% was observed in potassium levels. No significant alteration in serum cholesterol, total serum protein and blood urea occurred. Approximately one-third experienced feelings of hunger, frequency of micturition or dizziness during the 24 hours after ingestion. The aqueous extract effectively reduced blood glucose in normal subjects safely. Its hypokalaemic effect merits further investigation.
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PMID:Hypoglycaemic effect of aqueous extract of the leaves of Trigonella foenum-graecum in healthy volunteers. 1137 Mar 45

We undertook a study to assess whether patients who had both spontaneous vertigo and headache would respond to treatment for endolymphatic hydrops rather than treatment for migraine. We also attempted to discover if there were any individual characteristics that might predict which patients with an equivocal history and symptoms would be more likely to have either of the two conditions as opposed to the other. All patients were initially treated for endolymphatic hydrops with sodium restriction and increased water intake. Response to treatment was assessed by three tools: the Dizziness Handicap Inventory, a symptom severity scale, and a disability scale. Patients who did not respond to treatment for endolymphatic hydrops were switched to treatment for migraine. At the first follow-up period, 23 patients were available for analysis by telephone survey. According to data obtained by the three assessment tools, 14 patients (60.9%) improved after initial therapy and six (26.1%) improved following subsequent migraine treatment; the remaining three patients (13.0%) did not comply with their initial treatment regimen, and they showed no improvement. Although no statistically significant conclusions can be drawn because of the small sample size, there were trends to suggest that certain demographic, clinical, and objective-testing characteristics might predict which patients are likely to have one of these two conditions as opposed to the other. We conclude that a stepwise approach to treatment, beginning with therapy for endolymphatic hydrops, is an appropriate strategy. Also, the fact that no improvement was seen among the three patients who did not comply suggests that improvement is indeed the result of treatment rather than simply a function of the passage of time.
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PMID:Spontaneous vertigo and headache: endolymphatic hydrops or migraine? 1177 22

We like to think that our homes are a safe haven. However, in recent years we have been discovering that certain products, designs, and even the siting of our homes can create health risks. When families moved into a new development in Waynesville, NC, called "Barber Orchard," they were ecstatic about their new surroundings--the fresh air, mountain views, and clean water. When one of the new residents had his well water tested, their dream homes took on a different character. The water was reflective of the years of pesticide use on the former orchard on which their homes were sited; it contained DDT, DDE, and benzene hydrochlorides (Manual, 2000). The soil was contaminated with lead and arsenic, also the result of pesticide applications. The Environmental Protection Agency (EPA) sent in an emergency response team, removed toposil, and advised residents to install carbon filters on their water systems. Sometimes, we unintentionally bring pollution into our homes. In the homes of middle-income families with small children, vacuum dust was found to have pesticide concentrations 10-100 times greater than those found in the surface soils surrounding their houses (Lewis et al, 1994). In the agricultural area of Washington State, 47 of 48 farm homes had chlorpyrifos (an organophosphate pesticide) measured in the house dust. The human health risks associated with chlorpyrifos are substantial (including headaches, dizziness, muscle twitching, vomiting, and blurred vision); hence, in 2000, the EPA eliminated the widely used pesticide for nearly all-household purposes. The purpose of this independent study module (ISM) is to introduce the reader to basic concepts and issues associated with environmental health risks to children in homes and communities. In this ISM, some of the key hazardous exposures occurring in the home will be discussed. Indoor air quality, drinking water, lead, mercury, pesticides, radon, and UV radiation have been selected as topics of focus. A resource section provides a brief listing of resources; many of them are Web sites, which, in turn will link the reader to additional resources. The EPA's Web site is particularly helpful. The University of Maryland School of Nursing has a new Web site, http://enviRN.umaryland.edu, with links to all of the Web sites noted in this ISM.
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PMID:Environmentally healthy homes and communities. Children's special vulnerabilities. 1178 92

The uses, pharmacology, clinical efficacy, dosage and administration, adverse effects, and drug interactions of hawthorn are discussed. Hawthorn (Crataegus oxyacantha) is a fruit-bearing shrub with a long history as a medicinal substance. Uses have included the treatment of digestive ailments, dyspnea, kidney stones, and cardiovascular disorders. Today, hawthorn is used primarily for various cardiovascular conditions. The cardiovascular effects are believed to be the result of positive inotropic activity, ability to increase the integrity of the blood vessel wall and improve coronary blood flow, and positive effects on oxygen utilization. Flavonoids are postulated to account for these effects. Hawthorn has shown promise in the treatment of New York Heart Association (NYHA) functional class II congestive heart failure (CHF) in both uncontrolled and controlled clinical trials. There are also suggestions of a beneficial effect on blood lipids. Trials to establish an antiarrhythmic effect in humans have not been conducted. The recommended daily dose of hawthorn is 160-900 mg of a native water-ethanol extract of the leaves or flowers (equivalent to 30-169 mg of epicatechin or 3.5-19.8 mg of flavonoids) administered in two or three doses. At therapeutic dosages, hawthorn may cause a mild rash, headache, sweating, dizziness, palpitations, sleepiness, agitation, and gastrointestinal symptoms. Hawthorn may interact with vasodilating medications and may potentiate or inhibit the actions of drugs used for heart failure, hypertension, angina, and arrhythmias. The limited data about hawthorn suggest that it may be useful in the treatment of NYHA functional class II CHF.
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PMID:Hawthorn: pharmacology and therapeutic uses. 1188 7

An 11-year-old girl presented with headache of 3 months' duration. There was bilateral disc edema. The cerebrospinal fluid pressure was 50 cm of water with normal cerebrospinal fluid cytology and biochemistry. She developed severe headache (different and disabling), dizziness, vomiting, and backache on sitting up 6 hours after lumbar puncture, and lying supine relieved all of her symptoms. Intravenous fluids, analgesics, and complete bed rest did not relieve her symptoms over the next 72 hours. She was completely relieved of her symptoms on receiving two tablets of Caffergot containing 200 mg of caffeine and 2 mg of ergotamine 72 hours after lumbar puncture. The symptoms recurred 48 hours later, and a repeat dose of Caffergot was required. Magnetic resonance imaging (MRI) done 96 hours after lumbar puncture revealed the entire dura overlying the brain, including the posterior fossa, showing intense enhancement on contrast injection with leak at the lumbar puncture site. Oral caffeine (coffee, three times a day) was advised over 1 week. The patient remained asymptomatic, and a repeat MRI scan after 10 days showed complete clearing of the cerebrospinal fluid leak with no dural enhancement. The syndrome of cerebrospinal fluid hypovolemia following lumbar puncture is reported in a girl with idiopathic intracranial hypertension.
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PMID:Syndrome of cerebrospinal fluid hypovolemia following lumbar puncture cerebrospinal fluid leak in a patient with idiopathic intracranial hypertension. 1191 82


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