Search Results (9)

Background: The early recognition of systemic hemodynamic changes resulting from uteroplacental circulation disturbance in preeclampsia (PE) is of great importance for its appropriate treatment and prevention. The aim of the present study was to assess the hemodynamic changes during a roll-over test in healthy normotensive and preeclamptic pregnant women using applanation tonometry. Patients and methods: Healthy pregnant and PE women in their third trimester were studied. First, applanation tonometry was performed in a resting state on the right radial artery of each subject. In the second phase, the measurements were repeated in the left-lateral position and 5 min after turning each patient into a supine position (roll-over test = ROT). The systolic and diastolic central and peripheral blood pressures, pulse pressures, and augmentation index (AIx₇₅) values were registered for all phases. Results: A total of 21 PE and 14 healthy pregnant women entered this study. At rest, the PE patients had higher systolic, diastolic, and mean blood pressures; the preeclamptic patients had higher peripheral and central blood pressure and pulse pressure values compared to the healthy controls. A statistically significant difference was found between the augmentation index (AIX-75) values for the preeclamptic and healthy pregnant women (healthy pregnant: 9.0 ± 2.4 vs. preeclamptic: 18.9 ± 6.0; p = 0.019). During the ROT, no significant differences could be detected in the applanation tonometry parameters within the groups. The differences between the PE and healthy pregnant women continued to exist in the left-lateral and supine positions during the roll-over test. Conclusions: This is the first study combining a roll-over test and arterial stiffness measurements in healthy pregnant females and in those with PE. Although we can confirm that arterial stiffness measurements can be used to detect hemodynamic changes in pregnant women with PE, combining it with a roll-over test is unsuitable for improving the method’s sensitivity. Full article

Background: Preeclampsia (PE) and eclampsia are characterized by changes in cerebral hemodynamics, which may result in serious and even life-threatening neurological complications. The aim of the present work was to compare cerebral hemodynamic changes during the roll-over test in women with mild and severe PE. Patients and methods: Healthy pregnant and PE women in their third trimester were studied. Transcranial Doppler (TCD) measurements of the right middle cerebral artery (MCA) were performed in the left lateral position and 5 min after turning to the supine position (roll-over test = ROT). Besides cerebral blood flow measurements, the blood pressure was measured in the right arm using a standard mercury sphygmomanometer. An independent gynecologist categorized the preeclamptic patients into mild and severe groups based on the clinical and laboratory results. The TCD assessors were unaware of the patient grouping while performing the TCD and blood pressure measurements. Results: A total of 21 healthy pregnant females (mean age: 26.1 ± 5.1 yrs), 11 females with mild PE (28.2 ± 6.8 yrs), and 18 females with severe PE (29 ± 7.4 yrs) were studied. A significant increase in the mean arterial pressure was observed in all of the groups during the roll-over test: healthy pregnant patients: from 106.3 ± 16.3 to 113.8 ± 15.9 mmHg; patients with mild PE: from 100 ± 11.2 to 110 ± 8.7 mmHg; and patients with severe PE: from 106.3 ± 16.3 to 113.8 ± 15.8 mmHg. The MCA mean blood flow velocities in the left lateral position were significantly lower in the control patients than in those with PE: MCAV control: 71.2 ± 12.7 cm/s; mild PE: 78.2 ± 19.4 cm/s; and severe PE: 96 ± 15.6 cm/s, p < 0.001. Turning to the supine position resulted in a decrease in the MCAV in all of the groups, but the differences between the groups remained unchanged: controls: 69.5 ± 9.1 cm/s; mild PE: 75.7 ± 17.5 cm/s; and severe PE: 85.7 ± 18.4 cm/s, respectively, p = 0.014. A slight but statistically insignificant increase in the pulsatility index was observed in all of the groups. Conclusions: This is the first study comparing cerebral hemodynamic changes in healthy pregnant females and in those with mild and severe PE during a roll-over test. Changing the posture did not result in changes in the cerebral blood flow velocities in the healthy and preeclamptic pregnant patients. Our results indicate that static cerebral autoregulation is preserved both in the mild and severe preeclamptic patients. Full article

Background/Objectives: Accurate head positioning is essential for diagnostics of benign paroxysmal positional vertigo (BPPV). This study aimed to quantify the head angles and angular velocities during traditional manual BPPV diagnostics in patients with positional vertigo. Methods: A prospective, observational cohort study was conducted at a tertiary university hospital outpatient clinic. One trained examiner performed the Supine Roll Test (SRT) and the Dix–Hallpike test (DHT) on 198 adults with positional vertigo. The primary outcomes included head angle variability and accuracy and angular velocity variability. The secondary outcomes examined the relationship between the head angle accuracy and participant-reported limitations. Results: The absolute variability for all head angles ranged from ±8.7° to ±11.0°. The yaw axis head angles during the DHT, particularly on the left side, had the highest relative variability (left DHT: coefficient of variance 0.29). Systematic errors included the yaw axis head angles undershooting the target (90°) by 19.7–23.8° during the SRT and the pitch axis head angles undershooting the target (120°) by 7.8–8.7° during the DHT. The left-sided yaw axis in the DHT was undershot by 11.8°, while the right-sided DHT angle was slightly overshot (2.5°). Right-sided yaw axis angles in the SRT and DHT were more accurate than the left-sided ones (right SRT: 19.9°; left SRT: 23.9°; p < 0.0001) (right DHT: 7.0°; left DHT: 13.2°; p < 0.0001). The regression analysis found no association between the participant-reported limitations and head angle accuracy. Conclusions: This study highlights the substantial variability and inaccuracies in head positioning during traditional manual BPPV diagnostics, supporting the relevance of a guidance system to improve BPPV diagnostics. Level of evidence: III. Trial registration: ClinicalTrials.gov identifier: NCT05846711. Full article

Objectives: Even though BPPV is one of the most common causes of vertigo, it is often underdiagnosed and omitted in the diagnosis of patients reporting vertigo. The aim of the study was to establish a diagnostic pattern useful in patients admitted due to vertigo, based on the most common clinical characteristics of patients suffered from posterior canal BPPV (PC-BPPV), horizontal canal BPPV with geotropic (HCG-BPPV) and apogeotropic nystagmus (HCA-BPPV). Methods: The analysis covered the results obtained in 105 patients with a positive result of the Dix-Hallpike maneuver or the supine roll test. The patients were divided into 3 groups based on the BPPV type: gr.1:PC-BPPV (60%); gr.2: HCG-BPPV (27%); gr.3: HCA-BPPV (13%). Patients before the diagnostic maneuvers filled the questionnaire concerning their symptoms and previous diseases. Results: Almost all patients had vertigo during turning over in bed and the character of the symptoms was paroxysmal. The answers to questions about the type of head movement evoked vertigo and how long vertigo lasted were differentiating. The percentages of correct diagnosis speculated by the combined answers were 69.6% in PC-BPPV, 61.8% in HCG-BPPV, and 80% in HCA-BPPV. Conclusions: Basing on those observations there is presented the diagnostic schedule which could be useful in dizziness examination. The above results indicate that a properly collected interview with the patient allows for a high percentage of accurate diagnosis. Full article

Objective: This study’s objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. Methods: This is a case and control design study. The consecutive patients’ visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix–Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. Results: The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette–water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. Conclusions: The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients. Full article

Direction-changing positional nystagmus (DCPN), which refers to the change in the direction of nystagmus with different head positions, is a well-known characteristic of horizontal semicircular canal BPPV. The supine head roll test is commonly used to diagnose horizontal canal BPPV. However, persistent geotropic DCPN observed during this test cannot be explained by the conventional explanations of canalolithiasis or cupulolithiasis. To account for this unique nystagmus, the concept of a “light cupula” has been recently introduced. In this review, we provide an overview of the historical background, clinical features and diagnostic methods, proposed mechanisms, and treatment strategies associated with the light cupula phenomenon based on the available literature to date. Full article

Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that causes dizziness. The incidence of horizontal semicircular canal (HSC) BPPV ranges from 5% to 40.5% of the total number of BPPV cases diagnosed. Several studies have focused on establishing methods to treat BPPV caused by the apogeotropic variant of the HSC, namely, the Appiani maneuver (App). In 2016, a new maneuver was proposed: the Zuma e Maia maneuver (ZeM), based on inertia and gravity. The aim of this study is to analyze the efficacy of App versus ZeM in the resolution of episodes of BPPV produced by an affectation of the horizontal semicircular canal with apogeotropic nystagmus (Apo-HSC). A retrospective, quasi-experimental study was conducted. Patients attended in office (November 2014–February 2019) at a third-level hospital and underwent a vestibular otoneurology assessment. Those who were diagnosed with Apo-HSC, treated with App or ZeM, were included. To consider the efficacy of the maneuvers, the presence of symptoms and/or nystagmus at the first follow up was studied. Patients classified as “A” were those with no symptoms, no nystagmus; “A/N+”: no symptoms, nystagmus present during supine roll test; “S”: symptoms present. Previous history of BPPV and/or otic pathology and calcium levels were also compiled. From the 54 patients included, 74% were women. The average age was 69. Mean follow-up: 52.51 days. In those patients without previous history of BPPV (n = 35), the probability of being group “A” was 63% and 56% (p = 0.687) when treated with App and ZeM, respectively, while being “A/N+” was 79% and 87% for App and ZeM (p = 0.508). Of the 19 patients who had previous history of BPPV, 13% and 64% were group “A” when treated with App and ZeM (p = 0.043), and 25% and 82% were “A/N+” after App and ZeM, respectively (p = 0.021). In conclusion, for HSC cupulolithiasis, ZeM is more effective than App in those cases in which there is a history of previous episodes of BPPV (“A”: 64% (p = 0.043); “A/N+”: 82% (p = 0.021)). Full article

The aim of this study was to assess the prevalence and analyze clinical parameters of benign positional paroxysmal vertigo (BPPV) in a pediatric age. A cohort of 423 children under the age of 15 (median age 11. interquartile range 9–13) was submitted to vestibular assessment for balance disorders. Dix-Hallpike and Roll-Supine tests were performed to look for positioning nystagmus using video-infrared goggles. BPPV was found in 43 of 423 children evaluated for balance disorders (10.2%). There were 28 females (65.1%) and 15 (34.9%) males. The posterior canal was involved in 79% of cases and the horizontal canal in 21% of cases. No apogeotropic bilateral or anterior canal form were seen. Thus, BPPV is not an infrequent type of vertigo in children and must be evaluated as soon as possible in order to plan the most appropriate maneuver and restore daily activities as soon as possible, avoiding anxiety and fear. Full article

Diagnosing the affected side in Benign Paroxysmal Positional Vertigo (BPPV) involving the Lateral Semicircular Canal (LSC) is often challenging and uncomfortable in patients with recent onset of vertigo and intense autonomic symptoms. The Minimum Stimulus Strategy (MSS) aims to diagnose side and canal involved by BPPV causing as little discomfort as possible to the patient. The strategy applied for LSC-BPPV includes the evaluation of pseudo-spontaneous nystagmus and oculomotor responses to the Head Pitch Test (HPT) in upright position, to the seated-supine test and to the Head Yaw Test (HYT) while supine. Matching data obtained by these tests enables clinicians to diagnose the affected side in LSC-BPPV. The purpose of this preliminary study is to propose a new diagnostic test for LSC-BPPV complimentary to the HPT, the Upright Head Roll Test (UHRT), to easily determine the affected ear and the involved arm in the sitting position and to evaluate its efficiency. Our results suggest that the UHRT can increase the sensitivity of the MSS without resorting to the HYT, thus reducing patient’s discomfort. Full article