• Title/Summary/Keyword: BPPV

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Differential diagnosis of vertigo (어지럼증의 감별진단)

  • Kang, Ji-Hoon;Shin, Ji-Yong;Kim, Min-Ju;Ma, Hyeo-Il
    • Journal of Medicine and Life Science
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    • v.16 no.3
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    • pp.64-75
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    • 2019
  • Vertigo and dizziness are common symptoms with various etiologies and pathogeneses. Vertigo is an illusion of motion due to disease of the vestibular system, usually a sense of rotation. Dizziness, a term that represents a wide range of non-vertigo symptoms, is commonly associated with non-vestibular disorders including old age, cardiac syncope, orthostatic hypotension, metabolic disease, anxiety, and drugs. Vertigo should be determined whether the cause is central or peripheral. Peripheral vertigo is usually benign but central vertigo is serious and often require urgent treatment. The careful history and detailed physical examinations(pattern of nystagmus, ocular tilt reaction, head impulse test and positional tests such as Dix-Hallpike maneuver) provide important clues to the diagnosis of vertigo. Most of patients have benign peripheral vestibular disorders - vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and Meniere's disease. BPPV is a leading cause of peripheral vertigo and can easily be cured with a canalith repositioning maneuver. In this review, a focus is on the differential diagnosis of common vestibular disorders with peripheral and central causes.

Spontaneous Direction-Changing or Reversing Positional Nystagmus without Changing Head Position during Head-Roll/Head-Hanging Maneuvers: Biphasic Positional Nystagmus

  • Yetiser, Sertac
    • Journal of Audiology & Otology
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    • v.25 no.1
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    • pp.43-48
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    • 2021
  • Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

Spontaneous Direction-Changing or Reversing Positional Nystagmus without Changing Head Position during Head-Roll/Head-Hanging Maneuvers: Biphasic Positional Nystagmus

  • Yetiser, Sertac
    • Korean Journal of Audiology
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    • v.25 no.1
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    • pp.43-48
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    • 2021
  • Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

A clinical report on the three cases of Benign paroxysmal positional vertigo improved with So-Yang-In Hyeong-Bang-Do-Jeok-San (양성 특발성 체위성 현훈 환자에 소양인(陽人) 형방도적산(荊防導赤散)을 투여하여 호전된 3예 보고)

  • Yun, Kyoung-Sun;Jeong, Sung-Hyun;Shin, Gil-Cho;Lee, Won-Chul;Lee, Ji-Hun
    • Journal of Sasang Constitutional Medicine
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    • v.15 no.2
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    • pp.101-110
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    • 2003
  • Benign paroxysmal positional vertigo(BPPV) is the most common peripheral vestivular disorder that is featured with paroxysmal vertigo caused by position changes. For a long time, it has been believed that the rendition is caused by inorganic particles in the cupula of the posterior semicircular canal. In the book 'DongyiSuseBowon(東醫壽世保元)', vertigo has been mentioned So-Yang-Sang-Pung syndrome and fever-aversive syndrome for Yin deficiency of So-Yang-In. Hyeong-Bang-Do-Jeok-San(荊防導赤散) is used at So-Yang-Sang-Pung and Gyeol-Hyung syndrome of So-Yang-In. Three patients in the cases have been suffered from vertigo, nausea and hot flushes etc. These patients were classified as So-Yang-In by features in the face, bodyshape and personality patterns. All of them have been improved in vertigo and other symptoms with Hyeong-Bang-Do-Jeok-San for a few days. The result showed that So-Yang-In Hyeong-Bang-Do-Jeok-San was effective on vertigo and other symptoms of BPPV patients.

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Three Cases of Acute Benign Paroxysmal Positional Vertigo Improved after Korean Medicine Treatment (한방 치료 후 호전된 급성기 양성 발작성 두위성 현훈 치험 3례)

  • Choi, Yoon-Young;Byun, Jung-Ah;Kim, Su-Yeong;Hwang, Mi-Lee;An, Jae-Hyun;Jung, Hyun-A
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.34 no.4
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    • pp.134-145
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    • 2021
  • Objectives : The purpose of this study is to report three cases of Korean medical treatment for acute benign paroxysmal positional vertigo(BPPV). Methods : This study was conducted with three acute benign paroxysmal positional vertigo patients who hospit alized in Ophthalmology, Otolaryngology & Dermatology Clinic of Korean medical Hospital. Three patients were treated with Korean medical treatment including herbal medicine(Banhabaeckchulchunma-tang), acupuncture, p harmacopuncture(Hwangryunhaedok-tang). After treatment, we evaluated subjective symptoms. Results : The results of three patient showed remarkable improvements on subjective symptoms after the treatment. Conclusions : It is considered that Korean medical treatment can be applied to the treatment of BPPV.

Clinical Characteristics of the Patients with Dizziness after Car Accidents (교통사고로 인한 어지럼 환자의 임상양상)

  • Hah, Young Min;Yang, Chul Won;Kim, Sang Hoon;Yeo, Seung Geun;Park, Moon Suh;Byun, Jae Yong
    • Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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    • v.60 no.8
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    • pp.390-395
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    • 2017
  • Background and Objectives With increasing frequency of car accidents, patients of dizziness caused by car accidents are also increasing. Various types of dizziness or vertigo can occur from car accidents depending on different injury mechanisms. Since accurate diagnosis is important for providing proper treatments, we evaluated clinical characteristics related to vestibular function of patients with dizziness caused car accidents. Subjects and Method In this retrospective case review study that runs from January 2011 to March 2013, a total of 82 patients with dizziness following car accident were enrolled consecutively. We analyzed the final diagnosis of dizziness according to different mechanisms of injury during car accident through clinical record review. Patients who developed dizziness within one month of car accident were included, excluding those who had temporal bone fracture and previous history of dizziness. Results Of the different types observed, 36.6% was head injury, 24.4% whiplash injury, 3.7% complex injury, 2.4% others and the rest was unknown. In the final diagnosis, the different types included 36.6% benign paroxysmal positional vertigo (BPPV), 23.2% unclassifiable dizziness, 18.3% cervical vertigo, 7.3% labyrinthine concussion, 3.7% BPPV with labyrinthine concussion and the rest was others. Of the different types of dizziness symptoms, 58.5% was headache, 45.1% was audiologic symptoms, and others included earfullness, tinnitus and hearing disturbance. Tinitogram and pure tone audiogram results show that 2.9% (27 people) of patients have tinnitus and 7.3% (6 people) have hearing disturbance. Conclusion An accurate diagnosis and timely management would be very important in forming a proper approach for post traumatic vertigo patients.

Five Case Report of Peripheral Vertigo Diagnosed Dam Hun with Oriental Medical Treatment - Banhabaeckchulchunma-tang gagam - (담훈으로 변증된 말초성 현훈 환자 5례에 대한 임상보고 - 반하백출천마방 가감방을 중심으로 -)

  • An, So-Hyun;Choi, Jeong-Sik;Cho, Chung-Sik;Kim, Cheol-Jung
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.23 no.1
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    • pp.263-268
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    • 2009
  • Pripheral vertigo occurs if there is a problem with the part of the inner ear that controls balance or with the vestibular nerve, which connects the inner ear to the brainstem. Peripheral vertigo is caused by benign paroxysmal positional vertigo(BPPV), Menieres disease, vestibular neuronitis, or labyrinthitis. We diagnosed five patients who have severe vertigo as peripheral vertigo and Dam Hun. We treated them with Banhabaeckchulchunma-tang gagam and acupuncture. After treatment, vertigo and other symptoms -nausea, vomiting, abdominal discomfort had improved. So I report these cases, but more clinical case reports are needed.

A Case of Vestibulopathy With Vertigo (전정 신경병증 환자 치험 1례에 대한 고찰)

  • Yu, Mi-Kyung;Choi, Jung-Hwa;Kim, Jong-Han;Park, Su-Yeon;Park, Yong-Ho
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.18 no.2
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    • pp.93-98
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    • 2005
  • Vertigo occurs when there is conflict between the signals sent to the brain by various balance- and position-sensing systems of the body. Injury to or diseases of the inner ear can send false signals to the brain indicating that the balance mechanism of the inner ear (labyrinth) detects motion. Inner ear disorders, such as benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuronitis, or labyrinthitis. Vestibular neuronitis is an inflammation of the vestibular nerve, which is located in your inner ear. In this case, She has vertigo occured suddenly and continued even when the person lies completely still. It may be accompanied by nausea and vomiting. She has taken herbal medication and treated by acupunture. Her symptoms become disappeared after 3 days and All most symptoms were disappeard. In conclusion, It is required to classify vestibulopathy into vestibular neuronitis or labyrinthitis. In this case we diagnosed her case as vestibular neuronitis. Her symptoms of vestibulopathy recovered fast by Korean traditional medical therapy.

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Clinical Analysis on the Positional Vertigo Patients treated in an Oriental Medical Center (한방병원에 입원한 두위 현훈 환자의 임상 분석)

  • Kim, Tae-Yeon;Kim, Gi-Tae;Go, Heung
    • The Journal of Internal Korean Medicine
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    • v.32 no.3
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    • pp.371-386
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    • 2011
  • Background : Vertigo is a very common complaint in clinical practice. The number of patients who complain of vertigo has been increasing due to rapid growth of the elderly population. This study was designed to review the clinical features and success of oriental medical treatment of positional vertigo. Methods : This observation was made on 70 subjects diagnosed with positional vertigo. They were hospitalized in the Semyung University Oriental Medicine Hospital. Results : The results were as follows 1. Female patients (82.9%) were more than male patients. The most common age group was 8th decade and the patients rapidly increased after the 5th decade of age. 2. The most common past history of positional vertigo was hypertension, the second was cerebral infarction, and the third was hyperlipidemia. 3. In the oriental medicine diagnosis, phlegm-dampness syndrome (痰濕交阻 眩暈) was the most common disease (92.9%), and in western medicine, BPPV was the most (82.9%). 4. In herbal medication, Banhabaekchulchunma-tang gami (45.7%) was the most commonly used, the second being Taeksa-tang (30%). 5. The vertigo score of 94.3% patients improved and none got worse. 6. In general characteristics, men over 64 years improved best. Past history had no effect on the improvement of vertigo. 7. The sooner patients visited hospital after onset, the shorter hospitalization time was. Conclusions : Vertigo attacks patients well in advanced age, with various causative diseases. Oriental medical treatments have considerable effects on positional vertigo, especially treated with Banhabaekchulchunma-tang gami and Taeksa-tang.

Factors Analysis Affecting Lateral Canal Benign Paroxysmal Positional Vertigo

  • Kim, Chul-Seung;Choi, Hee-Young;Kwon, Pil-Seung;Lee, Eun-Pyo;Seo, Choong-Won
    • Korean Journal of Clinical Laboratory Science
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    • v.47 no.1
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    • pp.35-38
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    • 2015
  • Lateral canal benign paroxysmal vertigo (BPPV) causing dizziness is a common cause is not found while continuing to appeal for vertigo is a typical disease. It is characterized by acute stand up, brief and rotatory vertigo attacks provoked by change in head position. Treatment requires only one treatment visit in most patients. However, there are significant numbers of patients who require multiple treatment visits for relief. The purpose of this study benign paroxysmal positional vertigo treatment of type affect is to analyze the cause. Dizziness and vertigo patient's in patients admitted to the dizziness center of lateral canal benign paroxysmal positional vertigo were classified. In patients with lateral canal benign paroxysmal positional vertigo and accompanying lateral 15 treatment affects disease were investigated. March 2008 to November 2010 lateral canal benign paroxysmal positional vertigo 166 people cure rate of patients was investigated. First time the success rate of 74.1%, twice times the success rate of 12.0%, three times the success rate of 9.6%, more than three times the success rate was 4.2%. Affecting factor treatment of benign paroxysmal positional vertigo in post-traumatic, medicine disease, headache, cerebral infarction, small vessel disease, vestibulopathy, (p<0.05). Statistical analysis using SPSS (version 12K) in coefficient measure through descriptive statistical of cross table.