Natural Ways to Treat Vertigo

Vertigo And Dizziness Program

You will learn: How to strengthen and loosen up the tongue. This is more important than you might imagine! The 4 most powerful exercises to establish whole-body balance. How to quickly straighten your head so that the fluid in your inner ear can regulate your balance. How to loosen up those stiff jaw muscles that are contributing to vertigo symptoms. How to relieve tension line between your shoulders and your jaw. Each of these muscle groups contributes to your dizziness, and Im going to teach you exactly to how deal with them all! How to use powerful breathing exercise to quickly eliminate dizziness, even in the midst of your worst vertigo attack. A simple, little-known breathing exercise that will change the way you breathe every day, relieving the tension that grips your muscles and causes vertigo symptoms. Read more here...

Vertigo And Dizziness Program Overview


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Extreme dizzinessvertigo

Although patients with cervicogenic disorders can sometimes present with associated dizziness, extreme dizziness, especially if associated with other neurological symptoms, can indicate pathology of the central nervous system, and treatment is contraindicated. Dizziness can also be associated with other pathologies. For dizziness to be deemed cervicogenic in origin, the onset and duration must parallel the neck pain and must be associated with neck movements. If with further questioning any of the symptoms listed in Table 8.4 are reported, pathology of the central nervous system should be suspected, further treatment is contraindicated and the patient should be referred to the appropriate specialist. See next section for fuller discussion about dizziness. constant dizziness vertigo feeling of being pushed to one side facial asymmetry dysarthria dysphagia

Blackouts Syncope and Lightheadedness Near Syncope

Syncope can also be caused by other heart problems. For example, if your heart beats in an abnormal rhythm called an arrhythmia, your heart rhythm may become very slow, or even miss a few beats or several beats in a row. This causes lightheadedness or even unconsciousness that passes after the heart begins beating again. You may also develop syncope as a result of very fast heart rhythms so fast, in fact in the range of 180 to 250 beats per minute that the heart is no longer able to effectively pump blood. In this case, not enough blood gets to the brain.

Benign Paroxysmal Positional Vertigo

The most common cause of peripheral vestibular vertigo in adults is benign paroxysmal positional vertigo. BPPV occurs in all age groups but more often between ages 50 and 70. The incidence of BPPV is 11 to 64 per 100,000 persons per year and is twice as common in women as men (Froehling et al., 1991). It is caused when otoconia particles from the utricle or saccule lodge in the posterior semicircular canal and is also referred to as canalithiasis. This causes the canal to be a gravity-sensing organ, and head movement results in displacement of the otoconia and a sensation of vertigo. The Dix-Hallpike maneuver reproduces this vertigo in the patient, resulting in nystagmus (see eFig. 19-3). Characteristics of the nystagmus of BPPV include fatigability, a latency period of 1 to 5 seconds before nystagmus begins after the head is moved, short duration of nystagmus from 5 to 30 seconds, and reversal of the nystagmus components when the patient is returned to the sitting position. If these...

Benign Positional Vertigo

Benign positional vertigo is believed to be caused by a dislodged otolith from the semicircular canal. Symptoms include episodic vertigo without aural symptoms. Nausea and vomiting may also be present secondary to the vertigo. Common histories include vertigo precipitated by rolling over in bed or bending over to tie shoes. The diagnosis can usually be made by the history and eliciting a positive Dix-Hallpike maneuver. Patients can be expected to have gradual resolution of their symptoms over 4 to 6 weeks with supportive therapy. The canalith repositioning (Epley) maneuver provides short-term resolution of the vertiginous symptoms (Cochrane review Pinder, 2004).

Dizziness of Cervical Origin

Cervical spine problems, especially osteoarthritic changes, can cause dizziness that may be vertiginous in nature and of vascular or proprioceptive origin. In cases of vascular origin, flow through one of the vertebral arteries is temporarily disrupted by an osteoarthritic spur that compresses the vessel when the patient turns the head or looks up. In cases of proprioceptive origin, overstimulation of the proprioceptive receptors in the facet joints produces the sensation of dizziness. Either of these conditions can cause a drop attack. These patients should avoid the position that precipitates the symptoms and, in some cases, cervical collars or cervical traction may be helpful.

Cervicogenic Dizziness

A controversial disorder referred to as cervicogenic dizziness may overlap with cervicogenic headache. Symptoms include a vague non-vertiginous dizziness, often worse with activity, and may or may not be associated with neck pain or with obvious vestibular pathology. The term cervicogenic dizziness is actually a misnomer in that the neck is not the genesis of the vestibular symptoms, although it plays a vital role. A more descriptive name for this disorder would be cervically mediated dizziness. This disorder may also occur without headache. Formal vestibular testing may be normal or non-specifically abnormal.

Migraine Dizziness and Orthostatic Intolerance OI

Orthostatic intolerance (OI) covers a spectrum of symptoms including presyncope and syncope, weakness and fatigue, tachycardia or palpitations, nausea, and difficulty concentrating. Symptoms can be aggravated by prolonged standing, physical exertion, environmental warming, post-prandial states, and menses. Diagnosis is based on history and results of heads-up tilt table testing. Postural orthostatic tachycardia syndrome is thought to be associated with abnormal venous pooling and fluid collection in the lower extremities. Symptoms that often accompany POTS are tachycardia, hypotension, dizziness, fatigue, palpitations, and nausea. A case series by Stillman in 2003 reviewed patients with headache (all meeting IHS criteria for migraine) and symptoms of presyncope or frank syncope, and revealed significant abnormalities frequently occurred on head-up tilt table testing.

Benign Paroxysmal Vertigo of Childhood BPVC

Benign Paroxysmal Vertigo of Childhood (BPVC) was first described by Basser in 1964. It is characterized by abrupt loss of balance, vertigo, and even falls. The pediatric prevalence is 2-2.6 with equal distribution between boys and girls. Table 7.2 ICHD-2 diagnostic criteria for benign paroxysmal vertigo of childhood At the beginning of the episode, children may appear frightened, while trying to hold on to furniture or another person to avoid falling they refuse to walk and want to lie still. Older children may describe dizziness and nausea. Associated symptoms include nystagmus, pallor, nausea, diaphoresis, phonophobia, and photophobia. Severe vomiting may also occur. There is no loss of consciousness. BPVC is a diagnosis of exclusion differential diagnosis includes posterior fossa pathology and episodic ataxia among others. It must also be differentiated from migraine-associated vertigo, which occurs in older children. Later in life, children may develop cyclical vomiting syndrome...

Vasovagal Fainting and Dizziness

Dizziness is different from lighthead-edness in that a person feels uncomfortable, as if the room is spinning, but usually does not feel as if he or she is about to pass out. A good example is the feeling that occurs after getting off a ride such as a roller coaster at an amusement park. Dizzy spells can also be caused by ear disorders or other problems. In many cases, people misinterpret their dizziness as a

Treatment of Cervically Mediated Dizziness

Cervicogenic dizziness can be successfully treated with a combination of neck physiotherapy, occipital nerve blocks, and oral antineuritic pain medications such as gabapentin or amitriptyline. Thus, nonsurgical treatment for both cervicogenic headache and dizziness overlap. Further understanding of cervicogenic dizziness comes from treating dizzy patients without headache and cervicogenic headache patients without dizziness. The disorder is suggested by not meeting IHS criteria for either cervicogenic headache or migraine. A spectrum of improvement was seen with greater occipital nerve injections for patients with dizziness and headache, including relief of symptoms of ear discomfort, tinnitus, and neck pain, along with improvements in the headache and dizziness. The upper cervical spine may play an important role in various headache and vestibular disorders, and an underlying mechanism may connect the trigeminal nucleus caudalis and trigeminocervical pathways. Due to the intricate...

Diagnosis and Treatment of Dizziness and Headache

Abstract Dizziness and headache are separately quite common. There are, however, a number of scenarios where the two can be interconnected. An area of significant clinical interest at this time is migraine-associated dizziness, in which the migraine generator produces vestibular symptoms. Also, there can be an overlap between orthostatic intolerance and migraine, with a spectrum of symptoms from palpitations and tachycardia to presyncope or actual syncope. A third important area of overlap is related to mechanical syndromes of the neck, cervicogenic headache, which may overlap, occurring with vestibular symptoms. There are also a number of systemic entities that can cause both dizziness and headache covered in this chapter. Keywords Vertigo Dizziness Migraine-associated dizziness Migrainous vertigo Orthostatic intolerance Cervicogenic dizziness Cervically mediated dizziness

Migraine Associated Dizziness MAD

The concept of migraine-associated dizziness has been around for many years but has been recognized more frequently in the past few years. There are a variety of similar terms used for MAD including migrainous vertigo, migraine-associated vertigo, migraine-associated dizziness, and vestibular migraine. Migraine-associated dizziness can occur ictally or interictally with typical migraine episodes. The diagnosis is not recognized by the International Headache Society. Table 20.3 Neuhauser criteria for migrainous vertigo Recurrent vestibular symptoms (rotatory positional vertigo, other illusory self or object motion, head motion intolerance) In 2001, Neuhauser set forth criteria for migrainous vertigo. Requirements included an established history of migraine headaches (see Table 20.3). Furman developed subsequent criteria discussing definite vs. probable migrainous vertigo, with inclusion of vertiginous symptoms triggered by typical migraine precipitants.

Conclusions on Diagnosis and Treatment of Dizziness and Headache

Dizziness and headache are separately quite common. There are, however, a number of scenarios where the two can be interconnected. An area of significant clinical interest at this time is migraine-associated dizziness in which the migraine generator produces the vestibular symptoms. Table 20.10 Factors linking headache and dizziness Migraine-associated dizziness should only be diagnosed in an individual with an established history of migraine. There can be an overlap between orthostatic intolerance and migraine, with a spectrum of symptoms from palpitations and tachycardia to presyncope to actual syncope. Treatment of cervicogenic headache with subsequent resolution of the vestibular symptoms may suggest cervically mediated dizziness. There are also a number of systemic entities that can cause both dizziness and headache (see Table 20.10).

Labyrinthitis Vestibular Abnormalities and Menieres Disease

A comprehensive review of these topics is beyond the scope of this chapter but should be considered when evaluating any patient with dizziness. Patients with the abrupt onset of a single episode of vertigo that gradually resolves over several days often have labyrinthitis or vestibular neuronitis, usually distinguished clinically by the presence or absence of hearing changes. Patients with labyrinthitis usually experience hearing changes, whereas those with vestibular neuronitis do not. A viral infection is the usual cause in younger patients while infarction becomes more likely in the older adult. Older-adult patients may recover more slowly and experience feelings of imbalance for several months. Treatment during the symptomatic period may include vestibular rehab exercises and pharmacologic agents such as meclizine, promethazine, or low-dose benzodiazepine (e.g., lorazepam). Meniere's disease should be suspected when an older adult reports recurrent episodes of vertigo, tinnitus,...

Pitfalls in the Diagnosis of Migraine Associated Dizziness

The Neuhauser criteria are sufficiently limited as to make it difficult to definitely pinpoint a syndrome. It is possible to have a person with a history of migraine, now with vertigo and phonophobia but no headache, and meet criteria for MAD. The issue becomes whether one can fully rule out other central or peripheral vestibular disorders causing vertiginous symptoms that are not related to migraine. Vertigo and phonophobia together can co-exist in an otogenic (inner ear) disorder even with normal audiometric and vestibular testing, particularly in early cases of Meniere's disease. Furthermore, the lifetime history of migraine does not preclude a non-migraine etiology of dizziness. To address these diagnostic problems, some authors use the terms migrainous vertigo and migraine-associated vertigo differently, in which the former refers to episodic vertigo spells that occur concurrently with other migraine features and the latter refers to episodic vertigo in an individual with a...

Vertigo Tinnitus

Vertigo and tinnitus can originate from the upper cervical region (CI, C2 dysfunction) or from an obstruction of the vertebral arteries (secondary to a dens defect or cervical osteophytes). It develops from prolonged cervical back bending (i.e., painting a ceiling), a postural forward head carriage, repeated cervical rotation, or rising from a supine to a sitting position or vice versa. This sensation can also be referred from inner ear (vestibular apparatus in semicircular canals) or temporomandibular joint problems.

Acoustic Neuroma

An acoustic neuroma (or more precisely, vestibular schwannoma) is a benign tumor that arises from the Schwann cells of cranial nerve VIII. Acoustic neuromas account for about 10 of all intracranial tumors. They are most commonly diagnosed in middle age. They are slightly more common in women than men. They are usually sporadic but may be associated with neurofibromatosis 1 or 2 (NF-1, NF-2). Most patients with NF-2 will develop bilateral acoustic neuromas. Acoustic neuromas in NF-1 are much less common. The primary symptoms of vestibular schwannoma are asymmetric hearing loss (sensorineural) and tinnitus. The hearing loss is usually gradual in onset and progressive but can occur suddenly. Disequilibrium is not usually the chief complaint on presentation, but patients often admit to mild unsteadiness. Larger tumors can cause dysesthesia around the ear or facial weakness, or both. If the neuroma is diagnosed late, patients can manifest cerebellar symptoms and symptoms of mass effect and...


Dizziness is a term used frequently by patients and should be avoided by the interviewer. Dizziness may be the patient's description of vertigo, ataxia, or lightheadedness. Any time the patient uses this term, it must be clarified by additional questioning, because different pathophysiologic mechanisms may be responsible. The interviewer needs to differentiate vertigo from ataxia. If the patient complains of dizziness, it is important to ask these questions ''Would you describe the dizziness as a strange spinning sensation in your head '' ''Did the room spin, or did it feel as if you were spinning '' ''Were you unsteady while walking '' Vertigo is partially discussed in Chapter 11, The Ear and Nose. Vertigo is the hallucination of movement. Acute vertigo may be associated with nausea, vomiting, perspiration, and a sense of anxiety. Ask patients whether they have the sensation that objects are moving around them or that they are spinning or moving. In addition to the questions in...

Postural Dizziness

Nonvertiginous postural dizziness suggests postural hypotension. Orthostatic hypotension is usually defined as a 20 mm Hg drop in systolic BP or 10 mm Hg drop in diastolic BP 2 minutes after moving from a recumbent to standing position. Older-adult patients, however, can develop postural dizziness without apparent postural hypotension. In some cases, no BP decline occurs, although enough blood pools in the older adult's lower extremities to impair cerebral perfusion. When postural dizziness without postural hypotension is suspected, an evaluation of the cardiovascular system should be considered. If significant cardiovascular pathology, such as congestive heart failure, is not identified, a therapeutic trial of support stockings and optimized hydration can be contemplated.

Nausea and Dizziness

Table 20.2 Clinical pearls on duration of dizziness Benign paroxysmal positional vertigo (BPPV) Migraine-associated dizziness (MAD) o Seconds to hours to days There is, however, much evidence to suggest that motion sickness may also have its roots in migraine. Furman and Marcus demonstrated that migrainous vertigo responded to rizatriptan. Therefore, factors that aggravate migraine may also increase sensitivity to motion, and associated dizziness in susceptible individuals.


As with vestibular neuronitis, labyrinthitis causes sudden and severe vertigo. In contrast to vestibular neuronitis, the patient also has tinnitus and hearing loss. The hearing loss is sensorineural, is often severe, and can be permanent. Laby-rinthitis is caused by inflammation within the inner ear. The cause is most often a viral infection but can be bacterial. Bacterial labyrinthitis usually results from extension of a bacterial otitis media into the inner ear. A noninfectious serous labyrinthitis can also occur after an episode of acute otitis media. Other, less common causes include treponemal infections (syphilis) and rickettsial infection (Lyme disease). Symptomatic treatment of labyrinthitis is similar to that for vestibular neuronitis. Antibiotics are recommended if a bacterial cause is suspected. As with acute otitis media, bacterial labyrinthitis can, in rare cases, lead to meningitis. Few other conditions cause the constellation of hearing loss, tinnitus, and vertigo, but...

Vestibular Examination

The vestibular system is highly integrated with the visual, pro-pioceptive, cerebellar, and motor systems. Dysfunction of any one of these systems may result in dizziness or imbalance. The vestibular examination consists of two principal components observation of eye movements to evaluate the vestibulocular reflex and examination of balance and coordination to evaluate the vestibulospinal, cerebellar, and proprioception function.

Diagnosis Using the ICHD2

A few clinical pearls help with using the ICHD-2 criteria. Although migraine is often suggested by the company it keeps (menses, stress, red wine, or weather triggers, history of motion sickness, family history), triggers are not included in the strict criteria for diagnosis. 6. Many migraine patients have either a family history of headaches, personal histories of motion sickness, especially in childhood, or both and aura can both be absent. Many migraine patients have either a family history of headaches, personal histories of motion sickness, especially in childhood, or both.

Dichotomous Classification

According to Jean Piaget, intrinsic motivation is preceded by certain cognitive operations. This occurs when individuals encounter new knowledge that they cannot make sense of. In this case, new ideas are not compatible with current conceptions, and disequilibrium emerges and continues until the individual assimilates or accommodates to reach equilibrium again. At that point, it is critical to point out that creativity is achieved as long as individuals can adapt to new information and expose themselves to perennial conflicts, even as they grow older. Morris I. Stein also acknowledged the role of disequilibrium, claiming that it takes place at the beginning of the creative process.

Anxiety and Obsessive Compulsive Disorder Syndromes

Anxiety is an extremely common occurrence that affects everyone at some time and is characterized by an unpleasant and unjustified sense of fear that is usually associated with autonomic symptoms including hypervigilance, palpitations, sweating, lightheadedness, hyperventilation, diarrhea, and urinary frequency as well as fatigue and insomnia. Anxiety is thought to be mediated through the limbic system, particularly the cingulate gyrus and the septal-hippocampal pathway, as well as the frontal and temporal cortex. The term anxiety disorder is used to denote significant distress and dysfunction resulting from anxiety, including panic attacks and anxiety with specific phobias. Chronic, moderately severe anxiety tends to run in families and may be associated with other anxiety disorders or depression. The differential diagnosis of anxiety states includes other psychiatric conditions such as anxious depression as well as schizophrenia, which may present as a panic attack with disordered...

Cerebellar Infarct and Vertebral Artery Neck Occlusion

A 55-year-old Caucasian man suddenly became dizzy while shoveling snow and could not walk. His wife helped him inside. In the ambulance he vomited and felt discomfort in the back of his left head, neck, and shoulder. He had had hypertension for 10 years, and 5 years ago he had coronary artery bypass surgery. He took aspirin, a statin, and an angiotensin converting enzyme inhibitor. Three days before, he had had a very brief attack of dizziness and blurred vision, and had veered to the left. He had not reported this episode to his doctor.

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Dizziness, mem- ing, dizziness, dizziness, nau- Increased emotionality, state of pleasure, sense of separation, rapidly changing feelings, anxiety, distorted perception of time, aggressive paranoia, confused behaviors, hallucinations, illusions, dizziness, confusions, suspicion, loss of control, shallow breathing, profuse sweating, generalized numbness of hands and feet, vomiting, blurred vision, schizophrenic behaviors, mental confusion, blackouts

History of Chiropractic

Palmer argued that his chiropractic approach offered the world an important new philosophy. He believed that God had created a balanced, ordered universe and that equilibrium was the fundamental organizing principle of life. Innate intelligence represented God's presence in human beings. Subluxations created disequilibrium, and the inevitable sequela of this violation of natural law was disease.

The Psychosomatic Patient

There are many ways of dealing with psychosomatic patients. First, identify the disorder Do not miss the possible diagnosis of an affective or anxiety disorder. Treatment of somatization is directed toward teaching the patient to cope with the psychological problems. Be aware that somatization operates unconsciously the patient really is suffering. Above all, the patient should never be told that his or her problem is ''in your head.'' Anxiety, fear, and depression are the main psychological problems associated with psychosomatic illness. The list of associated common symptoms and illnesses is long and includes chest pain, headaches, peptic ulcer disease, ulcerative colitis, irritable bowel syndrome, nausea, vomiting, anorexia nervosa, urticaria, tachycardia, hypertension, asthma, migraine, muscle tension syndromes, obesity, rashes, and dizziness. Answers to an open-ended question such as ''What's been happening in your life '' often provide insight into the problems.

The Symptoms of Pregnancy and Warning Signs of Cardiac Disease

Palpitations are coupled with extreme elevations in heart rate, or with lightheadedness, fainting, or chest pain, should a potentially dangerous heart rhythm be suspected. Outpatient heart rhythm monitoring can rule out an abnormality and reassure both patient and physician. If an abnormality is detected and treatment is considered, there are multiple available and safe therapies. Lightheadedness and fainting are not unusual during pregnancy. Nausea from early hormonal changes may trigger dizziness. Also, the uterine pressure on the veins causes pooling of the blood in the legs. The pregnant woman may not easily adjust to movement because venous return to the heart is limited. If fainting occurs unrelated to body position or after exercise, additional investigation is warranted.

Screening of Genes on the Linkage Region of Chromosome 21 Identification of COL6A1

To pinpoint the locus for OPLL on chromosome 21, linkage disequilibrium mapping was performed using gene-based SNPs in the linkage region (Ztr > 2.2) spanning approximately 30 cM. First, 600 SNPs of 150 genes in the linkage region with 96 selected patients and 96 controls were genotyped. Allelic association was carried out, and statistical significance was assessed by x2 analysis with a contingency table. Altogether, 74 SNPs of 24 genes exhibited significant allelic associations (P < 0.05). For the second screening, 74 SNPs in a larger number of OPLL patients (n 280) and non-OPLL controls (n 210) were genotyped. Furthermore, 14 SNPs of seven genes had allelic associations (P < 0.01) with OPLL. The most significant association with OPLL was observed with SNPs of COL6A1, which is located 1.2 Mb from the peak linkage marker D21S1903. Because the four genes (COL18A1, PCBP3, COL6A1, COL6A2) that showed positive associations with OPLL are clustered within a 750-kb region in the...

Clinical Presentation

The postconcussion syndrome represents persistent symptoms following a concussion and may include persistent headache, irritability, inability to concentrate, dizziness, vertigo, memory impairment, generalized fatigue, changes in mood, cognitive deficits, depression, and anxiety. Postconcussion syndrome in the athlete is usually self-limited, lasting approximately 7-10 days. However, athletes may underreport or minimize any neurological or cognitive symptoms in order to return to competition.

Lateral Medullary Infarction

A 43-year-old Chinese man came to the hospital because he could not swallow. Two days before he had suddenly felt a sharp hot stabbing feeling in his right eye and cheek, quickly followed by dizziness and unsteady gait. His voice became hoarse and he choked when he drank tea. He had been an insulin-dependent diabetic for 10 years. He had had several brief episodes of dizziness during the preceding weeks, once accompanied by a feeling that objects were jiggling (oscillopsia). Examination showed blood pressure 135 75, pulse 74 and regular, no cardiac abnormalities and no neck bruits. Neurological findings included decreased pain and temperature sensation on the face bilaterally and the left trunk and limbs right ptosis and meiosis nystagmus on right lateral horizontal gaze hoarse speech and an occasional crowing-like cough decreased motion of the right palate and unsteady gait. Hiccups developed later and were a continued nuisance.

What It Can Do for You

Proponents indicate that fasting may produce fatigue, anemia, irregular heartbeat, body aches, nausea, dizziness, and other negative effects. They refer to these as temporary problems that precede feelings of well-being, mental clarity, internal cleanliness, and other benefits.

Hemicrania Continua HC

The exacerbations of severe headache listed by the ICHD-2 are cluster headachelike with their autonomic features. However, it is clear that exacerbations may mimic migraine, not cluster, in some patients, and the exacerbations may be triptan responsive. Cittadini and Goadsby found photophonophobia in around 75 of their HC patients, ipsilateral in about half. Many had personal or family histories of migraine, often with histories of motion sickness.

What Are The Typical Side Effects Of Aeds

Within the first 6 months of treatment with a newly prescribed AED, systemic toxicity and neurotoxicity are as likely to contribute to AED failure as is lack of efficacy. Table 3.2 shows the common neurotoxic effects of AEDs these include diplopia, nystagmus, dysarthria, ataxia, incoordination, tremor, sedation, mood alteration, dizziness, headache, and cognitive impairment. Sufficient time should be allowed during office visits to determine whether a patient is experiencing any side effects. Patients often complain of memory loss. Neuropsychologic testing, as described in Chapter 6, may help determine whether memory loss or trouble concentrating is medication-related.

Nausea and Vomiting of Pregnancy

And should be avoided during the first 10 weeks of gestation. , , Motion Sickness and Vestibular Disturbances Nausea and vomiting can be caused by disturbances of the vestibular system in the inner ear.15,55 Vestibular disturbances can result from infection, traumatic injury, neoplasm, and motion. Patients may experience dizziness and vertigo in addition to nausea and vomiting. If a patient is susceptible to motion sickness, some general preventive measures include minimizing exposure to movement, restricting visual activity, ensuring adequate ventilation, reducing the magnitude of movement, and taking part in distracting activities.15 Because the vestibular system is replete with muscarinic type cholinergic and histaminic (Hi receptors, anticholinergics and antihistamines are the most commonly used pharmacologic agents to prevent and treat motion sickness. Oral medications should be taken prior to motion exposure to allow time for adequate absorption. Once nausea and vomiting due to...

General Medical Therapy

Seizures are prevalent in patients with glioma, particularly in slowly growing, low-grade gliomas, and require adequate management. Clinicians should recognize the possibility that seizures could be caused by hyponatremia, hypoglycemia, and hypocalcemia, as well as by mass effect. Seizures are generally managed with standard anticonvulsants, including phenytoin, phenobarbital, primidone, gabapentin, lamotrigine, carba-mazepine, valproic acid, and clonazepam. Anticonvulsants, which are generally dose dependent, can interact with drugs that are commonly given to patients with brain tumors to produce adverse effects, some of which are drowsiness, dizziness, ataxia, nausea, vomiting, confusion, constipation, tremor, hypersalivation, and blurred vision.

Primary Anxiety Disorders

Ated in children and adolescents with comorbid medical conditions that may also be associated with somatic symptoms. The psychological symptoms of anxiety are routinely associated with physical signs of autonomic activity (e.g., palpitations, shortness of breath, tremulousness, flushing, faintness, dizziness, chest pain, dry mouth, muscle tension). The most common somatic symptoms reported by children and adolescents with DSM-IV-TR anxiety disorders (i.e., social, separation, and generalized anxiety disorders) were as follows restlessness (74 ), stomachaches (70 ), blushing (51 ), palpitations (48 ), muscle tension (45 ), sweating (45 ), and trembling shaking (43 ) (Ginsburg et al. 2006).

Reviews And Selected Updates

Baloh RW, Foster CA, Yue Q, Nelson SF Familial migraine with vertigo and essential tremor. Neurology 1996 46 458-460. Brandt T Phobic postural vertigo. Neurology 1996 46(6) 1515-1519. Gomez CR, Cruz-Flores S, Malkoff MD, et al Isolated vertigo as a manifestation of vertebrobasilar ischemia. Neurology 1996 47(1) 94-97. Lawden MC, Bronstein AM, Kennard C Repetitive paroxysmal nystagmus and vertigo. Neurology 1995 45 276-280. Rascol O, Hain TC, Brefel C, et al Antivertigo medications and drug- induced vertigo. A pharmacological review. Drugs 1995 50(5) 777-791. Schuknecht HF Pathology of the Ear. Philadelphia, Lea & Febiger, 1993.

Importance of Early Interests

My colleague, Judy Gelbrich, and I also pointed out that interests which begin in very early childhood are the seeds of creative development. Born of disequilibrium among and between systems of knowledge, affect and other internal systems in interaction with the external world, the child cultivates passionate interest quests around 'centers of action'. Patterns in these quests become apparent quite early with interests clustered around six themes. Similarly, Jonathan Feinstein associated interests from childhood and young adulthood with creative development, wherein passions and interests direct the creator's attention. In the developmental phase, individuals connect to and conceptualize these interests in the exploration phase, they engage with receptiveness in these involvements and develop unique structures in interest areas

Consumption And Unhappy Consciousness

Remedied with a prescription for continued self-indulgence. The outcome is a type of consumer vertigo wherein a disintegrated social reality has been replaced by an intense inquisitiveness about the offerings of the consumer world.14 In the end, we no longer possess the ability to recognize ourselves except as a fluid identity that forms and reforms over the course of endless consumer trials.

Temporomandibular Disorder

Temporomandibular joint (TMJ) dysfunction is a fairly common problem. Patients may present with headache which is localized to the preauricular region, mandible, and TMJ region. In addition to frontotemporal headache, patients often complain of otalgia, tinnitus, and dizziness. Clinical history may elicit symptoms of bruxism during sleep and reported jaw locking or popping. Limited jaw opening and tenderness of the masticatory muscles may be noted during examination. TMJ dysfunction leads to myofascial pain contributing to the symptoms of headache. Symptoms are often self-limited but in persistent cases referral to a TMJ specialist may be required.

The Present and the Future

June 1975 A worker became ill with dizziness and trembling due to high concentration of kepone in his blood. State official investigations found 7 workers ill enough to require immediate hospitalization. Over 100 people, including wives and children, had kepone in their blood, and 30 more people were hospitalized with tremors and visual problems.

Intracranial Liposarcoma

Initial signs and symptoms were consistent with mass lesions within the skull. The 4-month-old girl had macrocra-nium and was vomiting,11 and the 70-year-old woman had dizziness and ataxia.18 Both of these cases were reported in the pre-CT era and were correctly diagnosed only after surgical resection. The 6-month-old girl had partial seizures following

Thesis AntithesisSynthesis Process of Dialectic Thinking

The thesis-antithesis-synthesis dynamic also underpins both Piaget's and Vygotsky's views of how cognitive development occurs. For Piaget development occurs when the stability or equilibrium of the organism is disturbed and a type of disequilibrium occurs. Equilibrium is restored when the organism is able to coordinate and integrate the source of disturbance or contradiction into the overall system. For the organism, stability is its normal state and it seeks this integration. Vygotsky, by contrast, holds that cognitive development is a product of the dialectical interaction between the self (internal) and the environment (external). He introduces the essential role of cultural context into this internal external interaction.

What do you do now

Pain in the posterior neck or occiput is common, as is generalized headache. Pain often precedes neurological symptoms by hours, days, and, rarely, weeks. Many patients with vertebral artery dissections have only neck pain and do not develop neurological symptoms or signs. Transient ischemic attacks (TIAs), when they do occur, are most often characterized by dizziness, diplopia, veering, staggering, and dysarthria. TIAs are less common in patients with vertebral artery neck dissections compared to internal carotid artery dissections. Infarcts usually cause symptoms and signs that begin suddenly. The commonest locations of ischemic brain damage are the portion of the

Evaluation Guidelines Tables125 and 126

Numerous laboratory procedures are commonly used for evaluation of patients with vertigo and dizziness. For efficiency and cost, procedures should be selected according to specific symptom complexes present in the patient. Neuroimaging. Skull films, cervical spine films, computed tomography (CT) scans of the head, and CT scans of the sinuses are not routinely recommended in the evaluation of vertigo or hearing disturbances. Magnetic resonance imaging (MRI) of the head can be used to evaluate Central vertigo Peripheral vertigo BPPV Vestibular neuritis the structural integrity of the brain stem, cerebellum, periventricular white matter, eighth nerve complexes, and sinuses. The T1 MRI with gadolinium contrast is the most useful study. MRI is not routinely needed to evaluate vertigo or hearing disturbance without accompanying neurological findings. Although the MRI may show enhancement of the vestibular nerve in vestibular neuritis, the expense of this study should be considered when...

Syndromes Primarily Involving Vestibular Function

Conditions that involve vestibular function can be separated into peripheral (otological vertigo) and central subgroups. Patients with these syndromes present clinically with a combination of vertigo and ataxia. Practically, there are far more cases of otological vertigo than central vertigo, and for this reason, in clinical practice, a detailed understanding of otological vertigo is essential. BENIGN PAROXYSMAL POSITIONAL VERTIGO Benign paroxysmal positional vertigo is the cause of half of all cases of otological vertigo it accounts for about 20 percent of all patients with vertigo. Benign paroxysmal positional vertigo is diagnosed by the history of positional vertigo with a typical nystagmus pattern (a burst of upbeating torsional nystagmus) on Dix-Hallpike positional testing. Symptoms are precipitated by movement or a position change of the head or body. Getting out of bed or rolling over in bed are the most common problem motions. A burst of nystagmus can often be provoked by...

General Management Goals

_TABLE 12-10 -- ON CAUSES OF CENTRAL VERTIGO_ Childhood variant (benign paroxysmal vertigo of childhood) Seizure (temporal lobe) practice to use potentially addictive medications, such as benzodiazepines, in the management of patients with vertigo or imbalance when other medications fail. Although these agents are indispensable in these settings, the doses should be kept low and patient use should be monitored.

Postsurgical Treatment Early Postoperative Therapy

Neuroma is exposed in the cerebellopontine angle and in the internal auditory canal (posterior wall is removed). B, After enucleation of the acoustic neuroma, the tumor capsule is pulled up, and cranial nerves VII and VIII are visible. C, After complete resection of the acoustic neuroma, the nerve bundle of VII and VIII is visible in the internal auditory canal (IAC).

Facial Nerve Schwannomas

The geniculate ganglion level grow into the middle fossa, and those with proximal origin extend into the internal auditory meatus and cerebellopontine angle. Mean age of patients is approximately 40 years.8,10 Facial palsy occurs in most, but not all, cases it can be absent in up to one quarter. Severity of facial weakness ranges from mild paresis to total palsy. It is usually progressive, often proceeded by periods of facial twitching. Sensorineural deafness is usually present. It can be severe or total. However, it is conductive in some cases and rarely the patient can have intact hearing.8 Other symptoms may include vertigo, tinnitus, or ear pain.10 There is a long interval between onset of symptoms and diagnosis.

Pharmacologic Therapy

Menstrual cycles, and reduces tumor size in 62 of patients. Adverse effects such as nausea, dizziness, and orthostatic hypotension often limit 5 to 10 of patients from continuing treatment. Thus, start bromocriptine at a low dose (e.g., 0.625-1.25 mg) at bedtime (taken with a snack) to decrease adverse effects.41 Slowly titrate up to the optimal therapeutic dose (2.5-15 mg day) because most adverse effects subside with continual treatment.43 If the adverse GI effects are not tolerable, bromocriptine

Transient Ischemic Attacks TIAs

A TIA is a transient episode of focal neurological or retinal dysfunction secondary to impaired blood supply in a vascular territory. Clinical signs typical of TIAs in the carotid and vertebrobasilar territories are outlined in T,aMe.2.2- 2. . It should be noted that transient vertigo, diplopia, dysarthria, or dysphagia in isolation is insufficient to establish a diagnosis of vertebrobasilar TIAs. In addition, isolated drop attacks in which the patient falls to the ground, maintains consciousness, and then arises without a deficit are seldom due to vertebrobasilar ischemia. The annual risk of stroke after a TIA is 3 to 4 percent per year. However, the risk of a subsequent stroke is at least three times greater for individuals who have had a TIA than in those individuals who have not had a TIA. y

Illustrative Case

A 56-year-old woman who was an ex-smoker was found to have a left lower lobe pulmonary mass 2 cm in maximal diameter. On careful questioning, the patient reported mild disequilibrium. An MRI scan of the brain revealed a solitary lesion 2.5 cm in maximal diameter in the left cerebellum. The remainder of the metastatic work-up revealed no evidence of disease. She underwent craniotomy for removal of the brain metastasis, followed by thoracotomy for resection of the lung primary. The

Research Evidence to Date

Studies have assessed acupressure's ability to treat several problems, including morning sickness in pregnant woman, headaches, motion sickness, backache and nausea and vomiting. In the acupressure acupuncture system, nausea is believed to be controlled by a small area on the inside of the wrist called the P6 acupoint. Pressing that point is believed to control nausea, and research backs this belief.

Clinical Manifestations and Pathology

Convulsive or spasmodic ergotism affects the central nervous system, causing areas of degeneration in the spinal cord. Early German accounts mentioned tingling and mortification in the fingers and toes, with occasional extension to the rest of the body, and vomiting, diarrhea, intense hunger, anxiety, unrest, headache, vertigo, noises in the ear, stupor, and insomnia as symptoms. Often the limbs became stiff, accompanied by convulsive contractions of the muscles which led to staggering and awkward movements, often aggravated by being touched. Although many victims recovered, symptoms sometimes remained for long periods, resulting in permanent stiffness of the joints, muscular weakness, optic disorders, and occasional imbecility. In the 1930s, Ralph Stockman demonstrated that convulsive ergotism was caused by poisons (phytates) normally present in rye and other grains which, unless broken down in the bowel, were absorbed, creating lesions in the nervous system. Gangrenous ergotism...

Pulmonary Stenosis with Interatrial Communication

Giddiness, lightheadedness, or syncope may be experienced with exertion. Large jugular venous A waves (see Fig. 16-5) are sometimes subjectively sensed, especially after effort or excitement. Chest pain occasionally resembles angina pectoris attributed to ischemia in the high-pressure hypertrophied right ventricle. Death is due to right ventricular failure, or less commonly to hypoxia, cerebral abscess, or infective endocarditis.12,38,39

Defining The Syndrome Of Panic Disorder

The syndrome now called panic disorder was first described in the medical literature in 1895, by Sigmund Freud (1895a), under the term anxiety neurosis. His description differed from the currently accepted one in Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) (APA, 2000), in that he included features of the illness other than panic attacks, including general irritability, anxious expectation, rudimentary anxiety attacks (which bear a similarity to our current conceptualization of limited symptom attacks), vertigo, phobias and agoraphobia, nausea and other gastrointestinal symptoms, and paresthesias.

Course Of Panic Disorder

Visits being precipitated by physical sensations associated with panic disorder, such as dizziness, heart palpitations, chest pain, dyspnea, and abdominal pain, as demonstrated by both epidemiological and retrospective studies (Katon, 1996). Patients with panic disorder account for 20 to 29 percent of all emergency room visits (Swenson et al., 1992 Weissman et al., 1989) and are 12.6 times more likely to visit emergency rooms than the general population (Markowitz et al., 1989).

Temporal Bone Syndrome

Conductive hearing loss is the most common manifestation of temporal bone metastasis. It is present in approximately 30 to 40 of symptomatic patients and is almost always the result of dysfunction of the eustachian tube with secondary serous otitis media.9,26,61 Sensorineural hearing loss, if it occurs, is usually due to involvement of the cochlear fibers in the internal auditory meatus.61 Maddox emphasized the triad of symptoms of otalgia, periauricular swelling, and facial nerve paresis as being the most suspect for malignant involvement of the temporal bone.41 He reported an incidence of facial nerve paralysis of 34 in his series. Schuknecht et al also reported a high incidence of facial palsy.63 Saito et al found that only 50 of patients with invasion of the facial canal manifested facial paralysis, although 100 of those who had tumors extending beyond the epineural sheath had complete paralysis.60 Much less common findings are otorrhea, vertigo, tinnitus, or a middle ear...

Neurofibromatosis 2

Neurofibromatosis 2 is an autosomal dominant disorder that occurs with only 10 the frequency of NF1, with an incidence of 1 in 33,000 to 40,000.4 NF2's hallmark is the presence of bilateral acoustic neuromas, which is pathognomonic for the disease. NF2 can also be diagnosed when a first-degree relative with NF2 and either a unilateral acoustic neuroma or two of the following are present neurofibroma, meningioma, glioma, schwannoma, or subcapsular lenticular opacities.1 NF2 is associated with a 90 incidence of spinal tumors (intramedullary, intradural extramedullary, dumbbell, extradural), 33 of which were symptomatic in a series of 48 patients.13 In NF2 patients,

Functional anatomy

Information regarding orientation and movement of the head in space hence balance (equilibrium) is conveyed via the vestibulocochlear nerve (cranial nerve VIII) to the vestibular nuclei in the brainstem. Here, it is integrated with information from the contralateral ear before information is relayed to the cerebellum, primary sensory cortex and motor nuclei in the brainstem. Reflexive connections in the brainstem enable coordinated eye, head and neck movements (via Cranial nerves III, IV, VI and XI) and adjustments to muscle tone via the descending vestibulospinal tract. Lesions result in nystagmus, dizziness, impaired equilibrium reactions and balance, awareness of midline, oculomotor difficulties, impacting on visual processing.

Xanax Valium and Other Sedatives

Motor functions, amnesia, and accidents. When taken during the day for anxiety, the dose is important because the drugs can produce excessive sleepiness. Some drug users take these drugs to get high, and others take them to treat anxiety and irritability associated with use of other drugs. Chronic use, say over several months, can lead to addiction. Withdrawal symptoms include anxiety, agitation, sleep disturbance, muscle cramps, and dizziness. However, if the addict has been using high doses, seizures and delirium are also possible.

Psychology Physician Psychiatrists and the Clinical Association of Genius and Madness

Other psychiatrists and scholars soon followed suit with their own views and analyses of other 'gifted' persons (e.g., Galton, Lombroso, Maudsley, Moreau, Stekel), with the result that within a century such works numbered in the hundreds. Importantly, the judgment of genius as pathological was the dominant position on the issue, one that derived its overwhelming support from members of the medical and the developing psychiatric professions. Those who projected the image of sickness distinguished themselves from each other by identification of different types of mental illness largely in step with the rise and fall of diagnostic categories in psychiatry then currently in favor. Whereas diagnostic labels such as psycho-physical disequilibrium, monomania, degeneracy, neurasthenia, and neurosis prevailed in the years up to 1950, the disease categories that have gained ascendency since that time are those, such as schizophrenia and manic-depressive illness,...

Implicit learning accounts for the knowledge of skills

Children must also learn how to deal with hunger, thirst, sexual desire, exploratory behavior and other biological needs, which are the primary engines that generate behavior. Desires and emotions can be conceptualized as states of disequilibrium that must be resolved by an appropriate action, which is naturally the satisfaction of the specific need. Feedback mechanisms check hedonic behavior, suggesting that satiation consists in the restoration of an internal equilibrium. When the behavior results in the satisfaction of the need, it becomes reinforcing, which is to say that reinforcement promotes the learning of the satisfactory behavior. Once the behavior is learned, the animal can easily repeat it, whenever the same need arises again. The reinforcement of the learned behavior is an essential characteristic of the process, because the behavior is initially a random or automatic exploratory response. Thus, the positive reinforcement of behavior is one of the key mechanisms for...

Panic Disorder Definition

The key feature of panic disorder in DSM-III is the occurrence of three or more panic attacks within a three week period. These attacks cannot be precipitated only by exposure to a feared situation, cannot be due to a physical disorder, and must be accompanied by at least four of the following symptoms dyspnea, palpitations, chest pain, smothering or choking, dizziness, feelings of unreality, paresthesias, hot and cold flashes, sweating, faintness, trembling or shaking (APA, 1980). In DSM-III-R, the definition was revised to require four attacks in four weeks or one or more attacks followed by a persistent fear of having another attack. In DSM-III-R, the list of potential symptoms was revised to include nausea or abdominal distress and to exclude depersonalization or derealization (APA, 1987).

Disorders Of Impulse Control Tourette Syndrome

A variety of genetic techniques and experimental paradigms, including genetic linkage and haplotype relative risk analyses, transmission disequilibrium tests, and sib-pair analyses. Although early segregation analyses of family data were consistent with the hypothesis of an autosomal dominant mode of genetic transmission, recent studies suggest that the mode of inheritance is likely to be considerably more complex, with the expression of genes of major effect being modified by other genes. Several completed genome scans have identified several regions of interest, but the findings thus far are neither robust nor replicated. The strongest linkage finding to date was reported in a large Canadian kindred, in which a log of the odds ratio (LOD) score of 3.24 was reported for chromosome 11 (11q23) (Merette et al., 2000).

Psychiatric Treatment And Its Evaluation The Early Twentieth Century

Both insulin therapy and lobotomies were slowly phased out as treatments for the mentally ill, but another of the physical therapies introduced in the mid-twentieth century, electric shock (ECT), remains in use to this day largely because it has been found to be effective in a number of studies (see next section). This treatment, introduced by Cerletti and Bini, consists of producing convulsions in a patient by means of passing an electric current through two electrodes placed on the forehead. The idea that such convulsions might help the mentally ill patient was not new as long ago as 1798, for example, Weickhardt had recommended the giving of camphor to the point of producing vertigo and epileptic fits.

Highaltitude Cerebral Edema Clinical Summary

Acute mountain sickness (AMS) is a symptom complex which usually begins 12 to 24 hours after ascent to high altitude and consists of headache and one or more other symptoms, including gastrointestinal symptoms, fatigue and or weakness, dizziness and or lightheadedness, and difficulty sleeping. High-altitude cerebral edema (HACE) is a severe form of AMS and is defined by the presence of truncal ataxia or the presence of altered mental status. Usually this occurs as progression from AMS to HACE, but

Ecological Demography And The Demographic Processes

Conversely, the diminution of certain sustenance functions results in a contraction of the number of niches and, hence, a reduction in the opportunities for employment. The net result of these developments, unless the effects of one cancel out those of the other, is a disturbance in the established equilibrium between population size and opportunities for living. Net migration is thus viewed as a population response, or as an effective method of returning to a condition of balance. Hawley writes that readjustments to disequilibrium are effected primarily through mobility. Population tends to distribute itself in relation to job opportunities, evacuating areas of diminishing opportunities and gravitating to areas of increasing opportunities (1950 167-168).

The Modern Existential Crisis

Young people are expressing a variety of existential concerns that relate to meaninglessness, purposelessness, hopelessness, indecision, isolation-related despair, dread of death, and general confusion. Escalating levels of antisocial behavior and atrophied emotion among youth have been interpreted in terms of their existential disequilibrium, a large part of which is due to their reliance on the media as the existential epicenter of their lives.35 In turn, the media assist in making consumption the existential framework for the world, a psychological situation that is fraught with disappointments. Not even the thriving loneliness industry that has followed

Organophosphate Insecticides

Clinical Features and Associated Findings. Clinically, patients with acute mild symptoms complain of vague fatigue, headache, dizziness, increased salivation, nausea and vomiting, diaphoresis, and abdominal cramps. Symptoms always develop within 24 hours after exposure. Difficulty with speaking or swallowing, shortness of breath, and muscular fasciculations have been reported in patients with more moderate poisoning. With increased severity of poisoning, more intense signs and symptoms can appear. These may include depressed levels of consciousness and marked myosis with no pupillary response. After initial recovery from acute severe intoxication, an organophosphate-induced delayed polyneuropathy (OPIDP) may develop. OPIDP is a distal dying back axonopathy characterized by cramping muscle pain in the legs, paresthesias, and motor weakness beginning 10 days to 3 weeks after the initial exposure. OPIDP-associated signs include foot drop, weakness of the intrinsic hand muscles, absent...

Encapsulated Disorders

The major limitations and alterations seen in symptom encapsulations are in thought and affect. The first type, limitation of thought, is found, for example, in hysterical symptoms such as periodic dizziness. Aside from such symptoms, the child may function at an age-appropriate level engage in warm, loving relationships be assertive and experience empathy and concern as well as anger and aggression. Only a narrow content area of psychic life dealing with specific wishes (e.g., of a pleasurable nature) is walled off. In the interview, the limitation of thought may become apparent only by the continued absence of this specific content in an otherwise flexible child who evinces a wide range of themes.

Evaluation of Symptoms

Because diastolic murmurs are often not very loud and sometimes very highly localized, as in mitral stenosis, they can be easily missed. Therefore, it is not common for patients with diastolic murmurs to present merely as problem of diagnosis of the cause of the murmur. More than likely they will be referred for other symptoms. A carefully obtained clinical history and its proper interpretation often will give clues as to what possibilities need to be considered. Symptoms of orthopnea and or paroxysmal nocturnal dyspnea would imply high left atrial pressures (62). Orthopnea occurs because of the gravitational shift of intravascular volume from the lower extremities raising the central blood volume and, therefore, the filling pressures in the left atrium. The nocturnal dyspnea occurs because of the elevation of the left atrial pressure occurring after a few hours of sleep at night, which is caused by the redistribution of fluid volume in the body compartments. The extra-vascular fluid...

What are the side effects of MUSE

The most common side effect, occurring in one-third to one-half of all men who take MUSE, is pain. This pain may be present in the penis, urethra, testis, or perineum. The intensity of the pain varies according to the dose taken. Thus, as the dose increases, the intensity of the pain may likewise increase. Hypotension and syncopal episodes (temporary loss of consciousness caused by decreased blood flow to the brain) have been reported in 1.2 to 4 of men who took MUSE, with their frequency depending on the dose used. Other side effects include urethral bleeding (in 4 to 5 of men who took MUSE), dizziness (in 1 ), and urinary tract infection (in 0.2 ). Prolonged erections and penile fibrosis (scarring) rarely occur. Ten percent of female partners experience vaginal irritation or vaginitis.

Emetics and antiemetic drugs

There are several classes of anti-emetic drugs, only some of which are effective against nausea triggered through activation of the chemoreceptor trigger zone. The most common clinical uses are in the treatment of motion sickness, vestibular disorders (e.g. M ni re's disease), chemotherapy and radiation therapy, and drug-induced nausea. H -receptor antagonists and muscarinic receptor antagonists are effective against motion sickness, sickness caused by stimulation of the gastric mucosa and often vestibular disorders, although they cannot prevent sickness from stimulation of the trigger zone. Commonly used are the H -receptor antagonists cyclizine and cinnar-izine and the muscarinic antagonist hyoscine. For the treatment of sickness caused by agents stimulating the trigger zone, the neuroleptic phenothi-azines are effective, probably through their D2-receptor antagonism. These include chlorpromazine, prochlorperazine and trifluoperazine. The drugs are useful in drug-induced emesis,...

Arrhythmias Pacemakers and Defibrillators

In most cases, an arrhythmia is caused by a faulty electrical conduction system, or pacemaker cells, in the heart muscle. Abnormal heart rhythms may interfere with the heart's pumping function and therefore may cause fatigue, lightheadedness, a sensation of uneasiness, or sometimes even passing out, particularly if the heart rate is very slow or very fast. Some patients can develop angina-type chest pain from a decreased flow of oxygenated blood to the coronary arteries or from very rapid heart rates.

Sheehans Syndrome 1977 1995

In 1995, Natalie Lomeo was delivered by elective Cesarean section at her local Community Medical Center (CMC) in Pennsylvania. She had an extensive blood loss during the operation, and a postpartum hemorrhage followed. Although she exhibited signs of hemorrhagic shock, blood was not transfused until much later in the day. Over the next 3 years, she complained of fatigue, weakness, dizziness, hair loss, amenorrhea, dyspareunia, and vasomotor symptomatology. In 1998, the diagnosis of Sheehan's syndrome was made. She then took legal action against her obstetrician and the CMC. However, the defendants filed for summary judgment, asserting that her claim was time-barred under Pennsylvania law, as it had been filed more than 2 years after the allegedly negligent conduct. The Common Pleas Court denied the motion for dismissal, saying that the litigation clock only started to run when Sheehan's syndrome was diagnosed27. What happened next was not reported, so the case was probably settled.

Diffuse brain injuries

Concussion is the most common head injury in sports. Historically, concussion was described as traumatic paralysis of nervous function with a tendency to recover without deficit and revealing no anatomic abnormality. There are many definitions of concussion in the literature. Most recently, the American Orthopaedic Society for Sports Medicine Concussion Workshop Group has defined cerebral concussions as any alteration in cerebral function caused by a direct or indirect force transmitted to the head resulting in one or more of the following acute signs or symptoms a brief loss of consciousness, light-headedness, vertigo, cognitive and memory dysfunction, blurred vision, difficulty concentrating, amnesia, headache, nausea, vomiting, photophobia or a balance disturbance. In 1983, Gerberich et al. surveyed the head coaches and players of 103 secondary school football teams in Minnesota. The incidence of cerebral concussion in foot

Management guidelines

In 1973, Schneider 20 described two young athletes who experienced initial concussive syndromes and subsequently died after relatively minor second impacts. Since then 19 deaths from second impact syndrome (SIS) have been documented in the US. Furthermore, successive concussive impacts may also lead to milder but still significant impairment of cognitive processes (attention, memory), personality, language functioning and somatic concerns (sensitivity to light, dizziness), commonly referred to as 'postconcussion syndrome'. Based on the perception that MTBI still has a high incidence and may cause late problems, renewed interest in neuropsychologic testing of athletes has occurred. While neuropsychologic tests were used in the early seventies 21 , it was first in 1989 that Barth et al. 22 published their results on more than 2350 college athletes participating in football. The study showed that effects of mild head injuries can be assessed by neuropsychologic tests and that the...

Depression Checklist Are You at Risk

> Insomnia, fatigue, headache, stomachache, and dizziness One of the most common diagnoses in traditional Oriental Medicine is heart-blood deficiency As you can tell by the name, this condition deals with issues concerning the heart organ or channel. These issues are usually emotional. Blood deficiency implies an energetic weakness. This usually presents itself as palpitations, insomnia, poor memory, dizziness, jumpiness, dull complexion, confusion, and lack of concentration.

Neurological examination

The neurological examination aims to differentiate between nerve root and spinal cord compression. Examination of cranial nerves, especially the eye movements with the aid of Frentzel goggles, is useful. There is clear evidence showing interaction between the receptors of the cervical joint capsules and the vestibular organ 28, 29 . However, it is well established that the center projection of the cervical spine mechanoreceptors is close to the vestibular nuclei at the region of the brain stem, which makes the clinical differentiation (cervical vs vestibular origin of dizziness) very difficult 26, 27 .

Psychosocial Adjustment

Delirium may occur in acute illness or be due to toxic drug interactions. Underlying medical causes such as medication intoxication should be evaluated. Certain antiretroviral agents such as efavirenz have been associated with a number of significant CNS effects including dizziness, sleep disturbances, and mood alterations that often resolve after the first few weeks of therapy but also may persist

Hypertension The Pressures On

Blood pressure is measured by a sphygmomanometer. A normal reading is about 120 80 a reading of 140 90 measured at least on two office visits is officially considered high blood pressure. Hypertension rarely exhibits symptoms, so it's often called the silent killer. Left untreated, high blood pressure can lead to serious conditions such as vision problems, heart attack, stroke, or kidney failure. If early symptoms do occur, they may include headaches, sweating, muscle cramping, palpitations, rapid pulse rate, dizziness, vision problems, or shortness of breath. Having your blood pressure checked every four to six months is an easy precaution to ensure your pressure is staying on course.

Dopamine Agonist Therapy

Dopamine is the physiologic inhibitor of PRL secretion. Accordingly, dopaminergic therapy has emerged as a powerful therapy for prolactinomas. Bromocriptine is the prototypic dopamine agonist and has been shown to effectively suppress PRL secretion, restore gonadal function, and shrink prolactin-omas. Its side effects, however, include nausea, dizziness, and headache, which may be debilitating enough to withdraw treatment. Cabergoline is a new, longer-lasting dopamine agonist

Bacterial Meningitis

Drowsiness or agitation, diplopia and blurred vision, disequilibrium, benign leukopenia, hepatic failure, rare SIADH, rare aplastic anemia Hyponatremia, hypersensitivity reaction, leukopenia, thrombocytopenia, angioedema, Stevens-Johnson syndrome, dizziness, somnolence, diplopia, headache, nausea, ataxia Rash, Stevens-Johnson syndrome, angioedema, neutropenia, pancreatitis, dizziness, headache, ataxia, nausea, somnolence CNS depression, seizures, weakness, rash, dizziness, asthenia, somnolence, nausea, diarrhea, tremor, confusion, impaired concentration Leukopenia, depression, dizziness, somnolence, ataxia, fatigue, peripheral edema, weight gain, tremor, diarrhea Thrombocytopenia, hypersensitivity reaction, angioedema, dizziness, somnolence, ataxia, peripheral edema, weight gain Syncope, atrial fibrillation (rare), dizziness, headache, diplopia, vomiting, fatigue, ataxia Suicidality, seizures, QT shortening, hypersensitivity reaction, leucopenia, somnolence, vomiting, headache,...

Vertebrobasilar Transient Ischemic Attacks and Stroke

The TIAs that produce vertigo of abrupt onset lasting minutes to hours are a manifestation of ischemia in the distribution of the vertebrobasilar arteries, not the carotid arteries. Unfortunately, the TIA diagnosis can be difficult to make because vertigo may be the only symptom reported, and more definitive neurologic symptoms suggestive of a verte-brobasilar event may be absent, such as blurred vision, visual field deficits, diplopia, dysarthria, and unilateral motor or sensory changes. When a patient presents with symptoms of a vertebrobasilar TIA, the physician should consider causes such as cardioembolic disease, polycythemia, and subclavian steal syndrome. A significant BP difference in the arms and symptoms with arm abduction may signal subclavian steal syndrome, which may be corrected surgically. If the cause of these symptoms is related to vertebrobasilar vascular disease, treatment is usually medical with aspirin or other antiplate-let agents. Vertigo is also a component of...

Postconcussion Syndrome

Postconcussion syndrome is a controversial construct currently included in DSM-IV-TR (American Psychiatric Association 2000) as a disorder proposed for further study. This proposed disorder includes a variety of postconcussive symptoms, which in adults have been characterized as consisting of somatic complaints (e.g., fatigue, headache, dizziness), cognitive difficulties (e.g., attention and memory disturbances), and emotional problems (e.g., mood and anxiety problems).

Aortic Balloon Valvuloplasty

Aortic valve stenosis accounts for 4 to 6 of all cases of congenital heart disease.36 Left ventricular outflow tract obstruction elicits left ventricular hypertrophy and myocardial fibrosis, which may eventually lead to left ventricular dysfunction and congestive heart failure. Unlike most cases of congenital pulmonary valve stenosis, congenital aortic stenosis tends to progress over time.37 Nevertheless, intervention usually is not indicated unless the degree of left ventricular outflow tract obstruction is severe (catheter gradient > 65 mm Hg) or there is associated left ventricular dysfunction, heart failure, ischemia, or symptoms of angina, syncope, or presyncope. This recommendation is based on the fact that all current forms of therapy for aortic valve stenosis are palliative in nature. Surgical valvotomy, widely regarded in the past as the initial treatment of choice for congenital aortic valve stenosis, is associated with a high incidence of late (5 to 20 years)...

Safety and Tolerability

The safety of rituximab is mainly related to infusion toxicity, a toxicity most MAb have in common (Kimby 2005). These side effects are observed during the infusion or in the first hours after drug infusion and particularly for the first infusion. They include fever, chills, dizziness, nausea, pruritus, throat swelling, cough, fatigue, hypotension and transient bronchospasm in a majority of patients. These symptoms are part of the cytokine-release syndrome. Their intensity correlates with the number of circulating malignant cells at time of infusion. More severe infusional toxicity includes bronchospasm, angioedema and acute lung injury, often associated with high circulating cell counts or pre-existing cardiac or pulmonary disease.

Contraception Methods An Overview

Of the ovary and the endometrium.12 However, a possible link between the use of OCs for a long period and breast cancer risk among young women and cancer of the cervix is still a concern. Side-effects of COCs are nausea, headaches, dizziness, spotting, weight gain, breast tenderness and chloasma. For POPs, the main side-effect is menstrual irregularities.

Beyond EitherOr The Cybernetic Paradoxes of Creativity

Paradox, in other words, is an aspect of humanness, that is highlighted in creativity. Instead of holding key systems dimensions such as equilibrium and disequilibrium, order and disorder, as opposites, with an either or logic, a systems approach views them as having a cybernetic relationship of both and. In the traditional view, which originated in modernity, equilibrium, and disequilibrium, order and disorder were viewed in a hierarchical opposition, with equilibrium and order privileged, and disequilibrium and disorder considered to be problematic. A systems approach shows they are interrelated like yin and yang, and provide a potentially generative interaction. Complexity theorists in particular have been showing that this cybernetic relationship between order and disorder is central to the more interesting natural and social phenomena (Morin, 2008). The now popular term 'on the edge of chaos' shows how far this relationship has been taken, a cybernetic process of navigating on a...

Self Organization and the Role of Disorder

Person, and the process of personal integration, and to creative groups. From a systems approach, premature articulation and selection of a solution is a way of reducing the disequilibrium created by a problem. This disequilibrium can be experienced as anxiety, fear, impatience, frustration, or irritation. Tolerance for ambiguity involves staying with the disequilibrium until a generative solution can emerge. The systems view also suggests why creative people, being more open to experience, and having a preference for complexity, might willingly disturb their own equilibrium in order to be challenged and stimulate their own creativity. The emergence of a new idea arises out of a process of self-orgaization. This demonstrates the applicability of a systems approach at various levels of granularity.

Olszewski Kubilius Model

Olszewski-Kubilius developed a psychosocial model for the development of the creative person that takes into account Context Family Characteristics, Child Characteristics, Family Status (e.g., socioeconomic status (SES), marginality), Birth Position, Family Generational Influences, Physical Disabilities (domain preference and resources), Asynchronies in Child, and Gender Conditions Stress (parental loss, harsh parenting, parental dysfunction, neglect, abuse), Threat to Security, Feeling Out-of-Control, Isolation, Rejection, Feeling Different, Reduced Affiliation and Identification with Parents, Disruptions in Socialization, Unconventional Socialization, Need for Refuge, Emotional Disequilibrium and Characteristics (which include Intellectual Activities such as a rich fantasy life, voracious reading, skill development, and coping strategies for isolation). Creative people compensate for developmental defects and lacks, 'seeking to relieve loss, obtain love and admiration,' and the...

Pathophysiology Of Hypertrophic Obstructive Cardiomyopathy

When the obstruction to outflow is severe, the cardiac output becomes fixed and will not significantly increase on exertion. In fact, exercise-induced peripheral vasodilatation may actually drop the systemic arterial pressure further and may cause the obstruction to become worse because of the decreased (distending) aortic root pressure (i.e., the opposing force of the systolic anterior motion of the anterior mitral leaflet). This may manifest as symptoms of exertional presyncope or syncope. The mitral regurgitation that accompanies the systolic anterior motion ofthe anterior mitral leaflet during systole may vary in severity, depending on the degree of obstruction. The longstanding effects of mitral regurgitation and the elevated left atrial pressure could result in the development of atrial arrhythmias especially atrial fibrillation. These may manifest as symptoms of palpitation. The underlying myocardial disease and the pathological changes of myo-cardial disarray and fibrosis...

Clinical Use and Adverse Effects of Specific Antiepileptic Drugs

Primidone has been available in the United States since 1954 for the treatment of partial and generalized seizures. Primidone is metabolized to phenobarbital and phenylethymalonamide (PEMA), both of which possess anticonvulsant properties. The adverse effects are similar to phenobarbital, although initiation of primidone is associated with a higher incidence of GI distress, dizziness, ataxia, and diplopia. Primidone is available in 50- and 250-mg scored tablets and elixir (250 mg 5 ml). Carbamazepine, available in the United States since 1974, has a similar mechanism and spectrum of action as phenytoin. The carbamazepine-10, 11-epoxide metabolite also possesses anticonvulsant properties. Autoinduction occurs during the first several weeks of therapy, necessitating gradual titration. Concomitant use of propoxyphene, erythromycin, and cimetidine results in significant accumulation of carbamazepine. Despite its association with aplastic anemia, serious hematological complications are...

Diagnosis and Emergency Treatment of Dehydration

Physicians should be aware of and educate athletes as to warning symptoms (Table 12.1). Besides thirst, athletes may experience headaches similar to those of a hangover visual field disturbances can occur in more severe cases. Clinical signs include hypotension, lightheadedness, and orthostatic hypotension, including fainting. Dehydration can lower blood pressure, and sitting in sauna or hot tub after an intense workout may further lower it through vasodilation and decreased venous return. The athlete should be aware of this phenomenon and instructed to

Diagnosis of Anxiety Disorders

Panic attacks, a collection of distressing physical, cognitive, and emotional symptoms, may occur in a variety of anxiety disorders, such as specific phobias, social phobias, PTSD, and acute stress disorder. Panic attacks are discrete periods of intense fear in the absence of real danger, accompanied by at least 4 of 13 cognitive and physical symptoms (Box 47-4). The attacks have a sudden onset, build to a peak quickly, and are often accompanied by feelings of doom, imminent danger, and a need to escape. Symptoms of panic attacks can include somatic complaints (e.g., sweating, chills), cardiovascular symptoms (pounding heart, accelerated heart rate, chest pain), neurologic symptoms (trembling, unsteadiness, lightheadedness, paresthesias), GI symptoms (choking sensations, nausea), and pulmonary symptoms (shortness of breath). In addition, patients with panic attacks may worry they are dying, going crazy, or have the sensation of being detached from reality.

Screening Tools for Anxiety Disorders

At present, screening tools for anxiety disorders have been developed to recognize anxiety as a broad syndrome, examining somatic symptoms (racing heart, lightheadedness) or cognitive symptoms (tendency to worry, intensity of worry). Other tools have been used to screen for single, distinct disorders, such as phobias or panic disorder. To date, no clear screening tool or symptom-severity measure has emerged for use in primary care settings, although newer instruments may be useful for primary care physicians. The Generalized Anxiety Disorder 7 (GAD-7) scale was developed and validated

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