122 results found
Mendis S, Ealing J, Larkin J, et al., 2021, Isolated imbalance due to bilateral vestibular failure following immune checkpoint inhibitor administration: two cases., Eur J Cancer, Vol: 156, Pages: 187-189
Castro Abarca P, Vadera S, Bancroft MJ, et al., 2021, Acute onset fear of falling and treatment with “Cognitive Physical Therapy”, Frontiers in Neurology, Vol: 12, Pages: 1-7, ISSN: 1664-2295
Fear of falling (FoF) is prevalent in older adults, especially those with previous falls, and typically starts insidiously. We present a 78-year-old woman with an abrupt onset FoF and no history of falls, balance problems, vertigo, oscillopsia, psychiatric or psychological issues to account for this. These cognitive changes led to a behavioural alteration of her gait that became slow and wide-based, with her gaze fixed on the floor. She began a tailored program of “Cognitive Physical Therapy (CPT)” combining cognitive behavioural therapy (CBT) and physical rehabilitation. One month later her 6m walk time and steps were reduced by a 25% and 35%, respectively and the stride length increased by 34%, with further improvement 2 months later. We postulate that the abrupt onset of symptoms triggered a central shift towards postural hypervigilance and anxiety, suppression of anticipatory (feed forward) postural adjustments (APA) leading to FoF. CPT improved objective gait parameters related to FoF and reduced postural anxiety suggesting that early diagnosis and prompt treatment may avoid chronic symptoms and social isolation.
Man Chan Y, Wong Y, Khalid N, et al., 2021, Prevalence of acute dizziness and vertigo in cortical stroke, EUROPEAN JOURNAL OF NEUROLOGY, Vol: 28, Pages: 3177-3181, ISSN: 1351-5101
Bonsu A, Walker P, Edey J, et al., 2021, Time to consider the role of rationalisation in health psychology, PUBLIC HEALTH, Vol: 196, Pages: 59-61, ISSN: 0033-3506
Kamourieh S, Sokolska M, Akram H, et al., 2021, Miners' Nystagmus Following Visual Deprivation: A Case Report, ANNALS OF INTERNAL MEDICINE, Vol: 174, Pages: 1021-+, ISSN: 0003-4819
Koohi N, Bancroft MJ, Patel J, et al., 2021, Saccadic Bradykinesia in Parkinson's Disease: Preliminary Observations., Mov Disord, Vol: 36, Pages: 1729-1731
Currò R, Salvalaggio A, Tozza S, et al., 2021, RFC1 expansions are a common cause of idiopathic sensory neuropathy., Brain, Vol: 144, Pages: 1542-1550
After extensive evaluation, one-third of patients affected by polyneuropathy remain undiagnosed and are labelled as having chronic idiopathic axonal polyneuropathy, which refers to a sensory or sensory-motor, axonal, slowly progressive neuropathy of unknown origin. Since a sensory neuropathy/neuronopathy is identified in all patients with genetically confirmed RFC1 cerebellar ataxia, neuropathy, vestibular areflexia syndrome, we speculated that RFC1 expansions could underlie a fraction of idiopathic sensory neuropathies also diagnosed as chronic idiopathic axonal polyneuropathy. We retrospectively identified 225 patients diagnosed with chronic idiopathic axonal polyneuropathy (125 sensory neuropathy, 100 sensory-motor neuropathy) from our general neuropathy clinics in Italy and the UK. All patients underwent full neurological evaluation and a blood sample was collected for RFC1 testing. Biallelic RFC1 expansions were identified in 43 patients (34%) with sensory neuropathy and in none with sensory-motor neuropathy. Forty-two per cent of RFC1-positive patients had isolated sensory neuropathy or sensory neuropathy with chronic cough, while vestibular and/or cerebellar involvement, often subclinical, were identified at examination in 58%. Although the sensory ganglia are the primary pathological target of the disease, the sensory impairment was typically worse distally and symmetric, while gait and limb ataxia were absent in two-thirds of the cases. Sensory amplitudes were either globally absent (26%) or reduced in a length-dependent (30%) or non-length dependent pattern (44%). A quarter of RFC1-positive patients had previously received an alternative diagnosis, including Sjögren's syndrome, sensory chronic inflammatory demyelinating polyneuropathy and paraneoplastic neuropathy, while three cases had been treated with immune therapies.
McCarthy J, Castro P, Cottier R, et al., 2021, Multisensory contribution in visuospatial orientation: an interaction between neck and trunk proprioception, EXPERIMENTAL BRAIN RESEARCH, Vol: 239, Pages: 2501-2508, ISSN: 0014-4819
Klarendic M, Hribar M, Urbancic NB, et al., 2021, Central nystagmus in progressive supranuclear palsy: A neglected clinical feature?, Parkinsonism Relat Disord, Vol: 84, Pages: 15-22
BACKGROUND: Progressive supranuclear palsy (PSP) features parkinsonism characterized by early postural instability, falls and prominent eye movement abnormalities that consist of saccadic slowing, followed by gaze limitation. Nystagmus is not considered typical for PSP, being more commonly associated with multiple system atrophy. OBJECTIVES: To describe the prevalence and phenomenology of nystagmus in patients with PSP. METHODS: 42 patients with probable PSP underwent detailed clinical eye movement examination. Patients with nystagmus performed video-nystagmography. T-test, Chi-Square test and Wilcoxon signed-rank test were used to test differences in demographic data, disease duration and PSP subtype between patients with and without nystagmus, and for analysis of video-nystagmographic data. RESULTS: Among 42 patients with PSP, we identified 15 patients (35,7%) with gaze-evoked nystagmus, predominantly horizontal. Clinically, 10/15 patients had symmetrical or asymmetrical gaze - evoked nystagmus (Type 1), while 5/15 patients had dissociated gaze-evoked nystagmus related to internuclear ophthalmoplegia (Type 2). Nystagmus and eye movement abnormalities were further characterized by video-nystagmography. There was no significant difference in age, disease duration or PSP subtypes between patients with and without nystagmus. CONCLUSION: Central nystagmus is present in more than a third of patients with progressive supranuclear palsy. It may present as symmetrical or asymmetrical gaze-evoked nystagmus or as dissociated gaze-evoked nystagmus related to internuclear ophthalmoplegia and probably arises from neurodegeneration of the neural integrator. Nystagmus in PSP has been a hitherto under-described feature and its presence should not deter clinicians from a diagnosis of PSP.
Russell LL, Greaves CV, Convery RS, et al., 2021, Novel instructionless eye tracking tasks identify emotion recognition deficits in frontotemporal dementia., Alzheimers Res Ther, Vol: 13
BACKGROUND: Current tasks measuring social cognition are usually 'pen and paper' tasks, have ceiling effects and include complicated test instructions that may be difficult to understand for those with cognitive impairment. We therefore aimed to develop a set of simple, instructionless, quantitative, tasks of emotion recognition using the methodology of eye tracking, with the subsequent aim of assessing their utility in individuals with behavioural variant frontotemporal dementia (bvFTD). METHODS: Using the Eyelink 1000 Plus eye tracker, 18 bvFTD and 22 controls completed tasks of simple and complex emotion recognition that involved viewing four images (one target face (simple) or pair of eyes (complex) and the others non-target) followed by a target emotion word and lastly the original four images alongside the emotion word. A dwell time change score was then calculated as the main outcome measure by subtracting the percentage dwell time for the target image before the emotion word appeared away from the percentage dwell time for the target image after the emotion word appeared. All participants also underwent a standard cognitive battery and volumetric T1-weighted magnetic resonance imaging. RESULTS: Analysis using a mixed effects model showed that the average (standard deviation) mean dwell time change score in the target interest area was 35 (27)% for the control group compared with only 4 (18)% for the bvFTD group (p < 0.05) for the simple emotion recognition task, and 15 (26)% for the control group compared with only 2 (18)% for the bvFTD group (p < 0.05) for the complex emotion recognition task. Worse performance in the bvFTD group correlated with atrophy in the right ventromedial prefrontal and orbitofrontal cortices, brain regions previously implicated in social cognition. CONCLUSIONS: In summary, eye tracking is a viable tool for assessing social cognition in individuals with bvFTD, being well-tolerated and able to overcom
Evangelista VRP, Mermelstein SA, da Silva MM, et al., 2021, Bedside video-ophthalmoscopy as an aid in the diagnosis of central vestibular syndromes, JOURNAL OF NEUROLOGY, ISSN: 0340-5354
Di Stadio A, Ralli M, Altieri M, et al., 2021, ENT-MS-12 questionnaire: A novel tool to investigate otolaryngology symptoms in patients with relapsing-remitting multiple sclerosis. Results from a pilot study., Mult Scler Relat Disord, Vol: 47
BACKGROUND: Multiple sclerosis (MS) is associated with otolaryngology-related manifestations including vestibular or auditory symptoms; facial motor or sensory disorders; voice or swallowing impairment; and snoring/sleep apnea. Because these symptoms are nonspecific, their significance in MS is seldom recognized by patients with MS and their physicians; yet, presence of these symptoms may be a harbinger of impending relapse or disease progression. We developed and investigated a survey instrument, the ENT-MS-12, to standardize reporting of otolaryngology symptoms in patients with MS, correlating its scoring with disability and lesions. METHODS: The ENT-MS-12 was administered to 40 patients with relapsing-remitting MS in different phases of their disease. We collected data using the Expanded Disability Status Scale (EDSS) and analyzed patient brain MRIs to evaluate the state (active or non-active) of brain lesions based on gadolinium enhancement. Odds ratios for diverse otolaryngology symptoms across the EDSS scores and brain lesions were calculated. RESULTS: Higher EDSS scores were associated with auditory and vestibular symptoms (Odd Ratio (OR): 3.06; p: 0.0003); voice and swallowing symptoms (OR: 6.8; p=0.007); and snoring/sleep apnea (OR: 5.1; p=0.03). Presence of active brain lesions was also associated with auditory and vestibular symptoms (OR: 6.7); voice and swallowing symptoms (OR: 5.7); and snoring/sleep apnea (OR: 5). CONCLUSIONS: The ENT-MS-12 survey instrument standardizes reporting of otolaryngology symptoms in patients with MS and documents association between symptoms and phase of disease in this series. Because ear, nose and throat (ENT)- related symptoms (i.e., sensory symptoms, such as numbness) are under-reported in MS, further investigation is warranted, as such data may improve clinical management of MS.
Kaski D, Herron D, Nachev P, 2021, Deconstructing Dizziness., Front Neurol, Vol: 12, ISSN: 1664-2295
Totilienė M, Uloza V, Lesauskaitė V, et al., 2021, Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls., Front Aging Neurosci, Vol: 13, ISSN: 1663-4365
Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.
Chandratheva A, Werring D, Kaski D, 2020, Vertebrobasilar insufficiency: an insufficient term that should be retired., Pract Neurol
BACKGROUND: Positional manoeuvres are an important part of the neurological examination, particularly in patients with vertigo where the presence and characteristics of provoked nystagmus can help differentiate central from peripheral neurological disorders. METHODS: Case series of functional positional eye and eyelid movements. RESULTS: We report four patients with functional eye and eyelid movements provoked during positional manoeuvres. The range of abnormalities observed included positional convergence spasm, brief functional saccadic oscillations, and excessive positional blinking mimicking upbeat nystagmus. The functional movements described were present on a background of pre-existing peripheral or central nystagmus, or positional vertigo. CONCLUSION: Functional positional eye and eyelid movements may co-exist with organic nystagmus that renders an accurate interpretation of the manoeuvre more challenging. A thorough understanding of the clinical features that differentiate these two categories of eye/eyelid movements makes the analysis easier, thus preventing misdiagnosis and avoiding unnecessary investigations.
Rau CJ, Terling L, Elkhodair S, et al., 2020, Acute vertigo in the emergency department: use of bedside oculomotor examination., Eur J Emerg Med, Vol: 27, Pages: 381-383
Uloziene I, Totiliene M, Balnyte R, et al., 2020, Subjective visual vertical and visual dependency in patients with multiple sclerosis, MULTIPLE SCLEROSIS AND RELATED DISORDERS, Vol: 44, ISSN: 2211-0348
Rau C, Terling L, Elkhodair S, et al., 2020, 92. Acute Vertigo in the Emergency Department - a retrospective study., Eur J Emerg Med, Vol: 27, Pages: e4-e5
Rivlin W, Habershon C, Tsang BK-T, et al., 2020, A Practical Approach to Vertigo: A Synthesis of the Emerging Evidence., Intern Med J
Vestibular presentations represent a large financial and symptomatic burden of disease1,2 , while remaining one of the most elusive presentations to accurately and confidently diagnose. A primary cause for this is that the same symptom can be the end-product of numerous aetiologies, and uncertainties can lead to unnecessary investigations and associated increased cost and delays in diagnosis. An effective method to narrow the diagnosis is firstly to determine, from a limited list, which type of vestibular syndrome the patient possesses, and then apply a focussed history and examination to define the most likely aetiology within that syndrome. This review provides a diagnostic approach to the vertiginous patient, outlining the underlying pathophysiology that accounts for the clinical symptoms and signs. With this approach, physicians should be able to diagnose the majority of common vestibular presentations and know when to refer the urgent, complex, or rare cases to sub-specialist neuro-otologists for prompt and appropriate management. This article is protected by copyright. All rights reserved.
Lin D, Castro P, Edwards A, et al., 2020, Dissociated motor learning and de-adaptation in patients with functional gait disorders, BRAIN, Vol: 143, Pages: 2594-2606, ISSN: 0006-8950
Klarendic M, Kaski D, 2020, Deep brain stimulation and eye movements, EUROPEAN JOURNAL OF NEUROSCIENCE, Vol: 53, Pages: 2344-2361, ISSN: 0953-816X
Kaski D, 2020, Neurological update: dizziness, Journal of Neurology, Vol: 267, Pages: 1864-1869, ISSN: 0340-5354
The diagnosis and management of vertigo remains a challenge for clinicians, including general neurology. In recent years there have been advances in the understanding of established vestibular syndromes, and the development of treatments for existing vestibular diagnoses. In this ‘update’ I will review how our understanding of previously “unexplained” dizziness in the elderly is changing, explore novel insights into the pathophysiology of vestibular migraine, and its relationship to the newly coined term ‘persistent postural perceptual dizziness’, and finally discuss how a simple bedside oculomotor assessment may help identify vestibular presentations of stroke.
Patel M, Roberts E, Arshad Q, et al., 2020, The "broken escalator" phenomenon: vestibular dizziness interferes with locomotor adaptation, Journal of Vestibular Research: Equilibrium and Orientation: an international journal of experimental and clinical vestibular science, Vol: 30, Pages: 81-94, ISSN: 0957-4271
BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and subjective vestibular symptoms to locomotor adaptation. OBJECTIVE: To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS: We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n = 20) and strongly symptomatic unilateral Meniere's disease (n = 15), compared to age-matched healthy controls (n = 15). We measured locomotor adaptive learning using the "broken escalator" aftereffect, simulated on a motorised moving sled. RESULTS: Patients with Meniere's disease had an enhanced "broken escalator" postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION: Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the "broken escalator" paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients.
Cortese A, Tozza S, Yau WY, et al., 2020, Cerebellar ataxia, neuropathy, vestibular areflexia syndrome due to RFC1 repeat expansion., Brain, Vol: 143, Pages: 480-490
Ataxia, causing imbalance, dizziness and falls, is a leading cause of neurological disability. We have recently identified a biallelic intronic AAGGG repeat expansion in replication factor complex subunit 1 (RFC1) as the cause of cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) and a major cause of late onset ataxia. Here we describe the full spectrum of the disease phenotype in our first 100 genetically confirmed carriers of biallelic repeat expansions in RFC1 and identify the sensory neuropathy as a common feature in all cases to date. All patients were Caucasian and half were sporadic. Patients typically reported progressive unsteadiness starting in the sixth decade. A dry spasmodic cough was also frequently associated and often preceded by decades the onset of walking difficulty. Sensory symptoms, oscillopsia, dysautonomia and dysarthria were also variably associated. The disease seems to follow a pattern of spatial progression from the early involvement of sensory neurons, to the later appearance of vestibular and cerebellar dysfunction. Half of the patients needed walking aids after 10 years of disease duration and a quarter were wheelchair dependent after 15 years. Overall, two-thirds of cases had full CANVAS. Sensory neuropathy was the only manifestation in 15 patients. Sixteen patients additionally showed cerebellar involvement, and six showed vestibular involvement. The disease is very likely to be underdiagnosed. Repeat expansion in RFC1 should be considered in all cases of sensory ataxic neuropathy, particularly, but not only, if cerebellar dysfunction, vestibular involvement and cough coexist.
Bednarczuk NF, Bradshaw JM, Mian SY, et al., 2020, Pathophysiological dissociation of the interaction between time pressure and trait anxiety during spatial orientation judgments, EUROPEAN JOURNAL OF NEUROSCIENCE, Vol: 52, Pages: 3215-3222, ISSN: 0953-816X
Mahlknecht P, Kaski D, Georgiev D, et al., 2020, Reply: Pathophysiology of gait disorders induced by bilateral globus pallidus interna stimulation in dystonia., Brain, Vol: 143
Valancius D, Ulyte A, Masiliunas R, et al., 2019, Validation and Factor Analysis of the Lithuanian Version of the Dizziness Handicap Inventory, JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY, Vol: 15, Pages: 447-453, ISSN: 1308-7649
Kaski D, Agarwal K, Murdin L, 2019, Acute vertigo., BMJ, Vol: 366
Chapelle A-C, Plant GT, Kaski D, 2019, Teaching Video NeuroImages: Cerebellar esotropia: A pitfall in ophthalmology and neurology., Neurology, Vol: 93, Pages: e114-e115
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