Dizziness and Balance Disturbances
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Differentiating Between Anxiety, Syncope & Anaphylaxis
Differentiating between anxiety, syncope & anaphylaxis Dr. Réka Gustafson Medical Health Officer Vancouver Coastal Health Introduction Anaphylaxis is a rare but much feared side-effect of vaccination. Most vaccine providers will never see a case of true anaphylaxis due to vaccination, but need to be prepared to diagnose and respond to this medical emergency. Since anaphylaxis is so rare, most of us rely on guidelines to assist us in assessment and response. Due to the highly variable presentation, and absence of clinical trials, guidelines are by necessity often vague and very conservative. Guidelines are no substitute for good clinical judgment. Anaphylaxis Guidelines • “Anaphylaxis is a potentially life-threatening IgE mediated allergic reaction” – How many people die or have died from anaphylaxis after immunization? Can we predict who is likely to die from anaphylaxis? • “Anaphylaxis is one of the rarer events reported in the post-marketing surveillance” – How rare? Will I or my colleagues ever see a case? • “Changes develop over several minutes” – What is “several”? 1, 2, 10, 20 minutes? • “Even when there are mild symptoms initially, there is a potential for progression to a severe and even irreversible outcome” – Do I park my clinical judgment at the door? What do I look for in my clinical assessment? • “Fatalities during anaphylaxis usually result from delayed administration of epinephrine and from severe cardiac and respiratory complications. “ – What is delayed? How much time do I have? What is anaphylaxis? •an acute, potentially -
Experimental Studies on the Function of the Stapedius Muscle Inman
EXPERIMENTAL STUDIES ON THE FUNCTION OF THE STAPEDIUS MUSCLE INMAN AKADEMISK AVHANDLING som med vederbörligt tillstånd av Medicinska fakulteten vid Umeå Universitet för vinnande av medicine doktorsgrad offentligen försvaras i Samhällsvetarhuset, sal D, lördagen den 25 maj 1974 kl. 9.15 f.m. av JOHN-ERIK ZAKRISSON med.lic. UMEÅ 1974 UMEÀ UNIVERSITY MEDICAL DISSERTATIONS No. 18 1974 From the Department of Otorhinolaryngology, University of Umeå, Umeå, Sweden and the Division of Physiological Acoustics, Department of Physiology II, Karolinska Institutet, Stockholm, Sweden EXPERIMENTAL STUDIES ON THE FUNCTION OF THE STAPEDIUS MUSCLE IN MAN BY JOHN-ERIK ZAKRISSON UMEÂ 1974 To Karin Eva and Gunilla The present thesis is based on the following papers which will be referred to in the text by the Roman numerals: I. Zakrisson, J.-E., Borg, E. & Blom, S. The acoustic impedance change as a measure of stapedius muscle activity in man. A methodological study with electromyography. Acta Otolaryng, preprint. II. Borg, E. & Zakrisson, J.-E. Stapedius reflex and monaural masking. Acta Otolaryng, preprint. III. Zakrisson, J.-E. The role of the stapedius reflex in poststimulatory audi tory fatigue. Acta Otolaryng, preprint. IV. Borg, E. & Zakrisson, J.-E. The activity of the stapedius muscle in man during vocalization. Acta Otolaryng, accepted for publication. CONTENTS ABBREVIATIONS .......................................... 8 INTRODUCTION.............................................................................................. 9 MATERIAL..................................................................................................... -
Balance and Aging by Charlotte Shupert, Phd, with Contributions by Fay Horak, Phd, PT Oregon Health & Science University, Portland, Oregon
TH 5018 NE 15 AVE · PORTLAND, OR 97211 · FAX: (503) 229-8064 · (800) 837-8428 · [email protected] · VESTIBULAR.ORG Balance and Aging By Charlotte Shupert, PhD, with contributions by Fay Horak, PhD, PT Oregon Health & Science University, Portland, Oregon One of the leading health concerns for in the feet and legs; and degeneration of people over the age of 60 is falling, which the vestibular system. is often related to balance problems. The percent of people falling increases from Balance is also dependent on muscle 40% to 65% to 82% with each decade strength, joint mobility, and healthy feet. after age 65 years. A sedentary lifestyle, painful arthritis or diseases of bones and muscles can The consequences of falls can be compromise strength, mobility, and the disastrous; between 12% and 67% of base of foot support. elderly adults who fracture a hip die Balance control also depends on healthy within one year. Even if a bone is not brain function across many brain areas. fractured during a fall, falls cause pain The brain needs to process and interpret and injury while reducing future mobility sensory information, select appropriate and quality of life. As a result, major balance strategies, and adapt and learn scientific efforts are devoted to deter- new strategies with practice. As we age, mining the causes of falling in older adults brain processing can slow down, which in an attempt to reduce this significant results in slower balance responses. health hazard. People with cognitive problems also have balance problems, showing the Causes of imbalance in older people importance of higher level brain Balance in walking and standing is processing in balance control. -
COVID-19 Vaccines: Update on Allergic Reactions, Contraindications, and Precautions
Centers for Disease Control and Prevention Center for Preparedness and Response COVID-19 Vaccines: Update on Allergic Reactions, Contraindications, and Precautions Clinician Outreach and Communication Activity (COCA) Webinar Wednesday, December 30, 2020 Continuing Education Continuing education will not be offered for this COCA Call. To Ask a Question ▪ All participants joining us today are in listen-only mode. ▪ Using the Webinar System – Click the “Q&A” button. – Type your question in the “Q&A” box. – Submit your question. ▪ The video recording of this COCA Call will be posted at https://emergency.cdc.gov/coca/calls/2020/callinfo_123020.asp and available to view on-demand a few hours after the call ends. ▪ If you are a patient, please refer your questions to your healthcare provider. ▪ For media questions, please contact CDC Media Relations at 404-639-3286, or send an email to [email protected]. Centers for Disease Control and Prevention Center for Preparedness and Response Today’s First Presenter Tom Shimabukuro, MD, MPH, MBA CAPT, U.S. Public Health Service Vaccine Safety Team Lead COVID-19 Response Centers for Disease Control and Prevention Centers for Disease Control and Prevention Center for Preparedness and Response Today’s Second Presenter Sarah Mbaeyi, MD, MPH CDR, U.S. Public Health Service Clinical Guidelines Team COVID-19 Response Centers for Disease Control and Prevention National Center for Immunization & Respiratory Diseases Anaphylaxis following mRNA COVID-19 vaccination Tom Shimabukuro, MD, MPH, MBA CDC COVID-19 Vaccine -
Common Vestibular Function Tests
Common Vestibular Function Tests Authors: Barbara Susan Robinson, PT, DPT; Lisa Heusel-Gillig PT DPT NCS Fact Sheet The purpose of Vestibular Function Tests (VFTs) is to determine the health of the vestibular portion of the inner ear. These tests are commonly performed by ENTs, Audiologists, and Otolaryngologists Electronystagmography or Videonystagmography Electronystagmography (ENG test) or Videonystagmography (VNG test) evaluate the inner ear. Both record eye movements during a group of tests in light and dark rooms. During the ENG test, small electrodes are placed on the skin near the eyes to record eye movements. For the VNG test, eye movements are recorded by a video camera mounted inside of goggles that are worn during testing. ENG and VNG tests evaluate eye movements while following a visual target (tracking Produced by test) or during body and head position changes (positional test). The caloric test evaluates eye movements in response to cool or warm air (or water) placed in the ear canal. If there is no response to warm or cool air or water, ice water may be used in order to try to produce a response. The caloric test determines the difference between the function of the left and right inner ear. During this test, you may experience dizziness or nausea. You may be asked questions (math questions, city names, alphabet tasks) to distract you in order to get the best results. A Special Interest Group of Contact us: ANPT Other Common Vestibular Function Tests 5841 Cedar Lake Rd S. The rotary chair test is used along with the VNG to confirm the diagnosis and assess Ste 204 compensation of the vestibular system. -
Vestibular Neuritis and Labyrinthitis
Vestibular Neuritis and DISORDERS Labyrinthitis: Infections of the Inner Ear By Charlotte L. Shupert, PhD with contributions from Bridget Kulick, PT and the Vestibular Disorders Association INFECTIONS Result in damage to inner ear and/or nerve. ARTICLE 079 DID THIS ARTICLE HELP YOU? SUPPORT VEDA @ VESTIBULAR.ORG Vestibular neuritis and labyrinthitis are disorders resulting from an 5018 NE 15th Ave. infection that inflames the inner ear or the nerves connecting the inner Portland, OR 97211 ear to the brain. This inflammation disrupts the transmission of sensory 1-800-837-8428 information from the ear to the brain. Vertigo, dizziness, and difficulties [email protected] with balance, vision, or hearing may result. vestibular.org Infections of the inner ear are usually viral; less commonly, the cause is bacterial. Such inner ear infections are not the same as middle ear infections, which are the type of bacterial infections common in childhood affecting the area around the eardrum. VESTIBULAR.ORG :: 079 / DISORDERS 1 INNER EAR STRUCTURE AND FUNCTION The inner ear consists of a system of fluid-filled DEFINITIONS tubes and sacs called the labyrinth. The labyrinth serves two functions: hearing and balance. Neuritis Inflamation of the nerve. The hearing function involves the cochlea, a snail- shaped tube filled with fluid and sensitive nerve Labyrinthitis Inflamation of the labyrinth. endings that transmit sound signals to the brain. Bacterial infection where The balance function involves the vestibular bacteria infect the middle organs. Fluid and hair cells in the three loop-shaped ear or the bone surrounding semicircular canals and the sac-shaped utricle and Serous the inner ear produce toxins saccule provide the brain with information about Labyrinthitis that invade the inner ear via head movement. -
Vestibular Neuritis, Labyrinthitis, and a Few Comments Regarding Sudden Sensorineural Hearing Loss Marcello Cherchi
Vestibular neuritis, labyrinthitis, and a few comments regarding sudden sensorineural hearing loss Marcello Cherchi §1: What are these diseases, how are they related, and what is their cause? §1.1: What is vestibular neuritis? Vestibular neuritis, also called vestibular neuronitis, was originally described by Margaret Ruth Dix and Charles Skinner Hallpike in 1952 (Dix and Hallpike 1952). It is currently suspected to be an inflammatory-mediated insult (damage) to the balance-related nerve (vestibular nerve) between the ear and the brain that manifests with abrupt-onset, severe dizziness that lasts days to weeks, and occasionally recurs. Although vestibular neuritis is usually regarded as a process affecting the vestibular nerve itself, damage restricted to the vestibule (balance components of the inner ear) would manifest clinically in a similar way, and might be termed “vestibulitis,” although that term is seldom applied (Izraeli, Rachmel et al. 1989). Thus, distinguishing between “vestibular neuritis” (inflammation of the vestibular nerve) and “vestibulitis” (inflammation of the balance-related components of the inner ear) would be difficult. §1.2: What is labyrinthitis? Labyrinthitis is currently suspected to be due to an inflammatory-mediated insult (damage) to both the “hearing component” (the cochlea) and the “balance component” (the semicircular canals and otolith organs) of the inner ear (labyrinth) itself. Labyrinthitis is sometimes also termed “vertigo with sudden hearing loss” (Pogson, Taylor et al. 2016, Kim, Choi et al. 2018) – and we will discuss sudden hearing loss further in a moment. Labyrinthitis usually manifests with severe dizziness (similar to vestibular neuritis) accompanied by ear symptoms on one side (typically hearing loss and tinnitus). -
Diseases of the Brainstem and Cranial Nerves of the Horse: Relevant Examination Techniques and Illustrative Video Segments
IN-DEPTH: NEUROLOGY Diseases of the Brainstem and Cranial Nerves of the Horse: Relevant Examination Techniques and Illustrative Video Segments Robert J. MacKay, BVSc (Dist), PhD, Diplomate ACVIM Author’s address: Alec P. and Louise H. Courtelis Equine Teaching Hospital, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610; e-mail: mackayr@ufl.edu. © 2011 AAEP. 1. Introduction (pons and cerebellum) and myelencephalon (me- This lecture focuses on the functions of the portions dulla oblongata). Because the diencephalon was of the brainstem caudal to the diencephalon. In discussed in the previous lecture under Forebrain addition to regulation of many of the homeostatic Diseases, it will not be covered here. mechanisms of the body, this part of the brainstem controls consciousness, pupillary diameter, eye 3. Functions (Location) movement, facial expression, balance, prehension, mastication and swallowing of food, and movement Pupillary Light Response, Pupil Size (Midbrain, Cranial and coordination of the trunk and limbs. Dysfunc- Nerves II, III) tion of the brainstem and/or cranial nerves therefore In the normal horse, pupil size reflects the balance of manifests in a great variety of ways including re- sympathetic (dilator) and parasympathetic (con- duced consciousness, ataxia, limb weakness, dys- strictor) influences on the smooth muscle of the phagia, facial paralysis, jaw weakness, nystagmus, iris.2–4 Preganglionic neurons for sympathetic and strabismus. Careful neurologic examination supply to the head arise in the gray matter of the in the field can provide accurate localization of first four thoracic segments of the spinal cord and brainstem and cranial nerve lesions. Recognition subsequently course rostrally in the cervical sympa- of brainstem/cranial nerve dysfunction is an impor- thetic nerve within the vagosympathetic trunk. -
Inner Ear Infection (Otitis Interna) in Dogs
Hurricane Harvey Client Education Kit Inner Ear Infection (Otitis Interna) in Dogs My dog has just been diagnosed with an inner ear infection. What is this? Inflammation of the inner ear is called otitis interna, and it is most often caused by an infection. The infectious agent is most commonly bacterial, although yeast and fungus can also be implicated in an inner ear infection. If your dog has ear mites in the external ear canal, this can ultimately cause a problem in the inner ear and pose a greater risk for a bacterial infection. Similarly, inner ear infections may develop if disease exists in one ear canal or when a benign polyp is growing from the middle ear. A foreign object, such as grass seed, may also set the stage for bacterial infection in the inner ear. Are some dogs more susceptible to inner ear infection? Dogs with long, heavy ears seem to be predisposed to chronic ear infections that ultimately lead to otitis interna. Spaniel breeds, such as the Cocker spaniel, and hound breeds, such as the bloodhound and basset hound, are the most commonly affected breeds. Regardless of breed, any dog with a chronic ear infection that is difficult to control may develop otitis interna if the eardrum (tympanic membrane) is damaged as it allows bacteria to migrate down into the inner ear. "Dogs with long, heavy ears seem to bepredisposed to chronic ear infections that ultimately lead to otitis interna." Excessively vigorous cleaning of an infected external ear canal can sometimes cause otitis interna. Some ear cleansers are irritating to the middle and inner ear and can cause signs of otitis interna if the eardrum is damaged and allows some of the solution to penetrate too deeply. -
Dizziness Related to Anxiety and Stress
Dizziness Related to Anxiety and Stress Author: Laura O. Morris, PT, NCS Fact Sheet Why does anxiety and stress cause me to be dizzy? Dizziness is a common symptom of anxiety stress and, and If one is experiencing anxiety, dizziness can result. On the other hand, dizziness can be anxiety producing. The vestibular system is responsible for sensing body position and movement in our surroundings. The vestibular system is made up of an inner ear on each side, specific areas of the brain, and the nerves that connect them. This system is responsible for the sense of dizziness when things go wrong. Scientists believe that the areas in the brain responsible for dizziness interact with the areas responsible for anxiety, and cause both symptoms. Produced by The dizziness that accompanies anxiety is often described as a sense of lightheadedness or wooziness. There may be a feeling of motion or spinning inside rather than in the environment. Sometimes there is a sense of swaying even though you are standing still. Environments like grocery stores, crowded malls or wide-open spaces may cause a sense of imbalance and disequilibrium. These symptoms are caused by legitimate physiologic changes within the brain. A Special Interest Group of If there is an abnormality in the vestibular system, the symptom of dizziness can be the result. If one already has a tendency toward anxiety, dizziness from the vestibular system and anxiety can interact, making symptoms worse. Often the anxiety and the dizziness must be treated together in order for improvement to be made. How does physical therapy help? Contact us: ANPT Scientists are starting to better understand how dizziness and 5841 Cedar Lake Rd S. -
Signs and Symptoms
Signs and Symptoms Some abnormal heart rhythms can happen without the person knowing it, while some may cause a feeling of the heart “racing,” lightheadedness, or dizziness. At some point in life, many adults Rapid Heartbeat – Tachycardia have had short-lived heart rhythm When the heart beats too quickly changes that are not serious. (usually above 100 beats per minute), the lower chambers, or Certain heart rhythms, especially ventricles, do not have enough time those that last long enough to af - to fill with blood, so they cannot ef - fect the heart’s function, can be fectively pump blood to the rest of serious or even deadly. the body. When this happens, some Palpitation or Skipped Beat people have symptoms such as: Although it may seem as if the Skipping a beat Slow Heartbeat – Bradycardia heart missed a beat, it has really had an early heartbeat — an extra If the heartbeat is too slow (usually Beating out of rhythm below 60 beats per minute), not beat that happens before the heart Palpitations has a chance to fill with blood. enough blood carrying oxygen Fast or racing heartbeat Therefore the squeeze is empty flows through the body. The symptoms of a slow heartbeat are: and results in a pause. Shortness of breath Fatigue (feeling tired) Fluttering Chest pain A fluttering sensation (like butter - Dizziness Dizziness flies in the chest) is usually due to Lightheadedness extra or “skipped beats” that occur Lightheadedness Fainting or near fainting one right after the other, or may be Fainting or near fainting caused by other kinds of abnormal heart rhythms. -
Cranial Nerves 1, 5, 7-12
Cranial Nerve I Olfactory Nerve Nerve fiber modality: Special sensory afferent Cranial Nerves 1, 5, 7-12 Function: Olfaction Remarkable features: – Peripheral processes act as sensory receptors (the other special sensory nerves have separate Warren L Felton III, MD receptors) Professor and Associate Chair of Clinical – Primary afferent neurons undergo continuous Activities, Department of Neurology replacement throughout life Associate Professor of Ophthalmology – Primary afferent neurons synapse with secondary neurons in the olfactory bulb without synapsing Chair, Division of Neuro-Ophthalmology first in the thalamus (as do all other sensory VCU School of Medicine neurons) – Pathways to cortical areas are entirely ipsilateral 1 2 Crania Nerve I Cranial Nerve I Clinical Testing Pathology Anosmia, hyposmia: loss of or impaired Frequently overlooked in neurologic olfaction examination – 1% of population, 50% of population >60 years Aromatic stimulus placed under each – Note: patients with bilateral anosmia often report nostril with the other nostril occluded, eg impaired taste (ageusia, hypogeusia), though coffee, cloves, or soap taste is normal when tested Note that noxious stimuli such as Dysosmia: disordered olfaction ammonia are not used due to concomitant – Parosmia: distorted olfaction stimulation of CN V – Olfactory hallucination: presence of perceived odor in the absence of odor Quantitative clinical tests are available: • Aura preceding complex partial seizures of eg, University of Pennsylvania Smell temporal lobe origin