Dizziness & Balance Problems
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How Does the Balance System Work?
How Does the Balance System Work? Author: Shannon L.G. Hoffman, PT, DPt Sara MacDowell PT, DPT Fact Sheet Many systems work together to help you keep your balance. The goal is to keep your body and vision stable Peripheral Sensory Systems: 1) Vision: Your vision helps you see where your head and body are in rela- tion to the world around you. 2) Somatosensory/Proprioception: We use the feeling from our feet against the ground as well as special sensors in our joints to know where our feet and legs are positioned. It also tells how your head is oriented to your neck and shoulders. Produced by 3) Vestibular system: Balance organs in the inner ear tell the brain about the movements and position of your head. There are 3 canals in each ear that sense when you move your head and help keep your vision clear. Central Processing: Information from these 3 systems is sent to the brain for processing. The brain stem also gets information from other parts of the brain called the cerebellum and cerebral cortex, mostly about past experiences that have A Special Interest affected your sense of balance. Your brain can control balance by using Group of the information that is most important for a certain situation. For example, in the dark, when you can’t use your vision, your brain will use more information from your legs and feet and your inner ear. If you are walking on a sandy beach during the day, you can’t trust your feet on the ground and your brain will use your eyes and inner ear more. -
Chemoreception
Senses 5 SENSES live version • discussion • edit lesson • comment • report an error enses are the physiological methods of perception. The senses and their operation, classification, Sand theory are overlapping topics studied by a variety of fields. Sense is a faculty by which outside stimuli are perceived. We experience reality through our senses. A sense is a faculty by which outside stimuli are perceived. Many neurologists disagree about how many senses there actually are due to a broad interpretation of the definition of a sense. Our senses are split into two different groups. Our Exteroceptors detect stimulation from the outsides of our body. For example smell,taste,and equilibrium. The Interoceptors receive stimulation from the inside of our bodies. For instance, blood pressure dropping, changes in the gluclose and Ph levels. Children are generally taught that there are five senses (sight, hearing, touch, smell, taste). However, it is generally agreed that there are at least seven different senses in humans, and a minimum of two more observed in other organisms. Sense can also differ from one person to the next. Take taste for an example, what may taste great to me will taste awful to someone else. This all has to do with how our brains interpret the stimuli that is given. Chemoreception The senses of Gustation (taste) and Olfaction (smell) fall under the category of Chemoreception. Specialized cells act as receptors for certain chemical compounds. As these compounds react with the receptors, an impulse is sent to the brain and is registered as a certain taste or smell. Gustation and Olfaction are chemical senses because the receptors they contain are sensitive to the molecules in the food we eat, along with the air we breath. -
Fullness, and Tinni- Tus
Neurology® Clinical Practice The evaluation of a patient with dizziness Kevin A. Kerber, MD Robert W. Baloh, MD Summary Dizziness is the quintessential symptom presenta- tion in all of clinical medicine. It can stem from a disturbance in nearly any system of the body. Pa- tient descriptions of the symptom are often vague and inconsistent, so careful probing is essential. The physical examination is performed by observ- ing the patient at rest and following simple move- ments or bedside tests. In general, no special tools are required. The causes of dizziness range from benign to life-threatening disorders, and features that distinguish among these may be subtle. When diagnostic testing is considered, parsimony should be the rule. Identifying common peripheral vestibu- lar disorders is a priority. Picking this “low hanging fruit” can be the key component to excluding more serious central causes of dizziness. eurologists play an important role in the evaluation and management of pa- tients with dizziness. The possibility of a serious neurologic disorder is un- Nnerving to front-line physicians who have ranked decision support for identifying central causes of vertigo as a top priority.1 Although dangerous cen- tral disorders do not commonly present as isolated dizziness, stroke and other neurologic disorders can occur in this manner. The history and physical examination are the critical elements in determining the management of these patients. In this article, we review the approach to the evaluation and management of patients with dizziness. History The first step in assessing a patient presenting with dizziness is to define the symptom (table 1). -
Vertebral Artery Dissection Presenting As Transient Global Amnesia: a Case Report and Review of Literature
Dementia and Neurocognitive Disorders 2014; 13: 46-49 CASE REPORT http://dx.doi.org/10.12779/dnd.2014.13.2.46 Vertebral Artery Dissection Presenting as Transient Global Amnesia: A Case Report and Review of Literature , Yeonsil Moon*, Seol-Heui Han* † Vertebral artery dissection is one of the most common causes of stroke in young adults. The course of the vertebral artery dissection is usually benign, and pure transient amnesia as an initial symptom has Department of Neurology*, Konkuk University Medical Center, Seoul; Center for Geriatric been rarely reported. We describe a patient with vertebral artery dissection who presented with acute Neuroscience Research, Institute of transient amnesia, and review the medical literatures about the pathophysiological mechanism of tran- Biomedical Science†, Konkuk University, sient global amenesia (TGA). This case could be a one of evidence which supports the cerebrovascular Seoul, Korea mechanism of TGA. Received: May 19, 2014 Revision received: June 26, 2014 Accepted: June 26, 2014 Address for correspondence Seol-Heui Han, M.D. Department of Neurology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea Tel: +82-2-2030-7561 Fax: +82-2-2030-7469 E-mail: [email protected] Key Words: Transient global amnesia, Vertebral artery dissection, Cerebrovascular Vertebral artery dissection is one of the most common longed cognitive decline and review the medical literatures causes of stroke in young adults [1]. The course of the verte- about the pathophysiological mechanism of transient global bral artery dissection is usually benign, but seldom reaches to amenesia (TGA). severe complication, such as brainstem infarction, subarach- noid hemorrhage (SAH) or death [2]. -
Second Edition
COVID-19 Evidence Update COVID-19 Update from SAHMRI, Health Translation SA and the Commission on Excellence and Innovation in Health Updated 4 May 2020 – 2nd Edition “What is the prevalence, positive predictive value, negative predictive value, sensitivity and specificity of anosmia in the diagnosis of COVID-19?” Executive Summary There is widespread reporting of a potential link between anosmia (loss of smell) and ageusia (loss of taste) and SARS-COV-2 infection, as an early sign and with sudden onset predominantly without nasal obstruction. There are calls for anosmia and ageusia to be recognised as symptoms for COVID-19. Since the 1st edition of this briefing (25 March 2020), there has been a significant expansion of literature on this topic, including 3 systematic reviews. Predictive value: The reported prevalence of anosmia/hyposmia and ageusia/hypogeusia in SARS-COV-2 positive patients are in the order of 36-68% and 33-71% respectively. There are reports of anosmia as the first symptom in some patients. Estimates from one study for hyposmia and hypogeusia: • Positive likelihood ratios: 4.5 and 5.8 • Sensitivity: 46% and 62% • Specificity: 90% and 89% The US Centres for Disease Control and Prevention (CDC) has added new loss or taste or smell to its list of recognised symptoms for SARS-COV-2 infection. To date, the World Health Organization has not. Conclusion: There is sufficient evidence to warrant adding loss of taste and smell to the list of symptoms for COVID-19 and promoting this information to the public. Context • Early detection of COVID-19 is key to the ongoing management of the pandemic. -
Migraine Associated Vertigo
Headache: The Journal of Head and Face Pain VC 2015 American Headache Society Published by JohnWiley & Sons, Inc. doi: 10.1111/head.12704 Headache Toolbox Migraine Associated Vertigo Between 30 and 50% of migraineurs will sometimes times a condition similar to benign positional vertigo experience dizziness, a sense of spinning, or feeling like called vestibular neuronitis (or vestibular neuritis/labyrinthi- their balance is off in the midst of their headaches. This is tis) is triggered by a viral infection of the inner ear, result- now termed vestibular migraine, but is also called ing in constant vertigo or unsteadiness. Symptoms can migraine associated vertigo. Sometimes migraineurs last for a few days to a few weeks and then go away as experience these symptoms before the headache, but mysteriously as they came on. Vestibular migraine, by they can occur during the headache, or even without any definition, should have migraine symptoms in at least head pain. In children, vertigo may be a precursor to 50% of the vertigo episodes, and these include head migraines developing in the teens or adulthood. Migraine pain, light and noise sensitivity, and nausea. associated vertigo may be more common in those with There are red flags, which are warning signs that ver- motion sickness. tigo is not part of a migraine. Sudden hearing loss can be For some patients this vertiginous sensation resem- the sign of an infection that needs treatment. Loss of bal- bles migraine aura, which is a reversible, relatively short- ance alone, or accompanied by weakness can be the lived neurologic symptom associated with their migraines. -
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 -
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). -
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. -
Hearing Loss, Vertigo and Tinnitus
HEARING LOSS, VERTIGO AND TINNITUS Jonathan Lara, DO April 29, 2012 Hearing Loss Facts S Men are more likely to experience hearing loss than women. S Approximately 17 percent (36 million) of American adults report some degree of hearing loss. S About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. S Nine out of every 10 children who are born deaf are born to parents who can hear. Hearing Loss Facts S The NIDCD estimates that approximately 15 percent (26 million) of Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities. S Only 1 out of 5 people who could benefit from a hearing aid actually wears one. S Three out of 4 children experience ear infection (otitis media) by the time they are 3 years old. Hearing Loss Facts S There is a strong relationship between age and reported hearing loss: 18 percent of American adults 45-64 years old, 30 percent of adults 65-74 years old, and 47 percent of adults 75 years old or older have a hearing impairment. S Roughly 25 million Americans have experienced tinnitus. S Approximately 4,000 new cases of sudden deafness occur each year in the United States. Hearing Loss Facts S Approximately 615,000 individuals have been diagnosed with Ménière's disease in the United States. Another 45,500 are newly diagnosed each year. S One out of every 100,000 individuals per year develops an acoustic neurinoma (vestibular schwannoma). -
Benign Paroxysmal Positional Vertigo (BPPV)
Patient Information Patient Information Benign Paroxysmal Positional Vertigo (BPPV) BPPV causes spinning dizziness (‘vertigo’) due to crystals in the inner ear breaking loose. The crystals are normally embedded in a jelly and when we move forwards and backwards, or up and down, in space they send our brain messages about where we are. If they become loose they can find their way into the wrong area and cause the sensation that we are moving when we are actually not – the result is a sudden feeling of spinning, usually set off by turning your head. What causes BPPV? Perhaps half of all cases of BPPV are "idiopathic" – they occur for no known reason. The most common identified cause of BPPV in people under fifty is a previous head injury. In older people the most common cause is ‘wear and tear’ of the vestibular (balance) system of the inner ear. Some people have a history of previous inner ear inflammation with a period of severe, prolonged dizziness. Diagnosing BPPV The diagnosis is made based on history, physical examination and sometimes with hearing or balance testing. Other diagnostic tests may be required: for example, a CT or MRI may be required for cases that don't fit the usual pattern. It is possible to have BPPV in both ears, which may make the diagnosis and treatment more challenging. How is BPPV Treated? BPPV is often described as ‘self-limiting’ because symptoms often subside or disappear without any medical treatment. Symptoms tend to wax and wane. Physical manoeuvres and exercises are very effective in stopping your symptoms, and are the main basis of treatment.