Dizziness and prevention of falls in the elderly

Disequilibrium is one of the most common complaints that older adults bring to their physician and falling is a frequent complication; because of the increasing number of elderly patients in western society the problem grows. The increasing susceptibility to falling can be consequence of age-related physiological changes and of a higher prevalence of comorbidities causing dizziness, vertigo and imbalance; these symptoms can worse the already poor balance of old adults increasing the risk of falling. Among the major reasons of vertigo and dizziness, central vertigo and orthostatic vertigo are very common; also vestibular disorders have a great role and are currently thought to account for 48% of dizziness reported by older adults. An early identification of the treatable condition underlying dizziness in elderly would surely ameliorate the outcome of these patients

Corrigendum: Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects

[This corrects the article DOI: 10.3389/fneur.2018.00395.]

Dizziness and prevention of falls in the elderly

Disequilibrium is one of the most common complaints that older adults bring to their physician and falling is a frequent complication; because of the increasing number of elderly patients in western society the problem grows. The increasing susceptibility to falling can be consequence of age-related physiological changes and of a higher prevalence of comorbidities causing dizziness, vertigo and imbalance; these symptoms can worse the already poor balance of old adults increasing the risk of falling. Among the major reasons of vertigo and dizziness, central vertigo and orthostatic vertigo are very common; also vestibular disorders have a great role and are currently thought to account for 48% of dizziness reported by older adults. An early identification of the treatable condition underlying dizziness in elderly would surely ameliorate the outcome of these patients

Update on the treatment of benign positional paroxysmal vertigo of the horizontal semi-circular canal

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is considered the most frequent vertigo in clinical practice, it can affect all ages, although in advanced age it can be underdiagnosed, and the fifth and sixth decade is the most affected age group. As the posterior one, lateral canalolithiasis is also susceptible to physical therapy, with maneuvers already proposed in the Guidelines for years and generally considered effective, also in the light of randomized double-blind studies. The maneuvers proposed in the 2017 guidelines, and other maneuvers proposed more recently, are taken into consideration and their effectiveness is evaluated according to what is reported in the literature. Since the results are very variable, an extensive personal review is reported regarding the Gufoni maneuver. METHODS: A total of 1008 cases of paroxysmal positional vertigo of the horizontal canal (HC), diagnosed by the Pagnini-McClure maneuver, have come to our attention in the last 20 years, both in geotropic and apogeotropic form. RESUlTS: In 347 patients with HC-VPPB the maneuver was effective in 91.2 per cent of cases in the geotropic form and in 83.5 per cent of cases in the apogeotropic form. CONClUSIONS: As with posterior canal BPPV, there are effective, well-tolerated treatments available for lateral canal BPPV, with very few side effects, which resolve the condition in most cases

Acute unilateral vestibulopathy: a practical diagnostic approach and new insight on management

Acute unilateral vestibulopathy (AUV) is the recommended term (rather than the more widely used vestibular neuritis) for all pathologies involving sudden impairment of the unilateral peripheral vestibular function regardless of the exact location of the lesion. The clinical picture of AUV is characterized by acute severe rotatory vertigo, nausea, vomiting and static and dynamic postural instability. The diagnosis is based on the presence of spontaneous nystagmus (horizontal/torsional, unidirectional), gait imbalance (falling toward the side of lesion) and a positive Head Impulse Test. Typically, no associated auditory or neurological symptoms and signs are present. AUV is thought to be caused by a viral or post-viral inflammation of the vestibular nerve (vestibular neuritis), but a vascular origin of the disease cannot be excluded, especially in presence of several vascular risk factors. A careful bedside examination and a complete battery of instrumental test (video Head Impulse Test, cervical and ocular VEMPs) could provide accurate information for a correct AUV diagnosis, both in the acute and the chronic stage of the disease, also allowing to exclude a possible central nervous system involvement (vertebrobasilar stroke syndromes may mimic peripheral disorders). After a short course of symptomatic treatment with vestibular suppressants to alleviate the patient’s neuro-vegetative symptoms and intense rotatory vertigo, vestibular rehabilitation is the treatment of choice, although recent reports suggest that an early steroidal treatment may improve long-term outcome. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed