Benign Paroxysmal Positional Vertigo after an episode of cerebral circulatory disorder consequent to neurosurgical treatment – case study

Introduction. Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It is described as short episodes of dizziness in trigger positions. They can be caused by many other disorders. In most cases, however, the etiology remains unknown. Aim. The paper presents the course of the disease and repositioning maneuvers in a female patient with cerebral circulation disorder after brain surgery. Material and methods. The work shows a case of a patient with numerous neurological disorders where BPPV has significantly intensified the already existing balance disorder. Results. The discovered BPPV was found to be multiple canal and unilateral; posterior and horizontal canals on the left side were affected. Performing TRV diagnostic and Epley maneuvers on the left side during the first visit caused displacement of otoliths to the superior canal. The treatment of this complication required performing positioning maneuver for the superior canal on the left side. The treatment resulted in balance control improvement. Conclusions. Disorders which co-existing cerebral circulation disorders and those imposing a long-lasting lying position as well as may be risk factors in BPPV symptoms.Wprowadzenie. Łagodne napadowe położeniowe zawroty głowy (BPPV) są najczęstszą przyczyną zawrotów głowy pochodzenia obwodowego. Charakteryzują się one krótkotrwałymi epizodami napadów zawrotów głowy, wyzwalanymi w tzw. pozycjach krytycznych. Mogą występować wtórnie do różnych stanów chorobowych. Jednak w większości przypadków etiologia zaburzeń pozostaje nieznana. Cel pracy. Opis przebiegu choroby i manewrów repozycyjnych u pacjentki z zaburzeniami krążenia mózgowego po przebytym leczeniu operacyjnym mózgu. Materiał i metody. W pracy opisano przypadek pacjentki z licznymi obciążeniami neurologicznymi, u której wystąpienie BPPV znacznie nasiliło już istniejące zaburzenia równowagi. Wyniki. Rozpoznane BPPV miało charakter wielokanałowy i jednostronny; zajęte były kanały półkoliste tylny i boczny po stronie lewej. Po wykonaniu na fotelu TRV manewrów diagnostycznych i manewru repozycyjnego Eplay’a po stronie lewej w trakcie pierwszorazowej wizyty doszło do przemieszczenia otolitów do przedniego kanału półkolistego lewego. Powikłanie to wymagało wykonania manewru repozycyjnego dodatkowo dla przedniego kanału półkolistego lewego. Po tym manewrze uzyskano znaczną poprawę stanu równowagi. Wnioski. Stany chorobowe przebiegające z zaburzeniami krą- żenia mózgowego oraz wymagające długotrwałego unieruchomienia mogą być czynnikiem ryzyka wystąpienia objawów BPPV

Vertigo and balance disorders as initial symptom of pulmonary embolism

Pulmonary embolism is a condition in cardiology, constituting direct threat to life, often difficult diagnostically, with an unpredictable process. It is characterized by wide spectrum of symptoms, from slightly flagged fatigue, cough, discreet pain in the chest in a poorly symptomatic form of no massive disease, to severe dyspnoe, symptoms of shock, through to a sudden stop of blood circulation. In the article, two cases are presented of patients who were admitted to the Otolaryngology Department because of vertigo accompanied by nystagmus as the only symptoms of systemic disorders. During hospitalization the D-dimer level was significantly in excess of the accepted norm, which directed a further course of diagnostic and therapeutic procedures. The authors have paid attention to the very differentiated disease etiology and the most common risk factors. They described the subsequent stages of the diagnostic process from otoneurological, audiological to internal and radiological examinations. They presented recommended methods of treatment and have stressed the necessity of long-term and meticulous follow-up in order to prevent recurrence of the disease.Zatorowość płucna jest stanem kardiologicznym, stanowiącym bezpośrednie zagrożenie życia, często trudnym diagnostycznie, o nieprzewidywalnym przebiegu. Charakteryzuje się szerokim panelem objawów – od słabo zaznaczonej męczliwości, kaszlu, dyskretnych dolegliwości bólowych w klatce piersiowej w ubogosymptomatycznej postaci choroby, po nasiloną duszność, objawy wstrząsu, aż do nagłego zatrzymania krążenia. W pracy przedstawiono dwa przypadki pacjentek przyjętych do Kliniki Laryngologii w trybie nagłym z powodu zawrotów głowy z towarzyszącym oczopląsem jako jedynym objawem zaburzeń ogólnoustrojowych. W trakcie hospitalizacji stwierdzono znacznie przekraczający przyjętą normę poziom D-dimerów, co ukierunkowało dalszy tok postępowania diagnostycznego i terapeutycznego. Autorzy pracy zwrócili też uwagę na bardzo zróżnicowaną etiologię choroby i najczęstsze czynniki ryzyka. Opisali kolejne etapy procesu diagnostycznego od oceny laryngologicznej, otoneurologicznej i audiologicznej po badania internistyczne i obrazowe. Przedstawili zalecane metody postępowania leczniczego. Podkreślili konieczność prowadzenia w celu zapobiegania nawrotom choroby, długotrwałej i skrupulatnej katamnezy

The Impact of the Angular Head Movement’s Velocity during Diagnostic Maneuvers on Proper Benign Positional Paroxysmal Vertigo Diagnosis and Therapy

Based on the current state of the BPPV field, there are no guidelines that specify an angular head movement’s velocity (AHMV) during diagnostic maneuvers of BPPV. The aim of this study was to evaluate the impact of AHMV during diagnostic maneuvers on proper BPPV diagnosis and therapy. The analysis covered the results obtained in 91 patients with a positive result of the Dix-Hallpike (D-H) maneuver or the roll test. The patients were divided into four groups based on values of AHMV (high 100–200°/s and low 40–70°/s) and the BPPV type (posterior: PC-BPPV or horizontal: HC-BPPV). The parameters of the obtained nystagmuses were analyzed and compared to AHMV. There was a significant negative correlation between AHMV and latency of nystagmus in all study groups. Furthermore, there was a significant positive correlation between AHMV and both maximum slow phase velocity and average frequency of nystagmus in the PC-BPPV groups, whereas it was not observed in the HC-BPPV patients. Complete relief of symptoms was reported after 2 weeks and was better in patients diagnosed with maneuvers performed with high AHMV. High AHMV during the D-H maneuver allows the nystagmus to be more visible, increasing the sensitivity of diagnostic tests and is crucial for a proper diagnosis and therapy

The role of tumor-derived exosomes in tumor angiogenesis and tumor progression

Exosomes, belonging to the group of extracellular bodies, are released by healthy as well as cancerous cells and serve as a communication pathway. Tumor-derived exosomes (TEX) possess the capacity to reprogram the function of normal cells owing to their genetic and molecular cargo. Such exosomes target endothelial cells (among others) in the tumor microenvironment to promote angiogenesis. Blood supply is essential in solid tumor growth and metastasis. The potential of pro-angiogenic changes is enhanced by an increased amount of circulating tumor-derived exosomes in the body fluids of cancer patients. A vascular network is important, since the proliferation, as well as the metastatic spread of cancer cells depends on an adequate supply of oxygen and nutrients, and the removal of waste products. New blood vessels and lymphatic vessels are formed through processes called angiogenesis and lymphangiogenesis, respectively. Angiogenesis is regulated by both activator and inhibitor molecules. Thousands of patients have received anti-angiogenic therapy to date. Despite their theoretical efficacy, anti-angiogenic treatments have not proved beneficial in terms of long-term survival. Tumor-derived exosomes carrying pro-angiogenic factors might be a target for new anti-cancer therapy

HMGB1 Carried by Small Extracellular Vesicles Potentially Plays a Role in Promoting Acquired Middle Ear Cholesteatoma

Cholesteatoma is a specific medical condition involving the abnormal, non-cancerous growth of skin-like tissue in the middle ear, potentially leading to a collection of debris and even infections. The receptor for advanced glycation (RAGE) and its ligand, high-mobility box 1 (HMGB1), are both known to be overexpressed in cholesteatoma and play a potential role in the pathogenesis of the disease. In this study, we investigated the role of small extracellular vesicles (sEVs) in carrying HMGB1 and inducing disease-promoting effects in cholesteatoma. No significant differences in the concentration of isolated sEVs in the plasma of cholesteatoma patients (n = 17) and controls (n = 22) were found (p > 0.05); however, cholesteatoma-derived sEVs carried significantly higher levels of HMGB1 (p p < 0.05), potentially by engaging multiple activation pathways including MAPKp44/p42, STAT3, and the NF-κB pathway. Thus, HMGB1(+) sEVs emerge as a novel factor potentially promoting cholesteatoma progression

Treatment Results of Endoscopic Transnasal Orbital Decompression for Graves’ Orbitopathy—A Single-Center Retrospective Analysis in 28 Orbits of 16 Patients

Graves’ orbitopathy (GO) is an extrathyroidal manifestation of Graves’ disease (GD), which can be associated with corneal ulcerations or optic neuropathy in severe forms. Transnasal endoscopic orbital decompression (TEOD) is a surgical procedure performed in order to decrease the intraorbital pressure by removing part of its bony borders in cases with excessive mass in orbit. The aim of this study was to present the results and evaluate the efficacy of TEOD for GO. The retrospective study included 28 orbits (16 patients) who underwent TEOD from 2017 to 2020. Outcome was evaluated based on visual acuity improvement, clinical activity score (CAS) decrease, proptosis, and intraocular pressure (IOP) reduction. A preoperative best-corrected visual acuity (BCVA) increased from 0.69 ± 0.385 (mean ± standard deviation) to 0.74 ± 0.332 (p = 0.17) postoperatively. CAS decreased in 15 orbits postoperatively. Proptosis decreased from 22.89 ± 1.873 mm to 21.25 ± 2.053 mm (p p < 0.05) postoperatively. In addition, postoperative relief of exposure keratitis was observed. The analysis of development of iatrogenic diplopia revealed increasing in degree of diplopia. TEOD shows rare complications, but significant improvements in BCVA, CAS, proptosis, and IOP

RAGE and HMGB1 Expression in Orbital Tissue Microenvironment in Graves’ Ophthalmopathy

Graves’ ophthalmopathy (GO) is a chronic autoimmune inflammatory disorder involving orbital tissues. A receptor for advanced glycation end products (RAGE) and its ligand high mobility group box 1 (HMGB1) protein trigger inflammation and cell proliferation and are involved in the pathogenesis of various chronic inflammatory diseases. This study was aimed to evaluate RAGE and HMGB1 expression in GO to determine its potential clinical significance. To the best of our knowledge, this is the first study showing RAGE and HMGB1 expression in orbital tissue using immunohistochemistry. Sections of orbital adipose tissue obtained from patients diagnosed with GO (23 patients; 36 orbits) and normal controls (NC) (15 patients; 15 orbits) were analyzed by immunohistochemistry for RAGE and HMGB1 expression. Expression profiles were then correlated with clinical data of the study group. RAGE and HMGB1 expression were elevated in GO patients in comparison with NC (p=0.001 and p=0.02, respectively). We observed a correlation between RAGE expression and occurrence of dysthyroid optic neuropathy (DON) (p=0.05) and levels of TSH Receptor Antibodies (TRAb) (p=0.01). Overexpression of RAGE and HMGB1 might be associated with GO pathogenesis. In addition, RAGE and HMGB1 proteins may be considered as promising therapeutic targets, but this requires further research