Diagnosis and treatment of dizziness in outpatient practice

Objective: to study the causes of dizziness and instability in patients during an outpatient specialized appointment and to analyze and improve typical management tactics for these patients. Patients and methods. In 2009 to 2014, neurologists, dizziness specialists, examined 300 patients (122 men and 178 women) aged 18 to 85 years, who complained of dizziness and instability. Prior to the examination, the patients had been diagnosed as having dyscirculatory encephalopathy (46%), vertebrobasilar insufficiency (30%), cervical osteochondrosis (12%), and vegetative dystonia (7%). Results and discussion. The examination established the causes of dizziness: benign paroxysmal positional vertigo (BPPV) (34%), phobic postural instability (22%), multiple sensory insufficiency (15%), Meniere's disease (7%), migraine-associated vertigo (5%), vestibular neuronitis (4%), acute cerebrovascular accident (4%), and other diseases (9%). In accordance with the established diagnosis, adequate treatment which could completely eliminate or substantially reduce the magnitude of dizziness in the majority of cases was performed. The paper describes two clinical cases (BPPV and Meniere's disease). Betahistine dihydrochloride (vesticap, betaserc) were most commonly used in a dose of 48 mg/day to treat vestibular vertigo. It gives the results of comparative treatment (with vesticap or betaserc) for vestibular vertigo in 62 patients. The authors note the low level of diagnosis and effective treatment in patients with dizziness in outpatient practice. They show the expediency of a specialized examination, the efficiency and safety of current treatments, including medication therapy with betahistine dihydrochloride (betaserc and vesticap) and rehabilitation on a stabiligraphic platform with biofeedback, for vestibular vertigo

Institutional tool of financial policy : contractual policy

Under the market conditions, the most important role in economic subject belongs to the financial aspect – therefore, effective decisions at the micro-level are predetermined by financial policy, as realization of the strategy in the tactics of finances management is not possible if there’s none. Finances of economic subject are a component of the financial system of the Russian Federation. Together with the state financial policy, which is aimed at overcoming of consequences of the global financial crisis, there is financial policy of separate economic subjects and corporate structures. For the purpose of study of financial policy, the authors deem it expedient to clarify the definition of “policy”. According to M. Weber, policy is “striving for participation in authority or influencing the distribution of authority, be it between states or within a state between groups of people”.peer-reviewe

Use of betahistine medications for vertigo

A post-registration, open randomized comparative trial of clinical efficacy and safety of betahistine medications Vestikap and Betaserc in patients with vestibular vertigo was carried out. 62 patients met the inclusion criteria and were included in the observation: 17 men and 45 women, mean age 47 ± 13,1 years. The treatment regimen was completed by all 62 patients. Administration of either medication was associated with a significant clinical benefit reflected in vertigo reduction by the vertigo severity scale and improved quality of life by the Dizziness Handicap Inventory. No significant differences were revealed in the efficacy, tolerability or safety of treatment with Vestikap compared with Betaserc

Benign paroxysmal positional vertigo in outpatient practice: Diagnosis and treatment

Dizziness is one of the common reasons for visits to physicians of various specialties; the data of foreign investigations show that benign paroxysmal positional vertigo (BPPV) is most frequently encountered.Objective: to study the causes of dizziness, to analyze the frequency of BPPV and the efficiency of its treatment in outpatient practice.Patients and methods. The investigation enrolled 80 patients, including 55 (68.7%) women and 25 (31.3%) men, aged 18 to 75 years (mean age 53.8±12.8 years), who complained of dizziness and sought for medical advice in the Therapeutic-and-Diagnostic Unit, A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University.Results. The most common causes of dizziness in outpatient practice were BPPV (46.2%) and postural phobic vertigo (35%). The diagnosis of VPPV, if special positional testing (Dix-Hallpike and McClure-Pagnini tests) was carried out, was shown to create no significant difficulties. The diagnosis was not established in the majority (97.5%) of the patients; effective treatment was performed in one of the patients. Combined treatment, by performing the positional tests and using betaserc for 2 months, led to complete resolution of positional vertigo in most (97.3%) patients.Discussion. The findings indicate the efficiency of examining patients with complaints of dizziness, by using the special otoneurological tests to detect BPPV. The purposeful questioning of patients with BPPV can suspect this disease in the majority of cases. Our investigation shows the high efficiency of rehabilitation maneuvers for BPPV, which agrees well with the data of other authors. Physicians’ poor awareness of BPPV among physicians and the high efficiency of its treatment in outpatient practice are noted