A specialized approach to diagnosing and treating vertigo

Vertigo is one of the most common reasons for visits to physicians of different specialties. Thorough collection of history data and neurovestibular examination by a set of simple clinical tests are of great importance for the diagnosis of diseases of the vestibular system. The paper gives an update on the principles of diagnosis of different forms of vertigo, diagnostic errors, and treatment of major diseases manifesting by vertigo. The authors present their own data concerning the diagnosis and treatment of the most common vestibular disorders, such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuronitis, and postural phobic instability. They also describe a clinical case of a female patient with vestibular neuronitis, in whom a specialized examination (neurovestibular examination, videonystagmography, and caloric testing) could identify right labyrinthine hypofunction that could not be detected prior to the examination in the clinic

Major diseases manifesting by vestibular vertigo: Treatment and rehabilitation

Betahistine hydrochloride is the drug of choice for the treatment of vestibular vertigo in the presence of benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuronitis. Effective combination therapy regimens that contain, along with drugs from other pharmacological groups, betahistine hydrochloride that improves blood circulation in the vestibular structures, accelerates vestibular compensation, and prevents recurrent dizzy spells, have been elaborated to treat central vestibular vertigo in migraine-associated dizziness and in acute cerebrovascular accident. Of great importance is a combination of drug therapy and the current rehabilitation methods for vestibular diseases, which contribute to prompter and complete recovery of vestibular function. Biofeedback instrumental rehabilitation techniques using a stabilographic platformare highly effective. Successful treatment depends on the correctness of the established diagnosis. The diagnosis of peripheral and central vestibular vertigo frequently poses challenges. The essential reason for this is physicians’ unawareness about outpatient methods for the diagnosis of major vestibular diseases when the patient is at a doctor. It is important to follow a vestibular system study protocol since the use and correct assessment of diagnostic tests in most cases make it possible to estimate the degree of vestibular analyzer injury and to make an accurate diagnosis. The paper describes the diseases that are the most common causes of vestibular vertigo. The most effective methods for their treatment and current rehabilitation methods are discussed

Thermoelectric performance of weakly coupled granular materials

We study thermoelectric properties of inhomogeneous nanogranular materials for weak tunneling conductance between the grains, g_t < 1. We calculate the thermopower and figure of merit taking into account the shift of the chemical potential and the asymmetry of the density of states in the vicinity of the Fermi surface. We show that the weak coupling between the grains leads to a high thermopower and low thermal conductivity resulting in relatively high values of the figure of merit on the order of one. We estimate the temperature at which the figure of merit has its maximum value for two- and three-dimensional samples. Our results are applicable for many emerging materials, including artificially self-assembled nanoparticle arrays.Comment: 4 pages, 3 figure

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

ALMA sub-mm maser and dust distribution of VY Canis Majoris

Cool, evolved stars have copious, enriched winds. The structure of these winds and the way they are accelerated is not well known. We need to improve our understanding by studying the dynamics from the pulsating stellar surface to about 10 stellar radii, where radiation pressure on dust is fully effective. Some red supergiants have highly asymmetric nebulae, implicating additional forces. We retrieved ALMA Science Verification data providing images of sub-mm line and continuum emission from VY CMa. This enables us to locate water masers with milli-arcsec precision and resolve the dusty continuum. The 658-, 321- and 325-GHz masers lie in irregular, thick shells at increasing distances from the centre of expansion. For the first time this is confirmed as the stellar position, coinciding with a compact peak offset to the NW of the brightest continuum emission. The maser shells (and dust formation zone) overlap but avoid each other on tens-au scales. Their distribution is broadly consistent with excitation models but the conditions and kinematics appear to be complicated by wind collisions, clumping and asymmetries.Comment: Letter 4 pages, 5 figures plus appendix with 3 figures. Accepted by Astronomy and Astrophysics Letter

Common Causes of Vertigo and Dizziness in Different Age Groups of Patients

© 2016, Springer Science+Business Media New York.Dizziness and vertigo are among the most common symptoms occurring in clinical practice. However, the data on the main causes of dizziness and vertigo remain contradictory. We have analyzed the causes of dizziness in 590 outpatients who were referred to the neurologist. The most common causes of vertigo and dizziness in outpatient practice were benign paroxysmal positional vertigo (BPPV) (33.9 %), phobic postural vertigo (PPV) (21.4 %), Ménière’s disease/delayed endolymphatic hydrops (20 %), vestibular neuronitis/labyrinthitis (8.1 %), and vestibular migraine (4.1 %). Stroke as a cause of vertigo or dizziness was diagnosed only in 0.8 % of patients. Peripheral vestibular disorders were the most frequent cause of vertigo and dizziness in all age groups of patients: in patients younger than 45 years they were diagnosed in 57 % and in patients older than 60 years in 63.3 % of cases. PPV was the second most common cause of dizziness in patients younger than 45 years (37.4 %) but was established only in 7.6 % of patients older than 60 years. Most of the causes of vertigo and dizziness can be reliably diagnosed with bedside examination while laboratory investigation can be considered as an important but complementary entity