Psychogenic dizziness

Psychogenic dizziness is one of the most common types of vertigo. To diagnose psychogenic dizziness is a complex task since it requires a thorough patient examination and exclusion of possible organic causes of dizziness. The paper describes the clinical case of a female patient with phobic postural vertigo, which demonstrates the efficiency of the early diagnosis and adequate therapy of this disease. Combination therapy for psychogenic dizziness, which encompasses different psychotherapeutic procedures, vestibular rehabilitation, and drug therapy, is most effective. Among the medications, vinpocetine is effective in treating patients with cerebrovascular disease. Inappropriate treatment may lead to the progression of psychogenic dizziness, to a considerable deterioration in quality of life, and to obvious social disadaptation. There is a worse treatment prognosis with a longer interval between of disease onset and diagnosis

Current aspects of the treatment of different types of vertigo

Dizziness is one of the most frequent complaints of patients in daily clinical practice. The prevalence of vertigo increases significantly in older patients. In most cases, vertigo is caused by pathology of the peripheral vestibular system: benign paroxysmal positional vertigo, vestibular neuronitis, Meniere’s disease. Episodes of recurrent vestibular vertigo without hearing loss can be associated with vestibular migraine, a diagnosis of which remains low in our country. Modern treatment regimens have been developed for patients with various causes of vertigo and unsteadiness. High effectiveness is achieved with a comprehensive approach to the management of patients with vertigo, which includes vestibular exercises, psychological training, and medications that help to reduce the severity and frequency of vertigo attacks and improve vestibular compensation. Many studies have shown high efficacy of the low-dose combination drug cinnarizine 20 mg + dimenhydrinate 40 mg for the treatment of peripheral and central vertigo, which is well tolerated and does not delay vestibular compensation. The efficacy of the low-dose combination drug cinnarizine + dimenhydrinate and betahistine dihydrochloride was compared in the treatment of patients with unilateral vestibular neuronitis, Meniere’s disease, and other diseases of the peripheral and central vestibular system. Studies have shown no less efficacy of the combined drug cinnarizine + dimenhydrinate in the treatment of Meniere’s disease than of betahistine, a more pronounced improvement in vestibular function in the treatment of vestibular neuronitis with the combined drug than with betahistine. For patients with peripheral vestibulopathy of various etiologies, treatment with the combination drug was more effective than therapy with betahistine

Monte Carlo renormalization group study of the Heisenberg and XY antiferromagnet on the stacked triangular lattice and the chiral ϕ4\phi^4 model

With the help of the improved Monte Carlo renormalization-group scheme, we numerically investigate the renormalization group flow of the antiferromagnetic Heisenberg and XY spin model on the stacked triangular lattice (STA-model) and its effective Hamiltonian, 2N-component chiral $\phi^4$ model which is used in the field-theoretical studies. We find that the XY-STA model with the lattice size $126\times 144 \times 126$ exhibits clear first-order behavior. We also find that the renormalization-group flow of STA model is well reproduced by the chiral $\phi^4$ model, and that there are no chiral fixed point of renormalization-group flow for N=2 and 3 cases. This result indicates that the Heisenberg-STA model also undergoes first-order transition.Comment: v1:15 pages, 15 figures v2:updated references v3:added comments on the higher order irrelevant scaling variables v4:added results of larger sizes v5:final version to appear in J.Phys.Soc.Jpn Vol.72, No.

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

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

Vitamin D and homocysteine in benign paroxysmal positional vertigo

Introduction. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. Among the possible pathophysiological concepts, the largest evidence to date has been collected on the relationship of BPPV with a lack of vitamin D. Few studies have also been published on the assessment of factors of endothelial dysfunction (and, as a result, disturbances in the microcirculation of the inner ear) and BPPV. The problems of metabolic disorders in BPPV were still poorly highlighted in Russian sources.Objective. To investigate the levels of 25-OH-vitamin D and homocysteine among patients with BPPV and compare these factors depending on recurrence.Materials and methods. The study included 53 patients with BPPV, age 60 ± 12.6 (Me 62 [55; 68]), men accounted for 24.5%, women – 75.5%. All patients underwent a study of the neurological status and neurovestibularexamination, which included the Halmagi test, the head shake test, the Fukuda test, the Dix – Hallpike and McClure – Pagnini tests. Plasma 25-OH-vitamin D and homocysteine levels were assessed using enzyme-linked immunosorbent assay. The severity of vertigo was assessed using the dizziness handicap inventory (DHI).Results. The level of 25-OH vitamin D in with BPPV varied from 5.2 to 40 ng/ml, the average value was 19.53 ± 9.07 ng/ml, which corresponds to the deficit according to international recommendations (Me 17 [13; 24.8]). The level of 25-OH vitamin D in the group with recurrent BPPV was (Me 15 [12 and 22]), which was significantly lower than in the group with a single BPPV episode. The DHI score was significantly lower in the group with recurrent BPPV. There was a negative relationship between 25-OH-vitamin D levels and age, and a negative relationship between 25-OH-vitamin D and homocysteine in the DPPV group.Conclusion. There was a decrease in the level of 25-OH-vitamin D among patients with BPPV; in the group with recurrent BPPV, the level of 25-OH-vitamin D was significantly lower than in the group with a single dose of BPPV. The presence of an inverse correlation between the level of homocysteine and 25-OH-vitamin D indicates the advisability of more detailed studies of the potential contribution of endothelial dysfunction to the development of peripheral vestibular disorders due to impaired microcirculation of the otoconial apparatus

THE STATE OF HYGIENE AND LOCAL IMMUNITY OF THE ORAL CAVITY IN PATIENTS WITH ANOREXIA NERVOSA

Aim: to study the state of local immunity and oral hygiene in patients with GP suffering from AN.Materials and methods: 35 patients with AN were examined at the age of 19-35 years. In the study we used immunological methods, an index assessment of the state of oral hygiene (PMA, API, GI).Results and discussion: in patients of I group poor oral hygiene was established. The amount of lysozyme in the oral fluid in I group was 0.014 ± 0.07 g/l. A decrease SIgA (11SIgA) was established in patients of I group: I, II and control (135.31 ± 23.17, 130.26 ± 24.21 and 300.34 ± 27.38 mg/l, respectively). A tendency to an increase in the level of IgG in the oral fluid in patients of group II compared with I and the control group (5.35 ± 0.36, vs. 4.57 ± 0.04 and 4.98 ± 0.23 g/l, respectively) was established.Conclusions: poor oral hygiene is an objective indicator which reflects low motivation to maintain oral health. The observed immunodeficiency (11SIgA) in patients with GP is a mirror image of changes occurring in the body of patients with AN.Aim: to study the state of local immunity and oral hygiene in patients with GP suffering from AN.Materials and methods: 35 patients with AN were examined at the age of 19-35 years. In the study we used immunological methods, an index assessment of the state of oral hygiene (PMA, API, GI).Results and discussion: in patients of I group poor oral hygiene was established. The amount of lysozyme in the oral fluid in I group was 0.014 ± 0.07 g/l. A decrease SIgA (11SIgA) was established in patients of I group: I, II and control (135.31 ± 23.17, 130.26 ± 24.21 and 300.34 ± 27.38 mg/l, respectively). A tendency to an increase in the level of IgG in the oral fluid in patients of group II compared with I and the control group (5.35 ± 0.36, vs. 4.57 ± 0.04 and 4.98 ± 0.23 g/l, respectively) was established.Conclusions: poor oral hygiene is an objective indicator which reflects low motivation to maintain oral health. The observed immunodeficiency (11SIgA) in patients with GP is a mirror image of changes occurring in the body of patients with AN

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

The critical behavior of frustrated spin models with noncollinear order

We study the critical behavior of frustrated spin models with noncollinear order, including stacked triangular antiferromagnets and helimagnets. For this purpose we compute the field-theoretic expansions at fixed dimension to six loops and determine their large-order behavior. For the physically relevant cases of two and three components, we show the existence of a new stable fixed point that corresponds to the conjectured chiral universality class. This contradicts previous three-loop field-theoretical results but is in agreement with experiments.Comment: 4 pages, RevTe

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