PURPOSE: Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, can be treated with a simple repositioning maneuver. But there are few reports about the underlying mechanism of this problem or about prognostic factors for recurrent BPPV, which is frequently encountered after symptoms have subsided. Among reported prognostic factors in BPPV, repositioning timing in the treatment of BPPV has been considered by some physicians to be an important one, especially for recurrence. Our study was done to demonstrate, in patients with BPPV, the effect of early repositioning therapy on disease recurrence. METHODS: We enrolled consecutive 73 patients who had been diagnosed BPPV in the department of emergency and otolaryngology in Seoul Samyook hospital between January 2009 and June 2009. All patients who were diagnosed with BPPV immediately had appropriate canalith repositioning maneuvers (CRM) done (depending on the type of BPPV) by emergency department or otolaryngology department doctors. Patients were classified according to the timing of treatment after onset (within 24 hours, after 24 hours). We prospectively compared recurrence rates between the two groups. RESULTS: Of the 73 patients, recurrence was seen in 16 (22.2%): 4(11%) of 36 patients in the early treatment group (within 24 hours), and 12(31.4%) of 37 patients in the delayed group (after 24 hours). The between group difference in recurrence rates was significant (p<0.05, chi-square test; p=0.053, logistic regression). The incidence of recurrence of BPPV was much higher in older patients (p<0.05, t-test. logistic regression>0.1). CONCLUSION: Recurrence of BPPV is affected by early CRM after symptom onset. Doing CRM as soon as possible after symptom onset is important
Emergencies ; Humans ; Incidence ; Otolaryngology ; Prospective Studies ; Recurrence ; Vertigo

OBJECTIVE: The authors present eight cases of immediate post-operative epidural hematomas(EDHs) adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. METHODS: Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. RESULTS: In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography (CT) scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. CONCLUSION: Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.
Brain ; Brain Neoplasms ; Cerebrospinal Fluid ; Craniotomy* ; Drainage ; Epidural Space ; Hematoma* ; Intracranial Aneurysm ; Medical Records ; Neck ; Retrospective Studies ; Risk Factors ; Skull ; Suction ; Ventriculoperitoneal Shunt

Intraventricular arachnoid cyst has been rarely reported. Here we present two cases of symptomatic intraventricular arachnoid cysts in the fourth ventricle and right lateral ventricle. The first patient was a 38-year-old female who complained of headache and left facial hypesthesia. Computed tomography and MR scan revealed large cystic lesion in the fourth ventricle. After cyst wall removal, facial hypesthesia disappeared immediately and headache improved slowly. The second patient was a 9-year-old girl who complained of headache, vomiting and paresthesia in her right low extremity. Cystic lesion in the right lateral ventricle was detected in the CT and MR scan. The symptoms improved after cyst wall removal. Surgical findings of these two cases showed that the cyst walls were attached firmly to the choroid plexus. Symptomatic intraventricular arachnoid cyst must be treated appropriately and we recommend complete cyst wall removal.
Adult ; Arachnoid Cysts* ; Arachnoid* ; Child ; Choroid Plexus ; Extremities ; Female ; Fourth Ventricle ; Headache ; Humans ; Hypesthesia ; Lateral Ventricles ; Paresthesia ; Vomiting