Objective:To investigate the clinical characteristics of residual dizziness（RD） after repositioning in patients with benign paroxysmal positional vertigo（BPPV）, identify its potential risk factors, and develop a predictive risk model. Methods:A total of 137 patients diagnosed with BPPV at the First Affiliated Hospital of Xi'an Jiaotong University between January 2023 and June 2023 were enrolled. Based on the presence or absence of subjective discomfort within 3 months after successful repositioning, patients were divided into the non-RD group（NRD, n=93） and the RD group（n=44）. Differences in demographic characteristics, comorbidities, and disease-related features were compared between groups. Multivariate logistic regression analysis was used to identify independent risk factors for RD, and a nomogram was constructed based on these factors. The predictive performance of the model was assessed using the area under the curve（AUC）. Results:The RD group showed significantly higher values in body mass index, prevalence of diabetes and motion sickness history, dizziness duration before repositioning, history of repositioning at external hospitals, number of treatments, and recurrence（all P<0.001）. Multivariate logistic regression revealed that diabetes（adjusted OR=8.73, P=0.039）, motion sickness history（adjusted OR=23.08, P<0.001）, dizziness duration ≥30 days before repositioning（adjusted OR=15.16, P<0.001）, and recurrence（adjusted OR=15.72, P=0.001） were independent risk factors for RD. The nomogram model based on these variables demonstrated good predictive ability, with an AUC of 0.804（95%CI 0.684-0.924）. Conclusion:Diabetes, motion sickness history, dizziness duration ≥30 days, and recurrence are independent risk factors for RD after repositioning in patients with BPPV. The nomogram model based on these variables shows good predictive performance, with recurrence having the highest predictive value. This model can aid in early identification of high-risk patients and guide individualized intervention strategies.
Humans ; Nomograms ; Benign Paroxysmal Positional Vertigo/therapy* ; Dizziness/etiology* ; Risk Factors ; Risk Assessment ; Multivariate Analysis ; Male ; Female ; Logistic Models ; Middle Aged ; Patient Positioning ; Adult

Vertigo （or dizziness） is one of the most common symptoms in clinical practice. The misdiagnosis rate of vertigo diseases is high due to the factors that vertigo disorders involve multiple systems and organs throughout the body with a wide range of pathogenesis, and different kind of vertigo diseases often present with overlapping clinical presentation. In recent years, scholars have conducted many explorations in the diagnosis model of vertigo disorders, the identification model of high-risk central vertigo, or the combination of diagnostic tests such as the TiTrATE diagnostic model for vertigo disorders （Newman-Toker and Edlow, 2015）, the ATTEST differential diagnosis model for acute vertigo （Gurley and Edlow, 2019）; the application of the ABCD2 score to assess the risk of high-risk vertigo （Navi et al, 2012）, and the "TriAGe+" score to assess the risk of stroke in vertigo patients （Kuroda et al, 2017）; HINTS battery （Kattah et al, 2009）, HINTS+ battery （Newman-Toker et al, 2013）, and STANDING battery （Vanni et al, 2014） for acute serious vestibular disorders. These diagnostic approaches are immensely beneficial in enhancing the accuracy of vertigo diagnosis, as well as for identifying high-risk central vertigo with reducing the misdiagnosis of vertigo. Based on clinical experience, with referring to the diagnostic approaches mentioned above, the author propose the SCD programmatic diagnostic strategy for vertigo disorders[Strategy 1: Classification of vertigo syndromes （syndromes, S）; Strategy 2: Identify/diagnose high-risk central vertigo （central, C）; Strategy 3: differential diagnosis of peripheral vertigo （disease, D） ] and the A·E³GAP·AT differentiation battery and A²B²C²D²E³ alarm battery for dangerous central vertigo as well as targeted identifying and examining of E³GAP battery for central vertigo in five steps.The SCD programmatic diagnostic strategy for vertigo disorders is beneficial for clinicians to grasp diagnostic approach and pay special attention to dangerous central vertigo, while mastering the differential diagnosis model of dangerous central vertigo as well as the rapid diagnostic approach of peripheral vertigo.
Humans ; Vertigo/diagnosis* ; Diagnosis, Differential ; Dizziness/etiology*

Dizziness or vertigo is a common clinical symptom, and its underlying etiology is complex. Many clinicians are confused about its diagnosis and treatment. This article presents a case about chronic vestibular syndrome. And case appreciation and academic discussion are conducted by well-known domestic neurologists and otologists, so as to provide a good thinking model and basic ideas for the diagnosis and treatment of dizziness or vertigo, hoping to further improve the diagnosis and treatment level among clinicians.
Humans ; Dizziness/therapy* ; Vertigo/etiology* ; Vestibular Diseases/complications* ; Otolaryngologists

Objective: To summarize the clinical characteristics of patients with Takotsubo syndrome (TTS) from China and compare these features with patients from Europe/North America. Methods: We reviewed case reports published between 1990 and 2020 with the key words of "Takotsubo syndrome" "stress cardiomyopathy" "apical balloon syndrome" and "broken heart syndrome", in Wanfang, CNKI, Pubmed and Web of Science databases, and 1 294 articles were identified, including 128 articles reporting 163 cases in China and 1 166 articles reporting 1 256 cases in Europe/North America. The characteristics of demographics, triggers, symptoms, electrocardiogram, echocardiography, left ventriculogram,coronary angiography, treatment and prognosis were analyzed and compared between Chinese and European/North American cases. Results: A total of 1 294 articles (1 419 cases: 163 from China, 1 256 from Europe/North America) were included in the final analysis. The characteristics of Chinese cases included: (1) demographic:the age was (59.6±16.9) years, which was similar with that of European/North American ((59.7±17.4) years, P=0.90), and female accounting for 78.5% (128/163), which was lower than that of European/North American (85.4% (1 073/1 256), P=0.02). (2) Triggers:mental triggers accounted for 48.5% (79/163), physical triggers accounted for 43.6% (71/163), and no triggers accounted for 7.9% (13/163), respectively. Compared with Europe/North America, the ratio of patients with mental triggers was higher in China, while the ratio of patients with physical triggers and no triggers was lower (P<0.05). (3) Symptoms: chest pain (52.8% (86/163)), chest tightness (35.0% (57/163)), shortness of breath (33.1% (54/163)), dizziness (16.0% (26/163)), sweating (15.3% (25/163)), palpitations (12.3% (20/163)), syncope (9.2% (15/163)) abdominal pain/diarrhea (8.6% (14/163)), hypotension (7.4% (12/163)), and fatigue (1.2% (2/163)) were illustrated in sequence. Compared with patients in Europe/North America, the ratio of patients with chest tightness, dizziness, sweating, palpitations, abdominal pain/diarrhea was higher in Chinese patients, while the ratio of patients with hypotension was lower in Chinese patients (P<0.05). (4) Electrocardiogram: main manifestations were myocardial ischemia symptoms, such as ST-segment elevation (63.8% (104/163)), T wave inversion (46.0% (75/163)), ST-segment depression (8.6% (14/163)). Compared with European/North American, the ratio of patients with ST-segment elevation, T wave inversion, and atrioventricular block was higher in Chinese patients (P<0.05). (5) Echocardiography and imaging:apical dyskinesia (59.5% (97/163)) and apical/left ventricular bulbar dilation (36.2%(59/163)) dominated the echocardiography findings. Compared with European/North American, the ratio of patients with apical dyskinesia, apical/left ventricular bulbar dilation, and mitral regurgitation was higher in Chinese patients, while the ratio of patients with dyskinesia in other parts and left ventricular ejection fraction<50% was lower in Chinese patients (P<0.05). Left ventricular angiography showed 36.2% (59/163) of apical dyskinesia in Chinese patients, which was higher than that reported in European/North American patients, and 38.7% (63/163) of apical/left ventricular bulbar dilation was reported in Chinese patients, which was similar to that reported in European/North American patients. Coronary angiography showed percent of no stenosis or stenosis less than 50% was 87.1% (142/163), which was similar to that reported in European/North American patients (P>0.05). The typical type of TTS accounted for 96.3% (157/163), which was significantly higher than that reported in European/ American patients, while the ratio of basal type and midventricular type was lower (P<0.01). (6) Treatment and prognosis:the applied drugs in China were listed in order as following, β-blockers (41.1% (67/163)), antiplatelet agents (37.4%(61/163)), ACEI/ARB (36.2%(59/163)), anticoagulants (27.0%(44/163)), diuretics (19.6% (32/163)), etc. Compared with Europe/North America, the ratio of antiplatelet agents, anticoagulants, statins, diuretics, and nitrates use was higher in China (P<0.05), while the use of oxygen therapy and IABP was similar (P>0.05). The hospital mortality in China was 5.5% (9/163), during 1-year follow-up the recurrence rate was 3.7% (6/163) and the mortality was 0. The prognosis was similar with that in Europe/North America. Conclusions: Compared with TTS cases in Europe/North America, TTS cases in China also occur usually in middle-aged and elderly women, most of whom have mental/physical triggers and typical imaging manifestations, followed by a low hospital mortality rate and recurrence rate.
Abdominal Pain/complications* ; Adult ; Aged ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anticoagulants ; Arrhythmias, Cardiac/complications* ; China/epidemiology* ; Diuretics ; Dizziness/complications* ; Dyskinesias/complications* ; Electrocardiography ; Europe/epidemiology* ; Female ; Humans ; Hypotension/complications* ; Middle Aged ; Platelet Aggregation Inhibitors ; Stroke Volume ; Takotsubo Cardiomyopathy/etiology* ; Ventricular Function, Left

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.
Aged ; Carotid Arteries/diagnostic imaging ; Cerebrovascular Circulation/*physiology ; Dizziness/etiology ; Female ; Hemodynamics/*physiology ; Humans ; Kidney Failure, Chronic/*physiopathology ; Male ; Middle Aged ; Renal Dialysis ; Risk Factors ; Ultrasonography, Doppler, Duplex

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.
Aged ; Carotid Arteries/diagnostic imaging ; Cerebrovascular Circulation/*physiology ; Dizziness/etiology ; Female ; Hemodynamics/*physiology ; Humans ; Kidney Failure, Chronic/*physiopathology ; Male ; Middle Aged ; Renal Dialysis ; Risk Factors ; Ultrasonography, Doppler, Duplex

We investigated the efficacy and tolerability of various anticholinergics in Korean children with non-neurogenic overactive bladder (OAB). A total of 326 children (males:females= 157:169) aged under 18 yr (mean age 7.3+/-2.6 yr) who were diagnosed with OAB from 2008 to 2011 were retrospectively reviewed. The mean duration of OAB symptoms before anticholinergic treatment was 16.9+/-19.0 months. The mean duration of medication was 5.6+/-7.3 months. Urgency urinary incontinence episodes per week decreased from 1.9+/-3.1 to 0.4+/-1.5 times (P<0.001). The median voiding frequency during daytime was decreased from 9.2+/-5.4 to 6.3+/-4.2 times (P<0.001). According to 3-day voiding diaries, the maximum and average bladder capacity were increased from 145.5+/-66.9 to 196.8+/-80.3 mL and from 80.8+/-39.6 to 121.8+/-56.5 mL, respectively (P<0.001). On uroflowmetry, maximum flow rate was increased from 17.6+/-8.4 to 20.5+/-8.2 mL/sec (P<0.001). Adverse effects were reported in 14 (4.3%) children and six children (1.8%) discontinued medication due to adverse effects. Our results indicate that anticholinergics are effective to improve OAB symptoms and tolerability was acceptable without severe complications in children.
Child ; Child, Preschool ; Cholinergic Antagonists/adverse effects/*therapeutic use ; Constipation/etiology ; Dizziness/etiology ; Female ; Humans ; Male ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder, Overactive/*drug therapy

OBJECTIVE: To investigate the clinical features and therapeutic effects of sudden deafness after radiotherapy combined with chemotherapy in nasopharyngeal carcinoma patients. METHOD: Clinical data of 42 nasopharyngeal carcinoma patients suffered from sudden deafness after radiotherapy combined with chemotherapy were analyzed retrospectively. Among the 42 patients, 2 showed moderate deafness, 4 presented excessive deafness, 30 suffered from severe deafness, and 6 exhibited profound deafness. The audiogram pattern of 33 patients met with the type of high tone frequencies hearing loss, and that of the rest 9 cases showed hearing loss at all frequencies. All patients received medical therapy combined with hyperbaric oxygen therapy. RESULT: Of all the cases with hearing loss, 2 were cured, 2 showed excellent recovery, 9 came out partial recovery, and 29 showed no response to the treatment. The total effective rate was 30.95%. For the accompanied symptoms, none of the 30 cases of tinnitus were relieved, 3 out of 10 cases of aural fullness were cured, and the 5 cases of dizziness or vertigo were all improved. CONCLUSION The sudden deafness after radiotherapy combined with chemotherapy in patients with nasopharyngeal carcinoma is closely related to radiotherapy. The hearing loss is serious, and the therapeutic effects are not satisfactory.
Antineoplastic Agents ; adverse effects ; Carcinoma ; Dizziness ; etiology ; therapy ; Hearing Loss, High-Frequency ; etiology ; therapy ; Hearing Loss, Sudden ; etiology ; therapy ; Hearing Tests ; Humans ; Hyperbaric Oxygenation ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; drug therapy ; radiotherapy ; Radiotherapy ; adverse effects ; Retrospective Studies ; Tinnitus ; etiology ; therapy ; Vertigo ; etiology ; therapy

We investigated the safety and clinical applicability of 7.0 Tesla (T) brain magnetic resonance imaging (MRI) in patients with brain tumors. Twenty-four patients with intraaxial or extraaxial brain tumors were enrolled in this study. 7.0T MRIs of T2*-weighted axial and T1-weighted coronal or sagittal images were obtained and compared with 1.5T brain MRIs. The T2*-weighted images from 7.0T brain MRI revealed detailed microvasculature and the internal contents of supratentorial brain tumors better than that of 1.5T brain MRI. For brain tumors located in parasellar areas or areas adjacent to major cerebral vessels, flow-related artifacts were exaggerated in the 7.0T brain MRIs. For brain tumors adjacent to the skull base, susceptibility artifacts in the interfacing areas of the paranasal sinus and skull base hampered the aquisition of detailed images and information on brain tumors in the 7.0T brain MRIs. This study shows that 7.0T brain MRI can provide detailed information on the intratumoral components and margins in supratentorial brain tumors. Further studies are needed to develop refined MRI protocols for better images of brain tumors located in the skull base, parasellar, and adjacent major cerebrovascular structures.
Adult ; Brain Neoplasms/*radiography ; Dizziness/etiology ; Female ; Headache/etiology ; Humans ; Magnetic Resonance Imaging/adverse effects ; Male ; Middle Aged ; Muscle Contraction/radiation effects

A 26-yr-old male patient reported worsened dyspnea, dizziness one year after an emergency Bentall operation for type A aortic dissection. There was evidence of hemolytic anemia and aortogram revealed a significant stenosis at the distal anastomosis site. During the reoperation, we found the inner felt at the distal anastomosis was inverted causing a significant stenosis. The reoperation successfully resolved this problem. Here, we report a rare case of hemolytic anemia caused by an inverted inner felt after Bentall operation.
Acute Disease ; Adult ; Anastomosis, Surgical ; Anemia, Hemolytic/*diagnosis/*etiology/surgery ; Aneurysm, Dissecting/complications/*surgery ; Aortic Aneurysm/complications/*surgery ; *Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/*adverse effects/instrumentation ; Dizziness/etiology ; Dyspnea/etiology ; Echocardiography ; Humans ; Male ; *Postoperative Complications/surgery ; Reoperation ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome