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      Vestibular Autorotation Test: The Differences in Peripheral and Central Acute Vestibular Syndrome

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      , , ,
      Evidence-based Complementary and Alternative Medicine : eCAM
      Hindawi

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          Abstract

          Objective

          To evaluate the difference between the vestibular autorotation test (VAT) in the peripheral and central acute vestibular syndrome (AVS). Methodology. Patients with AVS diagnosed by clinical manifestation admitted to the third affiliated hospital of Qiqihar Medical College from January 2019 to January 2021 were enrolled and divided into peripheral AVS (peripheral group) and central AVS (central group) according to the results of the MRI examination.

          Results

          A total of 332 patients with AVS were recruited, including 282 patients in the peripheral group and 50 patients in the central group. The horizontal gain of both groups showed a downward trend at 2–6 Hz. There was no significant change in the horizontal phase between the two groups at 2–6 Hz. The horizontal gain of the two groups was stable at 2–6 Hz with no significant changes in the horizontal phase between 2–6 Hz in both groups. The central group showed a significantly lower proportion of gain increase coupled with loss and a strikingly higher proportion of gain increase without a loss than in the peripheral group (all P < 0.001).

          Conclusion

          The increased horizontal and vertical gain of VAT in patients with AVS is of high value in the diagnosis of ACS. Significant differences in the results of VAT in patients with central and peripheral AVS could provide a reference for diagnosis.

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          Most cited references20

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          Vestibular Disorders.

          Recent research findings have improved the understanding of the diagnosis, pathophysiology, genetics, etiology, and treatment of peripheral, central, and functional vestibular vertigo syndromes.
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            Dizziness: Approach to Evaluation and Management.

            Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient's history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss suggests Meniere disease. Episodic vertigo not associated with any trigger may be a symptom of vestibular neuritis. Evaluation focuses on determining whether the etiology is peripheral or central. Peripheral etiologies are usually benign. Central etiologies often require urgent treatment. The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies. The physical examination includes orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver. Laboratory testing and imaging are not required and are usually not helpful. Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (e.g., Epley maneuver). Treatment of Meniere disease includes salt restriction and diuretics. Symptoms of vestibular neuritis are relieved with vestibular suppressant medications and vestibular rehabilitation.
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              Recent advances in central acute vestibular syndrome of a vascular cause.

              Acute vestibular syndrome (AVS) is characterized by acute onset of spontaneous prolonged vertigo (lasting days), spontaneous nystagmus, postural instability, and autonomic symptoms. Peripheral AVS commonly presents as vestibular neuritis, but may also include other disorders such as Meniere's disease. Vertigo in central AVS due to vertebrobasilar ischemic stroke is usually accompanied by other neurological dysfunction. However it can occur in isolation and mimicking peripheral AVS, particularly with cerebellar strokes. Recent large prospective studies have demonstrated that approximately 11% of patients with isolated cerebellar infarction presented with isolated vertigo mimicking peripheral AVS, and the bedside head impulse test is the most useful tool for differentiating central from peripheral AVS. Herein we review the keys to the diagnosis of central AVS of a vascular cause presenting with isolated vertigo or audiovestibular loss. Copyright © 2012 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi
                1741-427X
                1741-4288
                2022
                13 August 2022
                13 August 2022
                : 2022
                : 8180013
                Affiliations
                Electrophysiology Office, The Third Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
                Author notes

                Academic Editor: Zhaoqi Dong

                Author information
                https://orcid.org/0000-0002-6946-0107
                Article
                10.1155/2022/8180013
                9392635
                71f45e82-ab00-45da-bfdd-0e60a2443efb
                Copyright © 2022 Nan Guo et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 March 2022
                : 21 June 2022
                : 27 June 2022
                Funding
                Funded by: Health Commission of Heilongjiang Province
                Award ID: 2018148
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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