This article describes the clinical features of anterior semicircular canal benign paroxysmal positional vertigo (AC-BPPV) and a new therapeutic maneuver for its management. Our study was a retrospective review of cases from an ambulatory tertiary referral center. Thirteen patients afflicted with positional paroxysmal vertigo exhibiting brief positional down-beating nystagmus in positional tests (Dix-Hallpike and head-hanging position) were treated with a maneuver comprised of the following movements: Sequential head positioning beginning supine with head hanging 30 degrees dependent with respect to the body, then supine with head inclined 30 degrees forward, and ending sitting with head 30 degrees forward. All cases showed excellent therapeutic response to our repositioning procedure, i.e. relief of vertigo and elimination of nystagmus. The maneuver described is an option for AC-BPPV treatment.

Bilateral vestibular weakness (BVW) is a rare cause of imbalance. Patients with BVW complain of oscillopsia. In approximately half of the patients with BVW, the cause remains undetermined; in the remainder, the most common etiology by far is gentamicin ototoxicity, followed by much rarer entities such as autoimmune inner ear disease, meningitis, bilateral Ménière’s disease, bilateral vestibular neuritis, and bilateral vestibular schwannomas. While a number of bedside tests may raise the suspicion of BVW, the diagnosis should be confirmed by rotatory chair testing. Treatment of BVW is largely supportive. Medications with the unintended effect of vestibular suppression should be avoided.

Bilateral vestibular loss is a rare cause of visual disturbance (oscillopsia) and imbalance. When severe, the most common cause is iatrogenic-gentamicin ototoxicity. Bilateral loss is easily diagnosed at the bedside with the dynamic illegible E test. If this test is omitted, it can easily be misdiagnosed as a cerebellar syndrome. Treatment is largely supportive. Care should be taken to avoid medications that suppress vestibular function, and to encourage activity.

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Vertigo and dizziness are among the 20 most common causes of consultation in adult patients. 1 In 80% of these cases, the symptoms are so intense as to require medical intervention. Dizziness affects more than 50% of the population over 65 and is the most frequent reason for medical consultation after the age of 75. 1 Roughly 50% of patients who are referred for dizziness have vertigo. Among the various causes of vertigo, the so-called cervical vertigo, basically vertigo caused by neck disorders, has been the most controversial. Neurologists often face the situation of having to confirm or reject a diagnosis given by other specialists. Yet, the existence of cervical vertigo is not questioned in physiotherapy settings, possibly due to the extensive bibliography covering this condition in this specialty. 2 Cervical vertigo can be a rare cause of vertigo 3 or it can be among its main causes. 4 In the elderly, Colledge et al suggested that cervical spondylosis is the second most-frequent cause of dizziness, which would be more representative of those who complain of dizziness to their general practitioner. 5 Advocates of vertigo of cervical origin state that cervical vertigo is the most common cause of vertigo; however, there is no diagnostic method to establish whether a patient's vertigo is caused by an underlying neck condition. The central cervical vertigo hypothesis-that a neck condition causes dizziness-is plausible because dizziness is associated with head and cervical spine rotation. This could have possibly perpetuated the concept of cervical vertigo in nonmedical forums. Nevertheless, due to the lack of a specific diagnostic test and the condition's overlap with other commonly diagnosed conditions that also have no specific tests, cervical vertigo is still a controversial entity: Many patients preliminarily diagnosed with such a disorder are ultimately found to have other pathologies. 6 Our first objective in this review is to evaluate extensively and critically the scientific bibliography in search of the historical origin of cervical vertigo and its clinical variants.Our second objective is to analyze the anatomy and function of the neck in relation to cervical vertigo and its clinical presentation. Finally, we formulate an alternative hypothesis about the symptoms that are attributed to this condition. Neck StructuresThe neck has structures that are involved in 1. Balance control (cervical afferents) AbstractCervical vertigo has long been a controversial entity and its very existence as a medical entity has advocates and opponents. Supporters of cervical vertigo claim that its actual prevalence is underestimated due to the overestimation of other diagnostic categories in clinics. Furthermore, different pathophysiological mechanisms have been attributed to cervical vertigo. Here the authors discuss the clinical characteristics of rotational vertebral artery vertigo, postwhiplash vertigo, proprioceptive cervical vertigo, and cervicogenic vertigo of old age. A clinical entity named subclinical vertebrobasi...

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ABSTRACT. The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. Objective: To validate the MoCA in the elderly and study its usefulness in MCI and MD. Methods: This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with<3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. Results: Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p<0.0001). MoCA-A performance correlated with educational level (r: 0.406 p<0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD 100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. Conclusion: The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.

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