Patients with active acromegaly have more frequent middle ear ventilation problem than normal population, especially those with longer duration of the disease. Possible causes are discussed.
BPPV when diagnosed before any repositioning procedure is called primary BPPV. Primary BPPV canalithiasis treatment with repositioning procedures sometimes results in unintentional conversion of BPPV form: transitional BPPV. Objectives were to find transitional BPPV forms, how they influence relative rate of canal involvement and how to be treated. This study is a retrospective case review performed at an ambulatory, tertiary referral center. Participants were 189 consecutive BPPV patients. Main outcome measures were detection of transitional BPPV, outcome of repositioning procedures for transitional canalithiasis BPPV and spontaneous recovery for transitional cupulolithiasis BPPV. Canal distribution of primary BPPV was: posterior canal (Pc): 85.7% (162/189), horizontal canal (Hc): 11.6% (22/189), anterior canal (Ac): 2.6% (5/189); taken together with transitional BPPV it was: Pc: 71.3% (164/230), Hc: 26.5% (61/230), Ac: 2.2% (5/230). Transitional BPPV forms were: Hc canalithiasis 58% (24/41), Hc cupulolithiasis 37% (15/41) and common crux reentry 5% (2/41). Treated with barbecue maneuver transitional Hc canalithiasis cases either resolved in 58% (14/24) or transitioned further to transitional Hc cupulolithiasis in 42% (10/24). In follow-up of transitional Hc cupulolithiasis we confirmed spontaneous recovery in 14/15 cases in less than 2 days. The most frequent transitional BPPV form was Hc canalithiasis so it raises importance of barbecue maneuver treatment. Second most frequent was transitional Hc cupulolithiasis which very quickly spontaneously recovers and does not require any intervention. The rarest found transitional BPPV form was common crux reentry which is treated by Canalith repositioning procedure. Transitional BPPV taken together with primary BPPV may decrease relative rate of Pc BPPV, considerably increase relative rate of Hc BPPV and negligibly influence relative rate of Ac BPPV. Transitional BPPV forms can be produced by repositioning maneuvers (transitional Hc cupulolithiasis) or by the subsequent controlling positional test (transitional Hc canalithiasis and common crux reentry); underlying mechanisms are discussed.
Neurocysticercosis is the term used for human CNS involvement with T. solium cysts. Intraparenchymal cerebral cysts usually enlarge slowly, causing minimal or no symptoms, until years or decades after the onset of infection. Clinical manifestations vary from focal or generalized seisures to sensomotor deficits, intellectual impairment, psychiatric disorders and symptoms of elevated intracranial pressure. Work ability was evaluated in 12 patients treated for cysticercosis during 2005 and 2006. In all patient examinations for NCC were conducted in regional health centers, and all were referred to a hospital for further diagnosis and therapy. Diagnosis was made by the following clinical criteria: neurological disorder, CT and / or MRI typical findings, followed by the test for specific antibodies. We evaluated the period from the first complaints that could be connected with the diagnosis to the moment when diagnosis was made, and severity of symptoms like vertigo, headache, vision disorders and unconsciousness. Considering neurocysticercosis as a slowly progressing infection of the CNS, with an evolution period of more than several years, and the mean period of unrecognized complaints of 28 months, we suggest that all of neurological or psychiatric complaints in our surroundings, specially where breeding of pigs is widely spread, should be evaluated for cysticercosis.
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