Benign paroxysmal positional vertigo (BPPV) or bubble provoked positional vertigo?
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Acanthopanax has therapeutic efficacy against vertigo; however, the underlying mechanism remains unclear. This study aimed to elucidate the mechanism by which Acanthopanax treats vertigo through integrated network pharmacology and molecular docking techniques, and retrieved all target genes of Acanthopanax for vertigo treatment from July to October 2025. Vertigo-related target genes were subsequently identified from public databases, including GeneCards and Online Mendelian Inheritance in Man. The intersection between Acanthopanax-derived targets and vertigo-related targets was analyzed to identify candidate target genes. Using the STRING platform, we constructed protein-protein interaction networks for the identified candidate targets and mined the core functional modules within these networks. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed on candidate targets via the clusterProfiler package. A carp bile poisoning-liver injury target-pathway network was constructed via Cytoscape 3.8.2 software, network topology analysis was conducted, and the core components and targets were screened. The results found that A total of 295 candidate targets for the treatment of vertigo caused by Eleutherococcus senticosus were identified. Pathway enrichment analysis revealed that Eleutherococcus senticosus treatment for vertigo may be closely associated with pathways related to IL-17, TNF, phosphoinositide 3-kinase (PI3K)-Akt, p53, HIF-1, and Forkhead box O signaling. The core targets for the treatment of A. senticosus vertigo include TP53, AKT1, STAT3, TNF, and JUN. Network pharmacology and molecular docking studies suggest that A. senticosus may treat vertigo by regulating targets such as JUN, TNF, AKT1, STAT3, and STAT3 through pathways such as the IL-17, TNF, phosphoinositide 3-kinase-Akt, p53, HIF-1, and Forkhead box O signaling pathways. These mechanisms warrant further investigation in future o and in vitro studies.
Vertigo appeared to me in analysis to be an expression of separation anxiety; we can observe the vicissitudes of the object relationship by way of the development of this symptom in the treatment. I identify different forms of vertigo according to the particular stage reached by the patient, from fusion-related vertigo via vertigo about being dropped, vertigo associated with aspiration, vertigo connected with the alternation of prison and escape and vertigo related to the attraction of the void, to competition-related vertigo which appears in an oedipal context. They correspond to different moments in the constitution of relational space: first, the two-dimensional world in which even the void is inconceivable; then, the sensation of the void manifesting a disavowal of the absence of relationship; next, the constitution of a three-dimensional space in which the patient initially feels carried by the object but then discovers that he can carry himself; and, finally, the constitution of the internal space which allows internalization of the feeling of 'buoyancy'.
BACKGROUND: Observational studies suggest the potential association between sleep traits and vertigo; however, causal evidence remains limited. OBJECTIVE: This study aimed to explore the relationship between genetically predicted sleep traits and vertigo with the Mendelian randomization (MR) method. METHODS: Instrumental variables for sleep traits (snoring, sleep duration, insomnia, daytime sleepiness, daytime napping, and chronotype) were adopted from genomewide association studies (GWAS) data of European ancestry from UK Biobank. The summary-level datasets of vertigo were retrieved from the GWAS of FinnGen. Inversevariance weighted (IVW) method was adopted as the main analysis. RESULTS: IVW analysis revealed a significant association between genetically predicted daytime napping (OR = 1.51, 95% CI =1.08-2.12, P = 0.016) and chronotype (OR = 1.13, 95% CI =1.01-1.26, P = 0.033), both of which were associated with an increased risk of vertigo. However, we did not find evidence for a causal effect of snoring, overall sleep duration, long sleep duration, short sleep duration, insomnia, and excessive daytime sleepiness on vertigo. No reverse causality was detected. CONCLUSION: Our findings suggest that abnormal sleep patterns may serve as risk factors for vertigo disorders and offer opportunities for the prevention and management of vertigo disorders.
Positional and positioning vertigo and nystagmus syndromes can be attributed to either peripheral or central vestibular dysfunction. The most common form is benign paroxysmal positioning vertigo which is caused by cupulolithiasis into the posterior semicircular canal. Other labyrinthine manifestations such as positional alcohol nystagmus, positional nystagmus with macroglobulinaemia and "heavy water" or glycerol ingestion occur because of a specific gravity differential between the cupula and the endolymph (buoyancy mechanism). Neurovascular compression of the vestibular nerve may be a causative factor for "disabling positional vertigo" which is an insufficiently described entity. Hesitation is highly justifiable since retromastoid craniectomy for microvascular decompression is the recommended management. Central positional vertigo is either induced by head movements which result in a transient ischaemia of the ponto-medullary brainstem, or by a change in head position relative to the gravitational vector. The latter is comprised of at least three forms: positional downbeat nystagmus (nodulus), positional nystagmus without concurrent vertigo, and positional vertigo with nystagmus. The site of the lesion is always near the fourth ventricle and the vestibular nuclei. The most probable explanation for the positional response is a vestibular tone imbalance caused by disinhibition of the vestibular reflexes on perception, eye, head and body position.
The main difference between childhood and adulthood vertigo is that the evaluation of symptoms and examination pose special challenges in pediatric patients, depending on age. Vertigo in pre-teenage children is similar to vertigo in adults. In contrast, although benign paroxysmal vertigo, vestibular neuronitis, and Ménière's vertigo occur in children, the distribution of these conditions is different from that seen in adults. After vestibular and cochlear investigations as well as a CT scan or MRI study to outrule a tumor of the posterior cerebral fossa, the diagnosis of vestibular vertigo is established. Often, the diagnosis proposed cannot be considered as final and requires reappraisal according to the long-term course. Collation of case-reports with highly accurate documents is essential in order to strive to develop more satisfactory approaches.
A retrospective review of our population-based medical records linkage system for residents of Olmsted County, Minnesota, revealed 53 patients (34 women and 19 men; mean age, 51 years) with newly diagnosed benign positional vertigo in 1984. The age- and sex-adjusted incidence was 64 per 100,000 population per year (95% confidence interval, 46 to 81 per 100,000). The incidence of benign positional vertigo increased by 38% with each decade of life (95% confidence interval, 23 to 54%). One patient had an initial stroke during follow-up; thus, the relative risk for new stroke associated with benign positional vertigo was 1.62 (95% confidence interval, 0.04 to 8.98) in comparison with the expected occurrence based on incidence rates for an age- and sex-adjusted control population. The observed survival among the 53 Olmsted County residents with benign positional vertigo diagnosed in 1984 was not significantly different from that of an age- and sex-matched general population. Patients with benign positional vertigo seem to have a good prognosis.
Recurrent idiopathic vertigo associated with near-syncope and syncope is a common perplexing problem, some cases of which are considered autonomically mediated (vasovagal). Upright-tilt-table testing has emerged as a potential method to test for vasovagal episodes. This study evaluated the use of this technique in the evaluation and management of patients with recurrent idiopathic vertigo associated with near-syncope or syncope. Twenty-one patients with recurrent unexplained vertigo and syncope/near-syncope and 11 control subjects were evaluated by use of an upright-tilt-table test for 30 minutes, with or without a graded isoproterenol infusion (1 to 4 micrograms/min given intravenously), in an attempt to provoke hypotension, bradycardia, or both, which reproduced the patient's symptoms. The patients included 10 men and 11 women (mean age, 51 +/- 16 years). Eleven controls with no history of vertigo were also studied. Transcranial Doppler sonography was used to assess cerebral arteriolar blood flow during tilt. All tilt-positive patients were placed on therapy with either beta-blockers, disopyramide, or transdermal scopolamine, the effectiveness of which was determined with another tilt-table study. Symptoms occurred in seven patients (33%) during the baseline tilt and in eight patients (38%) during isoproterenol infusion (total positives, 71%). Transcranial Doppler sonography demonstrated a 225% +/- 192% increase in pulsatility index and a 70% +/- 29% increase in resistance index (indicative of cerebral arteriolar vasoconstriction) at the time of vertigo. No control subject experienced syncope during this test. Each tilt-positive patient eventually became tilt-negative with therapy, and over a mean follow-up period of 26 months, no further episodes have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
To test the validity of the hypothesis that irritation of the cervical sympathetic nerves is a cause of hypertonicity of the cervical soft supporting tissues, especially the deep nuchal muscles, and that this hypertonicity is a cause of traumatic vertigo of cervical origin, we examined 44 vertigo cases with whiplash injury by testing equilibrium function and EMG discharges from the neck before and after administration of drugs affecting the sympathetic receptors. The results obtained were as follows: 1. Administration of iso-proterenol (beta-receptor stimulant) caused a significant increase in the EMG's from the injured neck muscles, in parallel with increased impairment of the righting reflex. The blindfolded vertical writing test showed the appearance or intensification of ataxia or deviation in writing when this drug was given. In contrast, administration of propranolol (beta-receptor depressor) had the opposite effects on the EMG's, the righting reflex and blindfolded vertical writing. Furthermore, the resulting changes in the EMG's and equilibrium functions were parallel with alterations in subjects' complaints, i.e., increase or decrease in neck pain and vertigo. 2. Administration of drugs affecting the alpha receptors, such as noradrenaline (alpha-receptor stimulant) and phentolamine (alpha-receptor depressor) had no appreciable effect on the EMG's, equilibrium function or the subjects' complaints. These results show that in vertigo due to whiplash injury hypertonicity of the cervical erector muscles can be induced sympathetically, and that this hypertonicity is based on over-excitement of beta receptors in the injured neck muscles, which results in vertigo of cervical origin.
The efficacy of trimetazidine (60 mg/day) in vertigo was compared with that of betahistine (24 mg/day) in a three-month double-blind study. Included in the study were only patients with peripheral vertigo associated or not with tinnitus or hearing loss, and excluded were those presenting with symptoms related to retrocochlear or central disease. Out of the 40 patients enrolled, 20 suffered from Meniere's disease; 4 patients either dropped out of the study or were non-compliant to therapy and could not be taken into account in the final analysis, which bore on 36 patients (18 treated by trimetazidine and 18 with betahistine). There were no dropouts in the Meniere's disease subgroup (10 receiving trimetazidine and 10 receiving betahistine). Results revealed a better response to therapy with trimetazidine in patients suffering from vertigo, and this was particularly true of the Meniere's disease subgroup (p less than 0.025). Moreover, in the latter subgroup, all patients treated with trimetazidine fully recovered from vertigo spells, while these disappeared completely only in 4 of the patients administered betahistine (p less than 0.005). There was no noticeable difference between the two treatment groups as regards the evolution of the accompanying symptoms and the audiometric or vestibular test results. Clinical acceptability was equally excellent in both treatment groups. Overall, this study allowed to confirm the therapeutical efficacy of trimetazidine in the management of vertigo, as well as establishing the clinical advantage of trimetazidine over betahistine in patients suffering from Meniere's disease.
On the basis of literature and personal data the author qualifies vertigo as an important subjective symptom of a number of diseases. The author proposes and evaluates the existing classifications of vertigo and the applied terminology. The systematics of vertigo based on the clinical experience is proposed. The paper contains qualitative and quantitative characteristics of separate types of vertigo which were singled out according to the character of sensations, conditions of their appearance, time of their duration, attendant neurological and another objective symptomatics and categories of diseases. In this connection the author divides vertigo into peripheral (labyrinthiform and radicle) and central (nucleus, supra-nuclear, "higher"). Principals of treatment are described.
The role of emotional factors in patients with vertigo has been widely debated. Patients with vertigo, as well as patients in two separate control groups, were tested with the Eysenck Personality Inventory (EPI), the Cornell Medical Index (CMI), and a questionarie designed to evaluate the severity of the patients symptoms in order to further investigate the role of personality and its relationship to the symptom of vertigo. In patients with Meniere disease, a strong positive correlation was found between the severity of vertigo and the EPI and CMI scores. The concept of the psychological vulnerability" is useful in explaining these findings.
To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo. Extensive neurotologic examination confirmed the diagnosis. If no significant reduction of vertigo occurred within the first 24 hours of treatment, patients were instructed to switch medications. Patients were followed up prospectively for 1 month. Of the 10 patients receiving methylprednisolone, 9 had a marked reduction of vertiginous symptoms and 1 switched to the placebo medication. Of the 10 patients receiving placebo, 3 had relief of vertiginous symptoms, while the 7 with persistent symptoms switched to methylprednisolone and had subsequent effective reduction of vertigo within 24 hours. The electronystagmogram returned to normal within 1 month in all 16 patients taking methylprednisolone, but remained abnormal in 2 of the 4 patients treated with placebo. One patient receiving methylprednisolone had a relapse of symptoms when the dosage was tapered, but symptoms again remitted when the dosage was increased to 32 mg/d. From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing vertiginous symptoms in patients with acute vestibular vertigo.
The association of tinnitus and vertigo with temporomandibular disorder (TMD) has been debated for many years. The observation that patients with TMD have otologic symptoms is confounded because tinnitus and vertigo are common symptoms in the normal population. The present study was conducted to determine if tinnitus and vertigo are actually more prevalent in patients with TMD than in appropriate age-matched controls. One control group was recruited from patients seeking care for health maintenance and the other from patients seeking routine dental care. We surveyed 1032 patients: 338 had TMD and 694 served as two age-matched control groups. Tinnitus and vertigo symptoms were significantly more prevalent in the TMD group than in either of the control groups. The mechanism of the association of TMD and otologic symptoms is unknown.