| 1. Edlow JA, Gurley KL, Newman-Toker DE. A New Diagnostic Approach to the Adult Patient with Acute Dizziness. J Emerg Med. 54(4):469-483, 2018 04. |
Review/Other-Dx |
N/A |
To present a new approach to diagnosis of the acutely dizzy patient that emphasizes different aspects of the history to guide a focused physical examination with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes in the emergency department. |
Currently, misdiagnoses are frequent and diagnostic testing costs are high. This relates in part to use of an outdated, prevalent, diagnostic paradigm. The traditional approach, which relies on dizziness symptom quality or type (i.e., vertigo, presyncope, or disequilibrium) to guide inquiry, does not distinguish benign from dangerous causes, and is inconsistent with current best evidence. A new approach divides patients into three key categories using timing and triggers, guiding a differential diagnosis and targeted bedside examination protocol: 1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; 2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and 3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. |
4 |
| 2. Lawhn-Heath C, Buckle C, Christoforidis G, Straus C. Utility of head CT in the evaluation of vertigo/dizziness in the emergency department. EMERG. RADIOL.. 20(1):45-9, 2013 Jan. |
Review/Other-Dx |
448 patients |
To determine diagnostic yield for the patients with dizziness and for the patients undergoing head computed tomography (CT). |
The diagnostic yield for head CT ordered in the ER for acute dizziness is low (2.2 %; 1.6 % for emergent findings), but MRI changes the diagnosis up to 16 % of the time, acutely in 8 % of cases. |
4 |
| 3. Guarnizo A, Farah K, Lelli DA, Tse D, Zakhari N. Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department. Neuroradiol. j.. 34(4):335-340, 2021 Aug. |
Observational-Dx |
153 patients |
To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head. |
One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%. |
2 |
| 4. Idil H, Ozbay Yenice G, Kilic TY, Eyler Y, Duman Atilla O. The Incidence of Central Neurological Disorders Among Patients With Isolated Dizziness and the Diagnostic Yield of Neuroimaging Studies. Neurolog. 25(4):85-88, 2020 Jul. |
Observational-Dx |
143 patients |
To investigate the incidence of severe central neurological pathologies in isolated dizziness cases and the diagnostic efficiency of neuroimaging studies. |
The percentage of patients with isolated dizziness among all ED admissions was 2.5% (29,510/1,190,857). The median age of these patients was 52 years (interquartile range: 38 to 66) and 58% were female. During the study period, the rate of neuroimaging studies for isolated dizziness increased year by year, and a total of 6406 (21.7%) cranial CTs and 2896 (9.8%) DW-MRIs were performed. The diagnostic yield of neuroimaging studies was 0.6% for cranial CT and 3.9% for DW-MRI. Central neurological disorders were detected in 143 (0.48%) patients with isolated dizziness. The most common causes were posterior circulation ischemic strokes (47.5%), other ischemic strokes (18.9%), vertebrobasilar insufficiency (10.5%), and transient ischemic attack (8.4%). |
2 |
| 5. Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope. 123(9):2250-3, 2013 Sep. |
Review/Other-Dx |
1681 patients |
To determine the usefulness and the costs of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of patients with dizziness in the emergency department (ED). |
Of 1681 patients identified, 810 (48%) received CT brain/head scan totaling $988,200 in charges. Of these, only 0.74% yielded clinically significant pathology requiring intervention. However, 12.2% of MRI studies yielded discovery of significant abnormalities. Logistic regression analysis revealed that older patients (P = .001) were more likely to receive a CT scan. |
4 |
| 6. Machner B, Choi JH, Trillenberg P, Heide W, Helmchen C. Risk of acute brain lesions in dizzy patients presenting to the emergency room: who needs imaging and who does not?. J Neurol. 267(Suppl 1):126-135, 2020 Dec. |
Review/Other-Dx |
610 patients |
To assess the 'real-world' probability of ischemic stroke and other acute brain lesions (ABLs) in these patients to create an algorithm that helps decision-making on whether which and when brain imaging is needed. |
ABLs were extracted from CT/MRI reports. Uni-/multivariate logistic regression analyses investigated associations between clinical parameters and ABLs. Finally, the likelihood of ABLs was assessed for different clinically defined subgroups ('dizziness syndromes'). Early CT (day 1) was performed in 539 (88%) and delayed MR imaging (median: day 4) in 299 (49%) patients. ABLs (89% ischemic stroke) were revealed in 75 (24%) of 318 patients with adequate imaging (MRI or lesion-positive CT). The risk for ABLs increased with the presence of central oculomotor signs (odds ratio 2.8, 95% confidence interval 1.5-5.2) or focal abnormalities (OR 3.3, 95% CI 1.8-6.2). The likelihood of ABLs differed between dizziness syndromes, e.g., HINTS-negative acute vestibular syndrome: 0%, acute imbalance syndrome with ABCD2-score = 4: 50%. We propose a clinical pathway, according to which patients with HINTS-negative acute vestibular syndrome should not receive brain imaging, whereas imaging is suggested in dizzy patients with acute imbalance, central oculomotor signs or focal abnormalities. |
4 |
| 7. Salmela MB, Mortazavi S, Jagadeesan BD, et al. ACR Appropriateness Criteria® Cerebrovascular Disease. J Am Coll Radiol 2017;14:S34-S61. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for cerebrovascular disease. |
No results stated in abstract. |
4 |
| 8. Sharma A, Kirsch CFE, Aulino JM, et al. ACR Appropriateness Criteria® Hearing Loss and/or Vertigo. J Am Coll Radiol 2018;15:S321-S31. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for hearing loss and/or vertigo. |
No results stated in abstract. |
4 |
| 9. Kessler MM, Moussa M, Bykowski J, et al. ACR Appropriateness Criteria R Tinnitus. Journal of the American College of Radiology. 14(11S):S584-S591, 2017 Nov. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for tinnitus. |
No results stated in abstract. |
4 |
| 10. Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021;18:S13-S36. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for head trauma. |
No results stated in abstract. |
4 |
| 11. Harvey HB, Watson LC, Subramaniam RM, et al. ACR Appropriateness Criteria® Movement Disorders and Neurodegenerative Diseases. J Am Coll Radiol 2020;17:S175-S87. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for movement disorders and neurodegenerative diseases |
No results stated in abstract. |
4 |
| 12. Zaidi HA, Albuquerque FC, Chowdhry SA, Zabramski JM, Ducruet AF, Spetzler RF. Diagnosis and management of bow hunter's syndrome: 15-year experience at barrow neurological institute. World Neurosurg. 82(5):733-8, 2014 Nov. |
Review/Other-Dx |
14 patients |
To review all patients referred to Barrow Neurological Institute during the period 1999-2013 with signs and symptoms that were possibly indicative of bow hunter's syndrome. |
There were 14 patients referred to Barrow Neurological Institute with symptoms concerning for bow hunter's syndrome, and 11 of these patients were confirmed to have dynamic vertebral artery compression on angiography. The location of compression was centered on C1-2 (50%) or C5-7 (50%). The compressed vertebral artery was typically the left artery (72.7%), and in 54.5% of cases, rotation of the head to the contralateral side produced symptomatic dynamic compression. Surgical decompression, via either an anterior (44.4%) or a posterior (55.6%) approach, was eventually performed in 9 patients. Decompression alone was performed in all cases; however, 1 patient developed cervical instability requiring an anterior cervical instrumented fusion 5 years later. |
4 |
| 13. Neto ACL, Bor-Seng-Shu E, Oliveira ML, Macedo-Soares A, Topciu FR, Bittar RSM. Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency. Clinics. 75:e1212, 2020. |
Observational-Dx |
24 patients |
To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). |
The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. |
2 |
| 14. Gottesman RF, Sharma P, Robinson KA, et al. Imaging characteristics of symptomatic vertebral artery dissection: a systematic review. [Review]. Neurolog. 18(5):255-60, 2012 Sep. |
Review/Other-Dx |
3996 articles |
To summarize the diagnostic value of various imaging findings in patients with symptomatic vertebral artery dissection (VAD). |
Of 3996 citations, we screened 511 manuscripts and selected 75 studies describing 1972 VAD patients. Most studies utilized conventional angiography or magnetic resonance angiography (MRA) to diagnose VAD; computed tomographic angiography (CTA) and Doppler ultrasonography were described less frequently. Imaging findings reported were vertebral artery stenosis (51%), string and pearls (48%), arterial dilation (37%), arterial occlusion (36%), and pseudoaneurysm, double lumen, and intimal flap (22% each). In cases where conventional angiography was the reference standard, CTA was more sensitive (100%) than either MRA (77%) or Doppler ultrasonography (71%) (P=0.001). |
4 |
| 15. Mohamed ES, Kaf WA, Rageh TA, Kamel NF, Elattar AM. Evaluation of patients with vertigo of vertebrobasilar insufficiency origin using auditory brainstem response, electronystagmography, and transcranial Doppler. Int J Audiol. 51(5):379-88, 2012 May. |
Observational-Dx |
14 patients |
To investigate the correlation, sensitivity, and specificity of the auditory brainstem response (ABR), electronystagmorgraphy (ENG), and transcranial Doppler (TCD) collectively to distinguish between vertigo due to vertebrobasilar insufficiency (VBI) and vertigo due to non-VBI |
Participants with VBI had more abnormal findings in the ENG (86%), TCD (72%), and ABR (64%) compared to the non-VBI group (64%, 21%, and 7%, respectively) and the control group. The combined battery revealed positive correlations, 64% sensitivity, and 84% positive predictive value (PPV) in the VBI group, and 100% specificity with lack of correlations in the non-VBI group. |
2 |
| 16. Brockmann K, Reimold M, Globas C, et al. PET and MRI reveal early evidence of neurodegeneration in spinocerebellar ataxia type 17. J Nucl Med. 53(7):1074-80, 2012 Jul. |
Observational-Dx |
9 patients |
To discuss the reveal of PET and MRI early evidence of neurodegeneration in spinocerebellar ataxia type 17 |
MRI volumetry revealed atrophy of the cerebellum and caudate nucleus in manifesting patients (P = 0.04 and 0.05, respectively) and in presymptomatic mutation carriers (P = 0.04 and 0.01, respectively). PET demonstrated decreased glucose metabolism in the striatum, as well as in the cuneus, cingulum, and parietal lobe, in all SCA17 patients and presymptomatic mutation carriers. In addition, PET was closely correlated with motor performance as assessed by the Scale for the Assessment and Rating of Ataxia (P = 0.037) and Unified Parkinson Disease Rating Scale (P = 0.05) and with cognitive function as assessed by the Mini-Mental Status Examination (P = 0.037). Furthermore, (11)C-raclopride PET showed impairment of the postsynaptic dopaminergic compartment of the putamen and caudate nucleus not only in manifest SCA17 patients (P = 0.04 and 0.008, respectively) but also in yet-unaffected mutation carriers (P = 0.05 and 0.05, respectively). The degree of postsynaptic dopaminergic dysfunction was associated with impairment of motor performance. In contrast, significant presynaptic dopaminergic deficits assessed with (11)C-d-threo-methylphenidate PET were not detected.9 patients |
2 |
| 17. Aguiar P, Pardo J, Arias M, et al. PET and MRI detection of early and progressive neurodegeneration in spinocerebellar ataxia type 36. Mov Disord. 32(2):264-273, 2017 02. |
Review/Other-Dx |
20 patients |
To analyze the neurodegenerative process underlying SCA36 through fluorodeoxyglucose positron emission tomography (FDG-PET) and MRI scans. |
SARA ranged from 0 to 24.5 (4 patients asymptomatic, 3 with unspecific symptoms, and 13 with cerebellar signs). FDG-PET revealed hypometabolism in the asymptomatic stage in the vermis and right cerebellar hemisphere. In the ataxic stage, hypometabolism spread to both cerebellar hemispheres and the brain stem. MRI was normal in asymptomatic and preataxic individuals and showed superior cerebellar vermis atrophy early in the ataxic stage, diffuse cerebellar atrophy some years into the disease course, and a pattern of olivopontocerebellar atrophy in the oldest patients. There was no significant cerebellar atrophy in patients younger than 50 years. |
4 |
| 18. Imai T, Takeda N, Ikezono T, et al. Classification, diagnostic criteria and management of benign paroxysmal positional vertigo. [Review]. Auris Nasus Larynx. 44(1):1-6, 2017 Feb. |
Review/Other-Dx |
N/A |
To discuss the classification, diagnostic criteria and management of benign paroxysmal positional vertigo. |
No results stated in the abstract. |
4 |
| 19. Perez-Vazquez P, Franco-Gutierrez V, Soto-Varela A, et al. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. Acta Otorrinolaringol Esp (Engl Ed). 69(6):345-366, 2018 Nov - Dec. |
Review/Other-Dx |
N/A |
To supply a consensus document providing practical guidance for the management of Benign Paroxysmal Positional Vertigo(BPPV). |
No results is stated in the abstract. |
4 |
| 20. von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Barany Society. Acta Otorrinolaringol Esp (Engl Ed). 68(6):349-360, 2017 Nov - Dec. |
Review/Other-Dx |
N/A |
To present operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. |
No results is stated in the abstract. |
4 |
| 21. Tan F, Bartels C, Walsh RM. Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation. Auris Nasus Larynx. 45(2):248-253, 2018 Apr. |
Observational-Dx |
500 patients |
To explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population. |
The average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%. |
2 |
| 22. Beh SC. Vestibular Migraine: How to Sort it Out and What to Do About it. [Review]. J Neuroophthalmol. 39(2):208-219, 2019 06. |
Review/Other-Dx |
N/A |
To discuss how to sort it out or what to do about Vestibular Migraine |
VM can manifest with a variety of vestibular symptoms, including spontaneous vertigo, triggered vertigo, positional vertigo, and head-motion dizziness. Patients may report more than 1 vestibular symptom. Episodes of vertigo are often, but not always, accompanied by headache. Auditory symptoms are frequently associated with VM attacks and may mimic the manifestations of MD. Other migrainous features that accompany VM attacks include photophobia, phonophobia, osmophobia, and visual aura. Interictally, patients may suffer from persistent dizziness or isolated paroxysmal vestibular symptoms. Mood disorders (particularly anxiety) are often found in VM. Abnormal neuro-otologic findings are not uncommon in patients with VM. Differential diagnoses for VM include MD, VBI, EA2, and migraine with brainstem aura. For rescue treatment, triptans, vestibular suppressants, and/or antiemetic agents may be considered. Pharmacologic migraine preventives (antiepileptics, beta-blockers, and antidepressants) are often useful. |
4 |
| 23. Zhang D, Zhang S, Zhang H, et al. Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo. Neuroreport. 24(13):741-5, 2013 Sep 11. |
Observational-Dx |
126 patients |
To investigate vertebrobasilar artery (VBA) lesions in elderly patients with benign paroxysmal positional vertigo (BPPV) by magnetic resonance angiography |
Relevant comorbidities included diabetes (12 patients), hypertension (23 patients), and dyslipidemia (20 patients). Findings included left or right vertebral artery (VA) stenosis or occlusion (22 patients, 21.2%), VA tortuosity (25 patients, 24.0%), VA dominance (20 patients, 19.2%), basilar artery (BA) stenosis or occlusion (nine patients, 8.6%), and BA tortuosity (12 patients, 11.5%). These abnormal vessels differed between BPPV patients and the control group (all P<0.05). The severity of Vertigo did not differ between the abnormal VA and abnormal BA groups (P>0.05), but did differ between the normal group and the abnormal VA or BA group (P<0.05). Vertigo severity correlated with VA stenosis or occlusion, VA dominance, and unilateral or bilateral VA tortuosity. VBA tortuosity and VA dominance were common in BPPV patients and may contribute toward BPPV. |
2 |
| 24. Cha WW, Song K, Yu IK, et al. Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo. Am J Otolaryngol. 38(4):428-432, 2017 Jul - Aug. |
Observational-Dx |
120 patients |
To evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). |
The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p>0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67-34.48; p=0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11-21.28; p=0.036) were positively associated with dizziness lasting longer than 3months. |
1 |
| 25. Chuang PC, Huang YS, Chiang CY, Zhang EW, Cheng FJ. Effectiveness of peer pressure on computed tomography use for dizziness/vertigo patients. Medicine (Baltimore). 98(11):e14887, 2019 Mar. |
Observational-Dx |
1657 Patients |
To evaluate the effect of peer pressure on decision making in emergency physicians (EPs) to use computed tomography (CT) for patients with dizziness/vertigo. |
We conducted a before-and-after retrospective case review of patients who visited the ED with dizziness/vertigo. EPs were categorized into 3 groups according to seniority (in years of experience: >12, 7-12, and <7). The rate of CT use for EPs, patient number, and CT use were e-mailed monthly to update the EP team on the benchmark rate and shape of the behavior.Among the 1657 (preintervention) and 1508 (postintervention) patients with dizziness/vertigo, 320 (19.3%) and 230 (15.3%), respectively, underwent brain CT. A decrease in the rate of CT use was observed in the postintervention group (odds ratio [OR] = 0.743, 95% confidence interval [CI] = 0.615-0.897), especially in junior EPs (years of experience, <7; OR = 0.667, 95% CI: 0.474-0.933) and younger patients (age, <60) (OR = 0.625, 95% CI: 0.453-0.857).The intervention strategy created peer pressure through e-mail reminders and decreased the rate of CT use for patients with isolated dizziness/vertigo, especially in junior EPs and younger patients. |
2 |
| 26. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009;40:3504-10. |
Observational-Dx |
100 patients |
To discuss the diagnosis of stroke in the acute vestibular syndrome |
One hundred one high-risk patients with AVS included 25 peripheral and 76 central lesions (69 ischemic strokes, 4 hemorrhages, 3 other). The presence of normal horizontal head impulse test, direction-changing nystagmus in eccentric gaze, or skew deviation (vertical ocular misalignment) was 100% sensitive and 96% specific for stroke. Skew was present in 17% and associated with brainstem lesions (4% peripheral, 4% pure cerebellar, 30% brainstem involvement; chi(2), P=0.003). Skew correctly predicted lateral pontine stroke in 2 of 3 cases in which an abnormal horizontal head impulse test erroneously suggested peripheral localization. Initial MRI diffusion-weighted imaging was falsely negative in 12% (all <48 hours after symptom onset). |
2 |
| 27. Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. [Review]. CMAJ. 183(9):E571-92, 2011 Jun 14. |
Review/Other-Dx |
N/A |
To review bedside diagnosis in acute vestibular syndrome |
No results stated in the abstract |
4 |
| 28. Doijiri R, Uno H, Miyashita K, Ihara M, Nagatsuka K. How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack? J Stroke Cerebrovasc Dis 2016;25:2549-52. |
Observational-Dx |
221 patients |
To elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack. |
One hundred eighteen patients had vertigo whereas the other 103 had dizziness. Brain computed tomography or magnetic resonance imaging revealed recent stroke lesions in 25 patients (11.3%) (ischemic, 21; hemorrhagic, 4).The lesions were generally small and localized in the cerebellum (n = 21), pons (n = 1), medulla oblongata (n = 1), or corona radiata (n = 1). Of the 25 patients, 19 (76%) had dizzy-type spells; none had neurological dysfunction at the time of discharge. In the remaining 196 patients, no stroke was detected on computed tomography or magnetic resonance imaging. |
3 |
| 29. Saber Tehrani AS, Kattah JC, Mantokoudis G, et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 83(2):169-73, 2014 Jul 08. |
Observational-Dx |
15 patients |
To describe characteristics of small strokes causing acute vestibular syndrome (AVS). |
Of 190 high-risk AVS presentations (105 strokes), we found small strokes in 15 patients (median age 64 years, range 41-85). The most common vestibular structure infarcted was the inferior cerebellar peduncle (73%); the most common stroke location was the lateral medulla (60%). Focal neurologic signs were present in only 27%. The HINTS "plus" battery identified small strokes with greater sensitivity than early MRI-DWI (100% vs 47%, p < 0.001). False-negative initial MRIs (6-48 hours) were more common with small strokes than large strokes (53% [n = 8/15] vs 7.8% [n = 7/90], p < 0.001). Nonlacunar stroke mechanisms were responsible in 47%, including 6 vertebral artery occlusions or dissections. |
2 |
| 30. Newman-Toker DE, Kerber KA, Hsieh YH, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 20(10):986-96, 2013 Oct. |
Observational-Dx |
190 patients |
To compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2]). |
A total of 190 adult AVS patients were assessed (1999-2012). Median age was 60.5 years (range = 18 to 92 years; interquartile range [IQR] = 52.0 to 70.0 years); 60.5% were men. Final diagnoses were vestibular neuritis (34.7%), posterior fossa stroke (59.5% [105 infarctions, eight hemorrhages]), and other central causes (5.8%). Median ABCD2 was 4.0 (range = 2 to 7; IQR = 3.0 to 4.0). ABCD2 = 4 for stroke had sensitivity of 61.1%, specificity of 62.3%, LR+ of 1.62, and LR- of 0.62; sensitivity was lower for those younger than 60 years old (28.9%). HINTS stroke sensitivity was 96.5%, specificity was 84.4%, LR+ was 6.19, and LR- was 0.04 and did not vary by age. For any central lesion, sensitivity was 96.8%, specificity was 98.5%, LR+ was 63.9, and LR- was 0.03 for HINTS, and sensitivity was 99.2%, specificity was 97.0%, LR+ was 32.7, and LR- was 0.01 for HINTS "plus" (any new hearing loss added to HINTS). Initial MRIs were falsely negative in 15 of 105 (14.3%) infarctions; all but one was obtained before 48 hours after onset, and all were confirmed by delayed MRI. |
2 |
| 31. Ohle R, Montpellier RA, Marchadier V, et al. Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta-analysis. Acad Emerg Med. 27(9):887-896, 2020 09. |
Review/Other-Dx |
N/A |
To assess the diagnostic accuracy when performed by emergency physicians versus neurologists. |
A total of five studies with 617 participants met the inclusion criteria. The mean (±SD) study length was 5.3 (±3.3) years. Prevalence of vertebrobasilar stroke ranged 9.3% to 44% (mean ± SD = 39.1% ± 17.1%). The most common diagnoses were vertebrobasilar stroke (mean ± SD = 34.8% ± 17.1%), peripheral cause (mean ± SD = 30.9% ± 16%), and intracerebral hemorrhage (mean ± SD = 2.2% ± 0.5%). The HINTS examination, when performed by neurologists, had a sensitivity of 96.7% (95% CI = 93.1% to 98.5%, I2 = 0%) and specificity of 94.8% (95% CI = 91% to 97.1%, I2 = 0%). When performed by a cohort of physicians including both emergency physicians (board certified) and neurologists (fellowship trained in neurootology or vascular neurology) the sensitivity was 83% (95% CI = 63% to 95%) and specificity was 44% (95% CI = 36% to 51%). |
4 |
| 32. Pula JH, Newman-Toker DE, Kattah JC. Multiple sclerosis as a cause of the acute vestibular syndrome. J Neurol. 260(6):1649-54, 2013 Jun. |
Observational-Dx |
n/a |
To sought to determine frequency and clinical features of demyelinating acute vestibular syndrome (AVS) |
This is a prospective observational study (1999-2011). Consecutive AVS patients (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with a risk for central localization underwent structured bedside examination and neuroimaging. When applicable, we identified MS based on clinical, imaging, and laboratory features. Of 170 AVS presentations, 4% (n = 7) were due to demyelinating disease. Five had an acute MS plaque likely responsible for the clinical syndrome. Lesion location varied-1 medulla; 1 inferior cerebellar peduncle; 1 middle cerebellar peduncle; 1 posterior pontine tegmentum; 1 in the intrapontine 8th nerve fascicle; 1 superior cerebellar peduncle; 1 midbrain. Only two had a lesion in or near the intra-pontine 8th nerve fascicle. Three were first presentations (i.e., clinically isolated demyelinating syndrome), while the others were known MS. All had central oculomotor signs. In two patients, the only central sign was a normal horizontal head impulse test (h-HIT) of vestibular function. All patients improved with steroid therapy. Demyelinating disease was an uncommon cause of AVS in our series. Symptomatic lesions were not restricted to the 8th nerve fascicle. Five patients had relatively obvious oculomotor signs, making differentiation from vestibular neuritis straightforward. Two patients had unidirectional, horizontal nystagmus that followed Alexander's law and was suppressed with fixation (true pseudoneuritis). The presence of a normal h-HIT in these suggested central localization. |
2 |
| 33. von Brevern M, Lempert T. Vestibular migraine. [Review]. Handb. clin. neurol.. 137:301-16, 2016. |
Review/Other-Dx |
N/A |
To discuss Vestibular migraine. |
No results stated in the abstract |
4 |
| 34. Fundakowski CE, Anderson J, Angeli S. Cross-sectional vestibular nerve analysis in vestibular neuritis. Ann Otol Rhinol Laryngol. 121(7):466-70, 2012 Jul. |
Observational-Dx |
26 patients |
To examine the association between the size and cross-sectional area of the superior vestibular nerve as measured on constructive interference in steady-state (CISS) parasagittal magnetic resonance imaging (MRI) and the vestibular nerve function as measured by electronystagmography. |
A statistically significant decrease was observed in both vestibular nerve cross-sectional area and height as compared to the contralateral vestibular nerve. A non-statistically significant trend was observed for a relative decreased cross-sectional nerve area with increased age, as well as a decrease in nerve area with an increase in symptom duration. |
2 |
| 35. Freund W, Weber F, Schneider D, Mayer U, Scheithauer M, Beer M. Vestibular Nerve Atrophy After Vestibular Neuritis - Results from a Prospective High-Resolution MRI Study. ROFO Fortschr Geb Rontgenstr Nuklearmed. 192(9):854-861, 2020 Sep. |
Observational-Dx |
N/A |
To aim to prove if there is peripheral atrophy after vestibular neuritis (VN) with persistent canal paresis. |
The interrater difference regarding the area was 22 %. We found significant atrophy of the SVN with a 24 % smaller area (p = 0.026) and found a smaller ratio of SVN/IVN on the symptomatic side (p = 0.017). Concerning single subject data, only 5 patients showed extensive atrophy of the NVS, while 5 patients did not. The time since symptom onset did not significantly influence the atrophy. |
2 |
| 36. Venkatasamy A, Huynh TT, Wohlhuter N, et al. Superior vestibular neuritis: improved detection using FLAIR sequence with delayed enhancement (1 h). Eur Arch Otorhinolaryngol. 276(12):3309-3316, 2019 Dec. |
Observational-Dx |
33 patients |
To demonstrate that a single dose of gadolinium is sufficient. |
A strong enhancement of the sup VN was observed on the pathological side in 85% of patients with vestibular neuritis. The average signal intensity of the pathological sup VN (139 units ± 44) was more than two times the average intensity in the control group (58.5 units ± 5). The average ratios supVN/C were significantly different between the pathological side in vestibular neuritis (2.43 units ± 0.63) and the control group [1.16 ± 0.14 (Pr(diff > 0) = 1)]. A delayed enhancement > 71.5 units had a sensitivity of 96% and a specificity of 100% for the diagnosis of superior vestibular neuritis. |
2 |
| 37. Lee DH, Kim WY, Shim BS, et al. Characteristics of central lesions in patients with dizziness determined by diffusion MRI in the emergency department. Emerg Med J. 31(8):641-4, 2014 Aug. |
Review/Other-Dx |
645 patients |
To describe the rate and risk factors of central lesions among patients with dizziness in the emergency department based on diffusion-weighted MRI, which otologists consulted for evaluation of patients with dizziness need to know. |
Of 645 patients who underwent MRI, 23 (3.6%) had acute central lesions (22 infarcts/1 haemorrhage). Univariate analyses revealed that older age, hypertension, atrial fibrillation, non-whirling type of dizziness symptoms and combined neurological symptoms were significantly associated with the development of central lesions (p<0.05). The incidence of central lesions in patients aged in their 40s, 50s, 60s, 70s and =80s was 0, 3.9%, 3.4%, 7.4% and 16.7%. Multivariate analyses showed that hypertension (p=0.01, OR=3.42), symptoms of non-whirling type (p=0.03, OR=3.12) and combined neurological symptoms (p<0.01, OR=16.72) were independent predictors of central lesions. |
4 |
| 38. Adamec I, Krbot Skoric M, Ozretic D, Habek M. Predictors of development of chronic vestibular insufficiency after vestibular neuritis. J Neurol Sci. 347(1-2):224-8, 2014 Dec 15. |
Observational-Dx |
26 patients |
To evaluate the role of clinical parameters, MRI and ocular VEMP (oVEMP) and cervical VEMP (cVEMP) as predictors of development of chronic vestibular insufficiency after vestibular neuritis. |
Of all studied parameters, only chronic white matter supratentorial lesions present on brain MRI negatively correlated with clinical recovery (Phi coefficient=-0.637, p=0.001). The logistic regression analysis showed that positive brain MRI and older age reduced odds for clinical recovery. There was no correlation between clinical recovery and oVEMP AR recovery between groups (p=0.781). Seven patients showed improvement, and 19 showed worsening on oVEMP AR after a 1-year follow-up. Statistical regression model for predicting the outcome of clinical recovery using asymmetry score recovery, as an independent variable, was not statistically significant. |
2 |
| 39. Perloff MD, Patel NS, Kase CS, Oza AU, Voetsch B, Romero JR. Cerebellar stroke presenting with isolated dizziness: Brain MRI in 136 patients. Am J Emerg Med. 35(11):1724-1729, 2017 Nov. |
Observational-Dx |
136 patients |
To evaluate occurrence of cerebellar stroke in Emergency Department (ED) presentations of isolated dizziness (dizziness with a normal exam and negative neurological review of systems). |
One hundred and thirty-six patients, who had a brain MRI for isolated dizziness, were included. There was a low correlation of gait assessment between ED physician and Neurologist (49 patients, Spearman's correlation r2=0.17). Based on MRI DWI sequence, 3.7% (5/136 patients) had acute cerebellar strokes, limited to or including, the medial posterior inferior cerebellar artery vascular territory. In the 5 cerebellar stroke patients, mean age, body mass index (BMI), hemoglobin A1c, gender distribution, and prevalence of hypertension were similar to the non-cerebellar stroke patient group. Mean LDL/HDL ratio was 3.63±0.80 and smoking prevalence was 80% in the cerebellar stroke group compared to 2.43±0.79 and 22% (respectively, p values<0.01) in the non-cerebellar stroke group. |
2 |
| 40. American College of Radiology. ACR Appropriateness Criteria®: Cerebrovascular Diseases-Stroke and Stroke-Related Conditions. Available at: https://acsearch.acr.org/docs/3149012/Narrative/. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No abstract available. |
4 |
| 41. Kerber KA, Meurer WJ, Brown DL, et al. Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study. Neurology. 85(21):1869-78, 2015 Nov 24. |
Observational-Dx |
272 patients |
To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations. |
Acute stroke was identified in 29 of 272 patients (10.7%). Associations with stroke were as follows: ABCD(2) score (continuous) (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.20-2.51), any other CNS features (OR 2.54; 95% CI 1.06-6.08), OM assessment (OR 2.82; 95% CI 0.96-8.30), and prior stroke (OR 0.48; 95% CI 0.05-4.57). No stroke cases were in the model's low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%). |
1 |
| 42. Edlow JA, Carpenter C, Akhter M, et al. Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Acad Emerg Med 2023;30:442-86. |
Review/Other-Dx |
NA |
To discuss the guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department |
No results stated in the abstract. |
4 |
| 43. Lo BM, Carpenter CR, Ducey S, et al. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke. Annals of emergency medicine 2023;82:e17-e64. |
Review/Other-Dx |
NA |
To discuss Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke |
No results stated in the abstract. |
4 |
| 44. Morita S, Suzuki M, Iizuka K. False-negative diffusion-weighted MRI in acute cerebellar stroke. Auris Nasus Larynx. 38(5):577-82, 2011 Oct. |
Review/Other-Dx |
8 Patients |
To heighten physician awareness of false-negative diffusion-weighted (DW) magnetic-resonance imaging findings in patients with acute cerebellar infarction and the importance of periodically observing nystagmus after symptom onset. |
In three of the patients, the direction and/or type of nystagmus changed periodically. In four of the patients, severe vertigo, nausea, and vomiting persisted after the nystagmus had been resolved. A repeat MR examination was performed 24h after symptom onset because of the atypical pattern of nystagmus for benign peripheral vestibular disorders, at which point cerebellar infarction was detected. |
4 |
| 45. Shono Y, Koga M, Toyoda K, et al. Medial medullary infarction identified by diffusion-weighted magnetic resonance imaging. Cerebrovasc Dis. 30(5):519-24, 2010. |
Observational-Dx |
30 Patients |
To elucidate the frequency and clinical profiles of patients with medial medullary infarction (MMI) identified by diffusion-weighted MRI (DWI). |
Thirty patients (1.5% of 2,014 with ischemic stroke) had MMI, including isolated unilateral MMI in 26 patients. Lesions were located by DWI in the rostral medulla of 25 patients (83%). Culprit infarcts that were undetectable by DWI in 6 (38%) of 16 patients who were assessed within 24 h after onset were later confirmed as MMI. The major etiological mechanism was small artery occlusion (SAO; 19 patients) and the median initial National Institutes of Health Stroke Scale score was 4 (interquartile range: 3-4.75). The most frequent symptom was contralateral hemiparesis (27 patients). None of the patients fulfilled the classical Dejerine Triad. Twenty-two patients (73%) had a modified Rankin Scale score of =2 at 3 months. A patient developed transient ischemic attack within 3 months; none developed recurrent stroke. |
2 |
| 46. Kabra R, Robbie H, Connor SE. Diagnostic yield and impact of MRI for acute ischaemic stroke in patients presenting with dizziness and vertigo. Clin Radiol. 70(7):736-42, 2015 Jul. |
Observational-Dx |
188 patients |
To identify predictors of acute ischaemic stroke (AIS) and evaluate the diagnostic yield and impact of magnetic resonance imaging (MRI) in patients imaged for dizziness and vertigo. |
One hundred and eighty-eight patients were included: 39 with vertebrobasilar AIS (20.7%), 32 (17%) with a significant but non-ischaemic abnormality, and 117 (62.2%) with a normal or non-related abnormality. The sensitivity of CT in diagnosing AIS was 9.52% (95% CI: 1.67-31.8%). Posterior inferior cerebellar artery (PICA) territory infarcts were the most common (38.5%). Patients with AIS were significantly more likely to be older than 50 years (p = 0.04), have a greater number of cardiovascular risk factors (p < 0.01), shorter duration of symptoms (p = 0.03), and at least one neurological sign (p = 0.02). DWI MRI had a diagnostic impact on 21.6% patients with stroke. |
3 |
| 47. Karameshev A, Arnold M, Schroth G, et al. Diffusion-weighted MRI helps predict outcome in basilar artery occlusion patients treated with intra-arterial thrombolysis. Cerebrovasc Dis. 32(4):393-400, 2011. |
Observational-Dx |
36 patients |
To determine whether the severity of neurological symptoms, the extent of early ischemic damage on pretreatment diffusion-weighted MRI (DWI), and the lesion progression or regression on post-treatment MRI can predict functional outcome in patients with BAO treated with IAT. |
Median NIHSS and GCS scores on admission were 17 and 10, respectively. In univariate analysis, NIHSS and GCS scores (on admission) and all 4 DWI scores were significantly associated with clinical outcome. After regression analysis for each DWI score, the DWI score proposed herein was the only score that remained independently associated with clinical outcome at 3 months (p = 0.004). A decrease in DWI score was observed in 3 of 23 patients with post-IAT MRI. Successful recanalization was significantly associated with lesion regression (p = 0.044). |
2 |
| 48. Mainnemarre J, Hautefort C, Toupet M, et al. The vestibular aqueduct ossification on temporal bone CT: an old sign revisited to rule out the presence of endolymphatic hydrops in Meniere's disease patients. Eur Radiol. 30(11):6331-6338, 2020 Nov. |
Observational-Dx |
25 patients |
To discuss the vestibular aqueduct ossification on temporal bone CT |
In healthy subjects, the VA was normal (grade 0) in 22/25 (88%) ears and discontinuous (grade I) in 3 healthy ears (12%). In the symptomatic ears of MD patients, we found 17/56 ears (30.3%) with VA grade 0, 15/56 ears (26.8%) with grade I, and 24/56 ears (42.8%) with grade II (p < 0.001). In MD patients, EH was observed in 46/94 ears (48.9%). A VA of grade 0 would eliminate the presence of EH with a negative predictive value of 88.6%, while a VA grade II would predict the presence of saccular hydrops with a positive predictive value of 93.1%. |
2 |
| 49. Yamane H, Konishi K, Sakamaoto H, et al. Practical 3DCT imaging of the vestibular aqueduct for Meniere's disease. Acta Otolaryngol (Stockh). 135(8):799-806, 2015 Aug. |
Observational-Dx |
13 patients |
To visualize the detailed images of the VA using three-dimensional (3D) computed tomography (CT) and discuss its clinical utility in assessing MD. |
Examination of the VA from both the lateral outside and inside views on 3DCT yielded more precise images than generated by conventional CT and could be useful to estimate the VA function. The estimated VA function in the MD ears was significantly abnormal compared to the function in healthy ears. An obliterated VA was characteristic of affected MD ears. |
2 |
| 50. Hu J, Peng A, Deng K, et al. Value of CT and three-dimensional reconstruction revealing specific radiological signs for screening causative high jugular bulb in patients with Meniere's disease. BMC med. imaging. 20(1):103, 2020 08 31. |
Observational-Dx |
95 patients |
To investigate the pathological features of vestibular aqueduct (VA) related high jugular bulb (HJB) and explore the possible cause-consequence relation between HJB and endolymphatic hydrops (EH), and the potential specific radiological signs for screening causative HJB in Meniere's disease (MD). |
JB was classified as: Type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (PSCC); type 3, between the inferior margin of the PSCC and the inferior margin of the internal auditory canal (IAC); type 4, above the inferior margin of the IAC. There were no significant differences in the presence of types 1, 2 and 3 JB between two groups. The presence of type 4 JB, average height of the JB and prevalence of the non-visualization of the VA in CT scans showed significant differences between two groups. The morphological pattern between the JB and VA revealing by 3DRC was classified as: Type I, the JB was not in contact with the VA; type II, the JB was in contact with the VA, but the latter was intact without obstruction; type III, the VA was obliterated by HJB encroachment. There were no significant differences in the presence of type I and II between two groups. Type III was identified in 5 hydropic ears but no non-hydropic ears, with a significant difference observed between the two groups. |
2 |
| 51. Sousa R, Raposo F, Guerreiro C, et al. Magnetic resonance imaging and Meniere's disease-unavoidable alliance. [Review]. Neuroradiology. 63(11):1749-1763, 2021 Nov. |
Review/Other-Dx |
N/A |
To review MRI techniques and diagnostic criteria of endolymphatic hydrops and the role of MRI in MD is discussed |
No results stated in the abstract. |
4 |
| 52. Pai I, Mendis S, Murdin L, Touska P, Connor S. Magnetic resonance imaging of Meniere's disease: early clinical experience in a UK centre. J Laryngol Otol. 134(4):302-310, 2020 Apr. |
Review/Other-Dx |
31 patients |
To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo. |
The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears. |
4 |
| 53. Paskoniene A, Baltagalviene R, Lengvenis G, et al. The Importance of the Temporal Bone 3T MR Imaging in the Diagnosis of Meniere's Disease. Otol Neurotol. 41(2):235-241, 2020 02. |
Observational-Dx |
105 patients |
To evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease |
78.1% of subjects had abnormal MRI findings other than hydrops, and it was more than 90% (50/55) of patients in the definite MD group (p < 0.001). Changes in caloric test were observed in 63.8% of subjects in general, and in 76.4% of patients with a definite Menière's disease. The side of the endolymphatic hydrops observed on MR imaging corresponded to the clinical diagnosis of the Menière's disease based on the results of audiometry (p < 0.001) and unilateral weakness (p < 0.001). Endolymphatic hydrops on MRI and directional preponderance in caloric test were two independent predictors of the definite Menière's disease. |
2 |
| 54. Sepahdari AR, Ishiyama G, Vorasubin N, Peng KA, Linetsky M, Ishiyama A. Delayed intravenous contrast-enhanced 3D FLAIR MRI in Meniere's disease: correlation of quantitative measures of endolymphatic hydrops with hearing. Clin Imaging. 39(1):26-31, 2015 Jan-Feb. |
Observational-Dx |
22 subjects; 41 ears |
To correlate quantifiable measures of endolymphatic hydrops (EH) with auditory function in the setting of Meniere's disease (MD). |
EH was better evaluated on 3D maximum intensity projections (MIPs) than on two-dimensional (2D) images. Using MIPs, quantitative assessments EH correlated with severity of hearing impairment. |
2 |
| 55. Eliezer M, Attye A, Toupet M, Hautefort C. Imaging of endolymphatic hydrops: A comprehensive update in primary and secondary hydropic ear disease. J Vestib Res. 31(4):261-268, 2021. |
Review/Other-Dx |
N/A |
To summarize the methodology of hydrops exploration using MRI and the previously published radiological findings in patients with primary (PHED) and secondary hydropic ear disease (SHED). |
Before the emergence of delayed inner ear MRI, the presence of EH was assumed based on clinical symptoms. However, because of the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED. The presence of EH on MRI is related with the degree of sensorineural hearing loss whether in patients with PHED or SHED. By contrast, in PHED or SHED patients without sensorineural hearing loss, MRI showed no sign of EH. |
4 |
| 56. Liu Y, Jia H, Shi J, et al. Endolymphatic hydrops detected by 3-dimensional fluid-attenuated inversion recovery MRI following intratympanic injection of gadolinium in the asymptomatic contralateral ears of patients with unilateral Meniere's disease. Med Sci Monit. 21:701-7, 2015 Mar 06. |
Experimental-Dx |
30 patients |
To identify the incidence of endolymphatic hydrops using 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) in the contralateral ear in patients with unilateral Meniere's disease (MD). |
Endolymphatic hydrops was observed in 7 of the 30 (23.3%) asymptomatic ears. The mean PTA of the asymptomatic ears in the contralateral hydrops patients (33.0+/-6.1 dB) was significantly higher compared with the non-hydrops patients (17.8+/-5.7 dB). The patients with observed contralateral hydrops exhibited a significantly longer duration of the disease compared with the non-hydrops patients (6.7+/-6.3 vs. 2.9+/-3.1 years, respectively). Furthermore, the patients with contralateral hydrops had a worse hearing level in the affected ears compared with the non-hydrops patients (70.3+/-7.4 vs. 52.5+/-3.8 dB, respectively). |
2 |
| 57. Barlet J, Vaussy A, Ejzenberg Y, et al. Optimized 3D-FLAIR sequences to shorten the delay between intravenous administration of gadolinium and MRI acquisition in patients with Meniere's disease. Eur Radiol. 32(10):6900-6909, 2022 Oct. |
Observational-Dx |
29 patients |
To shorten the 4-h delay between the intravenous administration of gadolinium and MRI acquisition for hydrops evaluation using an optimized 3D-FLAIR sequence in patients with Menière's disease. |
For all ears, the signal intensity ratio was significantly non-inferior at 2 h compared to 4 h, with a mean geometric signal intensity ratio at 0.83 (95% CI: 0.76 to 0.90, one-sided p < .001 for non-inferiority at -30% margin). Mean volume equivalence of saccule and utricle between 2 and 4 h was proven at a ± 0.20 standardized deviation equivalence margin. Intra-rater agreements (Cohen's kappa) were all greater than 0.90 for all endolymphatic hydrops location and blood-labyrinthine-barrier impairment between the 2- and 4-h assessments. |
2 |
| 58. Wesseler A, Ovari A, Javorkova A, Kwiatkowski A, Meyer JE, Kivelitz DE. Diagnostic Value of the Magnetic Resonance Imaging With Intratympanic Gadolinium Administration (IT-Gd MRI) Versus Audio-Vestibular Tests in Meniere's Disease: IT-Gd MRI Makes the Difference. Otol Neurotol. 40(3):e225-e232, 2019 03. |
Observational-Dx |
31 patients |
To evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). |
Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH. |
2 |
| 59. Gu X, Fang ZM, Liu Y, Huang ZW, Zhang R, Chen X. Diagnostic advantages of intratympanically gadolinium contrast-enhanced magnetic resonance imaging in patients with bilateral Meniere's disease. Am J Otolaryngol. 36(1):67-73, 2015 Jan-Feb. |
Observational-Dx |
8 Patients |
To probe whether intratympanically gadolinium contrast-enhanced three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging, together with magnetic resonance imaging scoring system of the perilymphatic space, had advantages in diagnosing patients with bilateral Meniere's disease. |
According to the magnetic resonance imaging scoring system, 100% (8/8) of the patients with bilateral Meniere's disease had bilateral endolymphatic hydrops. The positive rates of vestibular evoked myogenic potential and caloric test were 50% (4/8) and 25% (2/8), respectively. There was a significant difference among the positive rates of the three examinations (P<.05). Two patients with 'possible' Meniere's disease had bilateral endolymphatic hydrops by magnetic resonance imaging. Eight patients with unilateral Meniere's disease displayed endolymphatic hydrops of the affected ears. |
2 |
| 60. Bernaerts A, Vanspauwen R, Blaivie C, et al. The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Meniere's disease on MRI. Neuroradiology. 61(4):421-429, 2019 Apr. |
Observational-Dx |
148 patients |
To investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière's disease (MD). |
The intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value. |
2 |
| 61. Shi S, Guo P, Li W, Wang W. Clinical Features and Endolymphatic Hydrops in Patients With MRI Evidence of Hydrops. Ann Otol Rhinol Laryngol. 128(4):286-292, 2019 Apr. |
Observational-Dx |
198 patients |
To investigate the correlation between grades of endolymphatic hydrops (ELH) and clinical characteristics and determine the detailed clinical characteristics of Ménière's disease (MD) patients with evidence of hydrops based on magnetic resonance imaging (MRI). |
Of 198 patients, ELH was observed in 100% of cases on the clinically affected side and 8.6% of cases on the asymptomatic side. In addition, 98.5% of ELH was classified as moderate or significant grade. Low-frequency hearing loss was significantly correlated with the extent of both vestibular and cochlear hydrops, whereas the vertigo attack frequency showed no significant correlation with ELH grades. The disease duration of MD with bilateral ELH was longer than that with unilateral ELH. The clinical characteristics were variant and did not completely fit the proposed diagnostic criteria. |
2 |
| 62. Xie J, Zhang W, Zhu J, et al. Differential Diagnosis of Endolymphatic Hydrops Between "Probable" and "Definite" Meniere's Disease via Magnetic Resonance Imaging. Otolaryngol Head Neck Surg. 165(5):696-700, 2021 11. |
Observational-Dx |
31 patients |
To evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). |
Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH. |
2 |
| 63. Li X, Wu Q, Sha Y, Dai C, Zhang R. Gadolinium-enhanced MRI reveals dynamic development of endolymphatic hydrops in Meniere's disease. Rev Bras Otorrinolaringol (Engl Ed). 86(2):165-173, 2020 Mar - Apr. |
Observational-Dx |
178 patients |
To investigate the development of endolymphatic hydrops in Meniere's disease by monitoring the vestibules and cochleae of affected patients. |
Symptomatic endolymphatic hydrops was detected on the affected side in all patients, whereas asymptomatic endolymphatic hydrops was detected on the unaffected contra-lateral side in 32 patients (18.0%). On the affected side, the cochlear apical turn and the cochlear middle turn demonstrated significantly higher rates of endolymphatic hydrops than the cochlear basal turn and the vestibule. The severity of endolymphatic hydrops gradually decreased from the cochlear apical turn to the cochlear basal turn. On the contra lateral side, the incidence and degree of the detected asymptomatic endolymphatic hydrops were significantly greater in the cochleae than in the vestibules (p<0.05), with no significant difference detected between the cochlear turns. |
2 |
| 64. Sluydts M, Bernaerts A, Casselman JW, et al. The relationship between cochleovestibular function tests and endolymphatic hydrops grading on MRI in patients with Meniere's disease. Eur Arch Otorhinolaryngol. 278(12):4783-4793, 2021 Dec. |
Observational-Dx |
78 patients |
To discuss the relationship between cochleovestibular function and a magnetic resonance imaging (MRI-) based classification system of endolymphatic hydrops was investigated. |
The low-frequency PTA was significantly different between cochlear EH grades I and II (p = 0.036; Grade I: mean (Standard Deviation, SD) = 51 decibel Hearing Level (dB HL) (18 dB HL); Grade II: mean (SD) = 60 dB HL (16 dB HL)), and vestibular EH grades 0 and III (p = 0.018; Grade 0: mean (SD) = 43 dB HL (21 dB HL); Grade III: mean = 60 dB HL (10 dB HL)). The ipsilateral caloric sum of ears with vestibular EH grade I (n = 6) was increased with regards to vestibular EH grades 0 (p = 0.001), II (p < 0.001), and III (p < 0.001) (Grade 0: mean (SD) = 24°/s (15°/s); Grade I: mean (SD) = 47°/s (11°/s); Grade II: mean (SD) = 21°/s (13°/s); Grade III: mean (SD) = 16°/s (8°/s)). |
2 |
| 65. Lopez-Escamez JA, Attye A. Systematic review of magnetic resonance imaging for diagnosis of Meniere disease. J Vestib Res. 29(2-3):121-129, 2019. |
Review/Other-Dx |
N/A |
To discuss the review of magnetic resonance imaging for diagnosis of Meniere disease. |
No results stated in the abstract. |
4 |
| 66. Conte G, Caschera L, Calloni S, et al. MR Imaging in Meniere Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker?. AJNR Am J Neuroradiol. 39(11):2114-2119, 2018 11. |
Observational-Dx |
49 patients |
To investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease. |
We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen ? = 0.87; 95% CI, 0.69-1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 88%, and negative predictive value = 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 96%, negative predictive value = 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears. |
2 |
| 67. Inui H, Sakamoto T, Ito T, Kitahara T. Volumetric measurements of the inner ear in patients with Meniere's disease using three-dimensional magnetic resonance imaging. Acta Otolaryngol (Stockh). 136(9):888-93, 2016 Sep. |
Review/Other-Dx |
32 patients |
To identify side or sex-related differences in the ALIE, the length of the spiral canal of cochlea (LSCC), and the volume of components of the inner ear in MD and CRS. |
In CRS, ALIE of the right ear in males was significantly longer than in females. Patients younger than 60 years old with CRS had a significantly larger VIE, VC, and VSC than older than 60. In MD, the ALIE in older than 60 was longer than below 60. |
4 |
| 68. Macintosh BJ, Marquardt L, Schulz UG, Jezzard P, Rothwell PM. Hemodynamic alterations in vertebrobasilar large artery disease assessed by arterial spin-labeling MR imaging. AJNR Am J Neuroradiol. 33(10):1939-44, 2012 Nov. |
Observational-Dx |
41 patients |
To assess multiple inflow pulsed ASL MR imaging for its ability to measure CBF and ATT in patients with VB disease. |
CBF was reduced (P < .003) in patients compared with controls, which was significant after excluding voxels with a poor fit. Differences in ATT between patients and controls were not significant after voxel correction. There was a strong correlation between CBF and ATT among patients. Finally, ATT was significantly correlated with VB disease severity (P = .026). |
2 |
| 69. Yi TY, Chen WH, Zhang MF, et al. Diagnostic ability of 3-dimensional contrast-enhanced MR angiography in identifying vertebral basilar artery stenosis. J Neurol Sci. 363:121-5, 2016 Apr 15. |
Review/Other-Dx |
149 patients |
To review the imagines of consecutive one hundred and forty-nine Chinese patients with ischemic stroke or vertigo/dizziness who underwent 3D-CE-MRA and DSA. |
Compared with DSA, sensitivity, specificity and accuracy of 3D-CE-MRA in detecting of vertebral artery origin =70% stenosis or occlusion was 97.1%, 77.4% and 81.9%, but diagnostic consistency was poor (K=0.59); Analysis combined with vascular origin images, the specificity (97.8%), accuracy (92.9%) and consistency (K=0.826) was significantly improved. |
4 |
| 70. Kim YS, Lim SH, Oh KW, et al. The advantage of high-resolution MRI in evaluating basilar plaques: a comparison study with MRA. Atherosclerosis. 224(2):411-6, 2012 Oct. |
Observational-Dx |
219 patients |
To discuss the advantage of high-resolution MRI in evaluating basilar plaques: a comparison study with MRA |
Patients with apparent plaque had higher frequencies of diabetes mellitus, lower high-density lipoprotein and higher hemoglobin A1c, erythrocyte sedimentation rate and homocysteine. Of the 62 cases of apparent plaque, severe stenosis (>50%) was observed in 10 (16%) by MRA and in 27 (43%) by HRMRI, which points to overestimation of plaques by HRMRI. In addition, no stenosis was evident on MRA in 13 patients with apparent plaque even though they had up to 72% stenosis on HRMRI. After adjusting for covariates, basilar artery apparent plaque was independently associated with old age, previous stroke, diabetes mellitus, low HDL and high levels of homocysteine. |
2 |
| 71. Lou X, Ma N, Ma L, Jiang WJ. Contrast-enhanced 3T high-resolution MR imaging in symptomatic atherosclerotic basilar artery stenosis. AJNR Am J Neuroradiol. 34(3):513-7, 2013 Mar. |
Observational-Dx |
60 patients |
To explore the relationship between wall enhancement and both recent infarction in the territory of the stenotic BA and subsequent ischemic events associated with the stenotic BA. |
Images from 56 patients were suitable for analysis. Thirty-three patients underwent stent placement for the stenotic BA, and 23 patients underwent conservative medical treatment with antiplatelet agents and risk-factor control. All 23 patients with medical treatment had a 12-month follow-up. Greater wall enhancement was seen in the section proximal to the MLN section in both patients with recent infarction (74 ± 65% versus 44 ± 44%; P = .046) and in patients with subsequent ischemic events (100 ± 57% versus 44 ± 44%; P = .014). |
2 |
| 72. Heidelberg D, Ronsin S, Bonneville F, Hannoun S, Tilikete C, Cotton F. Main inherited neurodegenerative cerebellar ataxias, how to recognize them using magnetic resonance imaging?. [Review]. J Neuroradiol. 45(5):265-275, 2018 Sep. |
Review/Other-Dx |
N/A |
To discuss a pattern recognition approach that, associated with the age at disease onset, and clinical manifestations, may help neuroradiologists differentiate the most frequent profiles of ataxia. |
No results state din the abstract |
4 |
| 73. Barsottini OG, Albuquerque MV, Braga-Neto P, Pedroso JL. Adult onset sporadic ataxias: a diagnostic challenge. [Review]. Arq Neuropsiquiatr. 72(3):232-40, 2014 Mar. |
Review/Other-Dx |
N/A |
To discuss the different disease categories that lead to sporadic ataxia with adult onset with special emphasis on their clinical and neuroimaging features, and diagnostic criteria. |
No results state din the abstract. |
4 |
| 74. Kirchner H, Kremmyda O, Hufner K, et al. Clinical, electrophysiological, and MRI findings in patients with cerebellar ataxia and a bilaterally pathological head-impulse test. Ann N Y Acad Sci. 1233:127-38, 2011 Sep. |
Observational-Dx |
31 patients |
To discuss the examination of 13 patients presented with the combination of gait and stance ataxia, cerebellar ocular motor signs, and a bilaterally pathological head-impulse test (HIT). |
Twenty-three patients had evidence of polyneuropathy (predominantly mixed sensorimotor involving axonal loss and demyelination) and twenty of hypoacusis (1 unilateral and 19 bilateral). Voxel-based morphometry comparing local gray matter brain volume between patients and controls revealed cerebellar atrophy involving both the vermis and the hemispheres. We conclude that there is a clinically relevant combination of cerebellar ataxia with cerebellar atrophy, bilaterally pathological HIT, polyneuropathy, and hypoacusis. This multisensory syndrome is most likely caused by a neurodegenerative disorder affecting different systems, leading to severe impairment of affected patients. |
2 |
| 75. Oz G, Harding IH, Krahe J, Reetz K. MR imaging and spectroscopy in degenerative ataxias: toward multimodal, multisite, multistage monitoring of neurodegeneration. [Review]. Curr Opin Neurol. 33(4):451-461, 2020 08. |
Review/Other-Dx |
N/A |
To highlight MRI studies with the most potential for utility in pending ataxia trials and underscore advances in disease characterization and diagnostics in the field. |
Magnetic resonance techniques are increasingly well placed for characterizing the expression and progression of degenerative ataxias. The most impactful work has arguably come through multi-institutional studies that monitor relatively large cohorts, multimodal investigations that assess the sensitivity of different measures and their interrelationships, and novel imaging approaches that are targeted to known pathophysiology (e.g., iron and spinal imaging in Friedreich ataxia). These multimodal, multi-institutional studies are paving the way to clinical trial readiness and enhanced understanding of disease in degenerative ataxias. |
4 |
| 76. Storey E, Gardner RJ. Spinocerebellar ataxia type 20. [Review]. Handb. clin. neurol.. 103:567-73, 2012. |
Review/Other-Dx |
N/A |
To discuss Spinocerebellar ataxia type 20 |
No results stated in the abstract. |
4 |
| 77. Cocozza S, Pontillo G, De Michele G, et al. Conventional MRI findings in hereditary degenerative ataxias: a pictorial review. [Review]. Neuroradiology. 63(7):983-999, 2021 Jul. |
Review/Other-Dx |
N/A |
To review of the main clinical and conventional imaging findings of the most common hereditary degenerative ataxias, to help neuroradiologists in the evaluation of these patients. |
Hereditary degenerative ataxias are all usually characterized from a neuroimaging standpoint by the presence, in almost all cases, of cerebellar atrophy. Nevertheless, a proper assessment of imaging data, extending beyond the mere evaluation of cerebellar atrophy, evaluating also the pattern of volume loss as well as concomitant MRI signs, is crucial to achieve a proper diagnosis. |
4 |
| 78. Martins CR Jr, Martinez ARM, de Rezende TJR, et al. Spinal Cord Damage in Spinocerebellar Ataxia Type 1. Cerebellum. 16(4):792-796, 2017 08. |
Observational-Dx |
31 patients |
To discuss the Spinal Cord Damage in Spinocerebellar Ataxia Type 1. |
MRI-based studies in SCA1 focused in the cerebellum and connections, but there are no data about cord damage in the disease and its clinical relevance. To evaluate in vivo spinal cord damage in SCA1, a group of 31 patients with SCA1 and 31 age- and gender-matched healthy controls underwent MRI on a 3T scanner. We used T1-weighted 3D images to estimate the cervical spinal cord area (CA) and eccentricity (CE) at three C2/C3 levels based on a semi-automatic image segmentation protocol. The scale for assessment and rating of ataxia (SARA) was used to quantify disease severity. The groups were significantly different regarding CA (47.26 ± 7.4 vs. 68.8 ± 5.7 mm2, p < 0.001) and CE values (0.803 ± 0.044 vs. 0.774 ± 0.043, p < 0.05). Furthermore, in the patient group, CA presented significant correlation with SARA scores (R = -0.633, p < 0.001) and CAGn expansion (R = -0.658, p < 0.001). CE was not associated with SARA scores (p = 0.431). In the multiple variable regression, CA was strongly associated with disease duration (coefficient -0.360, p < 0.05) and CAGn expansion (coefficient -1.124, p < 0.001). SCA1 is characterized by cervical cord atrophy and anteroposterior flattening. Morphometric analyses of the spinal cord MRI might be a useful biomarker in the disease. |
2 |
| 79. Hernandez-Castillo CR, Diaz R, Rezende TJR, et al. Cervical Spinal Cord Degeneration in Spinocerebellar Ataxia Type 7. AJNR Am J Neuroradiol. 42(9):1735-1739, 2021 09. |
Observational-Dx |
48 patients |
To evaluate the impact of the disease in the spinal cord and its relationship with the patient's impairment. |
Our analysis showed a significantly smaller cord area (t = 9.04, P < .001, d = 1.31) and greater eccentricity (t = -2.25, P =. 02, d = 0.32) in the patient group. Similarly, smaller cord area was significantly correlated with a greater Scale for Assessment and Rating of Ataxia score (r = -0.44, P = .001). A multiple regression model showed that the spinal cord area was strongly associated with longer CAG repetition expansions (P = .002) and greater disease duration (P = .020). |
2 |
| 80. Mascalchi M, Vella A. Neuroimaging Applications in Chronic Ataxias. [Review]. Int Rev Neurobiol. 143:109-162, 2018. |
Review/Other-Dx |
N/A |
To discuss neuroimaging Applications in Chronic Ataxias |
No results stated in the abstract. |
4 |
| 81. Klaes A, Reckziegel E, Franca MC Jr, et al. MR Imaging in Spinocerebellar Ataxias: A Systematic Review. AJNR Am J Neuroradiol. 37(8):1405-12, 2016 Aug. |
Review/Other-Dx |
18 studies |
To review quantitative central nervous system MR imaging technique findings in patients with polyglutamine expansion spinocerebellar ataxias and correlations with well-established clinical and molecular disease markers. |
After reviewing the 706 results, 18 studies were suitable for inclusion: 2 studies in SCA1, 1 in SCA2, 15 in SCA3, 1 in SCA7, 1 in SCA1 and SCA6 presymptomatic carriers, and none in SCA17 and dentatorubropallidoluysian atrophy. Cerebellar hemispheres and vermis, whole brain stem, midbrain, pons, medulla oblongata, cervical spine, striatum, and thalamus presented significant atrophy in SCA3. The caudate, putamen and whole brain stem presented similar sensitivity to change compared with ataxia scales after 2 years of follow-up in a single prospective study in SCA3. MR spectroscopy and DTI showed abnormalities only in cross-sectional studies in SCA3. Results from single studies in other polyglutamine expansion spinocerebellar ataxias should be replicated in different cohorts. |
4 |
| 82. Salvatore E, Tedeschi E, Mollica C, et al. Supratentorial and infratentorial damage in spinocerebellar ataxia 2: a diffusion-weighted MRI study. Mov Disord. 29(6):780-6, 2014 May. |
Observational-Dx |
13 patients; 15 controls |
To measure microstructural changes in both infratentorial and supratentorial regions in 13 Spinocerebellar ataxia type 2 (SCA2) patients (9 men, 4 women; mean age, 50 +/- 12 years) and 15 controls (10 men, 5 women; mean age, 49 +/- 14 years) using Diffusion-weighted imaging (DWI)-Magnetic Resonance Imaging (MRI) and correlated the DWI changes with disease severity and duration. |
In Spinocerebellar ataxia type 2 (SCA2) patients, regions of interest (ROIs) analysis and Statistical Parametric Mapping (SPM) confirmed significant increases in D values in the pons, cerebellar white matter (CWM) and middle cerebellar peduncles. Moreover, SPM analysis revealed increased D values in the right thalamus, bilateral temporal cortex/white matter, and motor cortex/pyramidal tract regions. Increased diffusivity in the frontal white matter (FWM) and the CWM was significantly correlated with ataxia severity. |
3 |
| 83. Lirng JF, Wang PS, Chen HC, et al. Differences between spinocerebellar ataxias and multiple system atrophy-cerebellar type on proton magnetic resonance spectroscopy. PLoS ONE. 7(10):e47925, 2012. |
Observational-Dx |
156 patients |
To investigate whether proton magnetic resonance spectroscopy (MRS) may help differentiate spinocerebellar ataxias (SCA) from multiple systemic atrophy- cerebellar type (MSA-C). |
When compared with healthy controls, the cerebellar and vermis NAA/Cr and NAA/Cho were lower in all patients(p<0.002). The Cho/Cr was lower in SCA2 and MSA-C (p<0.0005). The NAA/Cr and Cho/Cr were lower in MSA-C or SCA2 comparing with SCA3 or SCA6. The MRS features of SCA1 were in between (p<0.018). The cerebellar NAA/Cho was lower in SCA2 than SCA1, SCA3 or SCA6 (p<0.04). The cerebellar NAA/Cho in MSA-C was lower than SCA3 (p<0.0005). In the early stages of diseases (SARA score<10), significant lower NAA/Cr and NAA/Cho in SCA2, SCA3, SCA6 or MSA-C were observed comparing with healthy controls (p<0.017). The Cho/Cr was lower in MSA-C or SCA2 (p<0.0005). Patients with MSA-C and SCA2 had lower NAA/Cr and Cho/Cr than SCA3 or SCA6 (p<0.016). |
2 |
| 84. Chen HC, Lee LH, Lirng JF, Soong BW. Radiological hints for differentiation of cerebellar multiple system atrophy from spinocerebellar ataxia. Sci. rep.. 12(1):10499, 2022 06 22. |
Observational-Dx |
398 patients |
To compare their clinical parameters and neuroimaging features at different disease stages. The presence of HCBS was assessed using an axial T2 fast spin-echo or FLAIR sequence. Proton MRS was recorded with voxel of interest focusing on cerebellar hemispheres and cerebellar vermis and avoiding cerebrospinal fluid spaces space using a single-voxel stimulated echo acquisition mode sequence |
We found that patients with MSA-C tend to have a higher prevalence of pontine HCBS, worse Scale for the Assessment and Rating of Ataxia scores, lower cerebellar N-acetyl aspartate (NAA)/creatinine (Cr), and choline (Cho)/Cr, compared to patients with SCA at corresponding disease stages. In MSA-C patients with a disease duration < 1 year and without pontine HCBS, a cerebellar NAA/Cr = 0.79 is a good indicator of the possibility of MSA-C. By using the pontine HCBS and cerebellar MRS, discerning MSA-C from SCA became possible. This study provides cutoff values of MRS to serve as clues in differentiating MSA-C from SCAs. |
2 |
| 85. Szmulewicz DJ, Waterston JA, Halmagyi GM, et al. Sensory neuropathy as part of the cerebellar ataxia neuropathy vestibular areflexia syndrome. Neurology. 76(22):1903-10, 2011 May 31. |
Observational-Dx |
18 patients |
To characterize and estimate the frequency of neuropathy in this condition, and determine its typical MRI features. |
The reported age at onset range was 39-71 years, and symptom duration was 3-38 years. The syndrome was identified in one sibling pair, suggesting that this may be a late-onset recessive disorder, although the other 16 cases were apparently sporadic. All 18 had sensory neuropathy with absent sensory nerve action potentials, although this was not apparent clinically in 2, and the presence of neuropathy was not a selection criterion. In 5, the loss of pinprick sensation was virtually global, mimicking a neuronopathy. However, findings in the other 11 with clinically manifest neuropathy suggested a length-dependent neuropathy. MRI scans showed cerebellar atrophy in 16, involving anterior and dorsal vermis, and hemispheric crus I, while 2 were normal. The inferior vermis and brainstem were spared. |
2 |
| 86. Garcia-Santibanez R, Zaidman CM, Sommerville RB, et al. CANOMAD and other chronic ataxic neuropathies with disialosyl antibodies (CANDA). J Neurol. 265(6):1402-1409, 2018 Jun. |
Review/Other-Dx |
11 patients |
To discuss the review of our neuromuscular autoantibody panel database was performed. Anti-GD1b seropositive patients with ataxia were included. |
Eleven patients were identified. Median age at onset was 56 years. Median disease duration was 6 years. All patients had gait disorders. Nine had ocular motility abnormalities. Most had a monoclonal protein and all had elevated serum IgM. Electrodiagnostic studies showed a mixed axonal/demyelinating pattern (6), an axonal pattern (4), or a pure demyelinating pattern (1). Ultrasounds showed nerve enlargement patterns consistent with acquired demyelination. A nerve biopsy showed near complete loss of myelinated axons with preservation of smaller axons. Rituximab was the most effective immunotherapy. |
4 |
| 87. Lee H, Kim HA. Autonomic dysfunction in chronic persistent dizziness. J Neurol Sci. 344(1-2):165-70, 2014 Sep 15. |
Observational-Dx |
18 patients |
To investigate the autonomic dysfunction in patients with chronic persistent dizziness using standardized autonomic function tests. |
Approximately eighty percent of the patients showed at least one abnormality in autonomic tests. Two patterns of autonomic abnormality were identified: sympathetic failure, including abnormal decrease in blood pressure (BP) during HUT test or abnormal sympathetic indices related with the BP recovery during late phase II and phase IV during VM, and sympathetic hyperactivity, including abnormal increase in HR response during HUT test or an exaggerated phase IV response manifesting increased ß-adrenergic tone during VM. |
2 |
| 88. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
