Prognostic assessments of medical therapy and vestibular testing in post-traumatic migraine-associated dizziness patients

Otolaryngology - Head and Neck Surgery 143 (6), 820-5 (Dec 2010)

Donaldson CJ, Hoffer ME, Balough BJ, Gottshall KR

OBJECTIVE: The aim of this study was to characterize our clinical population of patients suffering with post-traumatic migraine-associated dizziness (PTMAD) and determine any associations with medical interventions and vestibular testing metrics to help predict response to treatments. 

STUDY DESIGN: Retrospective chart review. 

SETTING: Tertiary referral center. 

SUBJECTS AND METHODS: The electronic medical records of 83 patients presenting to a tertiary referral center who were given a diagnosis of PTMAD and who had been treated were retrospectively reviewed. General characteristics, clinical treatment, pre- and post-vestibular therapy testing metrics, and success and failure outcomes were assessed. Patients were assigned into responder and nonresponder groups related to their headaches and evaluated at two specific time points. Medication failures and vestibular test metrics were compared to identify and predict clinical outcomes. RESULTS: Seventy-two of 82 patients (88%) were analyzed at two time points. Use of verapamil, topiramate, gabapentin, amitryptiline, and valproic acid showed no comparative treatment benefit in responders compared to nonresponders (P = 0.294). Findings associated with successful treatments include response to initial medication (P = 0.001), final dynamic gait index (DGI) scores (P = 0.029), final vertical dynamic visual acuity test (DVAT) scores (up, 0.007; down, 0.006), and both final and change in computerized dynamic posturography-sensory organization test (CDP-SOT) scores (P = 0.001, P = 0.032). The antipsychotic quetiapine was specifically associated with outcome failures (P = 0.003). 

CONCLUSION: Specific prophylactic antimigraine medications were not associated with improved outcomes in PTMAD patients. Initial clinical responses and vestibular test metrics may guide physicians to predict successful outcomes.

Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly

EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY

DOI: 10.1007/s00405-010-1422-9

Roberto Teggi, Leone Giordano, Stefano Bondi, Beatrice Fabiano and Mario Bussi

Abstract

Even after successful repositioning maneuvers for benign paroxysmal positional vertigo (BPPV), some patients report dizziness lasting for a certain period afterwards. We studied the prevalence and clinical factors associated with residual dizziness in a sample of elderly patients. Sixty outpatients over 65 years of age, affected by idiopathic BPPV were recruited; the exclusion criterion was a history of previous episodes of vertigo, including positional. The patients were asked to describe their self-perceived anxiety for vertigo on a Visual Analogue Scale (VAS) and successively treated with appropriate maneuvers till resolution of nystagmus. Data concerning the demographic and clinical features of BPPV were collected. Patients were followed until complete resolution of subjective dizziness and imbalance without positional nystagmus. Data about residual dizziness were collected from the second day from resolution of BPPV. Clinical and demographic factors related to residual dizziness were analyzed. Twenty-two subjects (37%) reported residual dizziness. In these subjects, the mean duration of residual dizziness was 13.4 ± 7.5 days. No association was observed between residual dizziness and gender, involved canal and the number of repositioning maneuvers before resolution. On the other hand, age older than 72 years, symptom duration greater than 9 days and VAS scale for anxiety greater than 10/100 were associated with an increased risk of residual dizziness. The odds ratio were respectively 6.5 (age—residual dizziness, Confidence Interval 95%), 6.5 (duration of vertigo—residual dizziness, Confidence Interval 95%) and 15.5 (anxiety levels—residual dizziness, Confidence Interval 95%). Longer symptom duration before diagnosis was associated with higher anxiety levels. The results underline the necessity for an early and correct diagnosis of BPPV, especially in the elderly.

Eustachian tube function in patients with Meniere's disease

Auris Nasus Larynx (Oct 2010)Kitajima N, Watanabe Y, Suzuki M




OBJECTIVE: The aim of the present study was to clarify the relationship between Eustachian tube function and inner ear function, especially with respect to the hearing ability of patients with Meniere's disease. METHODS: Patients with Meniere's disease underwent nystagmic examinations and audiometric measurements, including hearing tests, tympanometry, and Eustachian tube function tests (sonotubometry). We compared the audiometric examination results of normal subjects to those of patients with Meniere's disease. RESULTS: Twenty-five percent of patients with Meniere's disease exhibited Eustachian tube dysfunction, but 92% displayed normal tympanometry findings. Their sonotubometry durations and amplitudes were not significantly different from those of normal subjects. However, the patients' hearing level was significantly correlated to sonotubometry duration and amplitude. Our patients were classified according to the four stages of Meniere's disease: stage 1 (n=9); stage 2 (n=5); stage 3 (n=8); and stage 4 (n=2). The incidence of Eustachian tube dysfunction in these four groups of patients were 0% (0/9); 40% (2/5); 38% (3/8); and 50% (1/2), respectively. CONCLUSION: Our study provides evidence demonstrating that treatment of Eustachian tube dysfunction may be useful in preventing the hearing of Meniere's patients from becoming worse.

Meniere's disease and the use of proton pump inhibitors

Swiss Medical Weekly 140 w13104 (2010)

Pirodda A, Modugno GC, Manzari L, Raimondi MC, Brandolini C, Ferri GG, Borghi C

PRINCIPLES: On the basis of previous observations we examined the possibility of a favourable effect of proton pump inhibitors (PPI) on Meniere's disease (MD). A preliminary step was made by retrospectively analysing the number of menieric crisis in group of patients suffering from MD and using PPI for other reasons as compared to a group of menieric subjects who had never used PPI. 

METHODS: Between January 2001 and December 2006, 42 patients affected by MD were examined in the tertiary referral centre at the University Hospital of Bologna, Italy and in the private office of an ENT specialist in Cassino, Italy. Within the study group, 18 patients had used PPI for various reasons for at least 12 consecutive months, whilst 24 patients had never been prescribed them. We recorded the number of menieric crises reported in the observation period. The mean follow-up period was 21.9 months. Statistical analysis was performed by means of the x2 test and significance was defined when p<0.05. 

RESULTS: Most of MD patients (72%) using PPI suffered less than one episode of menieric crisis/year. On the other hand patients who had never used a PPI, experienced considerably more episodes only 16.7% having less than one crisis per year. This difference was statistically significant (p<0, 001). 

CONCLUSIONS: Even taking the limitations of this retrospective study into account the reported data nevertheless strongly suggest a possible role for proton pumps in the pathogenesis of MD. This could lead to interesting developments and contribute to a better definition of MD and the therapeutic possibilities.

Geriatric vestibulopathy assessment and management

Current Opinion in Otolaryngology & Head and Neck Surgery (Jul 2010
Furman JM, Raz Y, Whitney SL; )



PURPOSE OF REVIEW: This review discusses the demographics of dizziness in the older person, the evaluation of the older dizzy patient and how the treatment of dizziness in older patients differs from that in younger individuals.
RECENT FINDINGS: Seven percent of all visits to primary care physicians for patients older than 65 years of age are for dizziness, and dizziness is the most common complaint for patients older than 75 years. In a German study, the 12-month prevalence of vertigo in the general population was 5% with an incidence of 1.4% in adults overall. For individuals aged 60-69 the 12-month prevalence was found to be 7.2% and in individuals 70 years of age or older 8.9%. Data from the United States National Health and Nutrition Examination Surveys indicated that the prevalence of vestibular dysfunction for individuals in the seventh decade of life, eighth decade of life, and older was 49.4, 68.7, and 84.8 percent, respectively. Only subtle age effects are seen on caloric and rotational testing whereas vestibular evoked myogenic potentials (VEMPs) change somewhat with age. Particle repositioning for benign paroxysmal positional vertigo combined with vestibular rehabilitation is more effective than only performing the repositioning maneuver. Tai Chi appears to be an effective intervention for older adults at risk for falling.
SUMMARY: When caring for an older dizzy patient always assess medication use, perform a Dix-Hallpike maneuver, obtain orthostatic vital signs, discuss fall risk precautions, and consider referral for vestibular rehabilitation.

Superior Canal Dehiscence Syndrome.

Braz J Otorhinolaryngol. 2006 May-Jun;72(3):414-8.

da Cunha Ferreira S, de Melo Tavares de Lima MA.

Department of Otorhinolaryngology and Opththalmology, Federal University of Rio de Janeiro, and the Hospital da Lagoa, Brazil. suzane.ferreira@gmail.com

Abstract

The Superior Canal Dehiscence Syndrome (SCDS) was first reported by Minor at. Al. (1998), and has been characterized by vertigo and vertical-torsional eye movements related to loud sounds or stimuli that change middle ear or intracranial pressure. Hearing loss, for the most part with conductive patterns on audiometry, may be present in this syndrome.

We performed a literature survey in order to to present symptoms, signs, diagnostic and therapeutic approaches to the SCDS, also aiming at stressing the great importance of including this syndrome among the tractable cause of vertigo. We should emphasize that this is a recent issue, still unknown by some specialists.

The Correct SCDS diagnosis, besides enabling patient treatment, precludes misdiagnosis and inadequate therapeutic approaches.

PMID: 17119781 [PubMed - indexed for MEDLINE]Free Article

Superior canal dehiscence: review of a new condition.

Clin Otolaryngol. 2005 Feb;30(1):9-15.

Banerjee A, Whyte A, Atlas MD.

Department of ENT, James Cook University Hospital, Middlesbrough, UK. anirvan.banerjee@stees.nhs.uk

Abstract

A new cause of sound and pressure induced vertigo, superior canal dehisence, is described. Auditory manifestations include hyperacusis to bone-conducted sounds and conductive hearing loss with normal acoustic reflexes.

The diagnosis is reached by a directed history, documentation of upward and torsional nystagmus evoked by sound and pressure, and radiology. Acoustic reflexes and VEMP (vestibular evoked myogenic potentials) aid in the identification of patients with an apparent conductive loss with normal acoustic reflexes or have an asymptomatic dehiscense on radiology.
Treatment involves avoidance of the precipitating stimuli. Surgical treatment, by resurfacing the dehiscence, is considered in patients with more severe symptoms.

PMID: 15748182 [PubMed - indexed for MEDLINE]

Migraine-Associated Vertigo: Diagnosis and Treatment

Seminars in Neurology 2010; 30(2): 167-174 DOI: 10.1055/s-0030-1249225

© Thieme Medical Publishers

Yoon-Hee Cha1

1 Department of Neurology, University of California Los Angeles, Los Angeles, California

ABSTRACT

Migraine-associated vertigo has become a well-recognized disease entity diagnosed based on a clinical history of recurrent vertigo attacks unexplained by other central or peripheral otologic abnormalities, which occurs in the patient with a history of migraine headaches.

There is no international agreement on what spectrum of symptoms should be covered under this diagnosis, or what terminology should be used.

The headaches and vestibular symptoms of migraine-associated vertigo may not be temporally associated, which often obscures the association.

Diagnostic tests usually show nonspecific abnormalities that are also seen in patients with migraine who do not experience vestibular symptoms.

Management generally follows the recommended treatment of migraine headaches, and includes
dietary and lifestyle modifications and
medical treatment
       with β blockers, calcium channel blockers, and tricyclic amines.

Small case series show that acetazolamide and lamotrigine appear to be more effective for the vertigo attacks than headaches.

Vestibular rehabilitation has also been shown to be helpful in several studies.

In this review, the epidemiologic and clinical features of the disorder, as well as the current state of knowledge on pathophysiology, diagnostic testing, and treatment are described.

Vestibular effects on cerebral blood flow

BMC Neuroscience 2009, 10:119doi:10.1186/1471-2202-10-119
Jorge M Serrador1,5 , Todd T Schlegel2 , F Owen Black3 and Scott J Wood2,4
1 Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
2 NASA Johnson Space Center, Houston, TX, USA
3 Neurotology Research, Legacy Health System, Portland, OR, USA
4 Universities Space Research Association, Houston, TX, USA
5 National University of Ireland Galway, Galway, Ireland


Abstract

Background
Humans demonstrate a number of unique adaptations that allow for the maintenance of blood pressure and brain blood flow when upright. While several physiological systems, including cerebral autoregulation, are involved in this adaptation the unique role the vestibular system plays in helping to maintain brain blood flow is just beginning to be elucidated. In this study, we tested the hypothesis that stimulation of the vestibular system, specifically the otoliths organs, would result in changes in cerebral blood flow.

Results
To test our hypothesis, we stimulated the vestibular organs of 25 healthy subjects by pitch tilt (stimulates both canals and otoliths) and by translation on a centrifuge (stimulates otoliths and not the canals) at five frequencies: 0.5, 0.25, 0.125 and 0.0625 Hz for 80 sec and 0.03125 Hz for 160 sec. Changes in cerebral flow velocity (by transcranial Doppler) and blood pressure (by Finapres) were similar during both stimuli and dependent on frequency of stimulation (P < 0.01). However, changes in cerebral blood flow were in opposition to changes in blood pressure and not fully dependent on changes in end tidal CO2.
Conclusion
The experimental results support our hypothesis and provide evidence that activation of the vestibular apparatus, specifically the otolith organs, directly affects cerebral blood flow regulation, independent of blood pressure and end tidal CO2 changes.

The electronic version of this article is the complete one and can be found online at:
http://www.biomedcentral.com/1471-2202/10/119

Migraine-Associated Vertigo: Diagnosis and Treatment

Semin Neurol 2010; 30(2): 167-174

Yoon-Hee Cha1
1 Department of Neurology, University of California Los Angeles, Los Angeles, California
ABSTRACT

Migraine-associated vertigo has become a well-recognized disease entity diagnosed based on a clinical history of recurrent vertigo attacks unexplained by other central or peripheral otologic abnormalities, which occurs in the patient with a history of migraine headaches. There is no international agreement on what spectrum of symptoms should be covered under this diagnosis, or what terminology should be used. The headaches and vestibular symptoms of migraine-associated vertigo may not be temporally associated, which often obscures the association. Diagnostic tests usually show nonspecific abnormalities that are also seen in patients with migraine who do not experience vestibular symptoms. Management generally follows the recommended treatment of migraine headaches, and includes dietary and lifestyle modifications and medical treatment with β blockers, calcium channel blockers, and tricyclic amines. Small case series show that acetazolamide and lamotrigine appear to be more effective for the vertigo attacks than headaches. Vestibular rehabilitation has also been shown to be helpful in several studies. In this review, the epidemiologic and clinical features of the disorder, as well as the current state of knowledge on pathophysiology, diagnostic testing, and treatment are described.

Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo

Acta Oto-Laryngologica (Mar 2010)

Kansu L, Avci S, Yilmaz I, Ozluoglu LN

Abstract
Conclusions: Recurrence of posterior canal benign paroxysmal positional vertigo (PC-BPPV) developed in one-third of patients when followed for an average of 5 years from diagnosis. History of head trauma and Ménière's disease contributed significantly to recurrence (p<0.05). History of head trauma as an etiologic cause was more frequent in patients with recurrence of PC-BPPV. 

Objectives: To estimate recurrence in the long-term follow-up of patients with PC-BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence.

Methods: The charts of 118 patients with PC-BPPV were reviewed. Data of patients were recorded from the initial evaluation and treatment. Follow-up was performed at mean of 64 +/- 7.7 months after the initial phase. The Dix-Hallpike maneuver was performed for diagnosis, and all patients were treated by the canalith repositioning maneuver, which was repeated every 3 days until the patients were symptom-free or results of the Dix-Hallpike maneuver were negative.

Results: At diagnosis, the most common etiology was idiopathic in 55 patients (46.6%). Recurrence occurred in 39 of 118 patients (33.1%). Recurrence occurred within the first 2 years in 21 of the 39 patients (53.8%). History of head trauma was a more frequent finding in patients who developed recurrence (12 of 39, 30.8%).

Rotational vertebrobasilar insufficiency secondary to vertebral artery occlusion from fibrous band of the longus coli muscle

 Neuroradiology,  Volume 32, Number 6 / December, 1990
M. R. Dadsetan1 and H. E. I. Skerhut2
(1) Department of Radiology, Neuroradiology Section, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, 78284 San Antonio, Texas, USA
(2) Division of Neurosurgery, The University of Texas Health Science Center at San Antonio, Texas, USA

Received: 7 March 1989  
Summary Rotation-induced vertebrobasilar artery hypoperfusion causes transient ischemic attacks (TIAs), affecting the cerebellum, brainstem and spinal cord. When these symptoms occur transiently due to head movement, compression of the vertebral artery by an extraluminal lesion should be suspected. Cervical spondylotic spurs and anterior scalene muscle or deep cervical fascia are among the factors which can compress the vertebral artery. When symptoms of vertebrobasilar insufficiency occur with rotational head movement, subclavian angiography for visualization of the entire vertebral artery in both neutral and rotated head positions should be undertaken.

Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency.

Neurosurgery. 1997 Aug;41(2):427-32; discussion 432-3.
Kuether TA, Nesbit GM, Clark WM, Barnwell SL.

Division of Neurosurgery, Oregon Health Science University, Portland, USA.

OBJECTIVE: Symptomatic dynamic changes in blood flow secondary to vertebral artery compression with rotational head motion are evaluated in a series of patients as a cause for posterior circulation transient ischemic attacks. These cases are classic examples of rotational vertebral artery occlusion and allow for the discussion of the anatomic basis, angiographic features, and treatment options. ILLUSTRATIVE CASES: In our series, symptoms of vertebrobasilar insufficiency were reproducible with rotational head movement. Compression of the vertebral artery was demonstrated angiographically. The correct site of occlusion of the vertebral artery was apparent only by dynamic angiography with progressive head rotation. All of the patients presented in the illustrative cases had occlusion at the C2 level; however, one patient had been previously misdiagnosed and another had an additional site of occlusion. The anatomic course of the vertebral artery is described in addition to the sites of rotational occlusion.
CONCLUSION: Rotational vertebral occlusion is an important cause of vertebrobasilar symptoms, which may lead to permanent neurological deficit if left undiagnosed. Dynamic angiography is the established method of diagnosis. Great care must be taken to avoid misdiagnosing the site of occlusion or missing a second occlusive site. For this reason, it is crucial to have a thorough understanding of the anatomic course of the vertebral artery and the muscular and tendinous insertions, which may cause rotational occlusion. The decision for treatment must be based on the site of occlusion as well as the assessment of the patient as a surgical candidate. A review of the literature reveals that surgical treatment is effective and must be considered to avoid further morbidity.

Rotational vertebrobasilar ischemia: hemodynamic assessment and surgical treatment

Neurosurgery. 2005;56(1):36-43; discussion 43-5.
Vilela MD, Goodkin R, Lundin DA, Newell DW.

Harborview Medical Center and Department of Neurological Surgery, University of Washington, Seattle, Washington 98122, USA.

OBJECTIVE: Rotational vertebrobasilar insufficiency is a severe and incapacitating condition. Proper investigation and management are essential to reestablish normal posterior circulation hemodynamics, improve symptoms, and prevent stroke. We present a series of 10 patients with rotational vertebrobasilar ischemia who were treated surgically and emphasize the importance of transcranial Doppler in the diagnosis and management of this condition.
METHODS: All patients presented with symptoms of vertebrobasilar insufficiency induced by head turning. Transcranial Doppler documented a significant decrease in the posterior cerebral artery velocities during head turning that correlated with the symptoms in all patients. A dynamic cerebral angiogram was performed to demonstrate the site and extent of vertebral artery compression.
RESULTS: The surgical technique performed was tailored to each individual patient on the basis of the anatomic location, pathogenesis, and mechanism of the vertebral artery compression. Five patients underwent removal of osteophytes at the level of the subaxial cervical spine, one patient had a discectomy, two patients had a decompression only at the level of C1-C2, and two patients had a decompression and fusion at the C1-C2 level.

CONCLUSION: The transcranial Doppler is extremely useful to document the altered hemodynamics preoperatively and verify the return of normal posterior circulation velocities after the surgical decompression in patients with rotational vertebrobasilar ischemia. Surgical treatment is very effective, and excellent long-term results can be expected in the vast majority of patients after decompression of the vertebral artery.

PMID: 15617584 [PubMed - indexed for MEDLINE]

Rotational vertebrobasilar ischemia due to vertebral artery dynamic stenoses complicated by an ostial atherosclerotic stenosis

Vascular Medicine, Vol. 14, No. 3, 265-269 (2009)
DOI: 10.1177/1358863X08099707
Gregory W Natello

Department of Cardiology, William Jennings Bryan Dorn Veterans Affairs Medical Centergregnatello@gmail.com

Christine M Carroll  Department of Cardiology, William Jennings Bryan Dorn Veterans Affairs Medical Center

Arabindra B Katwal  Department of Internal Medicine, University of South Carolina – Palmetto Health Richland

Abstract

We describe a patient with rotational vertebrobasilar ischemia (RVBI) due to vertebral artery (VA) compressive stenoses during neck rotation, complicated by an ostial atherosclerotic stenosis (OAS). Referred for ‘near-syncopal spells’, inquiry revealed a symptom-complex consistent with vertebrobasilar transient ischemic attacks (TIAs) provoked by head rotation. VA dynamic angiography with imaging via prevertebral subclavian injections in neck-rotated positions while reproducing symptoms, demonstrated two compressive stenoses not present in the neck-neutral position, establishing the diagnosis of RVBI due to CT-demonstrated cervical spondylosis. There was an occluded contralateral VA, isolated posterior circulation, and absent vertebral collateral flow. Disabling symptoms persisted despite using a cervical collar. Surgical decompression of the dynamic stenoses would not address the OAS, was considered high risk, and absence of a suitable donor artery precluded distal VA reconstruction. RVBI resolved with ostial stent placement by improving perfusion pressure across the compressive stenoses. To our knowledge, this is the first report of RVBI in which the affected VA had an obstructive atherosclerotic stenosis in addition to the characteristic rotation-induced dynamic stenoses, and the first report of stent placement in the culprit artery to treat this disorder. Diagnosis depends on recognizing the association of symptoms with positional neck changes and VA dynamic angiography demonstrating the compressive stenosis while reproducing symptoms. This case illustrates the management complexities when there are coexisting abnormalities, emphasizing the need to individualize treatment. RVBI is a potentially correctable cause of TIAs and particularly relevant due to the aging population which has a significant incidence of both degenerative cervical and atherosclerotic cerebrovascular disease.

Key words: atherosclerosis, cerebral angiography, cervical osteophytes, dynamic angiography, imaging -- diagnostic, posterior-circulation transient ischemic attack, rotation-induced compressive stenosis, rotational vertebrobasilar ischemia, stents, vertebral artery

Strategies to Distinguish Benign Paroxysmal Positional Vertigo from Rotational Vertebrobasilar Ischemia

Annals of Vascular Surgery, 02/05/10
Katherine D. Heidenreich1, Wendy J. Carender1, Michael J. Heidenreich2, Steven A. Telian1

Vertigo provoked by head rotation is a classic symptom of rotational vertebrobasilar ischemia (RVBI). Inner ear disease can cause positional vertigo and mimic RVBI. We review the case of a patient with vertigo consistently triggered by leftward head rotation when supine. Computed tomography angiogram and dynamic arteriogram failed to show compression of the vertebral arteries with head rotation. Further evaluation revealed benign paroxysmal positional vertigo (BPPV) as the underlying etiology. Treatment of her BPPV led to complete resolution of her symptoms. A succinct overview of this common otologic disorder is provided, and strategies to help distinguish it from RVBI are discussed.

Ann Arbor, Michigan

1 Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI
1 Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI
2 Department of General Surgery, Saint Joseph Mercy Hospital, Ann Arbor, MI
Correspondence to: Katherine D. Heidenreich, MD, Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, 1904 Taubman Center, 1500 E. Medical Center Dr., SPC 5312, Ann Arbor, MI 48109-5312.

Non-invasive evaluation of vertebral artery blood flow in cervical spondylosis with and without vertigo and association with degenerative changes

Clinical Rheumatology 0770-3198 (Print) 1434-9949 (Online), Published online: 16 February 2010
Remzi Cevik1 , Aslan Bilici2, Kemal Nas1, Zeynep Demircan1 and Rojbin Ceylan Tekin2
(1) Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey
(2) Department of Radiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
Received: 31 May 2009 Revised: 4 January 2010 Accepted: 8 January 2010 

Abstract Cervical spondylosis is a common disease that results from degenerative changes of the cervical spine and vertigo may occur in this process.
The aim of the present study was to assess the blood flow measurements of the vertebral artery (VA) using color Doppler ultrasonography (CDUS) in patients who have cervical spondylosis with and without vertigo. The study population included 101 patients with vertigo and spondylosis, 66 patients with spondylosis without vertigo, and 62 healthy controls. A bilateral decrease in the VA blood flow velocities were measured in patients with cervical spondylosis.
A negative correlation was found between the stage of cervical degenerative changes and the flow velocities in patients with vertigo, while this relationship was not found in patients without vertigo.
The CDUS evaluation of the pretransverse and transverse segments of VAs demonstrated significantly reduced flow velocities in patients with spondylosis.

The degenerative changes in the cervical spine seem to be related to these velocity changes in the subgroup of patients who are also affected with vertigo. The pretransverse segment of the VA provides valuable measurements as well as transverse segment of the VA, and it can be used as an appropriate segment for CDUS examination in cervical spondylosis and associated vertigo.

Non-invasive evaluation of vertebral artery blood flow in cervical spondylosis with and without vertigo and association with degenerative changes

Clinical Rheumatology 0770-3198 (Print) 1434-9949 (Online)
Remzi Cevik1 , Aslan Bilici2, Kemal Nas1, Zeynep Demircan1 and Rojbin Ceylan Tekin2

(1) Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey
(2) Department of Radiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey

Received: 31 May 2009 Revised: 4 January 2010 Accepted: 8 January 2010 Published online: 16 February 2010 
 
Abstract
Cervical spondylosis is a common disease that results from degenerative changes of the cervical spine and vertigo may occur in this process. The aim of the present study was to assess the blood flow measurements of the vertebral artery (VA) using color Doppler ultrasonography (CDUS) in patients who have cervical spondylosis with and without vertigo. The study population included 101 patients with vertigo and spondylosis, 66 patients with spondylosis without vertigo, and 62 healthy controls. A bilateral decrease in the VA blood flow velocities were measured in patients with cervical spondylosis. A negative correlation was found between the stage of cervical degenerative changes and the flow velocities in patients with vertigo, while this relationship was not found in patients without vertigo. The CDUS evaluation of the pretransverse and transverse segments of VAs demonstrated significantly reduced flow velocities in patients with spondylosis. The degenerative changes in the cervical spine seem to be related to these velocity changes in the subgroup of patients who are also affected with vertigo. The pretransverse segment of the VA provides valuable measurements as well as transverse segment of the VA, and it can be used as an appropriate segment for CDUS examination in cervical spondylosis and associated vertigo.