A comparative analysis of the clinical symptoms of benign paroxysmal positional vertigo between older and young and middle-aged patients / 中华内科杂志

Objective: To compare the differences in clinical symptoms and the time required for diagnosis of benign paroxysmal positional vertigo (BPPV) between older patients and young and middle-aged patients in the structured inquiry of dizziness history. Methods: The medical records of 6 807 patients diagnosed with BPPV from the Vertigo Database of Vertigo Clinical Diagnosis, Treatment, and Research Center of Beijing Tiantan Hospital, Capital Medical University, between January 2019 and October 2021 were retrospectively analyzed. The data included basic demographic information, clinical symptoms in a structured medical history questionnaire, and the time interval from the appearance of BPPV symptoms to diagnosis consultation. The patients were divided into the young and middle-aged group (<65 years old) and the older group (≥65 years old). The differences in clinical symptoms and consultation time were compared between these two groups. Categorical variables were represented by numbers (%), and compared using Chi-squared tests or Fisher's exact probability test for analysis; whereas, continuous variables conforming to normal distribution were represented by mean±standard deviation. Both data groups were compared and analyzed by Student's t-test. Results: The mean age of the older group was 65-92 (71±5) years, while the mean age of the middle-aged group was 18-64 (49±12) years. The incidence of vertigo (42.5% vs. 49.1%, χ2=23.69, P<0.001); vertigo triggered by changes in position of the head or body (52.4% vs. 58.7%, χ2=22.31, P<0.001); and autonomic symptoms (10.1% vs. 12.4%, χ2=7.09, P=0.008) were lower, but hearing loss (11.8% vs. 7.8%, χ2=27.36, P<0.001) and sleep disorders (18.5% vs. 15.2%, χ2=11.13, P=0.001) were higher in the older group than in the young and middle-aged group. The time from the appearance of dizziness to diagnosis was commonly longer in the older patient group than the other group (55.0% vs. 38.5%, χ2=55.95, P<0.001). Conclusions: Older patients with BPPV have more atypical symptoms and complex concomitant symptoms than young and middle-aged patients. For older patients with dizziness, positional testing is needed to confirm the possibility of BPPV even if the clinical symptoms are atypical.

Features of spinal cord MRI findings and clinical follow-up study on 8 children with hand-foot-and-mouth disease and acute flaccid paralysis / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand the features of magnetic resonance imaging (MRI) findings and the results of clinical follow-up study in 8 infants and children with hand-foot-and-mouth disease (HFMD) complicated with acute flaccid paralysis (AFP) who were admitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008.</p><p><b>METHODS</b>The clinical characteristics of the 8 HFMD cases were investigated, and MRI findings were analyzed. The recovery of their impairment in limbs was followed up for three months.</p><p><b>RESULTS</b>All the 8 cases showed poliomyelitis-like syndrome. MRI of spinal cord showed unilateral or bilateral hyperintense lesions which chiefly occurred in the anterior horn regions of the spinal cord (C(2)-C(7) or T(12)-L(1)) on T(1)/T(2)-weighted images. Lesions of spinal cord chiefly occurred in T(12)-L(1). Most of the cases showed mild paralysis, which occurred in more than half of cases in single lower extremity. The patients who had acute paralysis of single lower extremity recovered faster than those with paralysis of four limbs.</p><p><b>CONCLUSIONS</b>In HFMD with AFP cases, MRI of spinal cord showed unilateral or bilateral lesions in the anterior horn regions of the spinal cord (C(2)-C(7) or T(12)-L(1)) on T(1)/T(2)-weighted images. AFP may be to some degree reversible in HFMD cases. MRI can directly and completely show the range and degree of changes associated with AFP in HFMD cases, thus provide instructive suggestions to its treatment. The acute paralysis of HFMD cases may be benefited from earlier treatment for AFP.</p>