ABSTRACT
Inferior vestibular neuritis is a rare form of acute peripheral vestibular loss that only implies the lesion of the inferior vestibular nerve. The diagnosis is based on the observation of a spontaneous downbeating nystagmus, pathological head impulse test for the posterior semicircular canal and abnormal cervical vestibular-evoked myogenic potentials. Bithermal caloric testing and head impulse test for horizontal and anterior canals are normal, as well as the ocular vestibular-evoked myogenic potentials. The differential diagnosis of inferior vestibular neuritis includes the various central lesions that produce vertical down beating nystagmus (posterior fossa) and a cerebral magnetic resonance imaging is mandatory.
La névrite vestibulaire inférieure est une forme rare de névrite vestibulaire. Cliniquement, on observe un nystagmus vertical battant vers le bas et torsionnel, un head impulse test normal dans le plan horizontal et pathologique dans le plan du canal semi-circulaire postérieur du côté lésé. L'épreuve calorique est normale. Les potentiels évoqués myogéniques, vestibulaires cervicaux sont pathologiques du côté atteint. Le diagnostic différentiel de la névrite vestibulaire inférieure doit se faire avec une atteinte neurologique de la fosse postérieure et une IRM cérébrale est indiquée.
Subject(s)
Nystagmus, Pathologic , Vestibular Neuronitis , Vestibule, Labyrinth , Humans , Semicircular Canals , Vestibular Nerve , Vestibular Neuronitis/diagnosis , Vestibule, Labyrinth/physiopathologyABSTRACT
BACKGROUND: We investigated in a prospective cohort of patients treated with trans-oral robotic surgery (TORS) for oropharyngeal cancer (OPC), who were selected for the absence of radiographic extra-capsular extension (ECS) and surgically revised for inadequate margins, the possibility of reducing adjuvant radiation (RT)/chemo-radiation therapy (CRT) without jeopardizing tumor control and functional outcome. METHODS: We conducted a prospective observational cohort of patients treated with TORS for oropharyngeal cancer. RESULTS: Twenty-nine patients with T1/2N0 to N2B stage cancers were treated with TORS. Forty-five percent of them were treated for secondary primaries. Nine of 29 patients (31%) were revised for close/positive margins. Adjuvant RT was prescribed for 2 of 19 patients with early squamous cell carcinoma (SCCs) and CRT for 1 of 10 patients with advanced oropharyngeal SCCs. Overall survival (OS), disease-specific survival (DSS), and locoregional control at 2 years were 85%, 96%, and 93%, respectively. Posttreatment Functional Outcome Swallowing Scale (FOSS) scores worsened with prior or adjuvant RT, local recurrence, site, and revision for margins. CONCLUSION: Patients with early and moderately advanced oropharyngeal SCC selected for radiographic ECS and revised for inadequate margins have excellent tumor control and favorable functional recovery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 965-973, 2017.
Subject(s)
Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Oropharyngeal Neoplasms/pathology , Oropharyngeal Neoplasms/therapy , Robotic Surgical Procedures , Aged , Carcinoma, Squamous Cell/mortality , Female , Humans , Male , Margins of Excision , Middle Aged , Oropharyngeal Neoplasms/mortality , Prospective Studies , Radiotherapy, Adjuvant , Survival Rate , Treatment OutcomeABSTRACT
Anterior semicircular canal Benign Paroxysmal Positional Vertigo (antBPPV) is the rarest form of semicircular canalolithiasis, corresponding to about 1-2 % of the BPPV. The diagnosis is obtained by either the Dix-Hallpike maneuver or the straight head hanging positioning maneuver, which provoke a characteristic positional down-beating nystagmus. This vertical nystagmus can be associated with a torsional component that helps in localizing the affected side. The differential diagnosis of antBPPV includes the various central lesions that produce vertical down beating nystagmus (posterior fossa). Several liberatory maneuvers have been proposed for the treatment of antBPPV, but still need standardization.
Le vertige paroxystique positionnel bénin du canal semi-circulaire antérieur (VPPBant) est la forme la plus rare des canalolithiases, correspondant à 1-2 % environ de l'ensemble des VPPB. Le diagnostic repose sur l'observation d'un nystagmus positionnel vertical battant vers le bas, associé ou non à une composante rotatoire dirigée vers le côté lésé, provoqué par la manÅuvre de Dix-Hallpike ou le positionnement en décubitus dorsal tête en hyperextension. Le côté affecté n'est pas toujours identifiable, en raison de l'inconstance de la composante rotatoire du nystagmus. Le diagnostic différentiel du VPPBant se fait avec les atteintes centrales pouvant produire un nystagmus vertical battant vers le bas (fosse postérieure). Plusieurs manÅuvres thérapeutiques sont proposées, mais doivent encore être standardisées.
