ABSTRACT
The authors report serial MRI of a patient with Bickerstaff's brainstem encephalitis (BBE), disclosing caudal migration of an initial upper midbrain lesion. High apparent diffusion coefficient values imply a vasogenic rather than cytotoxic edema as the cause of the hyperintense signal changes on T2-weighted images.
Subject(s)
Brain Edema/etiology , Brain Stem/pathology , Encephalitis/complications , Magnetic Resonance Imaging , Mesencephalon/pathology , Brain Edema/diagnosis , Brain Edema/pathology , Consciousness Disorders/etiology , Diagnosis, Differential , Dysarthria/etiology , Encephalitis/diagnosis , Encephalitis/pathology , Gait Ataxia/etiology , Humans , Male , Middle Aged , Miller Fisher Syndrome/diagnosis , Ophthalmoplegia/etiologyABSTRACT
Two hundred and two consecutive patients with dizziness were evaluated using blind neuro-otological testing and examination, blind psychiatric examination, including structured interviews (according to DSM-IV), the Symptom Check-List (SCL 90 R), and the State-Trait Anxiety Inventory (STAI). In 28% of the patients (N=50) dizziness was of organic origin (O group); in 55.3% (N=99) of psychogenic origin (P group) and in 16.8% comorbid psychiatric disorders were found (Mixed group). In 5.3% (N=10) neither organic nor psychiatric results could be found, which could explain the dizziness (Ideopathic group). Compared with the Organic group the patients with psychiatric disorders (P and Mixed group) had much more extensive workups for dizziness, intense emotional distress (anxiety, depression), greater handicaps, and high somatization scores. In the P and Mixed groups three main subgroups of psychiatric disorders could be found: anxiety (N=56), depressive (N=20), and somatoform disorders (N=53). Patients with anxiety and depressive disorders showed the greatest emotional distress and handicaps. The results indicate that psychiatric disorders, above all anxiety disorders, should be included in the differential diagnosis in patients with a long duration of dizziness and great handicaps. An interdisciplinary treatment (including psychiatric treatment) would be superior to an exclusive somatic one.
Subject(s)
Anxiety Disorders/complications , Dizziness/complications , Mental Disorders/complications , Adolescent , Adult , Aged , Anxiety Disorders/psychology , Diagnosis, Differential , Female , Germany , Humans , Male , Mental Disorders/psychology , Middle Aged , Psychiatric Status Rating Scales , Stress, Psychological/complications , Vestibular Diseases/complicationsABSTRACT
The study explored the relationship between health locus of control and anxiety in 90 patients with the chief complaint of dizziness/vertigo. The patients were subjected to a neurological examination, including standardised history, physical examination, electronystagmography with caloric testing and posturography, auditory and visually brainstem-evoked responses, masseter reflex, vertebrobasiliar transcranial Doppler, optional: cranial imaging (CCT/MRI), cardial diagnostic, and a psychiatric-psychodynamic examination (including psychometric tests: STAI-G X2, KKG, SBA-S). The whole group of patients (psychogenic and organic dizziness) had a specific pattern of health locus of control: "double health external" (Type IV-Wallston and Wallston 1982). Patients with psychogenic dizziness showed a higher score of external locus of control (chance) compared with the patients with organic dizziness. High anxiety scores were accompanied by high scores of external locus of control (powerful others and chance) above all in the patients with psychogenic dizziness. Implications for therapy are discussed.
Subject(s)
Anxiety/psychology , Internal-External Control , Meniere Disease/psychology , Psychophysiologic Disorders/psychology , Somatoform Disorders/psychology , Vertigo/psychology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Patient Care Team , Personality Inventory , Psychoanalytic Therapy , Psychophysiologic Disorders/diagnosis , Somatoform Disorders/diagnosisABSTRACT
Due to the results of an interdisciplinary study on patients with vertigo as the chief symptom and on the background of psychodynamic theories concerning anxiety disorders the term of phobic postural vertigo (Brandt & Dieterich 1986) is discussed. It becomes obvious that phobic postural vertigo is a generalizing term which encompasses different forms of psychogenic vertigo. The authors plead for a more differentiated diagnosis and subgroup oriented classification of vertigo caused by psychiatric disorders.
Subject(s)
Phobic Disorders/classification , Postural Balance , Posture , Psychophysiologic Disorders/classification , Somatoform Disorders/classification , Vertigo/classification , Adolescent , Adult , Aged , Agoraphobia/classification , Agoraphobia/diagnosis , Agoraphobia/psychology , Anxiety Disorders/classification , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Diagnosis, Differential , Female , Humans , Male , Meniere Disease/classification , Meniere Disease/diagnosis , Meniere Disease/psychology , Middle Aged , Neurologic Examination , Personality Inventory , Phobic Disorders/diagnosis , Phobic Disorders/psychology , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Vertigo/diagnosis , Vertigo/psychologyABSTRACT
BACKGROUND: Vertigo is a common symptom that often remains unexplained despite extensive medical evaluation. Psychiatric and psychosomatic disorders are usually considered after all somatic causes of vertigo have been ruled out. METHODS: Eighty-three patients referred to neurological or psychosomatic outpatient treatment received an extensive neurootologic and psychosomatic evaluation: one (or two) diagnostic psychiatric psychodynamic exploration(s), a structured interview, psychometric tests (SCL-90-R, STAI-G X2 and GBB). The patients were divided into four diagnostic groups: psychic causes only (psychogenic group), neurootologic causes only (somatic group), both diagnoses (psychosomatic group), neither diagnosis (group IV). RESULTS: Twenty-three patients had organic vertigo, thirty-nine patients had psychogenic vertigo and in seventeen cases a vestibular lesion initiated the development of a neurotic disorder, particular anxiety disorder. Most of the patients of the psychogenic and psychosomatic group had anxiety or phobic disorders. The patients with psychogenic or psychosomatic symptoms of vertigo generally report a higher level of subjective distress; the periods of disability are significant longer. CONCLUSIONS: The study suggests that assessment of psychiatric and psychosomatic symptoms should always accompany, not follow, neurootologic evaluation of vertigo. An early interdisciplinary therapy should be started to prevent the chronicity of the symptomatology.
