RESUMO
Motorist's vestibular disorientation syndrome (MVDS) is a disorder in which patients experience dizziness while driving. MVDS is under-reported in the literature, and in clinical practice, it often goes unrecognized. We identified clinical characteristics of patients with MVDS using data from 24 patients who faced difficulties while driving and were diagnosed with MVDS. Their symptoms, duration of illness, precipitating factors, co-morbidities, history of other neuro-otological disorders, severity of symptoms, and associated anxiety and depression were reviewed. Ocular motor movements were recorded using video-nystagmography. Patients with vestibular disorders that can cause similar symptoms while driving were excluded. The mean age of the patients was 45.7 ± 8.7 years, and most were professional drivers (90.5%). The duration of the illness ranged from eight days to ten years. Most patients presented with disorientation (79.2%) exclusively while driving. The most common triggers for symptoms were higher speeds, i.e., >80 km/h (66.7%), multi-lane roads (58.3%), bends and turns (50%), and looking at other vehicles or signals while driving (41.7%). A history of migraines was reported in 62.5% of the patients, and motion sickness was reported in 50% of the patients. Anxiety was reported in 34.3% of patients, and 15.7% had depression. The video-nystagmography did not show any specific abnormalities. Patients responded to drugs used in prophylactic treatments for migraines such as Amitriptyline, Venlafaxine, Bisoprolol, and Magnesium, and to Pregabalin and Gabapentin. Based on these findings, a classification system and a diagnostic criterion for MVDS were proposed.
RESUMO
Introduction: Thyroglossal duct cysts are a common congenital anomaly in the neck which usually present in adulthood as a midline neck swelling the location of which can vary from lingual, suprahyoid, infrahyoid and suprasternal. Case Report: Here we have described the case of a thirty-year-old male who presented with a history of recent onset dysphonia and an unnoticed neck swelling. Clinical examination revealed a midline 2 x 2 cm cystic lesion in the neck. On further evaluation using laryngoscopy and computed tomography the patient was found to have a smooth mucosa-covered cyst in the subglottic location. Surgical excision of the cyst was done via laryngofissure and the postoperative course was uneventful. The postoperative biopsy revealed a subglottic thyroglossal cyst. Conclusions: Though there have been reports of intralaryngeal extension of thyroglossal duct cysts, the subglottic location is extremely rare. Through this case report, we would like to highlight the atypical presentation of thyroglossal duct cysts and how an innocuous pathology can turn potentially life-threatening. We would also recommend avoiding a fine needle aspiration cytology in such cases due to the critical location.
RESUMO
The aim of this study is to assess the incidence of post traumatic BPPV and evaluate its treatment outcomes in mild and moderate traumatic head injury patients. The study population consisted of 128 patients (89 male:39 female) who were admitted with head and neck injury (Motor Vehicle Accident, Blow to the head, Fall from Height, Whiplash injury) as inpatients in Department of Neurosurgery in Tertiary care hospital in Kerala during a 2 month period from 1st April 2014 to 31st May 2014. The age range was 10-70 years and mean 39.8 with standard deviation 15.5. All cases were evaluated and serially followed up to a period of 6 months in Department of Otorhinolaryngology. In our study, the number of patients with mild injuries (Glasgow coma scale 13-15) were 108 and moderate injury (Glasgow coma scale 9-12) were 20. We found out that post traumatic BPPV was found to be 17% of the traumatic brain injury patients. All patients were treated with particle re-positioning maneuvers and were followed up for a period of 6 months. Recurrence were reported in 9 (40.9%) patients. In these patients re positioning maneuvers were repeated.
