Vestibular disorders in elderly patients: characteristics, causes and consequences.

INTRODUCTION: This study assessed vestibular disorders in elderly patients, describing the causes, clinical characteristics, therapies and treatment outcomes. METHODS: Five-year hospital-based prospective study, conducted at the ENT clinic of a tertiary referral center. Subjects were consecutive elderly patients with dizziness, treated and followed-up for a minimum of six months. Data was generated using structured questionnaire and case record files. Analyzed results were presented in simple descriptive forms as graphs and tables. RESULTS: Among the elderly patients, prevalence of vestibular disorders was 18.6%, 49.1% were retired, 71.9% were married, M:F was 1:1.1. Mean age±SD were 69.4±1.1 and 69.0±0.8 years for males and females respectively. 56.9% of the patients presented early on experiencing the vestibular symptoms. The symptoms were associated with nausea or vomiting in 26.3%, with an aura in 12.3%. While 50.9% of the patients experienced intermittent symptoms, laterality of the symptoms was not clear in 45.6%. Positional vertigo was diagnosed in 33.3% while in 17.5%, the symptoms could be attributable to previous trauma or assaults. 31.6% of the elderly were referred to ENT surgeons by other specialties, 45.6% were managed with multidisciplinary approach, while 82.5% had the vestibular symptoms initially controlled with labyrinthine sedatives. At follow-up, 43.9% had intermittent periods of recurrence of symptoms. CONCLUSION: Prevalence of vestibular disorders in elderly patients is high, most patients present early with intermittent, relatively innocuous symptoms which may be difficult to lateralize. Positional vertigo was the most common cause, it is frequently relieved with labyrinthine sedatives but tends to recur intermittently.

Validation study of the Siriraj Stroke score in African Nigerians and evaluation of the discriminant values of its parameters: a preliminary prospective CT scan study.

BACKGROUND AND PURPOSE: CT scanning is important to identify stroke pathology and exclude mimics. Its poor availability in our environment makes the search for simple, reliable clinical-score imperative. This study aims to validate the Siriraj Stroke score (SSS) and determine the discriminant values of its parameters in the black population of African-Nigerians. METHODS: A prospective multicenter study was carried out on patients that presented with stroke and had brain CT scan done within 14 days of onset. An interviewer structured questionnaire was administered and SSS computed. The stroke-type was classified and compared with CT diagnosis. Data were analyzed using Epi-info-2002. RESULTS: 1122 patients presented with clinical features of stroke, of which only 101 (9%) could afford the cost of CT scan. Of these, 90 had CT-scan features consistent with acute stroke, 5 had cortical atrophy and 1 was normal. Thus, 96 patients were analyzed, of which 68 (71%) had cerebral ischemia and 28 (29%) had intracerebral hemorrhage. The 6 patients with no visible infarct on CT were regarded as cerebral infarction. The correlation between SSS, headache, vomiting, loss-of-consciousness and CT diagnosis achieved statistical significance, whereas atheroma markers and diastolic blood pressure did not. The SSS has an overall predictive accuracy of 80%. CONCLUSIONS: This preliminary study has shown that only 9% of our hospital stroke population had benefit of CT scan. The limited number of patients studied and their potential lack of representativeness, represent a funding issue to properly establish the performance of clinical scoring systems and assist in descriptive epidemiology of hospital and community-based stroke studies in resource-poor settings. However, in this study, the SSS diagnosis correlates significantly with CT diagnosis.