In the cardiovascular domain, as an underlying pathology that contributes to dizziness progresses, it often results in fainting or as a symptom in the pre-stage of fainting, often awareness of dizziness. Understanding that the causes of dizziness and fainting are almost the same, we consider that syncope is the most likely ultimate cause. There are many diseases that can lead to syncope. However, the causes that are commonly observed in routine practice include arrhythmia, orthostatic hypotension, neuroregulatory syncope, heart failure etc. The most important factor in diagnosis is obtaining a detailed medical history. By listening to the medical history in detail from the patient himself/herself or the discoverer with respect to the situation where the fainting occurred, the course of occurrence, the physical condition at that time, the outline of the disease can be obtained, and the examination can then be focused on confirming the diagnosis. There are also many cases to guide this process. Herein, we introduce the cardiovascular approach to syncope patients, from diagnosis to treatment.

View full abstract

Cerebrovascular disease is estimated to account for 4% of patients with vertigo or dizziness. However, cerebrovascular disease is an important and serious cause of vertigo. In these cases, since cerebrovascular events mainly involve the brainstem and cerebellum, most cases show various neurological signs, such as nystagmus, ataxia, dysarthria, dysphagia, diplopia, facial and limb weakness. In cases without these neurological signs (isolated vertigo), sudden onset, risk factors for stroke, constant severe vertigo/dizziness in supine position, standing and gait inability, and nystagmus (bilateral/vertical) are considered as features of vertigo due to cerebrovascular disease distinct from peripheral vertigo

View full abstract

Dizziness and vertigo are symptoms that are often encountered in general practice and emergency medical care. However, in Acute vestibular disorder, which manifests as severe and long-term vertigo, nausea, vomiting, spontaneous nystagmus and postural instability, it is often difficult to judge whether it is a central disorder or a peripheral disorder. In the clinical situation, it is often difficult to make such a decision due to the limitations of diagnostic instrumentation and time. In this paper, I will introduce the HINTS plus, which is useful for distinguishing between central and peripheral disorders in acute vestibular syndrome, and can be performed conveniently at the bedside.

View full abstract

Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV occurs when calcium carbonate crystals (otoconia) in the utricle dislodge and migrate into the semicircular canals. There are two pathogeneses of BPPV: canalolithiasis and cupulolithiasis. Canalolithiasis involves to the presence of free cumulates of otoconia in the semicircular canals. When they become displaced in response to head movements, an endolymphatic flow is generated that abnormally stimulates the cupula, leading to vertigo. Cupulolithiasis involves a deposit of otolith nests that adhere to the cupula of the semicircular canal; thus, changing its specific gravity. Thus, the cupula is sensitized to linear accelerations, such as gravitational acceleration. The canalith repositioning procedure (CRP) is used to treat BPPV by moving the otoconia from the semicircular canal to the utricle. Although BPPV can resolve spontaneously, BPPV treated with CRP is resolved more quickly than untreated BPPV. In order to treat BPPV appropriately with the CRP, we must ensure its appropriate diagnosis.

View full abstract

Vertigo reduces the quality of life of many patients, and may be associated with life-threatening disease. Physicians must correctly diagnose the cause of vertigo and administer adequate therapy to patients with this condition. Although the use of magnetic resonance imaging (MRI) has facilitated the diagnosis of dangerous vascular accidents in the central nervous system, it continues to be difficult to make a correct diagnosis in many cases. This review describes the characteristics and the cues for the diagnosis of such vertiginous disease, especially Ménière’s disease and vestibular migraine with frequent episodic history. These two diseases have similar symptomatic aspects and the diagnostic criteria are not sufficient. However, the International Classification of Vestibular Disorders committee recently described new diagnostic criteria for these vestibular diseases, based on longitudinal data. Further development of MRI techniques for demonstrating inner ear hydrops may be useful in the diagnosis of Ménière’s disease in the near future.

View full abstract

Chronic and persistent vertigo and dizziness patients are sometimes recognized clinically. In this paper, some cases of typical chronic dizziness relating to otolaryngology are introduced. Those peripheral vestibular disturbances tend to be prolonged by psychological phobia and a lack of physical exercise. Therefore, cognitive behavioral therapy and physical exercise therapy must be used for treatment. Sometimes, anti-depressant drugs are effective in avoiding phobia. In addition, presbystasis (dizziness induced by aging) requires a combination of cognitive behavioral therapy and physical exercise therapy, including strength exercise. Lifetime treatment is necessary since presbystasis is a progressive pathological situation like cancer. Also, the new dizziness concept of PPPD (Persistent Postural Perceptual Dizziness) has recently been described. In general, one important factor that can postpone recovery is the phobia of dizziness. Introducing the concept of PPPD could be important in clarifying the mechanism and approach to the treatment of this kind of chronic dizziness.

View full abstract

Background: Although patients with paroxysmal atrial fibrillation (PAF) and prolonged sinus pauses (bradycardia-tachycardia syndrome [BTS]) are generally treated by implantation of a permanent pacemaker, catheter ablation has been reported to be a curative therapy for BTS without pacemaker implantation. The purpose of this study was to clarify the potential role of catheter ablation in patients with BTS. Methods: Ten patients with BTS who underwent pulmonary vein isolation with or without additional left atrial ablation were analyzed. Results: Four patients required additional left atrial ablation. One patient required a repeat procedure. During the 28 ± 7 months follow-up, 9 patients were AF free without pacemaker implantation, and 1 patient required pacemaker implantation because of sustained sinus bradycardia and sinus pauses without recurrence of AF. Conclusion: Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of BTS patients.

View full abstract

A 5-month-old male infant was diagnosed with Kawasaki disease on the 4th day of disease onset. He was treated with intravenous immunoglobulin, oral aspirin, and prednisolone. However, owing to dilatation of his coronary arteries on the 18th day of illness, he was transferred to our hospital. Echocardiography revealed bilateral coronary artery aneurysms; however, no intraluminal thrombus was identified. Anticoagulation therapy with heparin was initiated after confirming these findings. Based on electrocardiographic changes and elevated serum levels of biomarkers of myocardial injury, he was diagnosed with acute myocardial infarction on the 20th day of illness. Intravenous or intracoronary thrombolysis was not performed because he was asymptomatic, and increasing heparin administration was expected to improve reperfusion. Sudden death can occur in patients with myocardial infarction complicating Kawasaki disease. Therefore, the indications for acute thrombolytic therapy should be carefully determined based on its need and safety

View full abstract

A 45-year-old woman underwent endoscopic transgastric necrosectomy for walled-off necrosis after acute pancreatitis at 36 weeks gestation. After recovery, she underwent laparoscopic cholecystectomy (LC) for cholecystolithiasis, which might have been the cause of pancreatitis. Abdominal CT revealed an abdominal tumor measuring 46mm in diameter one year after LC. We performed laparoscopic resection of the tumor for diagnosis and treatment. Histopathologically, the tumor was diagnosed as a desmoid tumor occurring in the mesentery of the small intestine. Desmoid tumor is a rare, clinically borderline tumor, that can recur locally and grows invasively. Herein, we report a case of laparoscopic surgery for an intra-abdominal desmoid tumor in the mesentery of the small intestine that was difficult to definitively diagnose preoperatively.

View full abstract