This interesting fMRI study from Munich, Germany (Deutschländer A et al, Brain 2008 131(4):1025-1034)designed to address the probe the activities of cortical visual motion-sensitive areas in individuals with vestibular failure observed that  patients with right-sided or left-sided UVN showed reduced visual cortex activation during visual motion stimulation compared to their healthy controls. and that reduced visual cortex activation was widespread and affected an assembly of early and higher visual areas of the dorsal and ventral streams; most prominent in MT/V5, in the cuneus, and in the middle occipital gyri bilaterally.

Editor’s choice :  UVF & Cortical VMA...

...?

Pregnancy, ORL Rx, and Safe Drugs...?

This informative study from Athens, Greece (Petros V. Vlastarakos et al, European Archives of Oto-Rhino-Laryngology, May 2008 265(5):499-508) reviewed the current medical literature database on drugs adjudged safe for use in treatment of ORL diseases in pregnancy

.
Text Box: otolaryngologyinafrica.net

April 27 2008

Vol 8 No 3

Otorhinolaryngology news

In this issue

· UVF & Cortical VMA…?

· Pregnancy, ORL Rx & Safe Drugs…?

· PSP, Falls & Otolith Reflexes..?

· Case of The week
Text Box: Biodun Olusesi Newsletter Editor View Page in French

Journal Watch: Mechanical problems in human hearing, Eiber A, 2008

 

 1. Home page of otolaryngologyinafrica.net re-designed for accessibility

2.    A new forum for ENT patients and clinicians launched, For Details, click HERE

3. Receive the latest newsletter info. On your cell phone. Simply point your phone browser HERE

 Till Next Week,

 Biodun

This interesting study from Ohio, USA (Liao K et al, Neurology. 2008 Mar 4;70(10):802-9) examined the reason for frequent falls in patients with progressive supraspinal palsy (a.k.a. Steele-Richardson-Olszewski syndrome) - a neurodegenerative disease that affects cognition, eye movements, and posture first described as a clinicopathologic entity in 1963 –and postulates that abnormal otolith reflexes may partly explain the frequent falls

Psp, falls & otolith reflexes...?

Text Box: Abstract: BACKGROUND: Patients with progressive supranuclear palsy (PSP) fall frequently, beginning early in the course of their disease. Abnormal vestibulospinal reflexes are suspected, but the angular vestibulo-ocular reflex, which is mediated by the labyrinthine semicircular canals, survives late into the course of the disease. OBJECTIVE: To test the hypothesis that otolithic-mediated reflexes are abnormal in PSP. METHODS: We tested otolith-ocular reflexes (the translational vestibulo-ocular reflex [tVOR]) during combined rotation-translation in nine patients with PSP and nine age-matched control subjects; subjects viewed far and near targets. We also tested click-induced otolith-spinal reflexes (vestibular-evoked myogenic potentials [VEMPs]) in 10 patients with PSP and 30 age-matched controls. RESULTS: All patients with PSP had small tVOR responses during near viewing that were, on average, only 12% of those of control subjects (p = 0.001). Patients with PSP also showed a reduction of the amplitude of VEMPs compared to control subjects (median [range]: 54.3 [16.8 to 214] vs 149 [11.6 to 466], p = 0.001). CONCLUSIONS: Taken together, these results indicate that abnormal otolith-mediated reflexes may be at least partly responsible for frequent falls in progressive supranuclear palsy, and deserve further study.

Abstract:

Patients with unilateral vestibular failure (UVF) experience oscillopsia (apparent motion of the visual scene) during rapid head movements due to increased retinal slip caused by vestibulo-ocular reflex impairment. Oscillopsia is always smaller than the net retinal slip and decreases over time in patients with acquired vestibular loss; this correlates with increased thresholds for visual motion detection and increased tolerance to retinal slip. We investigated the underlying cortical adaptive processes using visual motion stimulation during blood oxygen level-dependent (BOLD) fMRI. Optokinetic nystagmus was elicited in

seven patients with right-sided and seven patients with left-sided unilateral vestibular neurectomy and in seven age- and gender-matched healthy controls.

Patients showed diminished activation of bilateral visual cortex areas (including the motion-sensitive area MT/V5, cuneus, middle occipital, fusiform and ingual areas) and ocular motor regions compared to their controls during visual motion stimulation. Concurrent BOLD signal decreases of temporo-parietal and insular multisensory cortical areas occurred in controls and patients. The diminished activation of visual motion processing areas plausibly reflects an adaptive mechanism that suppresses distressing oscillopsia in patients with UVF and thereby stabilizes the perceived visual surroundings. This study provides

for the first time neuroimaging evidence of suppressed cortical visual motion processing in patients with vestibulopathy.

© Copyright Dr 'Biodun Olusesi,  2005 - 2008
Otolaryngology in Africa Feed

Reed Our Feed
Text Box: Abstract: Although all kinds of medications should be avoided during pregnancy, the majority of pregnant women receive at least one drug and 6% of them during the high-risk period of the first trimester. The aim of the present paper is to discuss the appropriate management of rhinologic and laryngeal conditions that may be encountered during pregnancy. A literature review from Medline and database sources was carried out. Related books and written guidelines were also included. Controlled clinical trials, prospective and retrospective studies, case–control studies, laboratory studies, clinical and systematic reviews, metanalyses, and case reports were analysed. The following drugs are considered relatively safe: beta-lactam antibiotics (with dose adjustment), macrolides (although the use of erythromycin and clarithromycin carries a certain risk), clindamycin, metronidazole (better avoided in the first trimester), amphotericin-B (especially in immunocompromised situations during the second and third trimester) and acyclovir. First-line antituberculous agents isoniazid, ethambutol, pyrazinamide, and ciprofloxacine in drug-resistant tuberculosis can be also used. Non-selective NSAIDs (until the 32nd week), nasal decongestants (with caution and up to 7 days), intranasal corticosteroids, with budesonide as the treatment of choice, second generation antihistamines (cetirizine in the third trimester, or loratadine in the second and third trimester), H2 receptor antagonists (except nizatidine) and proton pump inhibitors (except omeprazole) can be used to relieve patients from the related symptoms. In cases of emergencies, epinephrine, prednisone, prednisolone, methylprednisolone, dimetindene and nebulised b2 agonists can be used with extreme caution. By contrast, selective COX-2 inhibitors and BCG vaccination are contraindicated in pregnancy. When prescribing to a pregnant woman, the safety of the materno-foetal unit is considered paramount. Although medications are potentially hazardous, misconceptions and suboptimal treatment of the mother might be more harmful to the unborn child. Knowledge update is necessary to avoid unjustified hesitations and provide appropriate counselling and treatment for pregnant women. Text Box: Case of The Week

A 6 year old female presented with progressive right neck swelling of few months duration. There was no associated cough, weight loss, dysphagia, dental, nasal or pharyngeal symptoms. Examination revealed the findings here>>>   Guess the Diagnosis

 

Post a Comment To This Newsletter or click HERE to start a discussion forum on this topic

Name

Mail

Website