Diminishment of vertigo and TIA symptoms in a 67-year-old female using functional neurorehabilitation
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1
Life University, United States
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2
Southwest Brain Performance Center (SBPC), United States
Presentation:
A 67-year-old female patient presented to a chiropractic neurology clinic with a primary complaint of mild to moderate vertigo. Additional complaints were transient ischemic attack (TIA) symptoms such as brain fogginess, pain in the right ear, blurry vision, rushing sensations and tinnitus. The patient reported feeling as if her right brain had been “poured out”, a feeling of emptiness. Her history included physical and verbal abuse from her parents and then from her spouse, 54 years of bulimia, and a diagnosis of ADD/ADHD by her primary care physician. Multiple tests had been taken prior to her visit to the chiropractic neurology clinic (EEG, EKG, MRI and MRA) and none of them showed any alarming abnormalities/pathologies.
Findings:
Positive dysdiadochokinesia and ataxia of the left upper extremity was seen on alternating palms up/palms down testing and immediate leftward sway after closing her eyes on balance testing. Finger tapping test revealed decreased amplitude throughout on the left. Gait analysis showed decreased left arm swing with bilateral cantilevering. In smooth pursuit eye movement testing, saccadic intrusions were observed upon vertical eye movement upwards and downwards as well as to the left (horizontally). Dysmetric saccades were noted upon vertical saccadic testing both upwards and, downwards as well as to the left (horizontally). Patient had a left inward and upward convergence spasm with right beating nystagmus. Chiropractic analysis showed subluxations with myospasm and hypo-mobility in specific spinal and rib joints. Benign paroxysmal positional vertigo (BPPV) was evidenced by Dix-Hallpike testing of the left posterior canal. Computerized assessment of postural systems (CAPS) testing showed 39% stability on a perturbed surface with eyes closed and head position in extension (PSEC-HE).
Methods:
The treatment plan was aimed to increase the frequency of firing to the right parietal lobe while increasing central integrative state of the vestibulocerebellum. Passive cerebellar exercises were performed on the left side for left cerebellar and right cortical activation. Computerized right brain eye exercises were done using diagonal microsaccades from the lower right to the upper left field of vision, followed immediately by diagonal smooth pursuits from the upper left to the lower right field of vision. Optokinetic stimulations were performed in the following directions: left horizontally, down/left and up/left for three passes in each direction, to treat left inward and upward convergence spasm and right beating nystagmus. Head-Eye Vestibular Stimulation (HEVM) therapy was done using horizontal smooth pursuits and passive forward pitch head movements at 10 degrees to the left of midline. Additionally, HEVM therapy was used for vertical smooth pursuits and passive right yaw movements. Anti-saccades were performed using the Focus Builder application. Gait therapy was preformed utilizing turns to the left while having a tone pacer set at 100 Hz in the left ear and 500 Hz in the right ear. Cranial Nerve Non-Invasive Neuromodulation (CN-NINM) therapy was used on the left V1, V2 and bilateral V3/hypoglossal cranial nerve. Epley maneuver was done with vibracussor application to the bilateral mastoids and occipital bones to address BPPV symptoms. Additionally, each treatment session included one hour of neurofeedback therapy.
Results:
The patient received treatment for a total of 14 days within a 3-month period, consisting of two treatments per day. After the 14 visits, the patient reported feeling 75-85% improvement since her first visit. Her vertigo had almost diminished but some short-lived episodes persisted. Her additional complaints, (TIA) symptoms, brain fogginess, pain in the right ear, blurry vision, rushing sensations and tinnitus were all decreased but did not resolve completely. CAPS result for PSEC-HE increased to 64% stability. Some difficulties in oculomotor tracking and saccades persisted, but patient will continue her treatment to address the remaining symptoms.
Conclusion:
In this patient case, employing neurorehabilitation strategies proved effective in decreasing vertigo and other neurological symptoms. These results promote the need for further research of functional neurorehabilitation in the treatment of vertigo.
Keywords:
TIA,
Transient ischemic attack (TIA),
Neurorehabilitation,
chiropractic neurology,
Vertigo
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Chydenius
R,
Esposito
SE and
Pendleton
M
(2019). Diminishment of vertigo and TIA symptoms in a 67-year-old female using functional neurorehabilitation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00012
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Received:
01 Apr 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Mx. Susan E Esposito, Life University, Marietta, Ohio, 30060, United States, susanesposito@gmail.com