Explore the vast range of titles available.

On the surface, The Philosophical Hitchcock: Vertigo and the Anxieties of Unknowingness, is a close reading of Alfred Hitchcock's 1958 masterpiece Vertigo. This, however, is a book by Robert B. Pippin, one of our most penetrating and creative philosophers, and so it is also much more. Even as he provides detailed readings of each scene in the film, and its story of obsession and fantasy, Pippin reflects more broadly on the modern world depicted in Hitchcock's films. Hitchcock's characters, Pippin shows us, repeatedly face problems and dangers rooted in our general failure to understand others or even ourselves very well, or to make effective use of what little we do understand. Vertigo, with its impersonations, deceptions, and fantasies, embodies a general, common struggle for mutual understanding in the late modern social world of ever more complex dependencies.0By treating this problem through a filmed fictional narrative, rather than discursively, Pippin argues, Hitchcock is able to help us see the systematic and deep mutual misunderstanding and self-deceit that we are subject to when we try to establish the knowledge necessary for love, trust, and commitment, and what it might be to live in such a state of unknowingness. A bold, brilliant exploration of one of the most admired works of cinema, The Philosophical Hitchcock will lead philosophers and cinephiles alike to a new appreciation of Vertigo and its meanings.

One March morning, writer Floyd Skloot was inexplicably struck by an attack of unrelenting vertigo that ended 138 days later as suddenly as it had begun. With body and world askew, everything familiar had transformed. Nothing was ever still. Revertigo is Skloot’s account of that unceasingly vertiginous period, told in an inspired and appropriately off-kilter form. This intimate memoir—tenuous, shifting, sometimes humorous—demonstrates Skloot’s considerable literary skill honed as an award-winning essayist, memoirist, novelist, and poet. His recollections of a strange, spinning world prompt further musings on the forces of uncertainty, change, and displacement that have shaped him from childhood to late middle age, repeatedly knocking him awry, realigning his hopes and plans, even his perceptions. From the volatile forces of his mercurial, shape-shifting early years to his obsession with reading, acting, and writing, from the attack of vertigo to a trio of postvertigo (but nevertheless dizzying) journeys to Spain and England, and even to a place known only in his mother’s unhinged fantasies, Skloot makes sense of a life’s phantasmagoric unpredictability. Finalist, Sarah Winnemucca Award for Creative Nonfiction, Oregon Book Awards

\"In Classical Vertigo, Padilla analyzes narrative figures and themes of classical mythology within Hitchock's Vertigo to demonstrate that the film is a multifaceted work of intertextuality with artistic and cultural roots extending into antiquity itself\"-- Provided by publisher.

IntroductionResidual dizziness (RD) is common in patients with benign paroxysmal positional vertigo (BPPV) after successful canalith repositioning procedures. This study aimed to investigate the therapeutic effects of vestibular rehabilitation (VR) on BPPV patients experiencing RD, and to explore the impact of VR on functional connectivity (FC), specifically focusing on the bilateral parietal operculum (OP) cortex.MethodsSeventy patients with RD were randomly assigned to either a four-week VR group or a control group that received no treatment. Assessments included the dizziness Visual Analog Scale (VAS), Dizziness Handicap Inventory (DHI), Hamilton Anxiety/Depression Scale (HAMA/HAMD), and resting-state functional magnetic resonance imaging.ResultsThe VR group exhibited a significant decline in scores on VAS, DHI, HAMA and HAMD following training (all p < 0.05). Furthermore, the VR group demonstrated increased FC between the left OP and both the left precuneus and left middle frontal gyrus (MFG), and between the right OP and the right MFG (voxel-level p < 0.001; cluster-level p < 0.05, FDR corrected). Additionally, these changes in FC were found to correlate with clinical features, including scores on HAMA (p = 0.012, r =  − 0.513) and DHI (p = 0.022, r =  − 0.475) after the intervention.ConclusionThis study demonstrated the therapeutic effects of VR in alleviating RD and emotional disorders, as well as in improving overall quality of life. Notably, these positive outcomes might be associated with increased FC between brain regions involved in mood regulation and vestibular processing. Our findings offer novel neuroimaging evidence that supports the hypothesis that VR facilitates dynamic vestibular compensation.

The current theory in physiopathology of benign paroxysmal positional vertigo is the mechanical theory, namely the cupulolithiasis-canalolithiasis theory. Repositioning maneuvers based on this theory has now taken place in therapy. However, mechanical theory is insufficient to explain some clinical situations and cannot fully enlighten the physiopathology. Mechanical theory is based on very few histological studies. Currently, these few articles are still used for reference. Anatomically, there are uncertainties that need to be explained in this theory. In this literature review, the histological and anatomical evidence is reviewed and the value of mechanical theory in benign paroxysmal positional vertigo physiopathology has been questioned. Studies suggest that the debris in the semicircular canals is caused by degeneration due to aging and may not be responsible for the symptoms in benign paroxysmal positional vertigo. Some patients with debris in semicircular canals do not have benign paroxysmal positional vertigo symptomatology, while some patients without debris may have benign paroxysmal positional vertigo symptomatology. Experimental and histological findings suggest that vestibulopathy due to inflammation caused by neurotropic viruses may lead to benign paroxysmal positional vertigo picture. For all these reasons, in benign paroxysmal positional vertigo physiopathology, there must be other factors besides particle debris in semicircular canals.

Study question What is the long term efficacy of betahistine dihydrochloride on the incidence of vertigo attacks in patients with Meniere’s disease, compared with placebo?Methods The BEMED trial is a multicentre, double blind, randomised, placebo controlled, three arm, parallel group, phase III, dose defining superiority trial conducted in 14 German tertiary referral centres (for neurology or ear, nose, and throat). Adults aged 21-80 years (mean age 56 years) with definite unilateral or bilateral Meniere’s disease were recruited from March 2008 to November 2012. Participants received placebo (n=74), low dose betahistine (2×24 mg daily, (n=73)), or high dose betahistine (3×48 mg daily, (n=74)) over nine months. The primary outcome was the number of attacks per 30 days, based on patients’ diaries during a three month assessment period at months seven to nine. An internet based randomisation schedule performed a concealed 1:1:1 allocation, stratified by study site. Secondary outcomes included the duration and severity of attacks, change in quality of life scores, and several observer-reported parameters to assess changes in audiological and vestibular function.Study answer and limitations Incidence of attacks related to Meniere’s disease did not differ between the three treatment groups (P=0.759). Compared with placebo, attack rate ratios were 1.036 (95% confidence interval 0.942 to 1.140) and 1.012 (0.919 to 1.114) for low dose and high dose betahistine, respectively. The overall monthly attack rate fell significantly by the factor 0.758 (0.705 to 0.816; P<0.001). The population based, mean monthly incidence averaged over the assessment period was 2.722 (1.304 to 6.309), 3.204 (1.345 to 7.929), and 3.258 (1.685 to 7.266) for the placebo, low dose betahistine, and high dose betahistine groups, respectively. Results were consistent for all secondary outcomes. Treatment was well tolerated with no unexpected safety findings. Without a control group of patients who did not receive any intervention to follow the natural course of the disease, the placebo effect could not be accurately assessed and differentiated from spontaneous remission and fluctuation of symptoms. What this study adds Current evidence is limited as to whether betahistine prevents vertigo attacks caused by Meniere’s disease, compared with placebo. The trial provides information on symptom relief on placebo intervention which is relevant for the design of future studies on potential disease modifying treatments in patients with Meniere’s disease.Funding, competing interests, data sharing Support from the German Federal Ministry of Education and Research (BMBF support code 01KG0708). Potential competing interests have been reported in full at the end of the paper on thebmj.com. Data are available from the corresponding author (Michael.Strupp@med.uni-muenchen.de) or biostatistician (mansmann@ibe.med.uni-muenchen.de).Study registration EudraCT no 2005-000752-32; ISRCTN no ISRCTN44359668.

Background Vestibular vertigo is one of the leading causes of disability. The clinical standard of care for vestibular vertigo includes physical activity producing central vestibular compensation (CVC). Home exercises are considered an integral part of physical therapy. However, a reliable solution is still needed to support the regular and correct execution of home exercises. For this purpose, VH-90-D DiGA was developed, which is a digital therapeutic (DTx) for multimodular in-home therapeutic training. Objective The purpose of this study is to assess the clinical efficacy and safety of a vestibular health app for patients with vestibular vertigo. Methods A randomized group-controlled single-blinded clinical trial (RCT) has been designed. Patients will be randomly assigned to one of two treatment groups and the endpoints examined in a pre-determined order. The experimental group receives the DTx (around 15 min/daily for 90 days), and the control receives physiotherapy according to the German statutory health care plan (usually 6 × 20 min of live physiotherapy). The primary outcome will be vertigo intensity measured using the German version of the validated Vertigo Symptom Scale-short form VSS-sf-VER (0–32 score points). Evaluation is performed after 2, 6, and 12 weeks. Primary outcomes are determined by measuring the group differences of the VSS-sf-score point changes from baseline to week twelve. Including dropouts, the sample size has been determined to be 2 × 100. Expected results It is expected that therapy with the DTx will be statistically superior to physiotherapy in terms of effect size. Discussion This trial protocol marks a confirmatory RCT (GEVE II) to investigate the efficacy and safety of a digital vertigo treatment. The planned RCT is based on a series of primary and secondary efficacy variables. Examination of the endpoints in a pre-determined order ensures the rigor of confirmatory statistics and addresses the challenge of multiplicity. This sequential testing continues until significance is achieved. However, if a specific variable fails to reach significance, subsequent variables will be explored solely on a descriptive basis. Trial registration German National Registry of Clinical Studies (DRKS00028026), a WHO ICRTP registry. Registered on December 12, 2023.

Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.

Subklavyen steal sendromu (SSS), proksimal subklavyen arterin darlığına bağlı vertebrobaziler arter yetmezliğinin bir belirtisidir. Erişkin hastalarda yaygın olmasına rağmen çocuk yaş grubunda nadir görülür; çoğu hasta asemptomatiktir ve hastalık genellikle görüntüleme sırasında tesadüfen bulunur. Bununla birlikte, bazı hastalar kol iskemisi veya vertigo, baş dönmesi, diplopi, ataksi, dizartri ve senkop atakları gibi vertebrobaziler yetmezlik belirtileri ve semptomlarıyla başvurabilir. Bu yazıda son 3–4 aydır olan baş dönmesi, senkop atakları ve sağ kolunda uyuşukluk şikayetleriyle başvuran bir erkek hasta sunuldu.

Objective The study aimed to determine the etiological characteristics of patients with dizziness/vertigo attending a neurological clinic according to the criteria of the International Classification of Vestibular Disorders (ICVD), hoping to provide a valuable reference for clinicians to diagnose and treat dizziness/vertigo. Method A total of 638 consecutive patients with a chief complaint of dizziness/vertigo who attended the vertigo clinic of our neurology department from January 2019 to January 2020 were included. Clinical data of patients, including baseline data, medical history, neurological, neuro-otological, and auxiliary examination results were collected. The etiologic distribution of dizziness/vertigo was determined by analyzing the diagnoses of patients. Results Of the 638 patients with dizziness/vertigo, 38.8% were males, 61.2% were females, with a male: female ratio of 1:1.58 and a mean age of 52.9 ± 16.9 years. Benign paroxysmal positional vertigo (BPPV) was the most common cause of dizziness/vertigo in both female (38.9%) and male patients (25.5%). Subgroup analysis based on sex showed that vestibular migraine (VM) and probable autoimmune inner ear disease (p-AIED) were more prevalent in female patients (10.7% and 3.8%, respectively), while vascular vertigo/dizziness was more common in male patients (10.1%). Subgroup analysis based on age showed that the most common diseases were VM in patients aged 0–30 years (27.4%), BPPV in patients aged 31–60 years (27.1%) and 61–100 years (46.0%). Episodic vestibular syndrome (EVS) was the most commonly observed, accounting for up to 60.6% (389/638) of all patients, and the most common diagnoses were BPPV (55.3%, 215/389), VM (15.2%, 59/389), primary unilateral peripheral vestibular dysfunction (p-UPVD) of unknown etiology (11.8%, 46/389), p-AIED (4.4%, 17/389), and vascular vertigo/dizziness (2.8%, 11/389) in these patients. Chronic vestibular syndrome (CVS) was found in 14.0% (90/638) of the patients, and the most common diagnoses were persistent postural-perceptual dizziness (PPPD, 35.6%, 32/90), psychogenic dizziness (18.9%, 17/90), p-UPVD of unknown etiology (15.6%, 14/90), vascular vertigo/dizziness (15.6%, 14/90), and bilateral vestibulopathy (7.8%, 7/90). Acute vestibular syndrome (AVS) was observed in 8.4% (54/638) of the patients, and the most common diagnoses were p-UPVD of unknown etiology (31.5%, 17/54), vestibular neuritis (24.1%, 13/54), probable labyrinthine apoplexy (16.7%, 9/54), stroke (13.0%, 7/54), and psychogenic dizziness (11.1%, 6/54). 16.4% (105/638) of the patients were found to have other disorders, including 15.2% (16/105) of patients with internal diseases, and 84.8% (89/105) of patients with unknown causes. In terms of localization diagnosis, 56.1%, 17.0%, 10.0%, and 16.4% of the patients were diagnosed with peripheral vestibular disorder, central vestibular disorder, psychiatric and functional vestibular disorders, and other disorders, respectively. Conclusion (1) Dizziness/vertigo was more common in females, which was frequently caused by damage to the vestibular system. Non-vestibular or unknown etiologies were also seen in some patients; (2) VM was more prevalent in women than in men, vascular vertigo/dizziness was more commonly observed in men; (3) EVS was more common in patients with dizziness/vertigo. The most common causes of dizziness/vertigo were peripheral vestibular disorders in patients with AVS and EVS, PPPD and psychogenic dizziness in patients with CVS. The most common causes were BPPV and p-UPVD of unknown etiology in patients with a peripheral vestibular disorder, VM and vascular vertigo/dizziness in patients with central vestibular disorder, PPPD and psychogenic dizziness in patients with psychiatric and functional vestibular disorders.