Vestibular disorders in blast injuries. The role of growth hormone

K. Trinus
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Abstract

The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as a consequence of a blast injury, we have done present investigation. One hundred and ten patients were examined: 65 Anti-Terrorist Operation (ATO) participants with mild traumatic brain injury (mTBI), 44 non-ATO plus one patient with acromegaly was examined using posturography. Questionnaire “Types of Dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, showing that this complaint is not specific to mTBI. Objective vertigo (sensation of the subjects moving around the patient) was detected in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. Thus, we have two different qualitative groups. So, these complaints are specific to the patients, who survived blast injury. Complaints of subjective vertigo are also typical for those with blast injury. Complaints of pseudovertigo are specific to the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific to the people with blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) have been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not typical for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been revealed in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients; this complaint is not specific to mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is detected in 20 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. It is also an interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific to the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control). The results are discussed from the point of view of a severe vestibular disorder due to the blast injury. The tallness correlated with drop attacks (R29.6 according to ICD-10, the nosology is missing in the Ukrainian translation), it is suggested that growth hormone might cause the fluctuation of vestibular function. Conclusions. 1. ATO participants have pronounced vestibular disorders. 2. Patients with mTBI (ATO participants) experienced severe stress. 3. Signs of vestibular dysfunction such as complaints of objective and subjective vertigo, kinetosis differed quantitatively and qualitatively, therefore, being specific to the ATO participants. 4. Pseudovertigo, claustrophobia, descendophobia differed only qualitatively. 5. Dizziness, loss of consciousness, orthostatics, agoraphobia differed only quantitatively. 6. The tallness of patients with mTBI correlated with complaints of drop attacks, both quantitatively and qualitatively. 7. In statistical studies, it is important to use Fisher’s matrix test.
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爆炸伤的前庭功能障碍。生长激素的作用
关于爆炸损伤引起的前庭功能障碍的数据是相互矛盾的。为了揭示爆炸伤后前庭功能障碍的问题,我们进行了本研究。对110例患者进行体位检查,其中65例为反恐行动(ATO)轻度创伤性脑损伤(mTBI), 44例为非ATO, 1例为肢端肥大症。调查问卷“头晕类型”是根据前庭疾病(头晕)国际临床协议使用的。70.77%(46例)ATO患者和43.18%(19例)非ATO患者有头晕主诉(空间、运动和时间感知扭曲):f检验= 0.51,t检验= 0.004,表明这种主诉并非mTBI特有。26.15%(17例)ATO患者和11.56%(5例)非ATO患者存在客观眩晕(受试者在患者周围移动的感觉):f检验= 0.027,t检验= 0.046。因此,我们有两个不同的定性组。所以这些抱怨都是针对那些在爆炸中幸存下来的病人。主观性眩晕的抱怨也是典型的那些爆炸伤害。假性眩晕的抱怨是特定的病人,谁幸存的爆炸伤害。失衡和跌落发作在ATO患者中并不常见。运动障碍的主诉是爆炸伤患者所特有的。76.92%(50例)ATO患者和47.73%(21例)非ATO患者出现矫形(突然站起来后出现不适感),这种主诉在mTBI中并不常见。前庭系统组织空间定向四分体:前庭、体感、视觉和听觉信息来感知、定位和与环境相互作用。横向、纵向和上升恐惧症似乎并不重要。33.85%(22例)ATO患者和15.91%(7例)非ATO患者有广场恐惧症(希腊αγωρα -市场、超市综合征,在露天、公共场所或人群中不适);此投诉并非针对mTBI。幽闭恐惧症(出现在狭小封闭空间的不适)在20% (13)ATO患者和9.09%(4)非ATO患者中存在:f检验= 0.024,t检验= 0.10。因此,我们有两个不同的定性组。这也是一个有趣的例子,我们揭示了质的差异而没有量的差异。这就是在我们的研究中使用f检验的理由。所以,幽闭恐惧症的症状只存在于那些在爆炸中幸存下来的病人身上。下山恐惧症也是同样的情况(下山或下楼梯时感到不适,患者注意到视觉控制的必要性)。本文从爆炸伤引起的严重前庭功能障碍的角度对结果进行了讨论。身高与跌落发作相关(根据ICD-10 R29.6,乌克兰翻译中缺少分类学),提示生长激素可能引起前庭功能波动。结论:1。ATO参与者有明显的前庭功能障碍。2. mTBI患者(ATO参与者)经历了严重的压力。3.前庭功能障碍的迹象,如主客观眩晕、运动障碍的主诉,在数量上和质量上都存在差异,因此,对ATO参与者来说是特定的。4. 假性眩晕症、幽闭恐惧症、下山恐惧症仅在质量上有所不同。5. 头晕、意识丧失、站立障碍、广场恐怖症仅在数量上不同。6. mTBI患者的身高在数量和质量上都与跌落发作的主诉相关。7. 在统计研究中,使用费雪矩阵检验是很重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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