Ignacio Novoa Cornejo, PT

Publications

Introduction: Post-concussion vestibular disorders significantly impact patients' quality of life, but their complex nature challenges traditional clinical assessments.

Aim: To employ machine learning techniques to analyze vestibular disorders in post-concussion patients and describe patient behavior in the otoneurological field.

Material and Methods: This retrospective study examined 75 post-concussion patients in Chile. Random Forest, XGBoost, and Support Vector Regression (SVR) models explored relationships between clinical characteristics and symptom duration. Data included demographic information, concussion details, symptom characteristics, and otoneurological examination results.

Results: SVR demonstrated superior performance (RMSE 151.24), followed by XGBoost (RMSE 224.06) and Random Forest (RMSE 407.99). Key predictors included general health status, sex, and specific vestibular conditions. Vestibulovisual symptoms and specific types of benign paroxysmal positional vertigo (BPPV) emerged as significant factors. Bilateral vestibular hypofunction (BVH) alone did not significantly affect symptom duration. The analysis revealed complex interactions between clinical features and recovery time.

Conclusion: These findings provide insights into the multifaceted nature of post-concussion vestibular disorders and highlight the potential of machine learning in enhancing our understanding of patient trajectories. Results suggest the need for comprehensive evaluation and individualized treatment approaches, potentially leading to improved risk stratification and more targeted interventions for patients with post-concussion vestibular disorders.

Spontaneous intracerebral hemorrhage commonly affects the brainstem. This report describes a 31-year-old male with hypertension who developed a pontine hemorrhage. The neurological deficits included left-third nerve palsy, right-sided weakness, and disabling tinnitus. Tinnitus is linked to central auditory pathway disruption. Magnetic resonance imaging revealed the hemorrhagic lesion and additional micro-hemorrhages. The International Classification of Functioning, Disability, and Health (ICF) enhances rehabilitation by characterizing multifac- eted stroke disability. The ICF profile revealed impairments in body structures/ functions, limitations in activities/participation, and positive/negative environ- mental factors. ICF-based goal-setting informed interventions, including tinnitus retraining and physical/occupational therapy. Comprehensive ICF assessment is crucial for optimized, patient-centered post-stroke rehabilitation as it deter- mines the extent of impact on functional level of the patient irrespective of dis- ease severity.

This case report describes a 28-year-old patient with a history of right cerebellar astrocystoma surgery 2 years prior who presented with dizziness and imbalance; evaluations showed right spontaneous nystagmus, hypermetric horizontal saccades, hypometric vertical saccades, impaired smooth pursuit, and right unilateral weakness on calorics, indicating central pathology, as well as right posterior canal BPPV; after treating the BPPV with Epley maneuvers, he underwent weekly vestibular rehabilitation therapy sessions for 7 months, consisting of visuovestibular interaction exercises and gaze stabilization exercises; his Dizziness Handicap Inventory score improved from 60 (severe handicap) initially to 18 (mild handicap) after vestibular rehabilitation, with resolution of symptoms, demonstrating that even in mixed peripheral and central vestibular disorders, customized vestibular rehabilitation targeting deficits found on evaluation can lead to improved patient-reported symptoms and function.

This case report describes a 35-year-old woman presenting with a 5-year history of progressive unilateral sensorineural hearing loss and tinnitus. An MRI revealed a lesion in her left cochlea, diagnosed as an intracochlear schwannoma (ICS) - a rare benign tumor originating from Schwann cells. Review of an MRI from 5 years prior showed the tumor was present but smaller at the time, emphasizing the importance of clinical suspicion and dedicated MRI to diagnose these lesions early. ICS most commonly present with asymmetric hearing loss and tinnitus. Precise MRI localization aids diagnosis and directing treatment, which includes microsurgery, radiation, observation with serial imaging, and cochlear implantation. Early diagnosis allows for hearing preservation if treated promptly. This report highlights the need for prompt MRI investigation of unilateral audiovestibular symptoms to diagnose ICS early.

This paper reviews the applications of facial Doppler ultrasound in minimally invasive aesthetic procedures. It discusses the technical principles and normal ultrasound anatomy of facial skin and subcutaneous tissues. The authors describe the unique ultrasound patterns of different dermal filler materials which can help identify previously injected fillers. Potential uses of ultrasound in aesthetic dermatology include detecting/localizing fillers, vascular mapping to avoid complications, and guiding hyaluronidase injection to manage complications. For vascular mapping, the paper summarizes studies showing ultrasound localization of arteries supplying different facial regions. The authors also present techniques for ultrasound-guided filler injection and analysis of facial vasculature using Doppler ultrasound. Overall, the paper concludes that facial Doppler ultrasound is a valuable tool for improving safety and outcomes in minimally invasive facial procedures. It provides real-time visualization to help avoid vascular complications and properly place fillers.

This paper reviews the anatomy and variations of the facial artery (FA), highlighting its importance across medical specialties. It discusses the origin, course, branching patterns, and terminal branches of the FA. The paper summarizes studies showing variability in FA distribution, including different types based on terminal branches. It also describes FA perforators and angiosomes relevant for flap surgery. The paper explores uses of the FA musculomucosal flap for oral cavity reconstruction. For filler injections, it emphasizes knowing FA anatomy to avoid vascular complications from intra-arterial injection or compression. Imaging techniques like Doppler ultrasound and CT angiography can map patient-specific FA anatomy pre-procedure. Overall, the paper emphasizes understanding FA variability through imaging to enable safer surgery and filler injections, minimizing risks like blindness and tissue necrosis. Detailed knowledge of FA anatomy and its relationships is critical across specialties performing facial procedures.

This study analyzed the effects of the Epley maneuver on postural control in patients with posterior canal benign paroxysmal positional vertigo (BPPV), using computerized posturography. 21 BPPV patients underwent posturography before and after the Epley maneuver to reposition otoconia. Posturography parameters of center of pressure (CoP) displacement, velocity, and area were compared between pre- and post-maneuver conditions. No significant differences were observed in mean CoP displacement. However, CoP velocity and area showed statistically significant decreases following successful treatment with the Epley maneuver. The reduced CoP velocity and area indicate improved postural stability and control after repositioning the otoconia. The findings suggest the Epley maneuver helps restore more normal vestibulospinal function and balance control in BPPV patients. In conclusion, posturography provides objective evidence that successful otoconia repositioning with the Epley maneuver modulates and enhances postural control in patients with posterior canal BPPV.

Benign paroxysmal positional vertigo (BPPV) is recognized as the main cause of peripheral vertigo in adults, although the etiology of BPPV has not yet been fully de- monstrated and is classified as idiopathicin most cases, detachment of otoliths and their displacement in one of the three semicircular canals can be identifie. A careful history can address the clinical diagnosis of BPPV, but confirmation will be obtained through specific diagnostic maneuvers according to which canal is involved. This disorder alters the ability to carry out activities of daily living that determine a significant increase in the risk of falls and consequent injuries. Most patients recover after treatment, howe- ver, up to two thirds of these patients may perceive prolonged instability, dizziness and discomfort defined as residual dizziness. This residual symptomatology following BPPV resolution is variable among patients, the duration of residual symptoms can last 1 to 3 weeks, with some patients may recover later on. In this review, we will analyze residual dizziness, describing its clinical presentation, diagnosis, pathophysiology and current treatments of this clinical entity.

This study investigated the effects of vestibular rehabilitation on falls risk and confidence in elderly women with unilateral vestibular hypofunction (UVH). Twenty women over age 60 with peripheral vestibular disorders and UVH underwent 5 sessions of individualized vestibular rehabilitation. Before and after rehabilitation, falls risk was assessed using the Tinetti scale and confidence using the Activities-specific Balance Confidence (ABC) scale. Tinetti scores significantly increased from high fall risk to no fall risk following rehabilitation. ABC scores also showed significant improvement, increasing from moderate to high functioning levels. A significant correlation was found between the reduced falls risk and improved confidence levels after rehabilitation. The results provide evidence that short-term, individualized vestibular rehabilitation is effective in enhancing postural stability and confidence in daily activities, thereby reducing falls risk, in older women with UVH. The findings suggest vestibular rehabilitation should be considered for elderly patients with unilateral vestibular impairments to improve balance, confidence, and quality of life by reducing fall risk.

This paper reviews the concept of visual dependence in patients with vestibular disorders and its implications for vestibular rehabilitation. Patients with unilateral vestibular hypofunction often increase their reliance on visual signals to maintain postural control, creating maladaptive visual dependence. The cerebellum plays a major role in central vestibular compensation and motor learning, which are important mechanisms in vestibular rehabilitation. Evaluation of visual dependence is recommended using tests like the Dizziness Handicap Inventory, posturography, and videonystagmography. Vestibular rehabilitation aims to improve vestibulo-ocular reflex gain and enhance use of vestibular signals through exercises like optokinetic stimulation and visuo-vestibular motion habituation. For visually dependent patients, customized rehabilitation should avoid restricting head movements and instead expose patients to gradual optokinetic stimuli with multiple sensory inputs. Early detection and timely rehabilitation is optimal for producing positive neuroplastic changes in vestibular nuclei. In summary, understanding maladaptive visual dependence in vestibular disease enables therapists to design targeted rehabilitation programs that reshape central compensation and improve postural control.

This paper reviews the neurophysiological mechanisms underlying vestibular rehabilitation in patients with balance and spatial orientation deficits. It discusses the anatomical structures involved in processing vestibular signals, including the vestibular nuclei, vestibulo-ocular reflex, and vestibulospinal pathways. Damage to peripheral or central vestibular structures can lead to symptoms like vertigo, dizziness, and postural instability. Vestibular rehabilitation aims to promote central compensation and recovery through mechanisms of neuroplasticity. Key processes include habituation to provocative movements, adaptation of the vestibulo-ocular reflex, and sensory substitution using visual and proprioceptive cues. Vestibular rehabilitation guides positive neural changes using specific exercises tailored to the deficits. Optimal functional recovery depends on timely rehabilitation during critical periods of neuroplasticity. Understanding the neurophysiological pathways and plasticity mechanisms enables clinicians to design targeted, effective vestibular rehabilitation programs.

This paper reviews the integration of the vestibular system in higher brain centers and its influence on cognitive functions like visuospatial ability, attention, memory, and self-perception. It discusses anatomical pathways by which vestibular signals reach cortical areas involved in spatial cognition and navigation. Damage to peripheral or central vestibular structures can impair performance on tasks requiring spatial memory and orientation. Evaluation of cognitive deficits in vestibular patients is recommended using tests of visuospatial perception, dual-tasking attention, and memory. Vestibular disorders also increase fall risk. Vestibular rehabilitation promotes neuroplastic changes to compensate for deficits, utilizing mechanisms like substitution and adaptation. Understanding the cognitive impacts of vestibular dysfunction allows clinicians to provide more comprehensive assessment and rehabilitation. The goal is to improve symptoms, cognitive performance, balance, and quality of life in these patients.

One of the main objectives in the study of patients with symptoms of dizziness, ver- tigo or disorders of movement perception is to de- fine the functioning of the vestibular system. The thermal tests have been a valuable contribution in achieving this objective. Halmagyi and Curthoys (1988) describe the physiology of the oculomotor vestibular reflex and argue the clinical value in obtaining information on vestibular function. The Head Impulse Test or Head Impulse Test currently recorded by video, is added to the caloric test in the evaluation of vestibular function.

Vestibular symptoms are frequent reason for consultation in medical care, the elderly and especially the female gender is exposed to fall risk from this cause.

The superior semicircular dehiscence syndrome is a pathology Described in 1998 by Minor et al. Which presents several sound induced vertigo symptoms Included, hearing loss and autophony due to bone dehiscense de este semicircular canal. The diagnosis was based on clinical and confirmation is given by temporal bone CT the. Treatment is surgical repair of expectant or continuity if the clinic is disabling. In This paper we present a case of auditory and vestibular DCSS With symptoms in issuing the phoneme “mmm”.

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