Research in Vestibular Science

Volume 11 (2); June 2011

Review

Diagnosis and Differential Diagnosis of Migrainous Vertigo: Seong Hae Jeong; Res Vestib Sci. 2012;11(2):45-50.

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Abstract PDF: Migrainous vertigo is one of common recurrent vestibular disorders. Because the diagnostic criteria have not been yet settled internationally, we have a difficulty in both diagnosis and research in migraineurs with vertigo. Literature about the diagnostic criteria of migrainous vertigo and its differential diagnosis were reviewed. Until now, the criteria proposed by Neuhauser et al. is regarded as most adequate in diagnosis of migrainous vertigo. Differential diagnosis of migrainous vertigo should be guided by distinction of vestibular symptoms and nonvestibular dizziness and consider the common causes of recurrent vertigo. Just like migraine itself, migrainous vertigo is diagnosed on the basis of history and exclusion of other vestibular disorders mimicking migrainous vertigo. Therefore, delicate history taking is the most important in diagnosis and management of patients with migrainous vertigo.

Original Articles

Role of the Peripheral Vestibular End Organ in the Expression of c-Fos Protein in the Medial Vestibular Nucleus Following Occlusion of the Anterior Inferior Cerebellar Artery: Nari Kim, Jae Hee Lee, Myoung Ae Choi, Byung Geon Park, Min Sun Kim, Byung Rim Park; Res Vestib Sci. 2012;11(2):51-58.

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Abstract PDF: Background and Objectives: The present study investigated the role of the peripheral vestibular end organ in vestibular symptoms and temporal changes in expression of c-Fos protein in the vestibular nuclei following anterior inferior cerebellar artery (AICA) occlusion using rats with unilateral or bilateral labyrinthectomy. Materials and Methods: Expression of c-Fos protein in the vestibular nuclei was measured 2, 12, 24, and 48 hours after AICA occlusion. Results: Unilateral AICA occlusion significantly induced expression of c-Fos protein bilaterally in the medial, inferior, superior, and lateral vestibular nuclei. Following AICA occlusion, the medial vestibular nucleus (MVN) showed the highest expression of c-Fos protein among the 4 vestibular nuclei. The expression of c-Fos protein was asymmetric between the bilateral MVN, showing higher expression in the MVN contralateral to the side of AICA occlusion compared to the ipsilateral MVN. The degree of asymmetry in c-Fos protein expression between the bilateral MVN peaked 12 hours after AICA occlusion. The expression of c-Fos protein gradually decreased 24 hours after AICA occlusion and returned to control levels 48 hours after AICA occlusion. Unilateral labyrinthectomy significantly decreased expression of c-Fos protein in the MVN ipsilateral to the side of labyrinthectomy following AICA occlusion. Moreover, bilateral labyrinthectomy significantly decreased expression of c-Fos protein in the bilateral MVN flowing AICA occlusion. Conclusion: These results suggest that afferent signals from the peripheral vestibular end organ are crucial to the expression of c-Fos protein in the MVN following AICA occlusion and that expression of c-Fos protein is sustained for 24 hours after AICA occlusion.

Immunohistochemical Study on β1- and β2-Adrenergic Receptors in Rat Vestibular Nuclei: Seong Ki Ahn, Roza Khalmuratova, Dong Gu Hur, Ho Yeop Kim, Hyun Woo Park, Yeon Hee Joo, Hung Soo Kang; Res Vestib Sci. 2012;11(2):59-63.

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Abstract PDF: Background and Objectives: The aim of this study was to examine the localizations of β1- and β2-adrenergic receptors (ARs) in rat vestibular nuclei by immunohistochemical staining procedure. Materials and Methods: Twelve male Sprague- Dawley rats were used in this study. Primary antibodies for the β1- and β2-ARs were used. The sections were treated with a biotinylated goat anti-rabbit antibody. The sections were then incubated in avidin-biotin-peroxidase reagent and processed with immunoperoxidase using 3.3’-diaminobenzidine tetrahydrochloride. Results: β1-AR and β2-AR immunopositive neurons were found to be distributed throughout the four major vestibular nuclei. Both receptors were primarily detected in neuronal somata and their proximal dendrites. β1-AR and β2-AR were moderately expressed in the superior vestibular nucleus, lateral vestibular nucleus, medial vestibular nucleus, and spinal vestibular nucleus. Conclusion: The present study demonstrates, for the first time, that β1-AR and β2-AR receptors are localized in rat vestibular nuclei. Furthermore, this study may provide additional speculation into the role of ARs during vestibular signal processing. Further studies are needed to clarify the roles played by β1-ARs and β2-ARs through physiologic and functional studies.

Clinical Characteristics of 7 Patients with Lateral Semicircular Canal Dysplasia: Chang Hee Kim, Jung Eun Shin, Yeo Jin Lee, Hong Ju Park; Res Vestib Sci. 2012;11(2):64-68.

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Abstract PDF: Background and Objectives: Dysplasia of lateral semicircular canal (LSCC) is the most common inner ear malformation, because LSCC is the last single structure to be formed during inner ear embryogenesis. There have been several case reports about the LSCC anomaly which showed clinical spectrum ranging from no symptom to severe sensorineural hearing loss. The authors investigated the clinical characteristics of 7 patients with LSCC dysplasia. Materials and Methods: The medical records of 7 patients who were diagnosed as LSCC dysplasia from temporal bone computed tomography were retrospectively reviewed. We analysed the findings of history taking, pure tone audiometry, speech audiometry, and caloric tests. Results: The LSCC dysplasia was observed in all of 7 patients in which 5 showed unilaterally confined LSCC dysplasia, 1 showed bilaterally confined LSCC dysplasia, and 1 exhibited bilateral LSCC dysplasia combined with bilateral posterior semicircular canal dysplasia. From 7 patients, hearing loss was chief complaint only in 2 patients. Pure tone audiometry revealed sensorineural hearing loss in one patient, and conductive hearing loss in the other patient. Two patients complained of whirling type vertigo, and 3 complained of nonspecific dizziness. Conclusion: The patients with LSCC dysplasia may show variable symptoms such as sensorineural hearing loss, conductive hearing loss, vertigo and nonspecific dizziness.

Case Reports

Two Cases of Vestibular Pseudoneuritis Presenting Positive Sign on Head Impulse Test: Dong Gu Hur1,2, Eun Jae Lee1, Hung Soo Kang1, Seong-Ki Ahn1,2; Res Vestib Sci. 2012;11(2):69-72.

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Abstract PDF: At emergency room, most patients who presented with abrupt isolated vertigo without neurologic deficits were diagnosed as common vestibular disorder including vestibular neuritis. However posterior circulation stroke also can be a cause of the isolated vestibular vertigo. This condition is called vestibular pseudoneuritis. It is very important to differentiate vestibular pseudoneuritis from common vestibular disorder because of requiring different management and avoiding severe complication. Previous studies reported that head impulse test is one of bedside tests which represents unilateral vestibular hypofunction. Most patients of the vestibular neuritis shows positive head impulse test. However the head impulse test can be positive in central origin vertigo. So it is necessary to interpret the results of the test with caution. We report 2 cases of vestibular pseudoneuritis which showed positive head impulse test with a review of the related literatures.

Acute Dizziness With Down Beat Nystagmus in a Patient With Parkinson’s Disease: Byoung-Youn Ko, Kyu-Sung Kim, Hee-Kwun Park; Res Vestib Sci. 2012;11(2):73-76.

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Abstract PDF: A 80-year-old man presented with recently aggravated dizziness. He has taken an anti-Parkinson drug before 2 years ago. Left spontaneous down beating nystagmus was observed, also ataxic gait. Brain MRI showed diffuse brain atrophy, otherwise no abnormal finding. Rotation chair test showed decreased gain, phase lead and no asymmetry. Saccadic test showed delayed latency and decreased accuracy. And Calroic test didn’t show no canal paresis. Dizziness due to Parkinsonism has been known relatively common, especially in old age. However, it is often difficult to diagnosis a Parkinson disease when old age patient present with dizziness. Hence, we report a case of old aged Parkinsonism patient who presented with acute dizziness in perspective of diagnostic careful point with literature review.

A Case of Bilateral Benign Paroxysmal Positional Vertigo in Bilateral Mondini Malformation With Right Enlarged Vestibular Aqueduct Syndrome: Min Young Lee, Sung Do Jung, Myung Whan Suh, Jae Yun Jung; Res Vestib Sci. 2012;11(2):77-80.

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Abstract PDF: Enlarged vestibular aqueduct syndrome (EVAS) is well known congenital bony ear anomaly. It’s audiologic symptoms and radiological findings are reported in many literatures. However vestibular symptoms of EVAS are rarely reported. A patient with right EVAS developed sudden spinning vertigo on casual observation. He is diagnosed as bilateral benign paroxysmal positional vertigo and recovered by canal repositioning maneuver. We present this case with reviews of previous literatures.

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