Research in Vestibular Science

Volume 9 (1); March 2010

Review

Understanding of Structure and Function of Vestibular Cortex: Min Sun Kim, Jae Hee Lee, Gyoung Wan Lee, Byung Rim Park; Res Vestib Sci. 2010;9(1):1-11.

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Abstract PDF: The vestibular end-organs generate very sophisticated gravity sensory information about head movement by sensing head acceleration in three-dimensional space. Vestibular information is crucial for higher brain functions such as cognition of spatial orientation, spatial memory, and perception of self-motion. The term “vestibular cortex” represents cortical area where vestibular information is processed, converged with other sensory inputs to maintain cortical functions. The vestibular cortex gives rise to commend signals that control the vestibulosomatic reflex through the modulation of vestibular nuclear activity in the brainstem. The vestibular cortex includes such different cortical regions as the premotor region of the frontal cortex, parietal areas, temporal areas, and a central core region called parietoinsular vestibular cortex. This paper summarizes systemically animal and clinical research data concerned with the vestibular cortex in order to understand anatomy and functions of the vestibular cortex and to provide a basic literature for further study.

Original Articles

Acute Stroke in Patients With Isolated Vertigo: Jungmoo Nam, Curie Chung, Jung Ju Lee, Jong Moo Park, Ja Seong Koo, Ohyun Kwon, Byung Kun Kim; Res Vestib Sci. 2010;9(1):12-15.

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Abstract PDF: Background and Objectives Patients with isolated vertigo could have central or peripheral vestibular disorders. Although some differential points exist between the two conditions, sometimes it is not easy to differentiate central vertigo from that of peripheral vestibular origin, especially in patients with isolated vertigo. We performed this study to determine the frequency of acute infarction and predictors of vertigo associated with stroke in isolated spontaneous vertigo. Materials and Methods We prospectively evaluated 185 consecutive patients who were admitted to neurology department with acute isolated vertigo, after excluding the patients with benign paroxysmal positioning vertigo. Diffusion-weighted MRI (DWI) was obtained in 161 (87.0%) patients. Demographics, stroke risk factors, associated symptoms and signs were reviewed. Also, the locations and vascular territories of the lesions on DWI were investigated. Results Twenty three (14.3%) patients had acute infarction on DWI. Old age and male sex were the predictors of stroke using multivariate analysis (p=0.03 and 0.02). The lesions were located in the cerebellum in 17 patients, medulla in four, and pons in another four. Cerebellar lesions were in the territory of the posterior inferior cerebellar artery in all patients. ConclusionIsolated spontaneous vertigo may develop in posterior circulation stroke, especially in men of old age. The possibility of central origin should be considered in patients with isolated vertigo and DWI might be a good diagnostic tool.

Acute Low Tone Sensorineural Hearing Loss: Consideration for Progression to Meniere’s Disease: Yoon Suk Oh, Kyu Sung Kim, Hoseok Choi, Kyu Jin Kim; Res Vestib Sci. 2010;9(1):16-20.

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Abstract PDF: Background and Objectives Low tone sensorineural hearing loss is deterioration in audiometric low frequencies (250 and 500 Hz), preservation of high frequencies (2, 4, and 8 kHz). The aim of this study is to find out differences of clinical manifestation and prognosis of acute low tone sensorineural hearing loss (ALHL), a subtype of sudden sensorineural hearing loss, and potential progression to Meniere’s diseases. Materials and Methods Among 465 patients with unilateral hearing loss initially diagnosed with sudden sensorineural hearing loss, we analyzed clinical characteristics of 96 patients who had acute low tone sensorineural hearing loss, but had no history of previous ALHL. ResultsThe clinical features of ALHL include a predominance of female suffers (72.9%), more dizziness (36%), high incidence of sound perception change (16.7%), tinnitus (42.8%), and ear fullness (20.8%). The prognosis shows recovery in 67.7% of patients. However, 24.0% of patients show recurrence of low tone loss, and 15.6% develop Meniere’s disease. Specially, if the dizziness symptoms were accompanied, progression to Meniere’s disease was more common (31.4%). Conclusion Our results appear that clinical characteristics were different in the ALHL patients compared to the idiopathic sensorineural hearing loss patients. Therefore, when dizziness, ear fullness and tinnitus are accompanied with low tone hearing loss, an appropriate patient education on possible progression to Meniere’s disease is necessary.

Positional Nystagmus in Acute and Subacute Vestibular Neuritis: Do Joon Lee, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; Res Vestib Sci. 2010;9(1):21-26.

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Abstract PDF: Background and Objectives By understanding the typical pattern of nystagmus during diverse positional change, we might be able to diagnose the subacute vestibular neuritis (VN) more accurately. The aim of this study was to identify the typical pattern of positional nystagmus in compensated and uncompensated VN patients. Materials and Methods The videonystagmography of 182 patients who were diagnosed as VN were reviewed retrospectively. The patients were classified into two groups by the presence or absence of spontaneous nystagumus (SN). The amplitude of nystagmus evoked by head roll test (HRT) and body roll test (BRT) were compared between the lesion side (ipsilateral, i) and the healthy side (contralateral, c). Results In the VN patients with SN, positional nystagmus was stronger on the iHRT and iBRT compared to the cHRT and cBRT, respectively. But in the VN patients without SN, this pattern of nystagmus was not evident. Although a stronger nystagmus was found in the iBRT compared to the cBRT, the mean amplitude of nystagmus was not significantly different. Also there was no difference in the nystagmus between the iHRT and cHRT. Conclusion The typical pattern of positional nystagmus which can be found in the VN with SN was not evident in VN without SN. Positional nystagmus may not be able to give us useful information on diagnosing subacute VN.

The Effect of Serum Uric Acid in Generating Idiopathic Benign Paroxysmal Positional Vertigo: Seong Hae Jeong, Ji Soo Kim; Res Vestib Sci. 2010;9(1):27-31.

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Abstract PDF: Background and Objectives The causative role of serum uric acid has been controversial in Benign paroxysmal positional vertigo (BPPV). The aim of this study was vto determine the role of serum uric acid in developing idiopathic BPPV. Materials and Methods We recruited 168 consecutive patients with a confirmed diagnosis of idiopathic BPPV. The patients comprised 116 women (age range: 29~70 years, mean±SD: 55.8±9.7 years) and 52 men (age range: 32~70 years, mean±SD: 55.2±10.9 years). The serum uric acid levels of the patients were compared with those of 194 controls (age range: 20~70 years, mean±SD: 55.5±7.8 years) without a history of dizziness. Results The serum uric acid levels were decreased in patients with BPPV compared with those in normal controls (4.8±1.3 vs 5.3±1.3, p=0.001). However, multiple logistic regression analyses adjusted for age, sex, alcohol, smoking, hyperphosphatemia and osteopenia/osteoporosis did not demonstrate that the hypouricemia is an independent risk factor for BPPV. Conclusion This study suggests that serum uric acid level is not a risk factor for developing idiopathic BPPV.

Case Reports

A Case of Multiple Perilymph Fistula Induced by Tympanostomy Tube Insertion: Seung Won Chung, Mi Joo Kim, Gyu Cheol Han; Res Vestib Sci. 2010;9(1):32-37.

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Abstract PDF: This controversial diagnosis centers around the phenomenon of perilymph leaking from the inner ear into the middle ear cleft through the oval window, round window or other fissures in the bony labyrinth that may be abnormally patent. A perilymph fistula may develop after stapedectomy surgery, penetrating middle ear trauma, head trauma, barotrauma, or possibly spontaneously. Uncertainty regarding the clinical criteria for the diagnosis and the inability to document the presence of a microfistula at surgery contribute to the problematic nature of this diagnosis. However, this condition should be seriously considered in the patient with vertigo after head trauma, barotrauma injury, or previous middle ear surgery. It is particularly likely in patients with penetrating middle ear trauma with vertigo. Most authors agree that perilymph fistulas generally heal spontaneously, therefore a few days of bed rest is appropriate in acute cases. Cases suspected after penetrating trauma should be explored early if symptoms persist. Here, authors report a case of multiple perilymph fistula possibly caused by tympanostomy tube insertion in a 48-year-old man with a review of the literature.

A Human Immunodeficiency Virus-Positive Patient with Dizziness and Peripheral Facial Palsy: Eun Woong Ryu, Jae Yong Byun, Hoon Jung, Moon Suh Park; Res Vestib Sci. 2010;9(1):38-42.

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Abstract PDF: Various neurological complications occur in association with human immunodifiency virus (HIV) infection. These complications occur at all stages of infection and any level of central and peripheral nervous system. Neurological complications, such as aseptic meningitis, encephalopathy, neuropathy, myelopathy, and brachial neuritis, develop in association with primary HIV infection. We here in report a case of peripheral facial palsy with suspicious peripheral vertigo manifested as initial symptoms of primary HIV infection.

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