Objectives To investigate the correlation between subjective residual dizziness and objective postural imbalance after successful canalith repositioning procedure (CRP) in benign paroxysmal positional vertigo (BPPV) by using questionnaires and modified clinical test of sensory integration and balance (mCTSIB).
Methods Total 31 patients with BPPV were included prospectively in the study. All included patients were successfully treated after initial CRP and their symptoms and nystagmus disappeared. In 2 weeks after CRP, all patients were asked to fill out the questionnaire including both dizziness handicap inventory (DHI) and visual analog scale (VAS). We also conducted mCTSIB in 2 weeks after CRP. We divided patients with two groups according to VAS: RD (residual dizziness) group, VAS>0; non-RD group, VAS=0. We compared age, number of CRP, rates associated with three semicircular canals, DHI score and mCTSIB results between two groups. In addition, we analyzed the correlation between DHI score and mCTSIB results.
Results There were no significant differences of age, number of CRP and rates associated with three semicircular canals between two groups. RD group showed significantly higher DHI score and abnormal mCTSIB results than non-RD group (p<0.05). DHI score and the number of abnormal mCTSIB showed statistically significant correlation.
Conclusions We demonstrated the correlation between DHI score and mCTSIB after successful CRP for BPPV. It also represents that subjective residual dizziness is correlated with objective postural imbalance even after successful CRP. Therefore, mCTSIB would be useful test to evaluate both residual dizziness and postural imbalance after CRP in BPPV.
Key words: Benign paroxysmal positional vertigo
Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application
in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.
Citations
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Recently with the introduction of Video Head Impulse Test (vHIT), it can be easily performed quantitative and objective measurement of vestibule-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced Suppression Head Impulse Paradigm (SHIMP) test.
Objective: Cervical vestibular evoked myogenic potential (cVEMP) is thought to be assessing the function of the saccule and inferior vestibular nerve. Therefore, cVEMP indirectly reflects the function of the posterior semicircular canal. Recently, the video head impulse test (vHIT) is considered as useful clinical tool to detect each semicircular canal dysfunction. Goal of this study was to evaluate and compare the results of cVEMP with posterior canal plane of vHIT (p-vHIT).
Methods Retrospectively, we compared the results of cVEMP with p-vHIT in 43 patients who visited with dizziness. We analyzed the inter-test agreement of cVEMP with p-vHIT.
Results Positive asymmetry of cVEMP was present in 37.2% (16/43), and no responses of both ears were identified in 16.3% (7/43). In p-vHIT analysis, unilateral positive was 27.9% (12/43), bilateral positive was 11.6% (5/43) and negative in both sides was 60.5% (26/43). The inter-test agreement between cVEMP and p-vHIT was 75.8% (25/33) as we considered even in lesion side. And, Fleiss’s kappa value showed a fair to good agreement (kappa value=0.559). In bilateral no response group (7 patients) in cVEMP, variable additional information could be obtained using p-vHIT.
Conclusion cVEMP and p-vHIT showed relatively lower inter-test agreement than expected. But, p-vHIT could be easily performed, and give additional information for differential diagnosis.
Citations
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Clinical Characteristics of the Patients with Dizziness after Car Accidents Young Min Hah, Chul Won Yang, Sang Hoon Kim, Seung Geun Yeo, Moon Suh Park, Jae Yong Byun Korean Journal of Otorhinolaryngology-Head and Nec.2017; 60(8): 390. CrossRef
Hemangioblastoma is solid or cystic benign vascular tumor that may arise anywhere in the body. It is rarely presented tumor accounting for only 1% to 2.5% of all intracranial neoplasms. Usually, hemangioblastoma is located in the cerebellum and posterior cranial fossa and it occurs in a variety of symptoms depending on where the tumor is located. The initial symptoms in 80% to 90% of hemangioblastoma patients are headache and vomiting due to elevated intracranial pressure, and also dizziness and balance problems are initially presented in about half of the patients. We experienced 2 cases of hemangioblastoma who presented with isolated vertigo. All of them initially showed unidirectional spontaneous nystagmus during head impulse test. Finally, hemangioblastoma of the cerebellum has been diagnosed on magnetic resonance imaging scan. In one case, the tumor was successfully removed by retrosigmoid approach and the other case was treated conservatively due to pregnancy.