Research in Vestibular Science

Posterior Inferior Cerebellar Artery Stenosis Presenting as Recurrent Orthostatic Dizziness: Seongjin Jeon, Ji-Yun Park, Jong-min Lee, Seulgi Hong; Res Vestib Sci. 2022;21(2):53-56. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.53

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Abstract PDF: We report a unique case of vertebrobasilar transient ischemic attacks manifesting as isolated, recurrent, orthostatic dizziness with posterior inferior cerebellar artery (PICA) stenosis. A 57-year-old male patient without past medical history, presented with brief orthostatic dizziness for 2 weeks. There was no associated nausea, vomiting, diplopia, or weakness. On neuro-otologic examination, the patient did not show spontaneous, positional, or gaze-evoked nystagmus. Vestibular function tests such as caloric test, head impulse test, video-oculography, and tilt table test were normal. Brain diffusion-weighted images showed multiple small high signal intensities in the bilateral cerebellar hemispheres. Brain magnetic resonance angiography revealed hypoplasia of the right vertebral artery without focal intracranial focal stenosis. Four-vessel cerebral angiogram showed severe stenosis at the right PICA artery. Our patient’s clinical scenario appears unique hemodynamic spells without symptoms or signs of posterior circulation ischemia. Physicians should also consider cerebrovascular ischemic when the patient suffers repeated orthostatic dizziness that is not explained clinically.

Clinical Significance and Update of Postural Orthostatic Tachycardia Syndrome: Jung A Park, Jae Han Park; Res Vestib Sci. 2022;21(1):1-5. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.1

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Abstract PDF: Postural orthostatic tachycardia syndrome (POTS) is a cerebrovascular autonomic dysfunction that is common in young women. POTS can cause dizziness due to orthostatic intolerance. In patients with orthostatic intolerance, it can be diagnosed when the heart rate increases by more than 30 beats per minute within 10 minutes of standing up through the head-up tilt test. However, even a neuro-otologist has difficulty in diagnosing POTS due to the high possibility of misdiagnosis if not paying attention. In this paper, the clinical symptoms, pathophysiology, diagnosis, and treatment of POTS are investigated. In addition, the latest knowledge of POTS is searched to help diagnose and treat POTS.

Diagnostic Criteria and Differential Diagnosis of Hemodynamic Orthostatic Dizziness/Vertigo: Hyun Ah Kim, Ji-Soo Kim; Res Vestib Sci. 2020;19(2):35-41. Published online June 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.2.35

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Abstract PDF

We summarized recent diagnostic criteria for hemodynamic orthostatic dizziness/vertigo included in the International Classification of Vestibular Disorders (ICVD) in this paper. The aim of defining diagnostic criteria of hemodynamic orthostatic dizziness/vertigo is to help clinicians to understand the terminology related to orthostatic dizziness/vertigo and to distinguish orthostatic dizziness/vertigo due to global brain hypoperfusion from that caused by other etiologies. Detailed history taking and measurements of orthostatic blood pressure and heart rate are important for the screening and documentation of orthostatic hypotension or postural tachycardia syndrome to establish the diagnosis of hemodynamic orthostatic dizziness/vertigo.

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Posterior Inferior Cerebellar Artery Stenosis Presenting as Recurrent Orthostatic Dizziness
Seongjin Jeon, Ji-Yun Park, Jong-min Lee, Seulgi Hong
Research in Vestibular Science.2022; 21(2): 53. CrossRef

Delayed Audio-Vestibular Symptoms in Spontaneous Intracranial Hypotension: Han-Sol Choi, Jae-Myung Kim, Hong Chan Kim, Hyong-Ho Cho, Seung-Han Lee; Res Vestib Sci. 2020;19(1):29-33. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.29

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Abstract PDF: Intracranial hypotension (IH) is a neurological disorder characterized by orthostatic headache due to cerebrospinal fluid (CSF) volume depletion. IH usually results from CSF leak caused by either spontaneous or traumatic dural injury and may also present nausea, neck stiffness, tinnitus or dizziness. We experienced a 52-year-old woman presenting with acute spontaneous vertigo, tinnitus and hearing impairment on both ears with right side predominancy which mimicked Meniere’s disease. Video-oculography revealed spontaneous left-beating nystagmus which was modulated by position change. There was binaural low-frequency sensorineural hearing loss (SNHL) in pure tone audiometry. Other neuro-otologic evaluations including caloric test, vestibular evoked myogenic potential, video head impulse tests were unremarkable. Of interest, she had been treated of orthostatic headache due to spontaneous IH 10 days before admission. Taken together the clinical and laboratory findings, audio-vestibular symptoms of the patient were thought to be related with insufficient treatment of IH. After massive hydration and bed rest, her symptoms were markedly improved and SNHL was also disappeared in the follow-up pure tone audiometry. IH should be considered as a differential diagnosis in dizzy patient with tinnitus, hearing impairment even the typical orthostatic headache is not accompanied.

Autonomic Dysfunction in Dizziness Clinic: Eun Bin Cho, Ki-Jong Park; Res Vestib Sci. 2018;17(2):37-43. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.37

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Abstract PDF

Orthostatic dizziness is a common type of dizziness. In general, orthostatic dizziness is provoked by standing or tilting, and subsided by supine position. The patient with orthostatic intolerance complains multiple symptoms such as dizziness, palpitation, lightheadness, fatigue and rarely syncope. Common orthostatic intolerance is orthostatic hypotension (classic, initial, transient, and delayed orthostatic hypotension) and postural orthostatic tachycardia syndrome. Transcranial Doppler is a noninvasive technique that provides real-time measurement of cerebral blood flow velocity. It can be useful for understanding the relationship between orthostatic symptoms and cerebral autoregulatory function. The reciprocal causal relationship between vestibular and autonomic dysfunction should always be kept in mind.

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A Study on the Characteristics of Patients Treated for Dizziness with Jeoreongchajeonja-tang: A Retrospective Analysis of 63 Cases
Nu-ri Jung, Ki-tae Kim, Seon-mi Shin, Heung Ko
The Journal of Internal Korean Medicine.2019; 40(6): 1122. CrossRef
Pitfalls in the Diagnosis of Vertigo
Hyun Ah Kim, Hyung Lee
Journal of the Korean Neurological Association.2018; 36(4): 280. CrossRef

Evaluation of Adrenergic Function: Tilt-Table and Valsalva Test: Hyung Lee, Hyun Ah Kim; Res Vestib Sci. 2018;17(1):8-12. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.8

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Abstract PDF

Orthostatic dizziness is a common dizziness syndrome characterized by nonvertiginous lightheadedness when patients rise to stand from a sitting or supine position. Orthostatic dizziness is commonly believed to derive from orthostatic hypotension (OH) or postural tachycardia syndrome (POTS). Tilt-table test and Valsalva maneuver are standardized methods for evaluating of adrenergic autonomic function and essential for diagnosis of OH and POTS. We described the guidelines and interpretations of the tilt-table test and Valsalva maneuver.

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Interpretation of Autonomic Function Test
Kee Hong Park, Eun Hee Sohn
Journal of the Korean Neurological Association.2021; 39(2): 61. CrossRef

Classification of Chronic Dizziness in Elderly People and Relation with Falls: Dong-Suk Yang, Da-Young Lee, Sun-Young Oh, Ji-Yun Park; Res Vestib Sci. 2018;17(1):13-17. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.13

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Abstract PDF: Objectives
Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness.
Methods
We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or out patient department follow-up for 6 months.
Results
Thirty-four patients were enrolled and all completed follow-up for 6 months. Nine patients classified as the falling groups and 34 patients as nonfalling group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%), and vestibular migraine (n=3, 9%) were more frequent in nonfall group.
Conclusions
The presence of dizziness in the elderly is a strong predictor of fall, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.

Treatment of Neurogenic Orthostatic Hypotension: Jung-Ick Byun, Sang Beom Kim; Res Vestib Sci. 2017;16(3):73-79. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.73

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Abstract PDF

Orthostatic hypotension (OH) is a common feature of sympathetic autonomic dysfunction and can lead to lightheadedness, weakness, dizziness, and syncope. It is defined as decrease in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing. OH is associated with an increased incidence of cerebrovascular disease, myocardial infarction, and mortality. Non-pharmacological treatments may alleviate OH-related symptoms; however, are not sufficient when used alone. Pharmacological treatment is essential in managing OH. In this review, we aimed to discuss non-pharmacological and pharmacological treatment options for OH.

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Classification of Chronic Dizziness in Elderly People and Relation with Falls
Dong-Suk Yang, Da-Young Lee, Sun-Young Oh, Ji-Yun Park
Research in Vestibular Science.2018; 17(1): 13. CrossRef

Positional Dizziness and Vertigo without Nystagmus and Orthostatic Hypotension: Jae Han Park; Res Vestib Sci. 2016;15(4):107-111. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.107

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Abstract PDF: According to the Barany Society classification of vestibular symptoms, positional dizziness or vertigo is defined as dizziness or vertigo triggered by and occurring after a change of head position in space relative to gravity. Thus, positional dizziness or vertigo should be differentiated from orthostatic dizziness or vertigo, which is triggered by and occurs upon rising. Benign paroxysmal positional vertigo (BPPV) is the most common positional vertigo and accompanied by a characteristic paroxysmal positional nystagmus. But a problem occasionally encountered in clinical practice is the presence of a positive history of BPPV with a negative diagnostic maneuver for positional nystagmus. Orthostatic hypotension may be dependent upon various neurogenic and non-neurogenic disorders and conditions. Combination of non-pharmacological and pharmacological treatment improve orthostatic tolerance.

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