Research in Vestibular Science

Case Report

Fourth Nerve Paresis plus Crossed Horner Syndrome in Acute Leukemia: Sumin Kim, Sung-Hee Kim; Res Vestib Sci. 2022;21(3):86-88. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.86

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Abstract PDF: A 29-year-old patient with diplopia showed a unilateral fourth nerve palsy combined with a Horner syndrome on the opposite side. Magnetic resonance images disclosed a focal hemorrhage in the left dorsal midbrain, affecting the nucleus of the fourth nerve and adjacent oculosympathetic fibers. Further evaluations including a bone marrow biopsy confirmed acute lymphoblastic leukemia. The combination of ocular motor and oculosympathetic palsy has a distinct localizing value. Fourth nerve palsy ipsilateral to Horner syndrome locates lesion in the cavernous sinus, while contralateral fourth nerve palsy locates the lesion in the midbrain.

Review

The Interaction of Hypertension for Vertigo in Audiovestibular Medicine Clinic: Adaobi Elizabeth Osuji; Res Vestib Sci. 2022;21(2):29-39. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.29

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Abstract PDF: As the first audiovestibular medicine physician in the University of Port Harcourt Teaching Hospital, Nigeria, a keen observation revealed that a sizeable proportion of the adult patients presenting to our audiovestibular medicine clinic with vertigo are either known hypertensives, or hypertensives yet to have a formal diagnosis. This aroused an ardent curiosity to find the raison d’être, and to shed light on this pathological association between vertigo and hypertension. In line with this, it became imperative to highlight the dynamics of interaction, and pathophysiology behind the role of hypertension in vertigo.

Original Articles

Intravenous Zoledronic Acid in Elderly Patients with Benign Paroxysmal Positional Vertigo and Osteoporosis: Dong Won Kwack, Hyemi Lee, Dong Wook Kim; Res Vestib Sci. 2020;19(3):95-98. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.95

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Abstract PDF: Objectives
Benign paroxysmal positional vertigo (BPPV), a common cause of vertigo in the elderly, shares common pathogenic mechanisms with osteoporosis. We investigated the efficacy and safety of intravenous zoledronic acid in elderly patients with BPPV and osteoporosis.
Methods
We performed a 3-year observational study with elderly patients who were diagnosed with BPPV and osteoporosis. The recurrence of BPPV and changes in bone mineral densitometry (BMD) scores were evaluated one year after the administration of intravenous zoledronic acid.
Results
We enrolled 101 elderly patients with BPPV and 54 of them (53.5%) met the diagnostic criteria for osteoporosis. Intravenous zoledronic acid was administered in 51 patients. The recurrence of BPPV was observed in only two of 49 patients (4.1%) at 1 year’s follow-up. The mean lowest T-score of BMD improved from –3.23±0.51 to –3.05±0.58 (p=0.001).
Conclusions
Our study showed that the treatment of osteoporosis can be considered to prevent the recurrence of BPPV in the elderly. Further placebo-controlled studies are needed to estimate accurately the efficacy of zoledronic acid in the prevention of recurrence of BPPV in the elderly.

Analysis of Age-Dependent Normative Values of Suppression Video-Head-Impulse Test in Healthy Korean Subjects: Do Yoon Jeong, Yoon Sik Park, Sung Il Cho; Res Vestib Sci. 2019;18(1):8-13. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.8

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Abstract PDF

Objectives
Suppression head impulse paradigm (SHIMP) in video head impulse test is now newly used to test vestibular function. The aim of this study was to analyze normative values of SHIMP for healthy Korean subjects in each decade of life.
Methods
SHIMP and HIMP responses were measured with the video head impulse test in 70 healthy subjects. Vestibulo-ocular reflex gain and anticompensatory saccade were analyzed and compared at each decade of life.
Results
All subjects produced anticompensatory saccades in SHIMP. Gain values did not vary significantly with age. Gain values in SHIMP were lower than gain values in HIMP. The gain values of rightward impulse were higher than the gain values of leftward impulse.
Conclusions
Gain values and anticompensatory saccades in SHIMP were consistently equal in each decade of life. Normative values of SHIMP seems largely unaffected by aging.

Citations

Citations to this article as recorded by

Normalization of the Suppression Head Impulse Test (SHIMP) and its correlation with the Head Impulse Test (HIMP) in healthy adults
Suheda Baran, Gulce Kirazli, Pelin Pistav Akmese, Nese Celebisoy, Tayfun Kirazli
Journal of Vestibular Research.2024; : 1. CrossRef

The Effect, Compliance and Satisfaction of Customized Vestibular Rehabilitation: A Single Center Experience: Hyung Lee, Hyun Ah Kim; Res Vestib Sci. 2019;18(1):14-18. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.14

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Abstract PDF

Objectives
Over the last decades, numerous studies on the effect of vestibular rehabilitation (VR) have been reported in western countries, but there has been no report about real experiences of customized VR in Korea. The aim of this study was to analyze of the efficacy, compliance and satisfaction in patients with acute and chronic dizziness.
Methods
Patients with dizziness were treated with a customized VR at least 4 weeks. Subjects were assessed before and after at least 4 weeks of customized VR for visual analogue scale (VAS) and disability scale (DS). Patients were asked to score the satisfaction of their treatment as 1 (very poor) to 5 (excellent). Compliance to exercise program were graded as 1 (regularly performed), 2 (frequently performed), or 3 (rarely performed).
Results
Thirty-two patients with dizziness were included. Diagnosis of patients were vestibular migraine (n=5), Meniere’s disease (n=2), vestibular neuritis (n=10), persistent perceptual positional dizziness (n=10), bilateral vestibulopathy (n=3), and central dizziness (n=2). Mean VAS and DS before VR were 15.3 and 2.4, respectively. Mean VAS and DS after VR were 4.5 and 0.7, respectively. Significant improvements in VAS and DS were observed after VR (p=0.00). Mean treatment satisfaction score was 3.3±1.0 and mean compliance score was 2.3±0.8. Satisfaction to VR showed positive correlation with patient’s compliance. (p=0.00, r=0.644)
Conclusions
Significant improvements were seen in symptom and disability in patients with acute and chronic dizziness after customized VR. Patients showed moderate compliance to exercise program and overall satisfaction was fair.

Citations

Citations to this article as recorded by

A Survey of Educational, Clinical Background in Vestibular Rehabilitation Therapy of Korean Physical Therapists
Migyoung Kweon, Youn Bum Sung
The Journal of Korean Academy of Physical Therapy .2023; 30(2): 65. CrossRef
Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study
Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi
Research in Vestibular Science.2019; 18(3): 71. 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.

Case Report

Post Infectious Cerebellar Ataxia with Abnormal Brain Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Findings: Hae Joo Rha, Jae Han Park; Res Vestib Sci. 2017;16(4):167-170. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.167

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Abstract PDF: A 84-year-old woman presented with a two weeks history of dizziness, slurred speech and ataxia. The neurological exam showed spontaneous left beating nystagmus, horizontal gaze evoked nystagmus and limb ataxia. A few weeks earlier, she had an upper airway infection. Brain MRI revealed diffuse leptomeningeal enhancement in the both cerebellar hemisphere and brain single photon emission computed tomography (SPECT) showed hyperperfusion in both cerebellar hemisphere. Extensive laboratory studies with cerebrospinal fluid analysis did not reveal any etiologic factors. She was started on methylprednisolone (1 g/day for 7 days), gradually improved over the weeks. Post infectious cerebellar ataxia is a neurologic complication that occasionally follows systemic viral and bacterial infections. This case demonstrates that cerebellar abnormalities can be detected by brain magnetic resonance imaging and SPECT.

Review

Medications as Risk Factor for Falls: Ye Won Lee, Sung Il Nam; Res Vestib Sci. 2016;15(4):101-106. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.101

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Abstract PDF

Falls are the most common cause of accidents among the older population, leading to both fatal and non-fatal injuries. Falls is a syndrome resulting from the cumulative effect of various extrinsic and intrinsic factors. It is considered to be a multifactorial disorder. Medication use is considered a risk factor for falls. We reviewed medications associated with falls in older individuals. In geriatrics populations, polypharmacy is associated with falls. Medical doctors should be aware of the possibility that starting a new medication, such as antihypertensive agents, benzodiazepine, antidepressants, opioid agents and antihistamines, may act as a trigger for the onset of a fall.

Citations

Citations to this article as recorded by

A model for predicting fall experience in the elderly population over 65 years old: Decision tree analysis
Myeunghee Han
Journal of Korean Gerontological Nursing.2022; 24(4): 366. CrossRef
Medications and Falls Experiences among Older People
Jiyoon Han, Eunok Park
Journal of Korean Gerontological Nursing.2021; 23(4): 373. CrossRef
Triggers and Outcomes of Falls in Hematology Patients: Analysis of Electronic Health Records
Min Kyung Jung, Sun-Mi Lee
Journal of Korean Academy of Fundamentals of Nursi.2019; 26(1): 1. CrossRef

Case Report

Tullio Phenomenon Following Spontaneous Intralabyrinthine Gross Hemorrhage: Jae Won Choi, Jong Jun Kim, Young Hyo Kim, Hyun Woo Lim; Res Vestib Sci. 2013;12(4):140-144.

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Abstract: Tullio phenomenon is a pattern of sound induced unsteadiness, imbalance or vertigo, associated with disturbances of oculomotor and postural control. As a possible cause of sudden sensorineural hearing loss, intralabyrinthine gross hemorrhage has been reported in subjects with bleeding tendency. We report a case of spontaneous intralabyrinthine hemorrhage followed by presentation of Tullio phenomenon. A 35-year-old man presented with sudden left side hearing loss and vertigo. Audiometry results indicated left total deafness and magnetic resonance images revealed left intralabyrinthine hemorrhage. At 1 month after hearing loss, sound and pressure-induced vertigo and disequilibrium newly developed. Follow-up images indicated signs of fibrosis in the left labyrinth and nystagmography results showed induction of nystagmus according to the stapedial reflex. This case suggests possibility of Tullio phenomenon in sudden sensorineural hearing loss patients.

Review

Management of Benign Paroxysmal Positional Vertigo: Chan Il Song, Hong Ju Park; Res Vestib Sci. 2013;12(4):111-120.

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Abstract: Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by head positional changes. BPPV is one of the most common causes of recurrent vertigo. BPPV results from abnormal stimulation of the cupula within any of the three semicircular canals by free-floating otoliths (canalithiasis) or otoliths adhered to the cupula (cupulolithiasis). Spontaneous recovery occurs frequently even with conservative treatment. However, canalith repositioning maneuvers are believed to be the best way to treat BPPV by moving the canaliths from the semicircular canal to the vestibule. Various treatment methods of posterior, superior, and lateral canal BPPV are discussed in this review.

Original Article

Clinical Characteristics of the Benign Paroxysmal Positional Vertigo in the Elderly: Myung Joo Shim, Hyun Woo Lim, Woo Seok Kang, Jong Woo Chung; Res Vestib Sci. 2011;10(4):129-133.

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Abstract PDF: Background and Objectives: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. It constitutes the most common vestibular disorder in the elderly with vertigo. Purpose of this study to assess the clinical characteristics and treatment outcome of BPPV in elderly patients. Materials and Methods: We reviewed the medical records of 380 patients above age 60 who were treated for BPPV. Collated data of the elderly BPPV patients in terms of involved canals, number of canalith repositioning procedures and their underlying disease were analyzed and compared with the data of national health report in 2008 that represented the general population. Results: Number of BPPV patients was increased along with age. Three hundred and eighty patients (44.9%) of 847 BPPV patients were over 60. Most commonly involved canal was posterior semicircular canal. Lateral semicircular canal was involved much more frequently (46.8%) compared with previous reports. Along the age, involvement of lateral semicircular canal, frequency of multiple canal involvement and cupulolithiasis increased. In patients older than 60, treatment response was worse than younger ages. More canalith reposition procedures were needed in the elderly than younger patients with BPPV. Between patients with BPPV and normal population, no difference was found in prevalence of co‐morbities, such as diabetes, cerebrovascular disease, cardiovascular disease, other otologic disease, and psychiatric disease. Conclusion: We suggest that more careful diagnosis and intervention should be considered in BPPV of old age due to its complicated natures and lower treatment response.

Case Reports

A Case of Bilateral Horizontal Semicircular Canal Dysplasia with Normal Cochlea: Three Dimensional Volume Rendering Image Using MR CISS Sequence: Jae Hwan Choi, Hak Jin Kim, Han Young Jung, Kwang Dong Choi; Res Vestib Sci. 2011;10(1):38-41.

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Abstract PDF: Congenital inner ear malformations are frequently found in patients with sensorineural hearing loss, but isolated vestibular anomalies with normal cochlear development have been rarely reported. We report a 20-year-old man with recurrent dizziness and disequlibrium without hearing impairment. Neuro-otological evaluations showed a left peripheral vestibulopathy with normal hearing function. Three dimensional volume rendering image using magnetic resonance constructive interference in steady state sequence demonstrated isolated vestibular anomalies involving bilateral horizontal semicircular canals. Isolated vestibular anomalies might not be as rare as previously thought among patients with recurrent dizziness, and should be carefully evaluated through various imaging techniques

A Case of Lateral Medullary Syndrome with Ipsilesional Nystagmus due to Intramedullary Hemorrhage: Ki Bum Sung, Ji Yun Park, Sun Ah Park, Tae Kyeong Lee; Res Vestib Sci. 2009;8(1):52-55.

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Abstract PDF: We report a rare case of primary dorsal medullary hemorrhage showing lateral medullary syndrome with ipsilesional nystagmus. A 41-year woman, presented with the first degree horizontal vestibular nystagmus and ocular tilt reaction to the left in lateral medullary hemorrhagic lesion. Primary medullary hemorrhage is rare and details of the abnormal eye movement in the lesion have never been described well. While most of the reported vestibular nystagmus in the lateral medullary infarction was contralesional., the nystagmus in this case was ipsilesional. This ipsilesional beating of the nystagmus might be explained that either destruction of the rostral part of vestibular nuclei or irritative effect of blood to vestibular nuclei is responsible. In addition, ocular tilt reaction (OTR) can be more important in deciding the side of the lesion in medullary hemorrhage. Key Words: Lateral medullary syndrome; Medulla oblongata, Hemorrhage; Nystagmus, Pathologic

Bilateral Internuclear Ophthalmoplegia Following Spontaneous Subarachnoid Hemorrhage: Se Jin Oh, Kwang Dong Choi, Dae Soo Jung; J Korean Bal Soc. 2008;7(2):204-206.

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Abstract PDF: A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage. Key words: Bilateral internuclear ophthalmoplegia, Spontaneous subarachnoid hemorrhage, Vasogenic edema

Original Article

Changes of Vibration-Induced Nystagmus by Age in Normal Subjects: Yong Soo Jung, Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):186-191.

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Abstract PDF: Background and Objectives: It has been reported that vibration applied either on the mastoid or on the sternocleidomastoid (SCM) muscles induces nystagmus in normal subjects. The aims of the study were to characterize the direction and velocity of slow-phase eye movement which is induced by vibration in normal subjects and to propose the mechanism of vibration-induced nystagmus (VIN) in normal subjects. Materials and Method: We recorded eye movements during unilateral 100-Hz vibration on the mastoid bone and SCM muscles in 56 normal subjects. The subjects were divided into 4 groups in ages (20s, 30s, 40s, 50~60s). The directions of VIN, the degree of maximal slow-phase eye velocities were analyzed according to age. Positive value means slow-phase velocity (SPV) to the right side. Results: In 20s, vibration on right/left mastoids induced SPV of 1.2±2.0°/sec, 0±2.1°/sec and on right/left SCM muscles, 1.1±1.9°/sec, -1.2±2.5°/sec. In 30s, vibration on right/left mastoids induced SPV of 3.3±3.8°/sec, -0.3± 1.4°/sec and on right/left SCM muscles, 2.8±4.2°/sec, -1.0±1.5°/sec. In 40s, vibration on right/left mastoids induced SPV of 0±1.7°/sec, -0.2±1.2°/sec and on right/left SCM muscles, 0±1.8°/sec, 0±1.0°/sec. In 50~60s, vibration on the right/left mastoids induced SPV of -1.3±1.3°/sec, 1.2±1.3°/sec and on right/left SCM muscles, -0.6±0.9°/sec, 0.9 ±1.5°/sec. The directional preponderance of the slow-phase eye movement to the vibrated side was statistically significant in 20s and 30s, however, the preponderance of the slow-phase eye movement changed into the non-vibrated side in 50~60s. Conclusion: The proprioceptive input, changing major rotator from the inferior oblique muscle to the sternocleidomastoid muscles might explain the change of the directional preponderance of the slow-phase eye movements in normal subjects according to ages. Although this directional preponderance is not consistent in all age groups, it is still important in discriminating normal responses from abnormal responses which can be induced by vibration.

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