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Clinical Application of the Head Impulse Test in Vestibular Disorders
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Seung Han Lee
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Res Vestib Sci. 2015;14(1):1-8.
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- The head impulse test (HIT) is an established way to test the angular
vestibulo-ocular reflex (aVOR) at the bedside. When the aVOR is normal, the
eyes rotate opposite to the head movement through the angle required to keep
images stable on the fovea. If the aVOR is impaired, the eyes move less than
required and, at the end of the head rotation, the eyes are not directed at the
intended target and the visual image is displaced from the fovea. A
promptly-generated corrective saccade brings the image of the target back on the
fovea. The identification of this corrective saccade is the signature feature of
vestibular hypofunction and has greatly increased the utility of the bedside
examination for identifying an aVOR deficit. However, sometimes it is not easy
to detect corrective saccades without quantitative HIT devices. Exact execution
and interpretation of the HIT are warranted to reduce the diagnostic errors,
because the HIT has become an important part of the differential diagnosis of
both acute and chronic vestibular disturbances.
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Acute Vestibular Neuritis Associated with Herpes Zoster Ophthalmicus
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Yoon Chang Oh, Jong Kyung Lee, Jae Myung Kim, Seung Han Lee
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Res Vestib Sci. 2014;13(3):81-84.
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- Vestibular neuritis, one of common causes of acute spontaneous vertigo, is characterized by a sudden onset of vertigo with horizontal-torsional spontaneous nystagmus and unsteadiness with a falling tendency. Herpes zoster is a common infection caused by varicella-zoster virus (VZV), and herpes zoster ophthalmicus (HZO) occurs when this virus is reactivated in the ophthalmic branch of the trigeminal nerve. VZV can cause vestibular neuritis with cochlear dysfunction as a form of herpes zoster oticus, also known as Ramsay-Hunt syndrome. However, to our knowledge, isolated vestibular neuritis associated with HZO has been rarely reported, because of distance between the trigeminal nerve and the vestibulocochlear nerve. We present an unusual case of vestibular neuritis complicated by the HZO.
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Cavernous Sinus Syndrome Complicating Occlusion of the Internal Carotid Artery by Necrotizing Sinusitis
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Yun Ju Choi, Jae Myung Kim, Seung Han Lee, Myeong Kyu Kim
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Res Vestib Sci. 2013;12(4):145-148.
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- Cavernous sinus syndrome is characterized by multiple cranial nerve palsies manifesting with ophthalmoplegia, ptosis, facial sensory loss due to involvement of adjacent cranial nerves. Tumor, trauma, and non-infectious inflammatory disorders are principal causes of cavernous sinus syndrome. Rhinocerebral mucormycosis is one of the fatal causes of cavernous sinus syndrome usually in immunocompromised patients. Here is a case of cavernous sinus syndrome complicating occlusion of the internal carotid artery by necrotizing fungal sinusitis, which is highly suspicious of rhinocerebral mucormycosis with non-immunocompromised state.
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Pseudo-Vestibular Neuritis Caused by a Vascular Tumor Involving the Anterior Inferior Cerebellum
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Se Young Lee, Seung Han Lee, Eun Seon Park, Deok Sang Yoo
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Res Vestib Sci. 2012;11(4):142-145.
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- Acute vestibular syndrome (AVS) is characterized by the rapid onset of dizziness/ vertigo accompanied by nausea/vomiting, gait unsteadiness, and nystagmus lasting a day or more. Some patients with AVS have potentially dangerous central etiologies. AVS caused by central etiologies without significant other neurologic deficit, so called pseudo-vestibular neuritis (pseudo-VN), could be difficult to be differentiated from acute vestibular neuritis. In addition to imaging studies, bedside oculomotor examination-head impulse test, nystagmus and test of skew)-is essential to identify patients with pseudo-VN. Among several central causes of AVS, brain tumor is extremely rare. We report a case of vascular tumor involving the anterior inferior cerebellum with AVS presentations.
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Clinical Manifestations and Neuro-otological Findings of Migrainous Vertigo
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Hyun Jung Jung, Seung Han Lee
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Res Vestib Sci. 2012;11(1):1-7.
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- Background and Objectives: Migrainous vertigo (MV) is one of the recurrent vestibular syndromes and may present episodic vestibular and concurrent migraine symptoms. The clinical manifestations and neuro-otological findings of MV have been delineated over the last couple of decades, however, there are still lots of uncertainties. Materials and Methods: We performed a comprehensive literature search regarding the clinical manifestations and neuro-otological findings of MV compatible with the diagnostic criteria proposed by Neuhuaser. We found the published articles that addressed the clinical and neuro-otological findings and we performed a pooled analysis. Results: Even though the duration of MV attack was variable from seconds to days, the most common durations investigated in this study was minutes (range, 5-60 minutes). During MV attack, most patients had a migraine headache, but instead the other migraine symptoms (i.e., photophobia, phonophobia) could be found. There were positional nystagmus which may not meet a stimulated canal plane and spontaneous nystagmus and, less commonly, gaze-evoked nystagmus. Regarding bithermal caloric test, unilateral canal paresis could be found in 15-20% of MV patients as well as hyperexcitability in some patients. Oculomotor tests might show impaired pursuits (mainly saccadic pursuit) and saccadic abnormalities such as delayed latency and hypometric saccade. Conclusion: From the result of the pooled analysis, we have found several clinical and neuro-otological findings. However, vital neuro-otological findings which can provide a clue for the diagnosis of MV are still lacking. So the diagnosis of MV should depend on the clinical manifestations and a process of differential diagnosis.
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Recurrent positional vertigo
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Seung Han Lee
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J Korean Bal Soc. 2008;7(2):244-52.
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Eight-And-a-Half Syndrome in Pontine Infarction
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Hyun Jung Jung, Seung Han Lee, Myeong Kyu Kim, Ki Hyun Cho
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J Korean Bal Soc. 2008;7(1):77-80.
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- Eight-and-a-half syndrome is a clinical syndrome with the combination of a one-and-a-half syndrome and an ipsilateral seventh cranial nerve palsy usually due to a paramedian pontine tegmental lesion. A 57-year-old man presented with dizziness, diplopia, and a left facial palsy. Ocular motor manifestations showed combined left conjugate horizontal gaze palsy and left internuclear ophthalmoplegia (one-and-a-half syndrome). In addition, he had a left lower motor neuron pattern of facial palsy. Brain MR images showed an acute infarction in the left paramedian pontine tegmentum.
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Lithium-Induced Downbeat Nystagmus with Reversible Splenial Lesion
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Dong Uk Kim, Seung Han Lee, Hyun Jung Jung, Kyung Wook Kang
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J Korean Bal Soc. 2007;6(2):150-154.
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- Lithium is recognized as a cause of reversible or permanent downbeat nystagmus. Many patients who were treated with lithium for psychiatric illness developed downbeat nystagmus and other neurological manifestations. Reversible splenial lesions of corpus callosum are commonly seen on diffusion-weighted imaging (DWI) in various neurological disorders including metabolic/toxic encephalopathy, encephalitis, patients with epilepsy receiving antiepileptic drugs.
Herein, we report a patient with reversible downbeat nystagmus, disturbance of smooth pursuit, and gait ataxia who was treated with lithium. Also, we can observe reversible splenial lesion of corpus callosum on DWI in this patient.
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KBS
