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Postprandial Dizziness/Syncope Relieved by Alfa-Glucosidase Inhibitor: A Case Report
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Hakyeu An, Seong-Hae Jeong, Hyun Jin Kim, Eun Hee Sohn, Ae Young Lee, Jae Moon Kim
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Res Vestib Sci. 2018;17(2):67-70. Published online June 15, 2018
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DOI: https://doi.org/10.21790/rvs.2018.17.2.67
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 Abstract
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- A 74-year-old man presented with positional vertigo and prandial dizziness and syncope. He had experienced episodes of frequent dizziness and loss of consciousness for several months. He underwent total gastrectomy with esophagojejunostomy and brown anastomosis 30 years ago. Thirteen years ago, subtotal colectomy with ileo-descending colostomy was done due to colon cancer. And he also had mitral valve replacement and maze operation due to severe mitral valve stenosis and atrial fibrillation. After cardiac operation, he has suffered from sudden dizziness with diaphoresis and chalky face, which usually occurs especially within 30 minutes from the onset of eating. Sometimes, this event was followed by several seconds of loss of consciousness, which caused recurrent events of falling. Neurological examination showed positional nystagmus compatible with benign paroxysmal positional vertigo arising from posterior semicircular canal of the right ear. The positional vertigo disappeared immediately after canalith repositioning maneuver. We tried to monitor vital signs and serum level of glucose during eating. Hyperglycemia (range, 210–466 mg/dL) was noted during eating, which was accompanied by postprandial and prandial hypotension, up to 60/40 mmHg. The patient was prescribed 100 mg of the alfa-glucosidase, acarbose to be taken half an hour before each meal. Eventually, the treatment with acarbose ameliorated the prandial dizziness and hypotension associated with hyperglycemia. Our patient suggests the acarbose could prevent postprandial dizziness and hypotension.
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Gaze-Evoked and Perverted Head-Shaking Nystagmus in a Patient with Polycythemia Vera
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Yong Soo Kim, Ik-Chan Song, Seong-Hae Jeong, Ae Young Lee, Jae Moon Kim
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Res Vestib Sci. 2017;16(4):142-146. Published online December 15, 2017
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DOI: https://doi.org/10.21790/rvs.2017.16.4.142
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Abstract
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- Polycythemia vera (PV) is well known chronic myeloproliferative neoplasm, caused by clonal expansion of an abnormal hematopoietic stem cell. Patients with PV may present diverse neurologic symptoms including headache, dizziness or vertigo, tinnitus. However, the attention has not been directed to the neurootological findings in patients with PV. Here, we present a 71-year-old male patient with PV suffered from vertigo and headache. He demonstrated gaze-evoked nystagmus and perverted head shaking nystagmus. Transcranial Doppler showed decrement of blood flow velocity in posterior circulation. The patient’s neuro-otologic findings were normalized as polychethemia and blood flow improved with repetitive phlebotomy and medications such as hydroxyurea and aspirin. Considering the neurological and hemodynamic findings in our patient, the mechanism of vertigo in PV could be explained by central vestibulopathy because of vascular insufficiency rather than peripheral vestibulopathy because of inner ear blood hyperviscosity.
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Gaze-evoked and Perverted Head-Shaking Nystagmus In a Patient with Polycythemia Vera
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Yongsoo Kim, Ik-Chan Song, Seong-Hae Jeong, Ae Young Lee, Jae Moon Kim
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Received November 8, 2017 Accepted November 27, 2017 Published online November 27, 2017
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[Accepted]
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Abstract
- Polycythemia vera (PV) is well known chronic myeloproliferative neoplasm, caused by clonal expansion of an abnormal hematopoietic stem cell. Patients with PV may present diverse neurologic symptoms including headache, dizziness or vertigo, tinnitus. However, the attention has not been directed to the neuro-otological findings in patients with PV. Here, we present a 71-year-old male patient with PV suffered from vertigo and headache. He demonstrated gaze-evoked nystagmus and perverted head shaking nystagmus. Transcranial Doppler showed decrement of blood flow velocity in posterior circulation. The patient’s neuro-otologic findings were normalized as polychethemia and blood flow improved with repetitive phlebotomy and medications such as hydroxyurea and aspirin. Considering the neurological and hemodynamic findings in our patient, the mechanism of vertigo in PV could be explained by central vestibulopathy because of vascular insufficiency rather than peripheral vestibulopathy because of inner ear blood hyperviscosity.
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A Case of Unilateral Internal Carotid Artery Stenosis Presenting with Chronic Isolated Dizziness
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Ju Heon Lee, Seong Hae Jeong, Young Gi Lim, Joo Yeon Ham, Hye Seon Jeong, Jae Moon Kim
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Res Vestib Sci. 2016;15(2):60-63. Published online June 15, 2016
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- It is customary that the dizziness related to cerebral perfusion might be caused by insufficient posterior circulation. The occurrence and nature of dizziness originating from anterior circulation has not been well-known. Here, we report a chronic dizzy woman presenting with severe internal carotid artery stenosis, which improved after carotid artery stenting.
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