Research in Vestibular Science

Volume 11 (4); December 2011

Clinical Trial

Treatment of Vestibular Migraine: Byung Kun Kim; Res Vestib Sci. 2012;11(4):111-115.

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Abstract: Although vestibular migraine is considered to be the most common cause of non-positional recurrent vertigo, well designed clinical trials for the treatment of vestibular migraine are not yet available. Management includes dietary and lifestyle modifications and medications. Since treatment for vestibular migraine generally follows the recommended treatment of migraine, most drugs are also used for the prevention of migraine. In this review, preventive treatment with beta blockers, calcium channel blockers, antiepileptic drugs, antidepressants, acetazolamide and triptans are described. Nonpharmacological management such as diet, sleep and avoidance of triggers are also recommended for vestibular migraine.

Original Article

Effects of Meteorological Factors on the Onset of Vestibular Neuritis: Eun Ju Jeon, Dong Hyun Kim; Res Vestib Sci. 2012;11(4):116-122.

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Abstract: Background and Objectives: The objective of this study was to evaluate the effect of meteorological factors on the onset of vestibular neuritis. Materials and Methods: Meteorological data from 2004 to 2009 were obtained from the web-based ‘Monthly Weather Reports of the Meteorological Administration’ database. Patients with vestibular neuritis who visited Incheon St. Mary’s Hospital during this same period and presented the precise day on which the symptoms appeared were included in this study involving a retrospective chart review. Twelve meteorological factors were analyzed between the days when vestibular neuritis onset was observed and the days when vestibular neuritis did not occur. Time lags (D-₁-D-₇) which mean 1-7 days before the onset were included to assess a possible delayed meteorological effect in relation to the onset of vestibular neuritis. Seasonal incidence of vestibular neuritis and a relationship with seasonal patterns of weather parameters were evaluated. Results: Mean values for the meteorological parameters of the days when vestibular neuritis occurred were not significantly different from the days on which vestibular neuritis onset was not observed. At time lag of 3-5 days, mean and maximal wind velocities were significantly higher for the days when vestibular neuritis occurred than the days without vestibular neuritis onset. The incidence of vestibular neuritis was highest in spring, when the wind velocity was higher compared to other seasons. Conclusion: Wind speed and the spring season showed significant relationships with vestibular neuritis occurrence.

Evaluation Studies

Quantitative Analysis of Fixation Index of Caloric Induced Nystagmus and Its Clinical Implication: Joong Yeon Won, Sae Young Kwon, Ji Hee Kim, Hyo Jeong Lee, Hyung Jong Kim, Ja Won Koo, Sung Kwang Hong; Res Vestib Sci. 2012;11(4):123-130.

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Abstract: Background and Objectives: There is no general consensus as to the normal limit or recommended procedure for visual fixation index (VFI) during caloric test because fixation suppression (FS) could be influenced by different variables. In this study, we present our mathematical modeling according to different variables to establish a clinical implication of VFI in patients with vertigo. Materials and Methods: Data were analyzed from a retrospective record of patients who underwent caloric testing. Three subgroups were classified (normal caloric response, unilateral vestibular hypofunction and central vertigo). VFI distribution and mathematical modeling to estimate an associated probability were performed from each group. A receiver operation characteristics (ROC) curve was plotted to determine its diagnostic value. Results: Four hundred eighteen, 67 and 14 patients met our inclusion criteria for normal caloric response, unilateral vestibular hypofunction and cerebellar infarction respectively. VFIs on warm irrigation showed more consistent distribution than cold irrigation in normal caloric response group. In contrast, there was significant inconsistency of VFIs between each side in unilateral vestibular hypofunction group (p>0.05). FS ability was inversely propositional with increase in age on all caloric (p<0.05). The area under the ROC curve of VFIs on warm caloric irrigation was 0.821 and that on cold irrigation was 0.785 for detecting central vertigo. Conclusion: Calibrated normal limit for VFI according to age is needed to ensure its clinical implication. Diagnostic value of VFI and its reliability on warm stimulation was superior to that of cold, which indicates VFI on warm stimulation seems to be a more reliable parameter.

Original Article

Expression of Metabotropic Glutamate Receptors in the Medial Vestibular Nucleus Following Acute Hypotension in Rats: Myoung Ae Choi, Nari Kim, Sang Eon Park, Byung Geon Park, Min Sun Kim, Byung Rim Park; Res Vestib Sci. 2012;11(4):131-137.

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Abstract: Background and Objectives: Acute hypotension induces expression of c-Fos protein and phosphorylated extracellular signal-regulated kinase (pERK), and glutamate release in the vestibular nuclei. Expression of c-Fos protein and pERK is mediated by the excitatory neurotransmitter, glutamate. In this study, the signaling pathway of glutamate in the vestibular nuclei following acute hypotension was investigated. Materials and Methods: Expression of metabotropic glutamate receptors (mGluRs) was measured by Western blotting in the medial vestibular nucleus following acute hypotension in rats. Results: Expression of pGluR1 Ser831, a subtype of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, peaked at 30 minutes after acute hypotension insult, and expression of pNR2B, a subtype of N-methyl-D-aspartate (NMDA) receptors, peaked at 2 hours after acute hypotension insult. Acute hypotension induced expression of Homer1a and group I mGluR in the medial vestibular nucleus. Expression of mGluR1 and mGluR5 peaked at 6 hours following acute hypotension insults. Conclusion: These results suggest that afferent signals from the peripheral vestibular receptors, resulting from acute hypotension insult, are transmitted through group I mGluRs as well as AMPA and NMDA receptors in the vestibular system.

Case Reports

A Case of Herpes Zoster Oticus without Facial Nerve Palsy Associated with Vertigo and Hearing Loss: Jee Min Choi, Jung Eun Shin, Chang Hee Kim; Res Vestib Sci. 2012;11(4):138-141.

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Abstract: Herpes zoster oticus (HZO) is characterized by facial nerve palsy, otalgia and auricular vesicles on the affected side and accepted to be caused by the reactivation of varicella zoster virus (VZV) in the geniculate ganglion. Vestibulocochlear deficits are known to be frequently accompanied by HZO. Unusual clinical manifestations such as only vertigo without facial nerve palsy or hearing loss has been reported. We report a case of 27-year-old man presented with vertigo, sensorineural hearing loss and vesicular eruptions on the left auricle without facial nerve palsy. Serologic test revealed that the patient was positive for immunoglobulin G (IgG) and IgM antibodies against VZV.

Pseudo-Vestibular Neuritis Caused by a Vascular Tumor Involving the Anterior Inferior Cerebellum: Se Young Lee, Seung Han Lee, Eun Seon Park, Deok Sang Yoo; Res Vestib Sci. 2012;11(4):142-145.

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Abstract: 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.

Spontaneous Recovery of Vestibulo-Ocular Reflex Gain after Bilateral Complete Vestibular Loss Following Head Injury: Ga Young Park, Eun Wook Chung, Jong Sei Kim, Won Ho Chung; Res Vestib Sci. 2012;11(4):146-153.

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Abstract: Dizziness is a frequent complication of head injury and objective evidence of vestibular dysfunction in the dizzy patient following head injury has been reported in literatures. However, there is no report about bilateral spontaneous recovery of caloric response after complete loss of bilateral vestibular function following head injury. A 27-year-old male patient who presented with continuous dizziness and disequilibrium following head injury was diagnosed as diffuse axonal injury after brain magnetic resonance image and bilateral complete loss of vestibular function after caloric and rotary chair test. He showed gradual improvement of dizziness, vestibulo-ocular reflex gain and left caloric response at 2 months after vestibular exercise. After another 4 months, his caloric function was fully recovered, and dizziness disappeared at 16 months after the onset of dizziness. We present this case with reviews of previous literatures about dizziness following head injury and diffuse axonal injury.

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