Research in Vestibular Science

Volume 20 (2); June 2021

Review

Update on Genetic Study of Vestibular Disorder: Jae-Hwan Choi; Res Vestib Sci. 2021;20(2):37-44. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.37

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Abstract PDF: The wide availability of next-generation sequencing has enabled a rapid progress in the discovery of genetic variants associated with many disorders. However, the contribution of genetic factors in vestibular disorders is largely unknown due to the low prevalence of familial disorders and the clinical diversity. A detailed clinical characterization of patients and a choice of proper genetic tests are required to identify the genetic contribution in vestibular disorders. In this review, we will introduce a genetic approach for vestibular disorders and update the evidences to support the genetic contribution in vestibular disorders.

Original Articles

Clinical Characteristics of Recurrent Benign Paroxysmal Positional Vertigo: A Retrospective Cohort Study: Jae-Myung Kim, Bang-Hoon Cho, Jong-Kyung Lee, Myeong-Kyu Kim, Seung-Han Lee; Res Vestib Sci. 2021;20(2):45-50. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.45

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Abstract PDF Supplementary Material: Objectives
Benign paroxysmal positional vertigo (BPPV) is a potentially recurrent disease even after successful canalith repositioning maneuvers. However, the exact recurrence rate or any clinical factors affecting the recurrence of BPPV still need to be elucidated.
Methods
We recruited patients diagnosed as BPPV in a tertiary hospital for 3 years. We retrospectively reviewed the clinical information of the patients including baseline demographics, comorbidities and predisposing factors through the electronic medical records. We performed a telephone survey or direct interview 3 to 6 years later from the initial diagnosis of BPPV was made. To determine the factors associated with the recurrence, we divided study population into two subgroups; ‘recurrence group’ vs. ‘recurrence-free group.’ Then, intergroup comparative analyses were performed.
Results
Among 397 patients who were originally eligible for the study, we performed a telephone survey or direct interview in 289 patients (72.8%) to determine the recurrence of BPPV. The overall recurrence rate was 29.4% (85 of 289). Baseline demographics except female gender (p=0.014) were not different between subgroups. Neither clinical characteristics nor vascular comorbidities were associated with the recurrence. However, patients with low bone mineral density (BMD; T-score below ‒1, osteopenia/osteoporosis) showed significantly higher recurrence than those with normal BMD (40.6% vs. 0%, p=0.009).
Conclusions
Female gender and low BMD (T-score below ‒1) were associated with the recurrence of BPPV in this study. Further researches in various clinical settings with larger sample size are warranted to identify the factors affecting the relapse of BPPV.

Relationship between Chronological Orders of Symptoms and Vestibular Abnormality in Patients with Vestibular Migraine: Sae Eun YI, Jun Woo Park, Jang Wook Kwak, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park; Res Vestib Sci. 2021;20(2):51-57. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.51

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Abstract PDF: Objectives
Pathophysiology of vestibular migraine (VM) is still controversial. Vertigo may act as a trigger for migraine or there might other mechanisms which cause migraine and dizziness. VM patients have headaches and dizziness simultaneously or sequentially. Therefore, we hypothesized that the sequence of symptoms might suggest different mechanisms and compared the results of vestibular function tests (VFTs) according to chronological order of headache and vertigo.
Methods
Forty-two patients with VM were included. They were divided into three subgroups according to the chronological orders of headache and vertigo, and the results of VFTs and the symptomatic improvement were compared between each group.
Results
Dizziness appeared first in 15 patients (35.7%), both symptoms appeared simultaneously in 20 patients (47.6%), and headaches appeared first in 7 (16.7%). There were no significant differences in symptom duration among the groups. Fourteen (33.3%) showed abnormal caloric results, 7 (16.7%) in head impulse test, 16 (38.1%, vestibular score) and 19 (45.2%, composite score) in sensory organizing test, and 13 (31.0%) in vestibular evoked myogenic potential test. Abnormal rate of the caloric test in the simultaneous group was significantly lower than those of the other two groups. Nineteen (45.2%) showed complete remission in 3 months after preventive medication with no significant difference between each group.
Conclusions
VM patients whose vertigo occurred with headache simultaneously showed lower incidence of caloric abnormality, suggesting that they have abnormality in central vestibular system rather than peripheral vestibular organs.

Case Reports

Rare Neuro-Ophthalmological Manifestations of Focal Midbrain Infarction: Joong-Goo Kim, Ji-Hoon Kang, Jay Chol Choi, Hong Jun Kim, Chul-Hoo Kang; Res Vestib Sci. 2021;20(2):58-63. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.58

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1 Crossref

Abstract PDF

Because numerous important nuclei and white matter tracts are concentrated in the narrow midbrain, the tiny lesion can result in various symptoms. The anatomy of the neural network and related structures in the midbrain is complex. The most frequent clinical manifestation of lesions involving the midbrain is an eye movement disorder associated with a nuclear or fascicular origin. We have described patients with acute midbrain stroke, characterized by rare neuro-ophthalmologic manifestations, which neurologists should consider during diagnostic investigations. Case 1 showed internuclear ophthalmoplegia with Horner syndrome. In case 2 showed isolated oculomotor palsy. The third patient presented Parinaud syndrome with an unusual lesion location. Notably, patients with midbrain infarction may present with specific signs and symptoms that are compatible with mesencephalic localization. The isolated or combined neuro-ophthalmologic signs and symptoms should be interpreted in the complex anatomical context described here and investigated by immediate brainstem neuroimaging analyses and careful neurologic examinations.

Citations

Citations to this article as recorded by

A Improved Case of Post Cerebral Infarction Dizziness and Gait Discomfort after Treated with Korean Medicine Treatment and Vestibular Rehabilitation Practice
Hongmin Chu, Hyeon-Seo Lim, Kwangho Kim, Young-Ung Lee, Kyungtae Park, Jongwon Jang, Ho-sun Ryu, Su-hak Kim, Cheol-hyun Kim, Sangkwan Lee, Kang-keyng Sung
Journal of Korean Medicine Rehabilitation.2020; 30(4): 179. CrossRef

Acute Bilateral Vestibulopathy with Concomitant Progressive Deterioration of Binaural Hearing: Emil Dahl Overgaard, Dan Dupont Hougaard; Res Vestib Sci. 2021;20(2):64-68. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.64

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Abstract PDF: Bilateral vestibulopathy is a condition with vestibular hypofunction of both inner ears. Patients with this diagnosis will often complain of dizziness and/or imbalance in darkness and when walking in uneven terrain and will often also experience oscillopsia. Predominant etiology is idiopathic. A 73-year old man with complaints of dizziness for 2 days. Objective findings included spontaneous nystagmus, a positive Romberg test with eyes closed, and a pathological video head impulse test. Initial audiometry only revealed bilateral presbycusis. Following gradual non-complete remission of vertiginous symptoms, the patient was discharged and scheduled for follow-up. The patient was later readmitted due to gradual progressive bilateral hearing deterioration alongside persisting vertiginous symptoms. Various additional tests all came out negative, and the condition was classified as idiopathic acute bilateral vestibulopathy with concomitant progressive deterioration of binaural hearing. The patient was later referred to bilateral cochlear implantation. Acute monosymptomatic bilateral vestibulopathy is difficult to diagnose, as it requires very specific tests that are not routinely done by neurologists. Acute bilateral vestibulopathy with concomitant progressive deterioration of binaural hearing leading to bilateral anacusis is indeed so rare that it has not been possible to find any literature describing a similar case.

Acute Vestibular Syndrome Preceded by Otologic Symptoms in Sarcoidosis: Hyeon-Joong Park, Jae-Myung Kim, Han-Sol Choi, Taebum Lee, Seung-Han Lee; Res Vestib Sci. 2021;20(2):69-73. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.69

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Abstract PDF Supplementary Material: Sarcoidosis is a rare, multisystem granulomatous disease. Neurological complications occur in about 5% of patients and vestibulocochlear involvement is even rarer. A 27-year-old woman presented with acute spontaneous vertigo for 5 days. She was diagnosed with pulmonary sarcoidosis 4 months ago, but specific treatments have not yet started. She had preceding otologic symptoms including bilateral tinnitus and ear fullness in the right for 3 months without hearing loss. Initial bedside examinations revealed spontaneous right-beating nystagmus and abnormal catch-up saccades in the left during head impulse tests (HIT). After 2 weeks, video-oculography documented the direction of spontaneous nystagmus was changed into left-beating. Caloric test showed canal paresis in the left, and video HIT showed subtle covert saccades. After starting oral prednisolone, her symptoms improved rapidly. In our case, acute vestibular syndrome and otologic symptoms might be associated with sarcoidosis when considering clinical course and treatment response. Sarcoidosis may be considered as a cause in cases with audiovestibulopathy of unknown etiology.

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