Research in Vestibular Science

Electrophysiologic Response of the Vestibular Afferents and Efferents: Jae Ho Ban; Res Vestib Sci. 2009;8(2):117-121.

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Clinical Features and Treatment Pattern of Migrainous Vertigo in Korea: A Nationwide Prospective Multicenter Study: Seong Ki Ahn, Kyusik Kang, Ja Won Koo, Kyu Sung Kim, Beom Gyu Kim, Byung Kun Kim, Ji Soo Kim, Kyoung Ho Park, Shi Nae Park, Eun Ho Park, Hong Ju Park, Jae Yong Byun, Myung Whan Suh, Ki Bum Sung, Sun Young Oh, Chung Ku Rhee, Tae Kyeong Lee, Seong Hae Jeong, Won Ho Chung, Chang Il Cha, Sung Won Chae, Eui Kyung Goh; Res Vestib Sci. 2009;8(2):122-131.

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Abstract PDF: Background and Objectives It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. Materials and Methods Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. Results Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as-sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. Conclusions The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.

Metronidazole-induced Reversible Cerebellopathy: Ha Cheol Choi, Sun Young Oh, Byoung Soo Shin, Man Wook Seo, Young Hyun Kim; Res Vestib Sci. 2009;8(2):132-136.

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Abstract PDF: Metronidazole is a nitroimidazole antibiotic used for anaerobic infections, protozoan infections, and Helicobacter pylori infections. It may produce rare but well known neurological adverse effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. We describe three patients with metronidazole-induced reversible cerebellar dysfunctions characterized by abnormal oculomotor findings, dysmetria, and ataxia. The diagnosis of metronidazole toxicity was made clinically and supported by the brain MRI findings. The neurological signs and abnormal signal intensity on MRI resolved after discontinuation of metronidazole.

A Case of Neurovascular Cross-compression of the Eighth Cranial Nerve Representing Longstanding Uncompensated Vestibular Hypofunction: Jae Kwon Lee, Ho Suk Chu, Moon Hee Ko, Won Ho Chung; Res Vestib Sci. 2009;8(2):137-141.

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Abstract PDF: The neurovascular cross-compression (NVCC) of the eighth cranial nerve (CN) is a clinical entity with symptoms of recurrent vertigo or tinnitus. Although the diagnostic criteria have been defined, the precise clinical presentation and pathomechanism have not been clarified. The treatment response to the carbamazepine; drug of choice for first line medical treatment, has been considered as one of the diagnostic criteria. Herein, we present a case of chronic uncompensated unilateral vestibular hypofunction who responded dramatically to carbamazepine medication. A 55 year-old male admitted to the hospital with symptoms of recurrent oscillopsia and headache for more than 7 years. His symptoms were aggravated by positional changes. Vestibular function tests showed spontaneous nystagmus, canal paresis on caloric test and vestibular dysfunction on dynamic posturography, which represented unilateral uncompensated vestibular hypofunction. Although his symptom was not relived by vestibular rehabilitation, he was treated with carbamazepine. A long standing uncompensated unilateral vestibular hypofunction without any auditory symptoms could be one of the clinical presentations in NVCC of the eighth CN.

Multicanal Benign Paroxysmal Positional Vertigo: Concurrent Bilateral Posterior Canalolithiasis and Unilateral Lateral Cupulolithiasis: Seung Won Chung, Chang Hyun Cho, Gyu Cheol Han; Res Vestib Sci. 2009;8(2):142-146.

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Abstract PDF: Multicanal BPPV (benign paroxysmal positional vertigo), especially BPPV affecting both labyrinths, is uncommon. A review of the literature revealed that the majority of reported cases of multiple BPPV either involved a combination of two different canals limited to one labyrinth or two different canals in both labyrinths, although one case of multicanal BPPV was reported to involve three canals bilaterally. Here, the authors report a case of bilateral posterior canalolithiasis and unilateral horizontal canal cupulolithiasis in a 54-year-old man, and include a review of the literature.

A Case of Anterior Inferior Cerebellar Artery Infarction Initially Presented a Sudden Sensorineural Hearing Loss with a Normal Diffusion-weighted Brain MRI: Han Shin Kim, Jeong In Oh, Moon Il Park, Chang Woo Kim; Res Vestib Sci. 2009;8(2):147-151.

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Abstract PDF: A sudden hearing loss with vertigo may originate from vascular insufficiency and sometimes presents as a prodrome of anterior inferior cerebellar artery infarction. Here we describe the case of a 48-year-old male patient who presented with a sudden onset of hearing loss in his right ear and severe, whirling type dizziness without associated neurological signs or symptoms. The diffusion-weighted magnetic resonance imaging (MRI) was normal on initial presentation, but 4 weeks after the onset of symptoms, the patient developed ipsilateral facial paralysis and dysarthria. A follow-up MRI revealed acute infarction in the territory of the anterior inferior cerebellar artery, involving the right lateral pons, right middle cerebellar peduncle, and inferolateral cerebellum.

The Comparison of the Magnetic Resonance Images in the Patient With Definite Meniere’s Disease Before and After Endolymphatic Sac Decompression: Mi Joo Kim, Gyu Cheol Han, Seung Won Chung; Res Vestib Sci. 2009;8(2):152-155.

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Abstract PDF: Endolymphatic hydrops is believed to be underlying pathophysiology of Meniere’s disease. The degree of endolymphatic hydrops observed by MRI (magnetic resonance imaging) in patients with Meniere’s disease offers a new method to study the progression of Meniere’s disease. There have been multiple attempts to diagnose Meniere’s disease with the help of radiologic tests including MRI in Korea. We describe a case report of a patient with Meniere’s who showed changes of endolymphatic sac in MRI after endolymphatic sac decompression.

Acute Sensorineural Hearing Loss with Simultaneous Ipsilateral Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Report of a Case and Review of the Literature: Ji Hee Lee, Seong Hae Jeong, Eung Seok Oh, Eun Hee Sohn, Ae Young Lee, Jae Moon Kim; Res Vestib Sci. 2009;8(2):156-160.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder. Advanced age, head or ear trauma, other inner ear disorders, female sex and osteopenia/osteoporosis are known predisposing factors for pSCC BPPV. An association with simultaneous ipsilateral sudden deafness remains to be elucidated. We report a 62-year old woman with sudden deafness and simultaneous ipsilateral pSCC BPPV.

Downbeat, Gaze-evoked and Perverted Head-shaking Nystagmus Associated with Dapsone Toxicity: Tae Woo Kim, Sun Young Oh, Ha Cheol Choi, Byoung Soo Shin, Man Wook Seo, Young Hyun Kim; Res Vestib Sci. 2009;8(2):161-163.

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Abstract PDF: Dapsone is an agent commonly used to treat leprosy and its most common adverse effect is a hemolytic anemia. We present a patient who showed transient downbeat, bilateral horizontal gaze-evoked nystagmus (GEN), and perverted head-shaking nystagmus after taking a large dose of dapsone. These oculomotor abnormalities are assumed to be a reversible vestibulocerebellar dysfunction caused by over-dose of dapsone.

A Case of Vestibular Schwannoma Mimicking Acute Labyrinthitis: Dong Yeol Han, Won Ik Jang, Jong Dae Lee; Res Vestib Sci. 2009;8(2):164-167.

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Abstract PDF: Acute labyrinthitis is clinically characterized by cochlear symptom like sudden hearing loss, tinnitus and aural fullness and vestibular symptom like vertigo and spontaneous nystagmus. Several disease entities may mimic labyrinthitis when the disease does not manifest its own characteristic findings. We present the case of a 43-year-old female patient who was suffering from the acute vertigo and sudden hearing loss in her right ear. The speech discrimination score in right side was 24% and brain magnetic resonance imagine revealed a mass in internal auditory canal and minimally extending cerebellopontine angle. Removal of mass was performed via translabyrinthine approach and rapid vestibular compensation was accomplished after surgery.

Possibility of Misdiagnosing the Lesion Side in Unilateral Vestibular Weakness: Il Kwon Cho, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; Res Vestib Sci. 2009;8(2):168-173.

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Abstract PDF: Sudden sensorineural Hearing Loss with Vertigo (SHLV) is characteristic of sudden onset vertigo and unilateral hearing loss, due to acute and profound deterioration in a vestibular and cochlear system. It is relatively easy to determine the lesion side in SHLV, because the patient will complain of unilateral hearing loss. But, it might not beapplicable to vestibular neuritis case, and several vestibular function tests may be helpful in deciding the lesion side. We have recently encountered a patient with SHLV whose caloric and SHA did not match with the lesion side. We speculated that the uncompensated dynamic defect and imbalance of the cerebellar clamping has been implicated in this lab finding. Although the exact mechanism of this curious finding cannot be explained by this single case report, we should consider that one could make a mistake to determine the involved site just only by lab finding in vestibular neuritis.

A Case of Otosclerosis with Meniere’s Symptom: Dong Woo Hyun, Se Ra Park, Sung Huhn Kim, Won Sang Lee; Res Vestib Sci. 2009;8(2):174-177.

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Abstract PDF: It has been postulated that otosclerosis may produce vertigo by several mechanisms. An association between otosclerosis and Meniere’s disease has been proposed on both a clinical and histopathologic basis but the causal relationship is controversial. We report a case of bilateral otosclerosis in a man manifesting vertiginous symptoms. Fifty one year-old man was examined for rotational vertigo and poor hearing in his both ear for ten years. The audiogram revealed left sided hearing loss of a conductive type and right sided sensorineural hearing loss, and caloric asymmetry. Meniere’s disease was suspected, but temporal bone CT showed low attenuated lesion around bilateral cochlear and semicircular canal. A diagnosis of otosclerosis was made. He was recommended sodium fluoride therapy. Severe endolymphatic hydrops manifesting itself as Meniere’s disease can be the result of otosclerosis, so vertiginous and concurrent hearing symptoms should not be overlooked.

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