Research in Vestibular Science

Case Reports

Postprandial Dizziness/Syncope Relieved by Alfa-Glucosidase Inhibitor: A Case Report: Hakyeu An, Seong-Hae Jeong, Hyun Jin Kim, Eun Hee Sohn, Ae Young Lee, Jae Moon Kim; Res Vestib Sci. 2018;17(2):67-70. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.67

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Abstract PDF: 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.

Gaze-Evoked and Perverted Head-Shaking Nystagmus in a Patient with Polycythemia Vera: Yong Soo Kim, Ik-Chan Song, Seong-Hae Jeong, Ae Young Lee, Jae Moon Kim; Res Vestib Sci. 2017;16(4):142-146. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.142

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Abstract PDF: 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.

Gaze-evoked and Perverted Head-Shaking Nystagmus In a Patient with Polycythemia Vera: Yongsoo Kim, Ik-Chan Song, Seong-Hae Jeong, Ae Young Lee, Jae Moon Kim; Received November 8, 2017 Accepted November 27, 2017 Published online November 27, 2017; [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.

Case Report

A Case of Unilateral Internal Carotid Artery Stenosis Presenting with Chronic Isolated Dizziness: Ju Heon Lee, Seong Hae Jeong, Young Gi Lim, Joo Yeon Ham, Hye Seon Jeong, Jae Moon Kim; Res Vestib Sci. 2016;15(2):60-63. Published online June 15, 2016

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Abstract PDF: 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.

Original Articles

Can Nitroglycerin Differentiate Benign Recurrent Vertigo From Vestibular Migraine? A Preliminary Study: Jong Wook Shin, Seong Hae Jeong, Ji Eun Oh, Ae Young Lee, Jae Moon Kim, Ji Soo Kim; Res Vestib Sci. 2012;11(1):8-13.

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Abstract PDF: Background and Objectives: Nitroglycerin (NTG), a donor of nitric oxide, is known to provoke migraine attacks in patients with migraine. However, this effect was not explored in patients with benign recurrent vertigo (BRV). To infer the mechanism of BRV, we evaluated provocative effects of NTG in patients with vestibular migraine (VM) and BRV compared with normal controls. Materials and Methods: Thirteen patients with recurrent vertigo, 8 with VM and 5 with BRV, and 5 healthy controls received intravenous infusion of 0.5 μg/kg/min NTG over 20 minutes. Headache intensity (visual analog scale) and associated symptoms were recorded at baseline and every 10 minutes for an hour. And the subjects were also asked to complete a headache diary every hour for another 12 hours. Results: In contrast to normal controls (2/5, 40%, p=0.035) and the patients with BRV (1/5, 20%, p=0.007), all patients with VM (8/8, 100%) had migraine attacks after NTG injection. However, there was no difference in the proportion of the patients with migraine attacks after NTG injection between normal controls and the patients with BRV. Conclusion: In contrast to the patients with VM, patients with BRV are not sensitive to nitric oxide. These results suggest that the pathophysiology of BRV may be different from that of VM.

Prediction of Successful Repositioning of Horizontal Canal Benign Positional Vertigo in Gufoni’s Maneuver: A Preliminary Study: Jeong Soo Moon, Jong Wook Shin, Hyun Jung Kim, In Chul Baek, Eung Seok Oh, Ji Eun Oh, Kyung Jae Lee, Ji Hee Lee, Jae Moon Kim, Seong Hae Jeong; Res Vestib Sci. 2010;9(3):108-113.

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Abstract PDF: Background and Objectives: Although several methods of repositioning maneuver have been introduced for the benign paroxysmal positional vertigo involving horizontal canal (HC-BPPV), no study has investigated the nystagmus pattern during the repositioning maneuver and its correlation with the repositioning results. Therefore, we evaluated the predictive value of the nystagmus for successful repositioning by studying the nystagmus pattern during the position of the Gufoni’s maneuver. Materials and Methods: Seventeen consecutive patients (age range=36~76 years, median age=64), with a diagnosis of HC-BPPV were recruited between July and August 2010. The Gufoni's maneuver for apogeotropic and geotropic nystagmus was performed. After 30 minutes, the treatment outcome was evaluated according to the nystagmus pattern at the individual stage of Gufoni’s maneuver. Successful treatment was defined by the resolution of positional vertigo in geotropic HC-BPPV and nystagmus shifted from apogeotropic to geotropic in apogeotropic HC-BPPV. Results: In the successfully treated patients, 4 of 6 patients had the contralesional nystagmus between 1st and 2nd position of Gufoni’s maneuver. Ipsilesional nystagmus in 1st position of Gufoni’s maneuver was observed in 1 patient with apogeotropic nystagmus. And the other 1 patient with Geotropic HC-BPPV showed no nystagmus in 2nd position after contralesional nystagmus in 1st position of Gufoni’s maneuver. Unsuccessfully treated 11 patients had a conversion of nystagmus direction in 2nd position after 1st step. Conclusion: During the 2nd position of the Gufoni’s maneuver, a nystagmus toward unaffected side predicts a successful repositioning, whereas reversed nystagmus is suggestive of poor response to repositioning.

Case Reports

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.

Periodic Alternating Nystagmus in Vestibulocochlear Disorder: Seong Hae Jeong, Eung Seok Oh, Ji Hee Lee, Jae Moon Kim; Res Vestib Sci. 2009;8(1):49-51.

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Abstract PDF: Periodic alternating nystagmus (PAN) is characterized by horizontal nystagmus that reverses direction periodically. PAN can occur in both congenital and acquired conditions. We report a 58-year old man with peripheral vertigo and hearing impairment showing PAN in darkness. Key Words: Vertigo; Hearing loss; Nystagmus, Pathologic; Meniere Disease

Original Article

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles: Sun Young Oh, Kwang Dong Choi, Jae Moon Kim, Jei Kim, Seong Ho Park, Ji Soo Kim; J Korean Bal Soc. 2006;5(1):35-43.

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Abstract PDF: Background
and Objectives: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. Materials and Method: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points.
Results
The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV.
Conclusion
These results suggest that low level laser promotes hair cell viability in utricular explants. Key Words : Organotypic culture, Low level laser, FM 1-43, Utricle

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