Research in Vestibular Science

Case Report

Arnold-Chiari Malformation Presented with Spontaneous Down-Beating Nystagmus and Gait Disturbance: Minbum Kim, Youn Jin Cho; Res Vestib Sci. 2023;22(4):132-136. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.132

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Abstract PDF Supplementary Material: Arnold Chiari malformation is a disease which is characterized by herniation of a portion of the cerebellum through the foramen magnum. Symptoms vary depending on the extent of the affected area, including posterior neck pain, upper limb pain, paralysis, paresthesia, weakness, dizziness, and ataxia. Among the patients presenting with dizziness, nystagmus is frequently observed, which is primarily characterized by down-beating nystagmus. We experienced a 42- years-old female patient presented with vertigo and gait disturbance, who were diagnosed with type 1 Arnold-Chiari malformation and treated by surgical decompression.

Review

Canal Conversion and Reentry of Otolith in Benign Paroxysmal Positional Vertigo: Jong Sei Kim, Minbum Kim; Res Vestib Sci. 2023;22(3):59-67. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.59

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Abstract PDF: During the treatment process for benign paroxysmal positional vertigo (BPPV) using the canalith repositioning procedure, the otolith can inadvertently enter the semicircular canal instead of the utricle. Canal conversion refers to the situation where the otolith enters a different semicircular canal, while reentry occurs when the otolith returns to the same semicircular canal. The occurrence of a canal conversion can complicate the accurate diagnosis and treatment of BPPV, potentially leading to misdiagnosis and unsuccessful results in the canalith repositioning procedure. In this review, we aim to summarize the incidence, clinical features, and associated risk factors of canal conversion and reentries.

Original Articles

Clinical Characteristics of Benign Paroxysmal Positional Vertigo Positive on Bilateral Dix-Hallpike Test: Youngrok Jo, Gun Min Lee, Youn Jin Cho, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2023;22(1):14-18. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.14

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Abstract PDF: Objectives
The purpose of this study is to investigate the clinical characteristics of benign paroxysmal positional vertigo (BPPV) which showed torsional nystagmus on bilateral Dix-Hallpike test, and to analyze the clinical features of pseudo-bilateral BPPV.
Methods
This study is a retrospective chart review of a total of 341 patients diagnosed with BPPV of posterior canal (PC-BPPV). Among them, patients who showed torsional nystagmus on bilateral Dix-Hallpike test were defined as “bilateral DixHallpike positive patients,” who were classified into true- and pseudo-bilateral PC-BPPV group through analysis of nystagmus direction. And pseudo-bilateral PC-BPPV were categorized into two subtypes according to their pathomechanisms. Clinical characteristics including sex, age, underlying vestibular disorders, recurrence and the number of Epley maneuvers were analyzed. Student t-test and Mann-Whitney U-test were used for statistical analysis.
Results
Among 341 patients, 27 patients (7.9%) were “bilateral Dix-Hallpike positive patients”. They received more Epley maneuvers than the group of unilateral PC-BPPV until the resolution of nystagmus (2.3 vs. 1.4, p＜0.001). Fifteen patients out of 27 were diagnosed with pseudo-bilateral PC-BPPV, who were classified into two subtypes according to their pathomechanisms. The number of Epley maneuvers was not different between true- and pseudo-bilateral PC-BPPV.
Conclusions
Patients with pseudo-bilateral PC-BPPV were common among “bilateral Dix-Hallpike positive patients.” For their better treatment, understanding of possible pathophysiology, accurate Dix-Hallpike test and detailed analysis of nystagmus direction are necessary.

Characteristics of Nystagmus during Attack of Vestibular Migraine: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2019;18(2):38-42. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.38

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1 Crossref

Abstract PDF

Objectives
The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders.
Methods
This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis.
Results
During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p＜0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups.
Conclusion
Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.

Citations

Citations to this article as recorded by

Vestibular Migraine: A Recent Update on Diagnosis and Treatment
Young Seo Kim, Hak Seung Lee
Research in Vestibular Science.2022; 21(3): 67. CrossRef

Identification of Vestibular Organ Originated Information on Spatial Memory in Mice: Gyu Cheol Han, Minbum Kim, Mi Joo Kim; Res Vestib Sci. 2018;17(4):134-141. Published online December 21, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.4.134

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Abstract PDF

Objectives
We aimed to study the role of vestibular input on spatial memory performance in mice that had undergone bilateral surgical labyrinthectomy, semicircular canal (SCC) occlusion and 4G hypergravity exposure.
Methods
Twelve to 16 weeks old ICR mice (n=30) were used for the experiment. The experimental group divided into 3 groups. One group had undergone bilateral chemical labyrinthectomy, and the other group had performed SCC occlusion surgery, and the last group was exposed to 4G hypergravity for 2 weeks. The movement of mice was recorded using camera in Y maze which had 3 radial arms (35 cm long, 7 cm high, 10 cm wide). We counted the number of visiting arms and analyzed the information of arm selection using program we developed before and after procedure.
Results
The bilateral labyrinthectomy group which semicircular canal and otolithic function was impaired showed low behavioral performance and spacial memory. The semicircular canal occlusion with CO2 laser group which only semicircular canal function was impaired showed no difference in performance activity and spatial memory. However the hypergravity exposure group in which only otolithic function impaired showed spatial memory function was affected but the behavioral performance was spared. The impairment of spatial memory recovered after a few days after exposure in hypergravity group.
Conclusions
This spatial memory function was affected by bilateral vestibular loss. Space-related information processing seems to be determined by otolithic organ information rather than semicircular canals. Due to otolithic function impairment, spatial learning was impaired after exposure to gravity changes in animals and this impaired performance was compensated after normal gravity exposure.

Citations

Citations to this article as recorded by

Galvanic Vestibular Stimulation Improves Spatial Cognition After Unilateral Labyrinthectomy in Mice
Thanh Tin Nguyen, Gi-Sung Nam, Jin-Ju Kang, Gyu Cheol Han, Ji-Soo Kim, Marianne Dieterich, Sun-Young Oh
Frontiers in Neurology.2021;[Epub] CrossRef
The Differential Effects of Acute Right- vs. Left-Sided Vestibular Deafferentation on Spatial Cognition in Unilateral Labyrinthectomized Mice
Thanh Tin Nguyen, Gi-Sung Nam, Jin-Ju Kang, Gyu Cheol Han, Ji-Soo Kim, Marianne Dieterich, Sun-Young Oh
Frontiers in Neurology.2021;[Epub] CrossRef

Review

Posttraumatic Peripheral Vertigo: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2018;17(4):125-129. Published online December 21, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.4.125

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Abstract PDF: Posttraumatic vertigo can be defined as the vertiginous disorder occurred after head and neck trauma without other pre-existing vestibular disorder. Central, peripheral, and combined deficits might cause this condition. Especially, various peripheral vestibulopathies are possible causes of posttraumatic vertigo; benign paroxysmal positional vertigo, temporal bone fracture, perilymphatic fistula, labyrinthine concussion, posttraumatic hydrops, and cervical vertigo. Since the differential diagnosis of the posttraumatic vertigo is often difficult, it is essential to acquire knowledge of their pathophysiology and clinical features. In this review, peripheral vestibulopathy as the possible causes of posttraumatic vertigo were described according to the current literature.

마우스 공간지각과 기억 형성에 미치는 전정 유래 정보의 규명: Mi Joo Kim, Minbum Kim, Gyu Cheol Han; Received November 5, 2018 Accepted December 3, 2018 Published online December 3, 2018; [Accepted]

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Abstract: Objectives
: We aimed to study the role of vestibular input on spatial memory performance in mice that had undergone bilateral surgical labyrinthectomy, SCC occlusion and 4G hypergravity exposure.
Methods
: ICR mice(n=30) were used for the experiment. The experimental group divided into 3 groups. One group had undergone bilateral chemical labyrinthectomy, and the other group had performed SCC occlusion surgery and the last group was exposed to 4G hypergravity for two weeks. The movement of mice were recorded using camera in Y maze which had 3 radial arms. We counted the number of visiting arms and analyzed the information of arm selection using program we developed before and after procedure.
Results
: The bilateral labyrinthectomy group which semicircular canal & otolithic function was impaired showed low behavioral performance and spacial memory. The semicircular canal occlusion with CO2 laser group which only semicircular canal function was impaired showed no difference in performance activity and spatial memory. However the hypergravity exposure group in which only otolithic function impaired showed spatial memory function was affected but the behavioral performance was spared. The impairment of spatial memory recovered after a few days after exposure in hypergravity group.
Conclusion
: This spatial memory function was affected by bilateral vestibular loss. Space-related information processing seems to be determined by otolithic organ information rather than semicircular canals. Due to otolithic function impairment, spatial learning was impaired after exposure to gravity changes in animals and this impaired performance was compensated after normal gravity exposure.

Post-traumatic peripheral vertigo: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Received November 28, 2018 Accepted December 1, 2018 Published online December 1, 2018; [Accepted]

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Abstract: Post-traumatic vertigo can be defined as the vertiginous disorder occurred after head and neck trauma without other pre-existing vestibular disorder. Central, peripheral and combined deficits might cause this condition. Especially, various peripheral vestibulopathies are possible causes of post-traumatic vertigo; benign paroxysmal positional vertigo (BPPV), temporal bone fracture, perilymphatic fistula, labyrinthine concussion, post-traumatic hydrops and cervical vertigo. Since the differential diagnosis of the post-traumatic vertigo is often difficult, it is essential to acquire knowledge of their pathophysiology and clinical features. In this review, peripheral vestibulopathy as the possible causes of post-traumatic vertigo were described according to the current literature.

Post-traumatic peripheral vertigo: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Received November 28, 2018 Accepted December 1, 2018 Published online December 1, 2018; [Accepted]

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Abstract: Post-traumatic vertigo can be defined as the vertiginous disorder occurred after head and neck trauma without other pre-existing vestibular disorder. Central, peripheral and combined deficits might cause this condition. Especially, various peripheral vestibulopathies are possible causes of post-traumatic vertigo; benign paroxysmal positional vertigo (BPPV), temporal bone fracture, perilymphatic fistula, labyrinthine concussion, post-traumatic hydrops and cervical vertigo. Since the differential diagnosis of the post-traumatic vertigo is often difficult, it is essential to acquire knowledge of their pathophysiology and clinical features. In this review, peripheral vestibulopathy as the possible causes of post-traumatic vertigo were described according to the current literature.

Original Article

Hyper-response of Cervical Vestibular Evoked Myogenic Potential in Patients with Meniere Disease: A Preliminary Study: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2018;17(2):44-48. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.44

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2 Crossref

Abstract PDF

Objectives
The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere disease (MD), and to compare the result of cVEMP between probable and definite MD group.
Methods
A total of 110 patients satisfied with probable MD and definite MD criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An interpeak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into 2 groups; hyper-response and hypo-response. Chi-square test and Mann-Whitney U-test were used for statistical analysis.
Results
In the probable MD and definite MD group, the mean IAD was 25.24%±17.79% and 53.82%±34.98%, respectively (p＜0.01). The abnormal response of cVEMP at the affected ear was more frequent in the definite MD group, compared to the probable MD group (32/40 vs. 13/36, p＜0.01). However, hyper-response was more frequently observed in the patients with probable MD, compared to the patients with definite MD (13/36 vs. 3/40, p＜0.01).
Conclusion
Hyper-response of cVEMP was more frequently observed in the early probable MD patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

Citations

Citations to this article as recorded by

Superior Semicircular Canal Dehiscence Syndrome Manifested as Menière’s Disease: A Case Report
Byeong Jin Kim, Yun Na Yang, Chan Mi Lee, Eun Jung Lee
Research in Vestibular Science.2021; 20(3): 108. CrossRef
Characteristics of Nystagmus during Attack of Vestibular Migraine
Soyeon Yoon, Mi Joo Kim, Minbum Kim
Research in Vestibular Science.2019; 18(2): 38. CrossRef

Hyper-response of cVEMP (cervical vestibular evoked myogenic potential) in patients with Meniere disease : a preliminary study: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Received May 16, 2018 Accepted June 5, 2018 Published online June 5, 2018; [Accepted]

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Abstract: Objective: The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere’s disease (MD) , and to compare the result of cVEMP between probable and definite MD group.
Methods
A total of 110 patients satisfied with “Definite” and “Probable MD” criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An inter-peak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into two groups; “hyper-response” and “hypo-response”. Chi-square test and Mann-Whitney U test were used for statistical analysis.
Results
In the “Probable MD” and “Definite MD” group, the mean IAD was 25.24±17.79% and 53.82±34.98% , respectively (p<0.01). The abnormal response of cVEMP at the affected ear was more frequent in the “Definite MD” group, compared to the “Probable MD” group (32/40 vs. 13/36, p<0.01). However, hyper-response was more frequently observed in the patients with “Probable MD” , compared to the patients with “Definite MD” (13/36 vs. 3/40, p<0.01).
Conclusion
Hyper-response of cVEMP was more frequently observed in the early “probable MD” patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

Hyper-response of cVEMP (cervical vestibular evoked myogenic potential) in patients with Meniere disease : a preliminary study: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Received May 16, 2018 Accepted June 5, 2018 Published online June 5, 2018; [Accepted]

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4 Download

Abstract: Objective: The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere’s disease (MD) , and to compare the result of cVEMP between probable and definite MD group.
Methods
A total of 110 patients satisfied with “Definite” and “Probable MD” criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An inter-peak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into two groups; “hyper-response” and “hypo-response”. Chi-square test and Mann-Whitney U test were used for statistical analysis.
Results
In the “Probable MD” and “Definite MD” group, the mean IAD was 25.24±17.79% and 53.82±34.98% , respectively (p<0.01). The abnormal response of cVEMP at the affected ear was more frequent in the “Definite MD” group, compared to the “Probable MD” group (32/40 vs. 13/36, p<0.01). However, hyper-response was more frequently observed in the patients with “Probable MD” , compared to the patients with “Definite MD” (13/36 vs. 3/40, p<0.01).
Conclusion
Hyper-response of cVEMP was more frequently observed in the early “probable MD” patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

Hyper-response of cVEMP (cervical vestibular evoked myogenic potential) in patients with Meniere disease : a preliminary study: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Received May 16, 2018 Accepted June 5, 2018 Published online June 5, 2018; [Accepted]

1,071 View
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Abstract: Objective: The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere’s disease (MD) , and to compare the result of cVEMP between probable and definite MD group.
Methods
A total of 110 patients satisfied with “Definite” and “Probable MD” criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An inter-peak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into two groups; “hyper-response” and “hypo-response”. Chi-square test and Mann-Whitney U test were used for statistical analysis.
Results
In the “Probable MD” and “Definite MD” group, the mean IAD was 25.24±17.79% and 53.82±34.98% , respectively (p<0.01). The abnormal response of cVEMP at the affected ear was more frequent in the “Definite MD” group, compared to the “Probable MD” group (32/40 vs. 13/36, p<0.01). However, hyper-response was more frequently observed in the patients with “Probable MD” , compared to the patients with “Definite MD” (13/36 vs. 3/40, p<0.01).
Conclusion
Hyper-response of cVEMP was more frequently observed in the early “probable MD” patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

Reviews

Experiemental Model for Ménière’s Disease Using Surgical Ablation of Endolymphatic Sac: Minbum Kim, Mi Joo Kim; Res Vestib Sci. 2016;15(4):95-100. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.95

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Abstract PDF: Endolymphatic hydrops is a representing pathologic finding of Ménière's disease. For the induction of endolymphatic hydrops in an animal model, surgical ablation of endolymphatic sac has been used. Although traditional model with the blockage of endolymphatic sac induced severe hydrops, it has several limitations for the study of pathophysiology of Ménière's disease. Recently, modified experimental models have been introduced, in which additional procedure was performed to induce the acute aggravation of hydrops after the surgical ablation. These new models could be helpful to elucidate the mechanism and develop a new treatment of Ménière's disease. In this review, we introduce the characteristics of animal models using surgical ablation of endolymphatic sac from the classical model to novel modified models.

Acute Vestibular Neuritis and Ramsay-Hunt Syndrome: Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2016;15(4):112-120. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.112

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Abstract PDF: Acute vestibular neuritis is the disorder characterized by acute, spontaneous vertigo with the unilateral vestibular loss. Reactivation of herpes simplex virus is considered as its cause. Its management consists of symptomatic therapy in the acute phase and following rehabilitation exercise to improve central compensation. The differential diagnosis should include central vestibular disorders mimicking peripheral vertigo. Ramsay-Hunt syndrome, which defined as a herpes zoster oticus with facial paresis, is also a disorder frequently accompanied with vestibular deficit. Combination therapy of acyclovir and corticosteroid is recommended for the treatment. In this review, diagnosis and management of the two disorders are described.

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