Anxiety, depression, or other psychiatric symptoms can be the primary cause of dizziness and the secondary complication of dizziness. Regardless of precedence or consequence, dizziness is closely associated with the psychiatric problem. On this ground, this chapter reviews the association between dizziness and anxiety and the treatment for dizziness with psychiatric symptoms.
Objectives During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on the temporal relationship between caloric nystagmus and perception.
Methods Consecutive 57 participants underwent bithermal caloric test in the dizziness clinic of Chungnam National University Hospital from February 2018 to September 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results In most participants, the caloric nystagmus preceded the vestibular sensation (79.6% in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Menière’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1), and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7 seconds. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during the caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusions During the bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggest the bithermal caloric stimulation does not reflect only the signal originating from the horizontal canal pathway. A further validation study is needed.
Persistent postural perceptual dizziness (PPPD) is a chronic functional vestibular disorder that manifests with 3 or more months of dizziness, nonspinning vertigo, and unsteadiness. These main symptoms are exacerbated by upright posture, active or passive self-motion, and exposure to visual stimuli. PPPD is usually precipitated by illnesses that cause vertigo, dizziness, or unsteadiness. The common precipitants are acute or episodic peripheral vestibular diseases including vestibular neuritis, Meniere disease, or benign paroxysmal positional vertigo. PPPD is not a diagnosis of exclusion. An abnormal finding on examination or laboratory testing does not necessarily exclude a diagnosis of PPPD. This article reviewed the Bárány Society’s diagnostic criteria for PPPD in detail and discussed directions of future investigations.
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.
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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
Persistent postural-perceptual dizziness (PPPD) was derived from phobic postural vertigo and chronic subjective dizziness. Two key physical symptoms of PPPD are postural unsteadiness and visually induced dizziness. Although the underlying mechanism of PPPD is still enigmatic, the prognosis is good with adequate treatment. In this paper, diagnostic criteria, pathophysiology and treatment regarding PPPD will be reviewed.
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A Case Report of Persistent Postural-Perceptual Dizziness Treated with Korean Medicine Min-hwa Kim, Gi-yoon Heo, Hee-kyung Kang, I-rang Nam, Maria Kim, In Lee, Jung-nam Kwon, So-yeon Kim, Young-ju Yun, Jun-yong Choi, Chang-woo Han, So-jung Park, Jin-woo Hong The Journal of Internal Korean Medicine.2022; 43(4): 769. CrossRef
Pitfalls in the Diagnosis of Vertigo Hyun Ah Kim, Hyung Lee Journal of the Korean Neurological Association.2018; 36(4): 280. CrossRef