Research in Vestibular Science

Case Report

MRI Findings of a Cholesteatomatous Labyrinthine Fistula Showing Abnormal Inner Ear Enhancement: Yun Ah Park, Do Yang Park, Tae Sub Chung, Hyun Seok Choi, Eun Jin Son; Res Vestib Sci. 2010;9(4):144-148.

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Abstract PDF: A 59-year-old male patient presented with sudden onset of vertigo and hearing loss. Labyrinthitis due to lateral semicircular canal fistula caused by cholesteamatous otitis media was suspected from temporal bone computed tomography (CT) and clinical symptoms. The patient was treated with canal wall down mastoidectomy with removal of the cholesteatoma and lateral semicircular canal occlusion. Preoperative gadolinium-enhanced magnetic resonance imaging (MRI) images of the inner ear revealed increased signal in the cochlea as well as vestibule. Correlation of the MRI findings and the inner ear involvement in labyrinthine fistula is discussed.

Original Article

Acute Stroke in Patients With Isolated Vertigo: Jungmoo Nam, Curie Chung, Jung Ju Lee, Jong Moo Park, Ja Seong Koo, Ohyun Kwon, Byung Kun Kim; Res Vestib Sci. 2010;9(1):12-15.

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Abstract PDF: Background and Objectives Patients with isolated vertigo could have central or peripheral vestibular disorders. Although some differential points exist between the two conditions, sometimes it is not easy to differentiate central vertigo from that of peripheral vestibular origin, especially in patients with isolated vertigo. We performed this study to determine the frequency of acute infarction and predictors of vertigo associated with stroke in isolated spontaneous vertigo. Materials and Methods We prospectively evaluated 185 consecutive patients who were admitted to neurology department with acute isolated vertigo, after excluding the patients with benign paroxysmal positioning vertigo. Diffusion-weighted MRI (DWI) was obtained in 161 (87.0%) patients. Demographics, stroke risk factors, associated symptoms and signs were reviewed. Also, the locations and vascular territories of the lesions on DWI were investigated. Results Twenty three (14.3%) patients had acute infarction on DWI. Old age and male sex were the predictors of stroke using multivariate analysis (p=0.03 and 0.02). The lesions were located in the cerebellum in 17 patients, medulla in four, and pons in another four. Cerebellar lesions were in the territory of the posterior inferior cerebellar artery in all patients. ConclusionIsolated spontaneous vertigo may develop in posterior circulation stroke, especially in men of old age. The possibility of central origin should be considered in patients with isolated vertigo and DWI might be a good diagnostic tool.

Case Report

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.

Original Articles

Visualization of endolymphatic hydrops using Magnetic Resonance Imaging after intratympanic Gd-DTPA administration in patients with Meniere’s disease: Young Joon Seo, Dae Bo Shim, Jinna Kim, Won Sang Lee; J Korean Bal Soc. 2008;7(2):167-173.

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Abstract PDF: Background and Objectives: Endolymphatic hydrops are known as major causes of Meniere’s disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen –triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere’s disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces. Materials and Methods: Five normal adults and Five patients with Meniere’s disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time. Results: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops. Conclusions: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops. Key words: Endolymphatic hydrops, 3D-FLAIR MRI, Gd-DTPA, Intratympanic injection

3-D Model of The Oculomotor Fascicular Arrangement Within The Midbrain Using Brain MRI: Jeong Ho Park, Du Shin Jeong, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2008;7(1):22-32.

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Abstract PDF: Background and Purpose: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists. Methods: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively. Results: The mean values and range of the X, Y and Z are as follows: X=7.56±4.34, 1≤X≤15; Y=3.43±1.37, 0≤Y≤6; Z=6.51±3.91, 0≤Z≤12.5. Conclusions: The distribution of all the MRI lesions was 0≤|Y|≤6 (mm), 0≤|Z|≤12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.

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