Research in Vestibular Science

Efficacy of the Fixation Index of Bithermal Caloric Test for Differentiating Brain Lesions in Vestibular Disoder: Young Jae Lee, Wonyong Baek, Sung-Il Cho, Gi-Sung Nam; Res Vestib Sci. 2023;22(4):106-111. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.106

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Abstract PDF: Objectives
This study was performed to investigate the efficacy of the fixation index (FI) of the bithermal caloric test for differentiating brain lesions in vestibular disorder.
Methods
We reviewed the medical records of 286 consecutive dizzy patients who underwent brain magnetic resonance imaging (MRI) and the bithermal caloric test at department of otorhinolarnygology. Central vestibulopathy (CVP) was defined as when corresponding lesion was identified on brain MRI, otherwise peripheral vestibulopathy (PVP) was defined. The FI was defined as the mean slow phase velocity (SPV) with fixation divided by the mean SPV without fixation, and failure was indicated when the FI exceeded 70%.
Results
The CVP confirmed by brain MRI and PVP were 16.8% and 83.2%, respectively. The most common CVPs were cerebellopontine angle tumor (n=19, 39.6%) and chronic cerebellar infarction (n=18, 37.5%). There were 23 cases of CVP (47.9%) and 47 cases of PVP (19.7%) with abnormal number of FI in at least two of the four caloric irrigations. The FI score of right cool (RC), left cool (LC), and right warm (RW) were also increased significantly in patients with CVP (p=0.031 at RCFI, p=0.014 at LCFI, p=0.047 at RWFI, and p=0.057 at LWFI; Mann-Whitney U-test).
Conclusions
If two or more abnormal FIs are detected during bithermal caloric testing, there is a high likelihood of CVP. Consequently, additional brain MRI may be necessary for further evaluation.

Endolymphatic Hydrops in Vestibular Migraine Associated with Menière’s Disease: A Report of Two Cases: Bit Na Lee, Seung-Bae Hwang, Jin-ju Kang, Sun-Young Oh; Res Vestib Sci. 2021;20(4):156-160. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.156

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Vestibular migraine and Menière’s disease have similar clinical features which are recurrent dizziness or auditory symptoms, so it is challengeable to establish the correct diagnosis. Herein, a 31-year-old male and a 56-year-old female showed recurrent dizziness with auditory symptoms and suffered from vestibular migraine. They met the diagnostic criteria for vestibular migraine, but the Menière’s diagnostic criteria were not satisfied as there was no hearing loss. Delayed intravenous gadolinium enhanced magnetic resonance imaging of the inner ear was taken to find out of correlation of the inner ear and revealed endolymphatic hydrops. This case can improve the understanding of the pathophysiology of a vestibular migraine associated Menière’s disease.

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Functional and Molecular Markers for Hearing Loss and Vertigo Attacks in Meniere’s Disease
Chao-Hui Yang, Ming-Yu Yang, Chung-Feng Hwang, Kuang-Hsu Lien
International Journal of Molecular Sciences.2023; 24(3): 2504. CrossRef

Rare Neuro-Ophthalmological Manifestations of Focal Midbrain Infarction: Joong-Goo Kim, Ji-Hoon Kang, Jay Chol Choi, Hong Jun Kim, Chul-Hoo Kang; Res Vestib Sci. 2021;20(2):58-63. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.58

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Abstract PDF

Because numerous important nuclei and white matter tracts are concentrated in the narrow midbrain, the tiny lesion can result in various symptoms. The anatomy of the neural network and related structures in the midbrain is complex. The most frequent clinical manifestation of lesions involving the midbrain is an eye movement disorder associated with a nuclear or fascicular origin. We have described patients with acute midbrain stroke, characterized by rare neuro-ophthalmologic manifestations, which neurologists should consider during diagnostic investigations. Case 1 showed internuclear ophthalmoplegia with Horner syndrome. In case 2 showed isolated oculomotor palsy. The third patient presented Parinaud syndrome with an unusual lesion location. Notably, patients with midbrain infarction may present with specific signs and symptoms that are compatible with mesencephalic localization. The isolated or combined neuro-ophthalmologic signs and symptoms should be interpreted in the complex anatomical context described here and investigated by immediate brainstem neuroimaging analyses and careful neurologic examinations.

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A Improved Case of Post Cerebral Infarction Dizziness and Gait Discomfort after Treated with Korean Medicine Treatment and Vestibular Rehabilitation Practice
Hongmin Chu, Hyeon-Seo Lim, Kwangho Kim, Young-Ung Lee, Kyungtae Park, Jongwon Jang, Ho-sun Ryu, Su-hak Kim, Cheol-hyun Kim, Sangkwan Lee, Kang-keyng Sung
Journal of Korean Medicine Rehabilitation.2020; 30(4): 179. CrossRef

Acute Peripheral Vestibular Syndrome in Relapsing Polychondritis: Haemin Noh, Dong-Han Lee, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2020;19(3):104-109. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.104

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Abstract PDF Supplementary Material: Relapsing polychondritis is a rare multisystemic autoimmune disorder of unknown etiology and characterized by recurrent episodes of inflammation affecting the cartilaginous tissues. Otologic manifestation such as auricular chondritis is one of the most frequent presenting symptoms in relapsing polychondritis, and inner ear symptoms, such as hearing loss, tinnitus, and vertigo, may develop in 7% to 42% of the patients. In this study, we present a 42-year-old male patient with relapsing polychondritis, who experienced two separate episodes of acute vestibular syndrome at the interval of 6 years. At the first vertigo attack, the patient showed left-beating spontaneous nystagmus with sudden hearing loss on the right side, and a bithermal caloric test revealed canal paresis on the right side. At the second vertigo attack, he showed right-beating spontaneous nystagmus, and a bithermal caloric test, compared to that during the first vertigo attack, revealed additional decrease in caloric response on the left side.

Recent Research Trend for Ménièreʼs Disease: Sung-Il Nam; Res Vestib Sci. 2017;16(2):39-46. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.39

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Abstract PDF: Ménièreʼs disease is a poorly understood disorder of the inner ear characterized by intermittent episodic vertigo, fluctuating hearing loss, ear fullness and tinnitus. In this paper, we present a review of the histopathology, cytochemistry, gene, blood-labyrinthine barrier and imaging of Ménièreʼs disease. Histopathology is significant for neuroepithelial damage with hair cell loss, basement membrane thickening, perivascular damage and microvascular damage. Cytochemical alterations are significant for altered AQP4 and AQP6 expression in the supporting cell, and altered cochlin and mitochondrial protein expression. Since the discovery of aquaporin water channels (AQP1, AQP2, AQP3, AQP4, AQP5, AQP6, AQP7 and AQP9), it has become clear that these channels play a crucial role in inner ear fluid homeostasis. Several gene studies related to Ménièreʼs disease have been published, but there is no clear evidence that Ménièreʼs disease is associated with a special gene. Currently, imaging techniques to determine the extent and presence of endolymphatic hydrops are being studied, and further studies are needed to correlate the visualization of the endolymphatic hydrops with clinical symptoms.

Functional Neuroimaging in Neuro-Otology: Jae Jin Song; Res Vestib Sci. 2016;15(1):5-10.

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Abstract PDF: Neuro-otologic symptoms such as dizziness, hearing loss, or tinnitus give rise to peripheral change-induced neuroplasticity or central pathology-induced structural or functional changes. In this regard, functional neuroimaging modalities such as positron emission tomography (PET), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), quantitative electroencephalography (qEEG), or functional near infrared spectroscopy have provided researchers with possibility to observe neuro-otologic disease-induced central functional changes. Among these methods, PET and fMRI are advantageous over qEEG or MEG with regard to spatial resolution, while qEEG and MEG are advantageous over PET or fMRI with regard to temporal resolution. Also, fMRI or MEG is not suitable for patients with implanted devices, whereas PET is not ideal for repetitive measures due to radiation hazard. In other words, as these modalities are complementary to one another, researchers should choose optimum imaging modality on a case by case basis. Hereinafter, representative functional neuroimaging modalities and their application to neuro-otologic research will be summarized.

A Case of Posterior Inferior Cerebellar Artery Infarction Presenting with Sudden Hearing Loss and Vertigo: Sang Hyo Lee, Go Woon Kim, Bum Ki Cho, Chang Woo Kim; Res Vestib Sci. 2013;12(4):136-139.

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Abstract: Sudden hearing loss and vertigo are the typical presentation of anterior inferior cerebellar artery infarction, but may rarely occur in posterior inferior cerebellar artery (PICA) infarction. Here we describe a 65-year-old man who presented with sudden hearing loss in his left ear and severe vertigo. The diffusion-weighted magnetic resonance imaging revealed acute infarction in the territory of PICA and cerebral angiography showed non-visualization of left vertebral artery. Sudden hearing loss and vertigo may be a presentation of PICA infarction.

C-fos Expression of Vestibular Nucleus in C57BL/6 Mouse Under the 7 Tesla Ultra High Magnetic Field: Mi Joo Kim, Min Joo Jung, Ji Hye Bae, Eun Ji Lee, Duk Hyun Kim, Gyu Cheol Han; Res Vestib Sci. 2011;10(1):26-29.

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Abstract PDF: Background and Objectives: A typical side effect of super high magnetic field is dizziness and it is expected that 7 Tesla (T) super high magnetic field will have temporary influence on vestibular nucleus. Prevalence rate of dizziness generally increases with advancing years, so this study discusses whether the influence of 7 T super high magnetic field differs depending on the age. Materials and Methods: C57BL/6 mice weighting from 10-40 g were categorized into 4-week-old and 16-week-old groups. They were exposed to 7 T magnetic field and immunohistochemical staining was done to observe expression of c-fos protein in vestibular nucleus of mice. Results: Control group with normal vestibular system did not show c-fos protein. However, mice exposed to 7 T magnetic field showed c-fos expression selectively on medial and lateral parts of vestibular nucleus and there was no significant difference of c-fos expression between both sides (p<0.05). There was statistically significant difference between the different age group: 16-week-old mice group showed higher number of cells expressing c-fos protein than 4-week-old mice group did (p<0.05). Conclusion: It is statistically significant that 7 T super high magnetic field is more influential to older age group.

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.

Specific MRI and MRA findings of Dural Carotid Cavernous Sinus Fistula -A Case Report-: Won Hee Chung, Jong Se Lee, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2006;5(2):296-298.

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Abstract PDF: Dural carotid-cavernous sinus fistula (d-CCF) is a rare cause of ophthalmoplegia, and it may be overlooked when the prominent external orbito-ocular sign is lacking. Conventional angiography is the gold standard in the diagnosis of d-CCF. Recently, the specific MR findings of d-CCF have increasingly been reported. We report a patient with spontaneous d-CCF presenting with an isolated fourth-nerve palsy in whom magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) demonstrated d-CCF. Key Words : Carotid cavernous sinus fistula, Ophthalmoplegia, Angiography, Magnetic resonance imaging, Magnetic resonance angiography

A Rostro-Caudal Arrangement of the Oculomotor Fascicles Based on MR Findings of Midbrain Infarctions in Two Cases: Jeong Ho Park, Won Hee Chung, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2006;5(2):281-284.

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Abstract PDF: A rostro-caudal topography of the oculomotor nerve fascicles is relatively well known in animal but not in human. We experienced two cases of midbrain infarctions presenting with isolated oculomotor nerve palsies. The MRI of the patient who had monocular elevation palsy with ptosis revealed a lesion in the middle to lower midbrain, whereas that of the other who had monocular depression and adduction palsy with pupillary mydriasis showed a discrete lesion in the upper to middle midbrain. We present the rostro-caudal arrangement of the oculomotor fascicles within midbrain based on MRI findings. Key Words : Oculomotor nerve palsies, Magnetic resonance imaging

A Case of Tolosa-Hunt Syndrome with Serial MRI Findings: Jeong Ho Park, Won Hee Chung, Dae Ho Kim, Ki Bum Sung; J Korean Bal Soc. 2006;5(1):74-77.

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Abstract PDF: To diagnosis Tolosa-Hunt syndrome (TSH) used to be difficult because some other diseases like tumors, sarcoids, vasculitises or other inflammatory masses simulate the clinical manifestations, including steroid responsiveness and radiologic findings. According to the international classification of headache disorders 2nd edition, the diagnosis of THS requires demonstration of granuloma by MRI or biopsy. We performed MRI 4 times during 6 months in a patient who seemed to have THS. Initial MRI was normal but the second MRI showed granuloma which decreased gradually in size with steroid treatment. Key Words : Tolosa-Hunt syndrome, Magnetic resonance imaging, Granuloma

Retrospective Study of Magnetic Resonance Imaging & Vestibular Function Testing in Patients Suggestive of Central Vestibular Disorders: Gyu Cheol Han, Ju Hyoung Lee, Dong Kyu Kim, Hee Young Hwang, Jin Myoung Heo; J Korean Bal Soc. 2004;3(1):141-149.

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Abstract PDF: Background
and Objectives : There were many tools to evaluate dizzy patients with various causes. Our aim was to find the relationship between the magnetic resonance imaging(MRI) and vestibular function testing(VFT) in patients who are supposed of central vestibular disorders and to evaluate their effects. Materials and Methods : We selected 183 patients retrospectively by standardized questionnaires, physical examinations ,chart reviews from 3,825 patients who visited otorhinolaryngology via department of emergency and out patient clinic with chief complaints of dizziness. Among them, 13 patients were supposed to have MRI in relation to dizziness. We analyzed the result of VFT, MRI findings and then classified them in according to lesion locations, pathologic findings in MRI & optokinetic tests, caloric tests, step velocity tests, vestibulo-ocular tests, visual fixation tests in VFT.
Results
: There were 9 ischemic findings, 1 hemorrhagic finding, 3 neoplasms in pathologic findings. There were 5 pons lesions, 4 cerebellum lesions, 3 thalamus lesions, 2 medulla lesions, 2 pituitary lesions and 1 caudate nucleus lesions in locations.
Conclusions
: Dizzy patients visiting otorhinolaryngology OPD had 0.34%(13/3825) central origin vertigo, and vascular disease is most common. Therefore we supported that careful readings of VFT findings in identifying central vestibular disorders were valuable and might well represent the gold standard. MRI was an important tool for evaluating the central nervous system, and we should use MRI to assess central vestibular dysfunction. We concluded MRI correlated well with VFT findings of central vestibular dysfunction. Key Words : Vestibular function testing, Magnetic resonance imaging, Dizziness

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