Research in Vestibular Science

Case Reports

A Rare Case of Isolated Infarcts of the Pons with Sudden Vertigo: Clinical Features and Imaging Findings: Dong Hwan Kwon, Eun kyung Jeon, Young Joon Seo; Res Vestib Sci. 2023;22(3):89-94. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.89

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Abstract PDF: Isolated infarcts of the pons (IIP) are a rare subtype of ischemic stroke, accounting for less than 1% of all strokes. It refers to a specific type of ischemic stroke that occurs within the pons region of the brain. IIP can be associated with vertebrobasilar insufficiency in certain cases. This case report describes a 64-year-old female patient who presented with acute vertigo and spontaneous nystagmus to the lesion side, ultimately diagnosed with IIP in the posterior right side of pons. Tegmental pontine infarcts typically manifest as oblique small (lacunar) infarctions that are localized in the mediolateral tegmental area of the middle to upper pons. The patient’s symptoms resolved spontaneously, but a 2-mm infarct was confirmed by brain diffusion magnetic resonance imaging. This case highlights the distinctive symptoms associated with IIP and emphasizes the importance of careful neurological examination and advanced neuroimaging techniques for accurate diagnosis.

A Case of Pontine Infarction with Facial Palsy and Vertigo Confused with Ramsay Hunt Syndrome: Jae Seon Park, Sang Hyun Kim, Jung-Yup Lee, Min-Beom Kim; Res Vestib Sci. 2022;21(2):57-62. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.57

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Abstract PDF: Facial palsy can be caused by central and peripheral causes, and it can also be caused by brain tumors or infarction. A 59-year-old male, who lost his right hearing 13 years ago due to Ramsay Hunt syndrome, visited our hospital with facial palsy and dizziness. Initial brain diffusion-weighted magnetic resonance imaging (MRI) showed no abnormal findings, and recurrent Ramsay Hunt syndrome or a neoplastic lesion in the internal auditory canal was suspected. After hospitalization, the patient was administered high-dose steroids, and the videonystagmography showed direction-changing gaze-induced nystagmus, so a brain MRI reexamination was scheduled. While waiting for MRI, the patient complained of neurological symptoms such as diplopia, and right lower pontine infarction was diagnosed on MRI. The patient was transferred to the neurologic department and was discharged on the 10th day after conservative treatment. During the 1-year follow-up, pontine infarction did not recur, and neurological symptoms such as facial palsy gradually improved.

Original Articles

Rasch Analysis of the Clinimetric Properties of the Korean Dizziness Handicap Inventory in Patients with Parkinson Disease: Da-Young Lee, Hui-Jun Yang, Dong-Seok Yang, Jin-Hyuk Choi, Byoung-Soo Park, Ji-Yun Park; Res Vestib Sci. 2018;17(4):152-159. Published online December 21, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.4.152

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Abstract PDF

Objectives
The Korean Dizziness Handicap Inventory (KDHI), which includes 25 patient-reported items, has been used to assess self-reported dizziness in Korean patients with Parkinson disease (PD). Nevertheless, few studies have examined the KDHI based on item-response theory within this population. The aim of our study was to address the feasibility and clinimetric properties of the KDHI instrument using polytomous Rasch measurement analysis.
Methods
The unidimensionality, scale targeting, separation reliability, item difficulty (severity), and response category utility of the KDHI were statistically assessed based on the Andrich rating scale model. The utilities of the orderedresponse categories of the 3-point Likert scale were analyzed with reference to the probability curves of the response categories. The separation reliability of the KDHI was assessed based on person separation reliability (PSR), which is used to measure the capacity to discriminate among groups of patients with different levels of balance deficits.
Results
Principal component analyses of residuals revealed that the KDHI had unidimensionality. The KHDI had satisfactory PSR and there were no disordered thresholds in the 3-point rating scale. However, the KDHI showed several issues for inappropriate scale targeting and misfit items (items 1 and 2) for Rasch model. Conclusions: The KDHI provide unidimensional measures of imbalance symptoms in patients with PD with adequate separation reliability. There was no statistical evidence of disorder in polytomous rating scales. The Rasch analysis results suggest that the KDHI is a reliable scale for measuring the imbalance symptoms in PD patients, and identified parts for possible amendments in order to further improve the linear metric scale.

Citations

Citations to this article as recorded by

Validation and Reliability of the Cataract-related Visual Function Questionnaire (CVFQ)
Eun Jin Koh, Jong Min Lee, Dong Hui Lim, Danbee Kang, Juhee Cho, Min Kyung Song, In Kwon Chung, Hun Jin Choi, Ji Woong Chang, Jong Hyun Lee, Tae Young Chung, Young Sub Eom, Yeoun Sook Chun, So Hyang Chung, Eun Chul Kim, Joon Young Hyon, Do Hyung Lee
Journal of the Korean Ophthalmological Society.2023; 64(11): 1030. CrossRef
Dizziness in patients with early stages of Parkinson's disease: Prevalence, clinical characteristics and implications
Kyum‐Yil Kwon, Suyeon Park, Mina Lee, Hyunjin Ju, Kayeong Im, Byung‐Euk Joo, Kyung Bok Lee, Hakjae Roh, Moo‐Young Ahn
Geriatrics & Gerontology International.2020; 20(5): 443. CrossRef

Is the Auditory Brainstem Response Diagnostic for Vestibular Paroxysmia?: Ju Han Lee, Sung-Kwang Hong, Hyung-Jong Kim, Hyo-Jeong Lee; Res Vestib Sci. 2018;17(2):55-59. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.55

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Abstract PDF

Objectives
Vestibular paroxysmia (VP) of the eighth cranial nerve is characterized by recurrent auditory and vestibular disturbances when a proximal part of the eighth cranial nerve is continuously pressed by a vessel. A detailed history and several ancillary diagnostic tools, such as tinnitogram, caloric test, auditory brainstem response (ABR) and magnetic resonance imaging, are used for diagnosis of VP. Among them, although Møller criteria using ABR is a simple method, the previous study is insufficient. Therefore, this study aimed to evaluate ABR’s diagnostic value of VP.
Methods
ABR records of the 14 patients (patient group) who were diagnosed with VP and 45 patients (as control) who were diagnosed with only tinnitus were reviewed retrospectively. We analyzed the differences in Møller criteria between 2 groups.
Results
Mean age of the patient group was 52.9 years old and the control group was 55.4 years old. As compared with the control group, there were no significant differences of Møller 3 criteria contents (peak II wave amplitude＜33% [35.7% vs. 15.5%, p=0.133], interpeak latency I–III ≥2.3 msec [42.8% vs. 35.5%, p=0.622]), Contralateral interpeak latency III–V ≥2.2 msec (0% vs. 4.4%, p=1.000) in patient group.
Conclusion
There was no significant difference of ABR parameters according to the Møller criteria between patient and control groups.

Citations

Citations to this article as recorded by

Application of ABR in pathogenic neurovascular compression of the 8th cranial nerve in vestibular paroxysmia
Huiying Sun, Xu Tian, Yang Zhao, Hong Jiang, Zhiqiang Gao, Haiyan Wu
Acta Neurochirurgica.2022; 164(11): 2953. CrossRef
The Effects of Different Reference Methods on Decision-Making Implications of Auditory Brainstem Response
Zhenzhen Liu, Xin Wang, Mingxing Zhu, Yuchao He, Lin Li, Li Chen, Weimin Huang, Zhilong Wei, Shixiong Chen, Yan Chen, Guanglin Li, Plácido R. Pinheiro
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
The Effects of Random Stimulation Rate on Measurements of Auditory Brainstem Response
Xin Wang, Mingxing Zhu, Oluwarotimi Williams Samuel, Xiaochen Wang, Haoshi Zhang, Junjie Yao, Yun Lu, Mingjiang Wang, Subhas Chandra Mukhopadhyay, Wanqing Wu, Shixiong Chen, Guanglin Li
Frontiers in Human Neuroscience.2020;[Epub] CrossRef

Symposium I

Associated Symptoms in Dizziness: Hearing Loss and Tinnitus: Mi Na Park, Myung-Whan Suh; Res Vestib Sci. 2013;12:S16-S23. Published online June 1, 2013

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Abstract PDF: Dizziness is one of the most common complaint leading patients to visit their primary care physicians in older people. Despite its frequency, symptoms of dizziness can be difficult for the physician to categorize. Also many dizzy patients have hearing loss. The evaluation of patients with dizziness depends on not only the history of dizziness, physical findings but also basic laboratory tests such as audiometry, electrocochleogram, Cochlear hydrops analysis masking procedure, auditory brainstem response. Based on these considerations, this article outlines the interpretation of basic audiologic tests which is fundamental in evaluating dizzy patients.

Case Reports

A Case of inferior vestibular schwannoma which was lately diagnosed due to normal hearing level: Chang Jae Choi, Hyung Jin Chun, Hak Chun Lee, Sung Won Chae; J Korean Bal Soc. 2008;7(2):213-217.

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Abstract PDF: Vestibular schwannoma is a benign tumor arising from the Schwann cells in the vestibular nerve. It causes unilateral hearing loss, tinnitus, vertigo and unsteadiness. The most common symptom is reduced hearing on the affected side. In most cases patients present complaining of hearing impairment or vertigo from which the otologist can get a clue to diagnose vestibular schwannoma. We experienced an unusual case of 45-year-old woman presented with recurrent mild dizziness without any hearing loss so the patient initially diagnosed with recurrent vestibulopathy. However, subsequent neurotologic evaluation and posterior fossa MRI scanning confirmed diagnosis of huge vestibular schwannoma originated from inferior vestibular nerve. Key words: Vestibular schwannoma, Dizziness, Hearing loss, Auditory brainstem response

Eight-And-a-Half Syndrome in Pontine Infarction: Hyun Jung Jung, Seung Han Lee, Myeong Kyu Kim, Ki Hyun Cho; J Korean Bal Soc. 2008;7(1):77-80.

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Abstract PDF: Eight-and-a-half syndrome is a clinical syndrome with the combination of a one-and-a-half syndrome and an ipsilateral seventh cranial nerve palsy usually due to a paramedian pontine tegmental lesion. A 57-year-old man presented with dizziness, diplopia, and a left facial palsy. Ocular motor manifestations showed combined left conjugate horizontal gaze palsy and left internuclear ophthalmoplegia (one-and-a-half syndrome). In addition, he had a left lower motor neuron pattern of facial palsy. Brain MR images showed an acute infarction in the left paramedian pontine tegmentum.

Original Article

Body Lateropulsion as an Isolated or Predominant Symptom of a Pontine Infarction: Hyun Ah Kim, Hyung Lee, Byung Rim Park; J Korean Bal Soc. 2006;5(2):224-228.

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Abstract PDF: Background
and Objectives: Body lateropulsion with falling to one side is a well-known clinical feature of stroke in the posterior circulation. Body lateropulsion as an isolated or predominant manifestation of a pontine stroke has not previously been reported. To elucidate the possible mechanisms of patients presenting with body lateropulsion as an isolated or predominant symptom of isolated pontine infarction. Materials and Method: Between May 2004 and February 2006, out of 134 admitted patients with an isolated pontine stroke we identified 8 consecutive patients (6.0%) in the Keimyung University Stroke Registry who had body lateropulsion as the main presenting symptom.
Results
All lesions were localized to the paramedian tegmentum just ventral to the 4th ventricle. All except 1showed a uniform pattern of body lateropulsion, in which the direction of falling was away from the side of infarct. In 2 patients, body lateropulsion was the sole clinical manifestation, whereas the other patients had other neurological signs. All but 1 had contraversive tilting of the subjective visual vertical (SVV). In all cases, the direction of SVV tilt corresponded to the direction of body lateropulsion. The mean net tilt angle was 6.1
Conclusion
Based on the known anatomy of ascending vestibular pathways, the SVV tilting, and MRI findings, body lateropulsion probably results from damage to the graviceptive pathway ascending through paramedian pontine tegmentum. Key Words : Pons, Infarction

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