Research in Vestibular Science

Case Report

Rotatory Vertebral Artery Syndrome in Foramen Magnum Stenosis: Ileok Jung, Jin-Man Jung, Moon Ho Park; Res Vestib Sci. 2018;17(4):167-169. Published online December 21, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.4.167

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Rotatory vertebral artery syndrome (RVAS) is characterized by recurrent attacks of vertigo, nystagmus, and syncope induced by compression of the vertebral artery during head rotation. A 60-year-old man with atlas vertebrae fracture presented recurrent attacks of positional vertigo. Left-beat, upbeat and count clock-wise torsional nystagmus occurred after lying down and bilateral head roll (HR) showing no latency or fatigue. Magnetic resonance imaging revealed foramen magnum stenosis (FMS) and dominancy of right vertebral artery (VA). The flow of the right VA on transcranial Doppler decreased significantly during left HR. The slower the velocity was, the more the nystagmus was aggravated. RVAS can be evoked by FMS causing compression of the VA. And the nystagmus might be aggravated according to the blood flow insufficiency.

Citations

Citations to this article as recorded by

A Case of Rotational Vertebral Artery Syndrome after Vertebral Artery Dissection
Song Jae Lee, Ha Young Byun, Seung Hwan Lee, Jae Ho Chung
Korean Journal of Otorhinolaryngology-Head and Nec.2020; 63(5): 228. CrossRef

Symposium III

Treatment of Horizontal Canal Benign Paroxysmal Positional Vertigo: Sun-Young Oh; Res Vestib Sci. 2013;12:S77-S81. Published online June 1, 2013

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Abstract PDF: Several methods of physiotherapy have been advanced for benign paroxysmal positional vertigo involving horizontal semicircular canal (HC-BPPV). In this review article, the diagnosis and therapeutic maneuvers for HC-BPPV including recently published several randomized controlled trials are described.

Case Report

Vestibular Dysfunction in Acute Cerebellar Ataxia: Chang Min Lee; Res Vestib Sci. 2015;14(1):21-25.

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Abstract PDF: Acute cerebellar ataxia is described as a clinical syndrome of acute onset of cerebellar dysfunction with a good long-term prognosis. The pathogenesis of acute cerebellar ataxia remains unclear. A 55-year-old woman presented with acute onset of gait ataxia and dysarthria. The videonystagmography showed saccadic pursuit and saccadic abnormalities including slightly prolonged latency and hypometria. Rotational chair test revealed increased vestibuloocular reflex (VOR) gains and a failure of VOR suppression by visual fixation. Brain magnetic resonance imaging and cerebrospinal fluid examination were normal. The patient was treated with steroids and made nearly complete recovery over a period of 3 months.

Original Articles

New Proposal of Functional Status of Vestibular System Based on Vestibular Function Tests Findings in Dizzy Patients with Normal Caloric Response: Hye Youn Youm, Yang Sun Cho, Sung Hwa Hong, Won Ho Chung; Res Vestib Sci. 2011;10(4):121-128.

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Abstract PDF: Background and Objectives: Vestibular function tests are very useful in diagnosing dizzy patients. Among them, bithermal caloric test is most commonly used test for localizing their permanent vestibular loss. However, it causes much discomfort to the patients with non-physiologic stimuli. In addition, it doesn't represent the present functional status of vestibular system. Therefore, normal caloric result does not accurately correspond to normal vestibular function in dizzy patients. Currently, rotation chair test and dynamic posturography have been introduced adjunctly to assess vestibular function accompanied by bithermal caloric test. It has not been elucidated for their specific role in diverse settings of vestibular disorders. So we planned this study to evaluate clinical usefulness of rotation chair test, videonystagmography and computerized dynamic posturogr-phy in dizzy patients with normal caloric response. Materials and Methods: We reviewed clinical records of 46 patients who met their inclusion criteria. They were categorized into five subgroups according to abnormal vestibular function test findings. Results: In each subgroup, we hypothesized its clinical relevance, possible mechanism of dizz-iness and presumed diagnosis. Five categories are as below; visual dependency, imbalance of vestibular tones, chronic peripheral vestibulopathy, abnormality in the vestibulospinal tract and abnormality of oculomotor system. Conclusion: We suggest new classification of abnormal vestibular functional status in dizzy patients with normal caloric results. These are comparable according their clinical features and thought to be helpful in managing and counseling each patient.

Influence of Head Position in Rotation Test: Jeong Seok Choi, Jae Eun Kim, Kyu Sung Kim, Hoseok Choi; Res Vestib Sci. 2011;10(2):52-55.

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Abstract PDF: Background and Objectives: Rotation test is a widely used method to evaluate the function of the vestibular system. Generally, the head position to be tilted forwards 30° during rotation is preferred in order to bring the horizontal semicircular canals into the plane of rotation, thus ensuring maximum response. However literatures do not provide a clear reference concerning head position during the rotation test. So, we evaluated the vestibuloocular reflex (VOR) induced by sinusoidal rotation in the horizontal plane in the two different head positions: the head tilted forward 30° and with the head upright. Materials and Methods: A total of 20 men with no known neuro-otological disorders and 9 guinea pigs were studied. The rotations of slow harmonic acceleration on various frequencies were performed with the subject’s head in the upright position and in the 30 pitched down position. Computerized electronystagmography in human and magnetic coil in guinea pigs were used to measure the maximum velocity of slow component of horizontal nystagmus and to calculate gain, phase and symmetry of VOR responses. Results: In both groups, results showed no significant differences in gain, phase and symmetry. Conclusion: In the two different head positions, there were no significant differences in gain, phase and symmetry. The posture of head upright is more comfortable for the patient and gives enough response for the evaluation of vestibular function.

Subjective Visual Vertical during Eccentric Rotation in Acute Vestibular Neuritis Patients: Kee Hwan Kwon, Moon Suh Park, Jae Yong Byun; J Korean Bal Soc. 2008;7(2):182-187.

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Abstract PDF: Background and objective: By assessing unilateral utricular function at the acute unilateral vestinuloneuritis (Acute UVN), we sought to determine the ability of the subjective visual vertical (SVV) during eccentric rotation (dynamic SVV) in localizing the site of the lesion in unilateral vestibular neuritis (UVN). Methods: The static SVV and dynamic SVV of fifteen patients diagnosed with acute UVN were enrolled within 10 days of onset (average 7 days). First, the static SVV was measured in a dark booth without rotation. The dynamic SVV was measured during rotation with an eccentric displacement of the head to 3.5 cm from the vertical rotation axis during a constant velocity of 300°/s. Results: In the acute stage of UVN, the static SVV showed an increase in deviation to the side of the lesion compared to those of normal subjects. Also, we found 73% of abnormal findings in Acute UVN patients by assessing static conventional SVV. The dynamic SVV had a statistically significant increase in deviation to the side of the lesion compared to those of normal subjects and 93% patients showed beyond normal range. Conclusions: The dynamic SVV would be an effective method in the diagnosis and localization of acute unilateral vestibularneuritis, Key words: Acute vestibular neuritis, Subjective visual vertical, Eccentric rotation

Effect of Low Power Laser Irradiation on Gentamicin-Damaged Vestibular System in Guinea Pigs: Chung Ku Rhee, Myoung Chan Kim, Eun Seok Lim, Young Saeng Kim; J Korean Bal Soc. 2005;4(2):225-229.

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Abstract PDF: Background
and Objectives:The purpose of this study was to investigate the characteristics of gentamicin-induced vestibulotoxicity of otolith organs and preventive effect of low power laser to vestibulotoxicity by assessing the result of earth vertical and the off vertical axis rotation tests. Materials and Method: Twenty guinea pigs were grouped into two groups, laser and no laser group. Vestibulotoxicity was induced by intratympanic injection of gentamicin. Prevention of the vestibulotoxicity was studied by irradiation of low power laser. Off vertical axis rotation tilted 30 degree relative to the earth vertical axis was applied to evaluate the otolithic function.
Results
Gentamicin induced vestibulotoxicity was confirmed by gain decreasing in slow harmonic acceleration test and modulation decreasing in the off vertical axis rotation test. Prevention effect of low power laser to gentamicin induced vestibulotoxicity was confirmed by modulation maintaining in the off vertical axis rotation test and gain maintaining in the earth vertical axis rotation.

Review

Comparison of Vestibule-ocular Reflex of Eccentric Rotation with Centric Rotation in Normal Subjects: Byung Han Cho, Seung Yeun Jang, Ho Suk Choi, Seung Chul Lee, Kyu Sung Kim; J Korean Bal Soc. 2004;3(2):351-335.

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Abstract PDF: Background
and Objectives : Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. By placing subjects off from the axis of rotation, the otolithic organ may also be simultaneously stimulated by additional linear acceleration forces. In the present study, we compared the rotation with subjects placed on axis to those placed in an eccentric position. Materials and Method : In the eccentric rotation, the head of subject was facing outward and placed eccentrically for 33cm on naso-occipital axis. Slow harmonic acceleration test and velocity step test were performed.
Results
: The sinusoidal eccentric rotation at 0.32, 0.64 Hz produced a significantly higher vestibulo-ocular reflex gain than did on axis rotation. In velocity step test, initial slow component velocity was significantly higher in eccentric rotation than in centric rotation.
Conclusion
: These finding suggest that the gain enhancement due to eccentric rotation is a result of tangentiallinear acceleration, probably sensed by the otolithic organ. This study raises the possibility of using eccentric rotation for the diagnosis of the patients with otolithic dysfunction.

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