Objectives This study was performed to investigate seasonal variation in the incidence of vestibular neuritis (VN) without recent steroid treatments using nationwide health insurance data. The aim of the study is to elucidate whether seasonal trends can inform optimized diagnostic and treatment strategies for VN.
Methods A retrospective analysis was conducted using data from the Health Insurance Review and Assessment Service (HIRA) in South Korea from 2007 to 2022. Patients diagnosed with VN were identified using specific operational criteria. Seasonal trends were evaluated by analyzing monthly, quarterly, and seasonal variations in VN incidence, stratified by age and sex.
Results Out of 237,673 VN patients identified, our analysis revealed significant seasonal variations in incidence, with a notable decline during winter months—especially in February—and an increase during the spring. These patterns were consistent across sex and age groups.
Conclusions This nationwide study demonstrates that VN exhibits distinct seasonal variations that have significant implications for clinical practice. These results indicate a potential influence of seasonal factors on the occurrence of VN and contribute to more efficient allocation of healthcare resources. Future prospective studies are warranted to further elucidate the mechanisms behind these seasonal differences.
Objectives This study is performed to evaluate the effect of early steroid treatment within 24 hours of onset in acute vestibular neuritis (AVN).
Methods We performed a retrospective case-control study with 46 patients with AVN. Video head impulse test paradigm (HIMP) and suppression HIMP were performed, and dizziness handicap index (DHI) was determined at initial; all tests were repeated at 1 month. Patients were divided into two groups depending on whether they were treated with steroids (group S, n=21) or not (group n-S, n=25).
Results There was no significant difference in age, sex, and side between the two groups. In HIMP, group S showed a significantly lower occurrence of overt corrective saccade (CS) (p=0.034) and lower peak velocity of overt CS (p=0.020) than group n-S at 1 month. In addition, the DHI score at 1 month was significantly lower in group S than in group n-S (p=0.040). In correlation analysis between subjective symptom and objective parameters, the DHI score showed a significant correlation with the occurrence of overt CS (p=0.028) and PR score (p=0.006) at 1 month.
Conclusions Early steroid treatment in AVN would be helpful for relieving symptoms and the improvement of vestibular ocular reflex function in the recovery phase.
Objectives Big data analytics in healthcare research have gained momentum, offering unprecedented opportunities to investigate complex medical conditions like acute vestibular neuritis (AVN). However, an inappropriate definition can introduce bias and inaccuracies into prevalence estimation, making the results unreliable and hindering cross-study comparisons. The Health Insurance data in South Korea will be used to create a robust operational definition for AVN.
Methods The study utilized the National Patients Sample dataset from the Health Insurance Review and Assessment Service (HIRA) of the Republic of Korea. The operational definition of AVN was defined using the HIRA data, which includes specific codes for diagnosis, testing, and medications. The revised categorization scheme for AVN was presented as case 1 through case 5, with criteria for each category.
Results The optimal conditions are deemed to be those that encompass the outcomes of both case 5 and case 1-1, encompassing all conditions. The study also provided prevalence estimates for subgroups based on demographic factors (age, sex), and found a consistent pattern throughout all years, sex, and age.
Conclusions The study analyzed the prevalence of AVN in case 1 and case 5, which were similar to the reference prevalence of 3.5 per 100,000 people reported in other countries. The study’s results are encouraging for several reasons, including the validity of the operational definitions used, and the agreement between the study’s prevalence estimates and the reference prevalence. The operational definition in statistics, in the context of big data, serves as a precise and standardized criterion.
Coronavirus disease 2019 (COVID-19) spread rapidly and was declared a pandemic. In this situation, vaccination for COVID-19 is important and has been prompted in many countries. However, a number of adverse events have been reported for the Pfizer, Moderna, and AstraZeneca vaccines. Otolaryngologic adverse events after COVID-19 vaccination were reported, including several cases of sudden sensorineural hearing loss. Vestibular neuritis (VN) is an acute vestibular syndrome that causes acute and spontaneous vertigo due to unilateral vestibular deafferentiation, leading to nausea or vomiting and unsteadiness that can last from days to weeks. Neurotropism for the cochleovestibular nerve, immunoglobulin G mediated immune off-target reaction, and reactivation of latent viruses are hypothesized to be etiologies. Herein, the case of a 49-year-old female who developed VN after COVID-19 vaccination is presented. Although the association between VN and COVID-19 vaccination remains unclear, clinicians should be aware that VN may occur as an adverse event of COVID-19 vaccination.
Paraneoplastic cerebellar degeneration is a rare neurological manifestation of nonmetastatic malignancy. Its usual manifestation is subacute to chronic dizziness, gait ataxia, and dysarthria. There have been only a few cases of paraneoplastic cerebellar degeneration with acute presentation. This study describes a patient with paraneoplastic cerebellar degeneration, who presented acute vestibular syndrome and then episodically developed horizontal gaze-evoked nystagmus and gait ataxia.
Acute vestibular syndrome refers to the rapid onset of vertigo, nausea, vomiting, and unsteady gait. Acute unilateral vestibular neuritis is the most common cause of acute vestibular syndrome. However, vascular lesions involving the brainstem and cerebellum also produce acute vestibular syndrome even without other neurologic deficits. The vestibular nucleus or nucleus prepositus hypoglossi in the dorsal portion of the brainstem, cerebellar structures including flocculus, tonsil, and nodulus, and cerebellar peduncle can produce isolated vertigo and imbalance when damaged. Early recognition of the pseudo-vestibular neuritis of the vascular etiology is warranted for clinicians.
Vast majority of triggering factors preceding vestibular neuritis (VN) are unknown, although many cases are associated with viral infection. A 55-year-old woman was bitten by a viper on her right hand, and she was treated with antivenom at the primary clinic. Three days later, acute persistent vertigo was developed. Neuro-otologic examinations revealed spontaneous left-beating nystagmus and abnormal head impulse test in the right side. Taken together with negative result of brain magnetic resonance imaging, she was diagnosed with a right VN. Various neurological complications such as paralysis, optic neuritis, and stroke can occur after snakebite envenoming. In this case, given the time interval between snakebite and development of dizziness, snakebite envenoming might be a possible predisposing factor of VN as a proinflammatory condition rather than a direct cause of VN. Furthermore, the VN of this case was probably caused by late adverse reactions after antivenom administration. Since about 10% of the snake-bitten patients have complained dizziness, detailed neuro-otologic evaluations may lead to a proper understanding of pathomechanism and a correct diagnosis.
Objectives The aim of this paper was to determine if a correlation exists between video head impulse test (vHIT) and electronystagmography with caloric test (ENG). More specifically, comparison of covert and overt value from vHIT test with cold and warm stimulation value from ENG test.
Methods Retrospective study of our single institue from the period of January 2015 to January 2017 enrolled 91 patients. Patients were divided into 3 groups by their diagnosis of either vestibular neuritis (VN), Meniere disease, or sudden sensorineural loss with vertigo accordingly. Each of the patients’ both ENG and vHIT data were recorded and parameters were evaluated.
Results VN group was the only group to show a significant correlation between canal paresis (CP) with covert and overt saccades. Further analysis was done in the VN group and result showed covert saccade showing a larger area under the receiver operation characteristic curve value (0.77) compared to overt saccades (0.70), implying that covert saccade is a more accurate parameter for the prediction of the CP value. Furthermore, a positive correlation was seen between the gain value and the cold caloric stimulation value as well as between warm caloric stimulation value.
Conclusions The value of our study lies in the fact that we have attempted to find a correlation between different parameters of 2 different vestibular tests. We concluded that the evaluation of overt nystagmus by the bedside head thrust test is inappropriate for predicting CP, and a vHIT is required to accurately evaluate vestibular function.
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A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng Research in Vestibular Science.2023; 22(2): 34. CrossRef
Down-beat nystagmus in peripheral vestibulopathy may rarely occur in selective involvement of inferior division. Diagnosis of isolated inferior vestibular neuritis is based on torsional down-beating spontaneous nystagmus, abnormal head-impulse test for the posterior semicircular canal, and abnormal cervical vestibular evoked myogenic potentials (cVEMPs) with normal bithermal caloric tests and ocular vestibular evoked myogenic potentials (oVEMPs). Herein we report a 50-year-old male patient with spontaneous down-beat nystagmus who demonstrated vestibular dysfunction involving only the posterior semicircular canal. The patient showed normal results in the bithermal caloric test, the oVEMPs and cVEMPs test. Video head impulse test showed decreased gain and corrective saccades only in the posterior semicircular canal. This case is significant in showing that peripheral dizziness with spontaneous down-beating nystagmus can occur as a result of an abnormality involving only a single semicircular canal.
Objectives Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. To demonstrate gait variability in acute unilateral peripheral vestibular deficit, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and healthy subjects by the use of shoe-type inertial measurement unit (IMU) with sensors mounted.
Methods Between April 2017 and January 2019, 30 patients diagnosed with unilateral peripheral vestibular deficit presumed to be caused by VN were enrolled in this study. The shoe-type IMU was used to analysis subjects. We assessed gait speed, cadence, stride length, stance phase, normalized stride length, normalized step length, phase coordination index and gait asymmetry of data from shoe-type IMU sensors with the walking protocol. We tested 30 healthy volunteers as control group.
Results We identified spatiotemporal parameters of human gait. The gait speed of patients with VN was decreased to 3.82±0.8 compared to 4.93±1.08 in control group. In addition, there were differences in normalized stride length, normalized gait speed and related gait parameters, when comparing VN group and control group.
Conclusion Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with VN. Gait performance tests can examine gait variability quantitatively. It will be taken into consideration as a vestibular function test for patients with vertigo.
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Comparison of Gait Parameters during Forward Walking under Different Visual Conditions Using Inertial Motion Sensors Eun Jin Son, Ji Hyung Kim, Hye Eun Noh, Inon Kim, Joo Ae Lim, Seung Hwan Han Yonsei Medical Journal.2022; 63(1): 82. CrossRef
Acute vestibular neuritis (VN) is characterized by acute/subacute vertigo with spontaneous nystagmus and unilateral loss of semicircular canal function. Vestibular system in human is represented in the brain bilaterally with functional asymmetries of the right hemispheric dominance in the right handers. Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time which is also known as the right hemispheric dominance. Three patients (patient 1, 32-year-old female; patient 2, 18-year-old male; patient 3, 63-year-old male) suffered from acute onset of severe vertigo, nausea and vomiting. Patients 1 and 2’s examination revealed VN on the right side showing spontaneous left beating nystagmus and impaired vestibular ocular reflex on the right side in video head-impulse and caloric tests. Patient 3’s finding was fit for VN on the left side. We also evaluated visuospatial memory function with the block design test in these 3 VN patients which discovered lower scores in patients 1 and 2 and the average level in patient 3 compare to those of healthy controls. Follow-up block design test after resolved symptoms showed within normal range in both patients. Our cases suggest that the patients with unilateral peripheral vestibulopathy may have an asymmetrical effect on the higher vestibular cognitive function. The right VN can be associated with transient visuospatial memory dysfunction. These findings add the evidence of significant right hemispheric dominance for vestibular and visuospatial structures in the right-handed subjects, and of predominant dysfunction in the hemisphere ipsilateral to the peripheral lesion side.
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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
Objectives In vestibular neuritis (VN), the lesion preferentially affects the superior vestibular nerve because of the anatomic arrangement. It is well known that VN patients have a higher score of metabolic syndrome or a higher incidence of vertebral artery hypoplasia than controls. However, it is unclear whether the frequency of cardiovascular risk factors can affect the selective involvement of the branch of the vestibular nerve. Thus, we investigated the influence of cardiovascular risk factors on the development of total- or divisional VN. Methods: 61 patients with VN were enrolled. Video head impulse tests and caloric tests were performed to determine which vestibular divisionswere affected. The patients were divided into divisional-VN (superior or inferior) and total-VN groups. Statistical analysis of the frequency of cardiovascular risk factors was performed only in superior and total VN groups because the number of inferior VN patients was too small to be statistically analyzed. Results: Nineteen (31.1%) patients were classified as the total-VN group. In the divisional-VN group (42 patients, 65.6%), 40 were superior VN. The frequency of cardiovascular risk factors are not significantly different in superior VN and total-VN groups (All patients 50/61 [82.0%], superior-VN 36/40 [90.0%], total-VN 13/19 [68.4%]). The frequency of having more than one cardiovascular risk factor was slightly higher in the superior VN group, (13 [68.4%] vs. 36 [90.0%], p=0.062) but did not show any significant difference. Conclusions: The number of cardiovascular risk factors did not differ in superior VN patients compared to total VN patients.
Acute vestibular neuritis is the disorder characterized by acute, spontaneous vertigo with the unilateral vestibular loss. Reactivation of herpes simplex virus is considered as its cause. Its management consists of symptomatic therapy in the acute phase and following rehabilitation exercise to improve central compensation. The differential diagnosis should include central vestibular disorders mimicking peripheral vertigo. Ramsay-Hunt syndrome, which defined as a herpes zoster oticus with facial paresis, is also a disorder frequently accompanied with vestibular deficit. Combination therapy of acyclovir and corticosteroid is recommended for the treatment. In this review, diagnosis and management of the two disorders are described.
Vestibular neuritis is characterized by rapid onset of vertigo, nausea and vomiting
without neurological symptoms or signs, but central vestibular lesions can cause
similar symptoms and signs. A 66-year-old woman previously diagnosed with
ovarian cancer initially presented with vertigo. The patient had typical symptoms
and signs of vestibular neuritis. As time proceeded, the patient presented with
bilateral catch-up saccade and the symptoms and signs of cerebellar dysfunction.
Magnetic resonance image and computed tomography scan showed brain metastasis
surrounded by edematous lesion. We report an ovarian cancer patient with
metastasis mimicking vestibular neuritis with a review of related literature.
Background and Objectives: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. Materials and Methods: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. Results: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. Conclusion: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.
Background and Objectives: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we evaluated whether vestibular evoked myogenic potential (VEMP) responses can reflect the diagnosis and the stage of Meniere’s disease. And we studied about other vestibular disease such as vestibular neuritis and benign paroxysmal positional vertigo. Materials and Methods: Retrospectively, we analyzed the results of VEMP in 22 patients (12 men and 10 women) with unilateral definite Meniere’s disease, 21 patients (5 men and 16 women) with vestibular neuritis, and 23 patient (4 men and 19 women) with benign paroxysmal positional vertigo (BPPV). All subjects underwent VEMP testing using ipsilateral 1 KHz-tone burst sound with 105 dB nHL. Results: VEMP was present in 86% of Meniere affected ear. The latency of p13 of affected ears in patients with Meniere’s disease, vestibular neuritis (VN), BPPV was not significantly prolonged than that of normal ears in the control group except left n23 latency in meniere’s disease. In the patients with Meniere’s disease, the amplitude-ratio was larger than that of the control group, statistically (p=0.006). And relationship was found in amplitude ratio among groups classified by the stage of Meniere’s disease. Conclusion: This study shows that amplitude ratio of VEMP response is useful method to determine the severity and prognosis of Meniere’s disease. We recommend VEMP to explain to the patient about severity of Meniere’s disease quantitatively.
Vestibular neuritis (VN) is characterized by the acute onset of vertigo, nausea and vomiting, in the absence of hearing loss or tinnitus. Cerebellar and brain stem infarction represents approximately 2.3% of acute strokes overall. Those can result from occlusion of the superior cerebellar artery, anterior inferior cerebellar artery, or the posterior inferior cerebellar artery. Central vertigo such as cerebellar or brain stem infarction may present with nonspecific symptoms similar to those of VN. Patients with isolated vertigo due to cerebral infarction may pose a significant diagnostic challenge to the neurotologists. It is know n for being frequently misdiagnosed, often with consequent disability. We report 2 cases of cerebral infarction mimicking VN initially with a review of the related literatures.
Vestibular neuritis is generally thought to be caused by a viral or postviral inflammatory disorder of vestibular structures. But there is no definite evidence to explain this pathophysiological mechanism until now. We experienced an unusual case of 34-year-old man who presented with facial paralysis several days after vertigo of a whirling nature. We report a case of facial palsy developed in succession of ipsilateral vestibular neuritis involving superior vestibular nerve which may infer the viral pathophysiology for the vestibular neuritis with a brief literature review.
Background and Objectives: The etiology of vestibular neuritis is unknown. Many investigators have suggested that this condition spares the inferior vestibular nerve system. However, others have reported that the lesion sometimes affects the inferior vestibular nerve system based on vestibular evoked myogenic potential. The function of the inferior vestibular nerve was studied in acute vestibular neuritis by monitoring medial olivocochlear bundle (MOCB) function. Under normal conditions, contralateral acoustic stimulation has inhibitory effects on ipsilateral otoacoustic emissions through the MOCB. Materials and Methods: Twenty patients that presented with dizziness and spontaneous nystagmus, and were confirmed to have acute vestibular neuritis by rotatory chair and caloric testing were enrolled in this study. We evaluated the evoked otoacoustic emissions with and without contralateral acoustic stimulation in both ears in all patients. The percent loss of normal inhibitory action on otoacoustic emissions was determined in the normal and affected ears. Results: All patients showed inhibitory effects in response to contralateral acoustic stimulation on evoked otoacoustic emissions in normal ears. Fifteen patients (75%) had an absence of contralateral suppression of otoacoustic emissions on the affected side. Conclusion: The findings of this study suggest the presence of dysfunction of the MOCB in patients with acute vestibular neuritis.
Background and Objectives: To report the clinical features of six patients diagnosed with cases of inferior vestibular neuritis based on abnormal vestibular evoked myogenic potential (VEMP) responses with normal caloric test results. Materials and Methods: We retrospectively reviewed 62 patients presenting with dizziness. All patients underwent a battery of audiovestibular testing, including hearing tests, caloric test and VEMP test. Results: Six patients were diagnosed as inferior vestibular neuritis. All patients presented with acute onset of prolonged vertigo. The pure tone audiograms and caloric test results were normal. VEMP response was absent unilaterally, and normal in the contralateral ear. Conclusion: Inferior vestibular neuritis should be considered in patients presenting with acute vertigo, but normal caloric responses. Comprehensive vestibular testing including VEMP is necessary.
Background and Objectives The intimate relationship of vertigo and anxiety has been previously recognized. Anxiety may have an important influence on recovery of symptoms in vestibular neuritis (VN). The aim of study was to evaluate subjective anxiety of the pre-VN, at the time of onset of VN, and just after vestibular rehabilitation therapy (VRT) using Beck Anxiety Inventory (BAI) questionnaire, respectively.
Materials and Methods Twenty-eight patients with VN were asked to complete the BAI and dizziness handicap inventory (DHI). Each of the BAI and DHI was scored. We also evaluated the relationship between the DHI and BAI scores.
Results The VN patients at the time of attack had significantly more anxiety with vertigo and related symptoms (p<0.05). In most patients, anxiety level decreased following VRT. Conclusion These findings indicate that almost every VN patients can recovery from anxiety as vertigo regressed. However, the emotional support as well as physical and/or functional rehabilitation may be required to provide a more rapid and complete return to normal daily lives for these patients.
Background and Objectives Galvanic vestibular stimulation (GVS) is known to induce nystagmus, ocular torsion, a tilt of subjective visual vertical, and perceptual and postural shift. The aim of this study was to compare the findings of GVS among the patients with spontaneous nystagmus (SN) caused by Meniere’s disease (MD) or vestibular neuritis (VN).
Materials and Methods Three-dimensional video-oculography was performed without fixation in 4 patients with MD and 2 with VN, as diagnosed by history, independent vestibular function tests and neuroimaging. We recorded the eye-movements in response to bilateral, bipolar, and surface GVS (2.5~3 mA) for 30 seconds, and analyzed mean slow phase velocity of SN.
Results Of the 4 patients with MD, two exhibited a suppression of the left beating SN during anode stimulation of left mastoid and an augmentation of the nystagmus during cathode stimulation of left mastoid. The same patterns of galvanic modulation were observed in the other 2 patients with right beating SN due to MD. In contrast, the patients with VN showed an absent or decreased response to GVS.
Conclusion In MD, the responses to GVS were preserved while the responses were impaired in VN. These results suggest that the irregular vestibular fibers, which are sensitive to GVS, are relatively spared in MD. In contrast, both regular and irregular fibers appear to be damaged in VN. GVS may be helpful in discriminating MD from VN, especially when the patients presented without auditory symptoms.
Background and Objectives By understanding the typical pattern of nystagmus during diverse positional change, we might be able to diagnose the subacute vestibular neuritis (VN) more accurately. The aim of this study was to identify the typical pattern of positional nystagmus in compensated and uncompensated VN patients.
Materials and Methods The videonystagmography of 182 patients who were diagnosed as VN were reviewed retrospectively. The patients were classified into two groups by the presence or absence of spontaneous nystagumus (SN). The amplitude of nystagmus evoked by head roll test (HRT) and body roll test (BRT) were compared between the lesion side (ipsilateral, i) and the healthy side (contralateral, c).
Results In the VN patients with SN, positional nystagmus was stronger on the iHRT and iBRT compared to the cHRT and cBRT, respectively. But in the VN patients without SN, this pattern of nystagmus was not evident. Although a stronger nystagmus was found in the iBRT compared to the cBRT, the mean amplitude of nystagmus was not significantly different. Also there was no difference in the nystagmus between the iHRT and cHRT.
Conclusion The typical pattern of positional nystagmus which can be found in the VN with SN was not evident in VN without SN. Positional nystagmus may not be able to give us useful information on diagnosing subacute VN.
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
Background and Objectives: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis.
Materials and Methods: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests.
Results: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus.
Conclusions: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.
Background and Objectives: A significant recovery of resting activity in the vestibular nuclei ipsilateral to the unilateral labyrinthectomy has been reported by the time symptoms such as spontaneous nystagmus and roll head tilt have largely disappeared. However, the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover.
Materials and Methods: We investigated changes of the caloric responses in 32 patients with vestibular neuritis during in- and out-patient visits separated by 2 months in an attempt to identify changes brought about by peripheral and/or central compensation processes.
Results: The slow-phase eye velocities stimulated by warm caloric stimulation at acute and follow-up stage were 6.6±6.6°/s, 9.5±9.9°/s in the lesioned side; 28.4±19.1°/s, 24.5±11.6°/s in the intact side. The slow-phase eye velocities stimulated by cold caloric stimulation at acute and follow-up stage were 5.9±7.7°/s, 10.3±8.2°/s in the lesioned side; 19.8±10.3°/s, 18.8±9.9°/s in the intact side.
Conclusion: Our findings show that the recovery of caloric responses comes mostly from the recovery of the eye responses to the caloric stimulation in the lesioned side and the eye responses to the caloric stimulation in the intact side does not change over time after vestibular neuritis.
A 77-year-old man visited our department because of dizziness from one month ago. Dizziness was continuous and non-whirling and this type of dizziness was the first time. He also complained of tinnitus and hearing impairment of the right ear. On physical examination, he showed spontaneous left-beating horizontal and torsional nystagmus and rightward head thrust was positive. He was admitted under the first impression of right vestibular neuritis.
On inner ear MRI, there was a well-demarcated 2.5×2.3 cm sized mass of right cerebellopontine angle. This mass showed somewhat low signal intensity in both T1 and T2-weighted image and modest enhancement with Gadolinum.
And approximately 4.5×3 cm sized mass could be seen in the simple chest roentgenogram.
On chest CT, there was a poorly demarcated 3×2.5 cm sized mass in left lower lobe of lung. The patient was diagnosed as small cell lung cancer with brain metastasis by Per-Cutaneous Needle Aspiration of lung. In spite of radiotherapy and concurrent chemotherapy, he expired after 5 months.
Although vestibular neuritis is defined as acute peripheral vestibulopathy without associated hearing loss, a handful of cases reported sudden hearing loss without concurrent vertigo during follow-up of vestibular neuritis. In addition, some patients show benign paroxysmal postional vertigo(BPPV) ipsilateral to the lesion side with various interval after vestibular neuritis, and they are considered to be “secondary” BPPV. Viral and vascular etiologies have been assumed for the vestibular neuritis but, both of those failed to explain exact pathomechanism so far. Authors experienced a case of sudden hearing loss with simultaneous ipsilateral BPPV after vestibular neuritis. There has been no report of concurrent of BPPV and sudden hearing loss after vestibular neuritis. Sequential viral activations are considered to be responsible for this case.
Background and Objectives: There are known parameters that indicate vestibular asymmetry, such as directional preponderance (DP) on caloric test, asymmetry on slow harmonic acceleration (SHA) test, asymmetry of time constant (Tc) and slow cumulative eye position (SCEP) on velocity step test. Aim of this study is investigate the sensitivity and predictability of the vestibular asymmetry parameters among them.
Materials & Methods: Twenty six patients who were diagnosed as acute unilateral peripheral vestibulopathy were enrolled in this study. We compared each parameter with site of lesion based on the direction of spontaneous nystagmus and canal paresis (CP) which were totally correlated in this group of patients.
Results: Positive predictability of each parameter showed 58% in DP, 62% in SHA asymmetry, 62% in SCEP, 38% in Tc. In the cases that each parameter showed positive result, all of DP and SHA asymmetry indicated site of lesion, and showed high correlation coefficient(r=0.89). But in 27% of SCEP and 23% of Tc did not indicate site of lesion.
Conclusion: All parameters showed low sensitivity for identifying laterality of lesion even the tests were performed with in one week after vertigo attack. DP and VOR asymmetry showed high positive predictability for indicating lesion site.
Background and Objectives: It has been reported that vibration applied either on the mastoid or the sternocleidomastoid (SCM) muscles induces nystagmus in patients after unilateral vestibular neuritis. The aims of the study were to characterize the vibration-induced nystagmus (VIN) in patients with various vestibular disorders and to compare the results of VIN to unilateral weakness in caloric test.
Materials and Methods: Fifthy-four patients with Meniere’s disease, 58 patients with unilateral vestibular neuritis, 170 patients with migraine-associated dizziness, and 78 patients with chronic recurrent vestibulopathy were included. We recorded eye movements during unilateral 100-Hz vibration on the mastoids and SCM muscles. The bithermal caloric test was also performed. Abnormal criteria of VIN were slow-phase slow-phase velocity (SPV) at 4 all different conditions ≥ 2°/s with the same directions or mean of SPV at vibration on both mastoids or both SCM muscles ≥ 5°/s with the same directions.
Results: In Meniere’s disease, 28 of 57 (49.1%) of patients show pathologic VIN, 21 of 57 (36.8%) show pathologic canal paresis. 14 of 57 (24.6%) show abnormalities in both tests, and 35 of 57 (61.4%) show any abnormalities in either test. In unilateral vestibular neuritis, 43 of 58 (77.6%) showed pathologic VIN, 58 of 58 (100%) show canal paresis. In migraine-associated dizziness, 48 of 170 (28.2%) showed pathologic VIN, 58 of 170 (18.8%) show canal paresis. 15 of 170 (8.8%) showed abnormalities in both tests, and 65 of 170 (38.2%) show any abnormalities in either test. In chronic recurrent vestibulopathy, 23 of 78 (29.5%) of patients show pathologic VIN and 17 of 78 (21.8%) show pathologic canal paresis. Seven of 78 (9.0%) showed abnormalities in both tests, and 33 of 78 (42.3%) show any abnormalities in either test.
Conclusion: VIN test can increase the sensitivity in detecting vestibular imbalance in vestibular disorders when combined with caloric test.
Background and objectives: Romberg test has been regarded as simple and efficient bedside modality to evaluate the vestibulospinal reflex in patients with balance disorders. we compared the direction of fall and that of yaw head rotation during Romberg test to evaluate its lateralizing value in acute unilateral vestibular neuritis.
Materials and methods: Forty three patients (n=43) with acute unilateral vestibular neuritis were included. We did Romberg test in three different head positions: with a head looking straight ahead (Romberg test1), turned to the right by about 90 degrees (Romberg test2) and turned to the left by about 90 degrees (Romberg test3) in yaw. Affected side of the vestibular neuritis was decided by the direction of nystagmus and the side of canal paresis. We compared the falling direction in each Romberg test, direction of nystagmus and canal paresis.
Results: During Romberg test, 19 out of 43 fell to the lesion side (44%) and during modified Romberg test, 18 out of 43 fell to the lesion side (42%). On modified Romberg test, fallings to the side of affected labyrinth showed 14/18(78%) in the Romberg test 2 and 15/18 (83%) in the Romberg test 3. The direction of falling in each maneuvers correlated statistically to the side of the affected labyrinth (p<0.05). Direction of nystagmus and the side of the canal paresis also showed correlation to the direction of falling in modified Romberg test.
Conclusion: Romberg and Modified Romberg tests are helpful to decide the affected side in vestibular neuritis to some extents.
Vestibular neuritis (VN) is an idiopathic peripheral vestibular syndrome characterized by acute isolated prolonged vertigo. In most cases, it results from inflammation of the vestibular nerve presumably of viral origin. There has been no previous report of VN associated with a vascular cause. We here report a patient with VN of vascular origin who presented with acute onset of prolonged isolated vertigo, a unilateral decreased caloric response, and simultaneously with acute infarcts on brain MRI that were unrelated to patient's vertigo.
Key Words : Vestibular neuritis, Cerebral infarction
Background and Objectives: There are caloric test, SCEP, DP in Step velocity and VOR asymmetry in SHA test as parameters for evaluation in unilateral peripheral vestibulopathy in parameter of vestibular function test. The aim of this study is to assess the correlation between these parameters and intensity of spontaneous nystagmus in vestibular neuritis.
Materials and Method: We evaluated 75 patients who were diagnosed as vestibular neuritis with 3 degree spontaneous nystagmus at vestibular function test lab from January 2000 to July 2005 in Dankook university hospital. The correlations between direction and intensity of spontaneous nystagmus and monothermal caloric test, SCEP and DP in step velocity, VOR asymmetry (0.01, 0.04, 0.16 Hz) in SHA test were analysed. And correlations according to sex, age were also analysed.
Results The correlation coefficient between intensity of spontaneous nystagmus and monothermal caloric test was 0.60. The correlation coefficient between intensity of spontaneous nystagmus and SCEP was 0.35. The correlation coefficient between intensity of spontaneous nystagmus and Tc DP was 0.36 and it showed no significant correlation. The correlation coefficient between intensity of spontaneous nystagmus and VOR asymmetry (0.01, 0.04, 0.16) was 0.57, 0.46, 0.51, respectively and there was higher correlation in man, age under 60.
Conclusion Intensity of spontaneous nystagmus showed close relations to monothermal caloric test, VOR asymmetry of SHA, Tc DP, SCEP DP in sequence. In addition, young male patients tends to be closely related to intensity of spontaneous nystagmus.
Key Words : Spontaneous nystagmus, Vestibular function test, Vestibular neuritis
Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion.
Key Words : Canalolithiasis, Cupulolithiasis, Vestibular neuritis
Background and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis.
Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis.
Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials
The acute vestibular neuritis is rarely seen in children and it is hard to find the related reports. In this paper, we report three cases of acute vestibular neuritis less than 15 years old that we experienced during last 10 years. The three cases are 14 and 11-year old boys and a 12-year-old-girl. They complained vertigo without hearing loss. Only one of three cases had previous common cold history and they showed all negative reactions in virus blood tests. After medical treatment and early rehabilitation, vertigo was completely controlled within 3 weeks and there was no recurrent symptoms so far. This recovery in children seems to be faster and more complete than in adults.
An isolated nodular infarction presenting as an isolated vertigo with unidirectional, gaze-fixed nystagmus has not been previously reported. We reported a patient with cerebellar infarction who presented with purely isolated vertigo, ipsilesional, spontaneous nystagmus, and contralesional axial lateropulsion without usual symptoms or signs of cerebellar dysfunction. An MRI of the brain showed a small infarct selectively involving the nodulus. A pure vestibular syndrome in our patient may be explained by an ipsilateral involvement of nodulo-vestibular inhibitory projection to vestibular nucleus. Clinicians should be aware of the possibility of a nodulus infarction in patients with an acute vestibular syndrome, even if the pattern of nystagmus and lateropulsion is typical of vestibular neuritis.