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J Korean Bal Soc > Volume 5(2); 2006 > Article
Journal of the Korean Balance Society 2006;5(2): 416-416.
Vestibular Evoked Myogenic Potentials in Wallenberg Syndrome
Ji Soo Kim, M.D.1
Vestibular Evoked Myogenic Potentials in Wallenberg Syndrome
Ji Soo Kim, M.D.1, Young-Mi Oh, M.D.1, Sung-Hae Jung1, Ja-Won Koo2
Departments of Neurology1 and Otolaryngology2, College of Medicine, Seoul National University, Seoul National University Bundang Hospital
Background: Sound stimuli may evoke inhibitory potentials in the contracting sternocleidomastoid (SCM) muscles. This vestibular evoked myogenic potential (VEMP) has been known to occur through a disynaptic pathway, originating from the saccule. The characteristics and diagnostic value of VEMP have not been studied in central vestibulopathies. Objective:   To investigate saccular dysfunction in patients with Wallenberg syndrome by using VEMP, and to correlate the findings with those of other vestibular function tests.
Method:   Thirty patients with Wallenberg syndrome, 21 with restricted infarction in the dorsolateral medulla, eight with combined infarctions in the cerebellum supplied by the posterior or anterior inferior cerebellar artery (AICA), and one with hemimedullary infarction, underwent VEMP which was induced by short tone burst(90 dB nHL, 500 Hz, 2.1/s) and was recorded in the contracting SCM while the patients turned his head forcefully to the contralateral side against resistance.
Results:   VEMP was abnormal in 15 patients. Four of them showed no VEMP in the ipsilesional side and six exhibited decreased amplitude of ipsilesional VEMP. Three patients showed increased P13 latency and two had both decreased amplitude and increased P13 latency of ipsilesional VEMP. VEMP was normal in 15 patients. Results of the caloric tests were normal in all the patients except for one with combined AICA infarction. Compared with the patients with normal VEMP, patients with abnormal VEMP tended to have ipsilesional ocular tilt reaction (OTR) or ipsilesional tilt of the subjective visual vertical (SVV) more commonly. No difference was found in age, sex, and interval from symptom onset to VEMP between the patients with abnormal and those with normal VEMP.
Conclusion:   VEMP detects saccular dysfunction even in patients with Wallenberg syndrome and normal calorics. The more frequent association of abnormal VEMP with ipsilesional OTR and SVV tilt supports an integration of the otolithic signals from the utricle and saccule by the nearby area of the vestibular nucleus. The strict ipsilesional abnormalities of VEMP in Wallenberg syndrome, observed in half of our patients, indicate an uncrossed nature of the sacculocollic pathway.
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