Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) can be classified as either the geotropic or apogeotropic subtype by the pattern of nystagmus triggered by supine head roll test. Most studies have reported the geotropic subtype as a more common pathophysiology in HC-BPPV than the apogeotropic subtype. According to the BPPV clinical practice guideline provided by the American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Neurology in 2008, variations of the roll maneuver (Lempert maneuver of barbecue roll maneuver) are the most widely published treatments for HC-BPPV. In addition, various treatment techniques including Gufoni maneuver, Vannuchi-Asprella liberatory maneuver and forced prolonged positioning have been applied for HC-BPPV. However, the guideline failed to provide specific treatment guidelines for HC-BPPV based on evidence-based researches since only Class IV data on HC-BPPV treatment were available at the point of 2008 when the BPPV clinical practice guideline was published. This review article focused on the evidences of the efficacy of various maneuvers in the treatment of HC-BPPV published after the BPPV clinical practice guidelines of 2008.
Benign Paroxysmal Positional Vertigo ; Evidence-Based Medicine ; Head ; Neck ; Neurology ; Semicircular Canals

Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.
Cholesteatoma* ; Ear, Inner ; Female ; Fistula* ; Hearing Loss, Sensorineural ; Humans ; Labyrinthitis ; Meniere Disease ; Middle Aged ; Neuroma, Acoustic ; Otitis Media ; Semicircular Canals ; Vertigo* ; Vestibular Neuronitis

Pseudo-vestibular neuritis is a central pathology of acute vestibular syndrome, characterized by unidirectional nystagmus mimicking acute peripheral vestibulophaty. We report a 39-year-old female patient who developed cerebellar infarction with isolated vertigo, spontaneous nystagmus, a positive head thrust test, and unilateral canal paresis in the contralesional side. The patient had no vascular risk factors. A diffusion-weighted image of the brain showed infarction of medial branch of posterior inferior and superior cerebellar artery on the left side. A magnetic resonance angiography of neck disclosed a wide range of diffused severe stenosis and narrowing of right and left vertebral arteries, respectively. This case suggests the possibility of vestibular ischemia masking the central pathology in isolated vertigo.
Adult ; Arteries ; Brain ; Constriction, Pathologic ; Embolism ; Female ; Head Impulse Test ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Angiography ; Masks ; Neck ; Neuritis* ; Nystagmus, Pathologic ; Paresis* ; Pathology ; Risk Factors ; Vertebral Artery ; Vertebral Artery Dissection* ; Vertigo ; Vestibular Neuronitis

Hematogenous spread from tuberculous lesions of other parts of the body represent the origin of intracranial tuberculomas. In most series of the literature, the cerebellum has about two thirds and the cerebral hemispheres about one third of the intracranial tuberculomas. It may occurs as a single lesion, but multiple intracranial tuberculomas varies from 10% to 33% of the cases due to the hematogenous spread. Calcium deposits are rare, occurring in about 6% of cases. Ramamurthi and Varadarajan described the two types of the intracranial tuberculoma; 1. Superficial and vascular type, produces early focal signs of increased intracranial pressure. 2. deep and avascular type, accompanied by signs of increased intracranial pressure. We have been experienced in one case of symmetrical and bilateral cerebellar tuberculomas probably originated from the pulmonary lesion.
Calcium ; Cerebellum ; Cerebrum ; Intracranial Pressure ; Tuberculoma* ; Tuberculoma, Intracranial

Lymphangioma is a congenital malformation of the lymphatic system that easily expands into surrounding tissue similar to malignancies. Surgical excision has been the treatment of choice, but the results of surgical resection have been unsatisfactory due to incomplete resection, fluid collection and recurrence after surgery. Intralesional injection of OK-432(lyophilized incubation mixture of group A. streptococcus pyogenes of human origin) was employed in treating 24 patients with lymphangiomas between 1992 and 1997. The therapy was used as a primary therapy in 21 patients. Also it used in 3 patients with unresectable or recurrent lymphangioma. The results of intralesional injection of OK-432 were excellent in 8 patients (33.3%), good in 7 patients (21.8%) and poor in 7 patients (21.8%). The side effects were fever under 39.0degrees C and a local inflammation, however, were subsided in a few days without serious complications. These data suggest that intralesional injection of OK-432 is safe and effective for lymphangioma as a primary therapy and unresectable or recurrent lymphangioma as a secondary therapy.
Child* ; Fever ; Humans ; Inflammation ; Injections, Intralesional ; Lymphangioma* ; Lymphatic System ; Picibanil* ; Recurrence ; Streptococcus pyogenes

Usually, large amount of acute subdural hematoma needs prompt surgical removal. We report a case of rapid spontaneous resolution in a day. A 78-old female was admitted in comatose state after falling off from a bus. Initial brain CT scan revealed large amount of acute subdural hematoma that was completely resolved on follow-up brain CT taken 26hours after craniocerebral trauma. The spontaneous resolution needs redistribution of hematoma and dilution by CSF. The low density space between inner skull table and hematoma may suggest the possibility of spontaneous resolution.
Brain ; Coma ; Craniocerebral Trauma ; Female ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural, Acute* ; Humans ; Skull ; Tomography, X-Ray Computed

OBJECTIVES: To investigate the vestibular evoked myogenic potentials (VEMP) results in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV. SUBJECTS AND METHODS: Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment. RESULTS: VEMP results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the "no response" group, the number of times was considerably greater than those in the "response" group. CONCLUSIONS: We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as "no response" in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.
Humans ; Neurons ; Prognosis ; Saccule and Utricle ; Vertigo ; Vestibular Evoked Myogenic Potentials

BACKGROUND AND OBJECTIVES: Endolymphatic hydrops are known as major causes of Meniere's disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen-triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere's disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces. MATERIALS AND METHODS: Five normal adults and Five patients with Meniere's disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time. RESULTS: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops. CONCLUSIONS: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops.
Adult ; Diffusion ; Ear, Inner ; Endolymphatic Hydrops ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Meniere Disease

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. MATERIALS AND METHODS: Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. RESULTS: Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. CONCLUSIONS: As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.
Diagnosis ; Ear Diseases ; Ear, Inner ; Head ; Humans ; Labyrinthitis ; Retrospective Studies ; Semicircular Canals* ; Vertigo*