Ineffective cerebral perfusion by low cardiac output may cause various types of dizziness like mild lightheadedness, vertigo or presyncope, and sometimes it can be the only heralding symptom. Differential diagnosis with other causes of dizziness is important because the symptom may progress into life-threatening bradyarrythmia and loss of consciousness. There are several literatures that reporting the association between cardiac disease and dizziness and their improvement with treatment of cardiac problem including pacemaker placement. But these are only indirect evidences to explain the cause-symptom relationship. We experienced 48-year old woman who has had recurrent dizziness of rotatory type lasting for about 5 seconds since first year, and then diagnosed atrioventricular block after. She has been having anti-hypertension medications for 2 years. She didn't have any abnormalities in electrocardiography, chest x-ray, or routine blood tests. There were no abnormalities in vestibular function test and electronystgmography. Her result of 24-hour Holter monitoring clearly elucidated temporal relationship between arrhythmia and her episodic symptoms of dizziness. The authors report a case with review of literatures about cardiogenic dizziness.
Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiac Output, Low ; Diagnosis, Differential ; Dizziness ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Heart Diseases ; Hematologic Tests ; Humans ; Perfusion ; Syncope ; Thorax ; Unconsciousness ; Vertigo ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: After bilateral mastoidectomy, taste change is common because of injury to chorda tympani nerve. We aimed to understand about the appropriate interval of sequential bilateral mastoidectomy. SUBJECTS AND METHOD: Retrospective review was carried out for 25 patients who underwent sequential bilateral mastoidectomy from March 2004 to November 2011. RESULTS: Among the 25 patients, there were 19 patients whose chorda tympani nerve was injured after bilateral mastoidectomy, and eight of those 19 patients complained of taste disturbance. The rates of dysfunction according to operation interval were within 6 month (55%, 5/9), between 6 and 12 months (33%, 2/6), and above 12 months (10%, 1/10). Compared to canal wall up mastoidectomy, for canal wall down mastoidectomy, taste disturbance was more common (p=0.001). CONCLUSION: The result supports that at least 6 months interoperative period for bilateral chronic otitis media may be needed to avoid taste disturbance. A further large study may validate this result.
Chorda Tympani Nerve ; Dysgeusia ; Humans ; Otitis Media ; Retrospective Studies

Lermoyez's syndrome is usually regarded as a rare variant of Meniere's disease which is characterized by the disappearance of aural symptoms after vertiginous attacks. It is recognized as an uncommon paroxysmal clinical syndrome caused by pathological endolymphatic change in the labyrinth. It is thought that the cause of Lermoyez's syndrome is due to cochlea hydrops which result from endolymphatic blockage of the ductus reunions. With its distinct characteristic manifestations, the diagnosis is not difficult, but Lermoyez's syndrome has been rarely reported universally. Otologists are in a whirl about its rare occurrence. We report a unique case of a 46-year-old woman, who showed typical clinical features of Lermoyez's syndrome with review of literatures. We focused on the sequential clinical change during our observation.
Cochlea ; Ear, Inner ; Edema ; Endolymphatic Hydrops ; Female ; Humans ; Meniere Disease ; Middle Aged ; Reunion ; Vertigo

BACKGROUND AND OBJECTIVES: Ocular torsion may be a result of vestibulopathy. The funduscopy is the most reliable method of measuring an ocular torsion. However, the reference value of ocular torsion in Korean is available at only limited ages. Therefore, we analyzed the angle of ocular torsion more age-specific than previous study. MATERIALS AND METHODS: We used the fundus photograph of health check-up visitor. And age and sex specific average angle of ocular torsion was measured. RESULTS: The right and left average angle of ocular torsion were 7.7+/-3.6degrees, 5.3+/-3.0degrees, respectively. In addition, there was no significant difference in age or sex specific angle of ocular torsion. CONCLUSION: This result might give an aid to evaluating the function of otolithic organ by measurement of ocular torsion.
Ophthalmoscopes ; Otolithic Membrane ; Reference Values ; Reflex, Vestibulo-Ocular

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 30degrees 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 30degrees 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.
Acceleration ; Animals ; Electronystagmography ; Guinea Pigs ; Head ; Humans ; Magnetics ; Magnets ; Male ; Nystagmus, Pathologic ; Posture ; Reflex, Vestibulo-Ocular ; Semicircular Canals

BACKGROUND AND OBJECTIVES: Pediatric dizziness is difficult to diagnose because of the nonspecific nature of symptom, and difficulty in history taking, physical examination or diagnostic tests. The authors tried to analyze the proportion of diseases in children suffering from dizziness, and introduce cases with atypical clinical characteristics and uncommon diagnosis. MATERIALS AND METHODS: The medical records of 53 pediatric patients suffering from dizziness were analyzed retrospectively. We analyzed the findings of history taking, physical examination for nystagmus and cerebellar function, pure tone audiogram and caloric tests in all patients. RESULTS: Diagnosis of migrainous vertigo was most common (32.7%), followed by psychological cause (11.5%) and labyrinthitis due to the otitis media (7.7%). Cases of cerebellar hemangioblastoma, neurofibromatosis and drug intoxication were also found. CONCLUSION: The clinical characteristics and causative diseases of pediatric dizziness are different from those of adults. Appropriate history taking and diagnostic tests are improtant for differential diagnosis.
Adult ; Caloric Tests ; Child ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Dizziness ; Ear, Inner ; Hemangioblastoma ; Humans ; Labyrinthitis ; Medical Records ; Migraine Disorders ; Neurofibromatoses ; Otitis Media ; Physical Examination ; Retrospective Studies ; Stress, Psychological ; Vertigo

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 2.5x2.3 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 4.5x3 cm sized mass could be seen in the simple chest roentgenogram. On chest CT, there was a poorly demarcated 3x2.5 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.
Aged ; Brain ; Cerebellopontine Angle ; Dizziness ; Drug Therapy ; Ear ; Ear, Inner ; Head ; Hearing Loss ; Humans ; Lung ; Magnetic Resonance Imaging ; Needles ; Neoplasm Metastasis ; Physical Examination ; Radiotherapy ; Small Cell Lung Carcinoma* ; Thorax ; Tinnitus ; Tomography, X-Ray Computed ; Vestibular Neuronitis*

Traumatic pseudoaneurysms in the head and neck region are very rare. Particularyly, pseudoaneurysms of the internal maxillary artery are known to be very rare. The authors report a 20-year old male who was diagnosed as having a pseudoaneurysm of the internal maxillary artery. The cause was assumed to be a mandible ramus fracture. When he visited our emergency room, we did not consider a pseudoaneurysm because of his other life-threatening conditions. Fortunately, he re-visited our hosipital before the aneurysm ruptured. He was diagnosed with angiography and was treated by using embolization with glue. The rupture of the pseudoaneurysm could have caused a life-threatening hemorrhage.
Adhesives ; Aneurysm ; Aneurysm, False ; Angiography ; Emergencies ; Head ; Hemorrhage ; Humans ; Male ; Mandible ; Maxillary Artery ; Neck ; Rupture

BACKGROUND AND OBJECTIVES: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. MATERIALS AND METHODS: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. RESULTS: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. CONCLUSIONS: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.
Diagnosis, Differential ; Female ; Headache ; Hearing Loss ; Humans ; Incidence ; Migraine Disorders ; Neurologic Manifestations ; Nystagmus, Physiologic ; Prevalence ; Retrospective Studies ; Tinnitus ; Vertigo ; Vestibular Function Tests

PURPOSE: To evaluate the diagnostic accuracy of non-invasive coronary angiography by electron beam tomography(EBT) for the depiction of coronary artery stenosis, as compared with conventional coronary angiography. MATERIALS AND METHODS: In 20 patients with no history of coronary artery disease, EBT (Imatron C-150) study was performed with EKG-gating. Forty images were obtained in each patient from the pulmonary trunk to the cardiac base at 80% R-R interval, and data were reconstructed into a three-dimensional coronary angiography. The interval between conventional coronary arteriograpy and EBT was less than 30 (mean, 9) days. Coronary arteries were divided into seven segments, and stenosis was defined as a narrowing of the luminal diameter of the coronary artery of more than 50 %. The results of EBT and of conventional angiography were compared for diagnostic accuracy. RESULTS: Conventional argiography revealed significant stenosis of the coronary artery in 12 of the 20 patients, while the use of three-dimensional coronary angiography by EBT revealed this in 16. The sensitivity and specificity of EBT were relatively high in the depiction of stenosis in the proximal left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA) and middle LAD, but low sensitivity in the middle LCx and RCA. In the left main coronary artery, sensitivity was 50%. The sensitivity, specificity, accuracy, and positive and negative predictive values for the depiction of coronary artery stenosis with three-dimensional coronary arteriography by EBT were 79%, 95 %, 93 %, 71%, and 97 %, respectively. CONCLUSION: Three-dimensional coronary angiography by EBT is a non-invasive diagnostic modality for the depiction of proximal epicardial coronary artery stenosis and appears to be useful for excluding the probability of ischemic heart disease in a selected patient group.
Angiography* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Myocardial Ischemia ; Phenobarbital ; Sensitivity and Specificity