Rotational vertebral artery syndrome (RVAS) is a rare disease entity. RVAS is characterized by recurrent attacks of vertigo, nystagmus, ataxia, and tinnitus, which is elicited by head-rotation when the contralateral dominant vertebral artery is compressed, leading to an acute reduction of blood flow in the vertebrobasilar territory. A 50-year-old female presented with a whirling type vertigo which, when turning her head to the left, compressed the dominant right vertebral artery, as documented by the dynamic neck angiography. The patient underwent posterior cervical decompression of the foramina transversaria and the surrounding soft tissues at the level of C1-C2. The patients's symptom disappeared after the surgery and she has been followed up for the last four months without the recurrence of vertigo.
Angiography ; Ataxia ; Decompression ; Female ; Head ; Humans ; Lateral Medullary Syndrome ; Middle Aged ; Neck ; Rare Diseases ; Recurrence ; Tinnitus ; Vertebral Artery ; Vertigo

Herpes zoster oticus (HZO) is characterized by auricular vesicles, facial palsy and vestibulocochlear dysfunction. The 8th cranial nerve can be most frequently involved. Rarely, it may be associated with the involvement of 5th, 6th, 9th, 11th or 12th cranial nerve. However, only few cases of HZO involving vestibular nerve without facial nerve palsy have been previously reported. We experienced an unusual case of 38-year-old woman who presented with auricular vesicles, otalgia, and vertigo of whilrling nature but not with facial palsy. Vestibular evoked myogenic potential (VEMP) and caloric tests that were performed to determine which division of vestibular nerve was involved demonstrated that decreased responses in this case. We report a case of HZO involving superior and inferior vestibular nerve without facial palsy that was confirmed by VEMP and caloric tests with a review of literature.
Adult ; Caloric Tests ; Cranial Nerves ; Earache ; Facial Nerve ; Facial Paralysis ; Female ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Paralysis ; Vertigo ; Vestibular Nerve

A pseudocyst of the auricle is a benign idiopathic, uncommon condition, which typically presents as a unilateral painless swelling over the anterior aspect of the auricle. If left untreated, the permanent deformity of the pinna may occur. Many modalities of treatment have been reported but the definitive treatment still remains controversial because of the high recurrence rate. It seems predominantly only one sided with most of the bilateral lesions developing asynchronously, and only a few cases have reported on simultaneous involvement of both pinna. We experienced a case of a 23-years-old man with an endochondral pseudocyst of simultaneous involvement of his both auricles. This is the first report in Korea, so we report this case with a review of the literature.
Congenital Abnormalities ; Ear Cartilage ; Korea ; Recurrence

Lou Gehrig's disease, also called amyotrophic lateral sclerosis, is a chronic progressive motor neuron disease of an unknown etiology, characterized by upper and lower motor neuron degeneration with a resultant progressive weakness of bulbar muscles or the extremities. The early symptoms may include twitching, cramping, muscle weakness of distal extremities and slurred nasal speech. Rhinolalia aperta is abnormal speech attributable to inadequate velopharyngeal closure. Hypernasality is thequality of voice in which the emission of air through the nose is excessive due to velopharyngeal insufficiency so that the voice is highpitched and speech intelligibility deteriorates. We experienced a rare case of Lou Gehrig's disease presenting with rhinolia aperta in its early stage. We report the case with a literature review.
Amyotrophic Lateral Sclerosis ; Extremities ; Motor Neuron Disease ; Motor Neurons ; Muscle Cramp ; Muscle Weakness ; Muscles ; Nose ; Speech Disorders ; Speech Intelligibility ; Velopharyngeal Insufficiency ; Voice

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.
Arteries ; Brain Infarction ; Brain Stem Infarctions ; Cerebral Infarction ; Hearing Loss ; Humans ; Nausea ; Stroke ; Tinnitus ; Vertigo ; Vestibular Neuronitis ; Vomiting

At emergency room, most patients who presented with abrupt isolated vertigo without neurologic deficits were diagnosed as common vestibular disorder including vestibular neuritis. However posterior circulation stroke also can be a cause of the isolated vestibular vertigo. This condition is called vestibular pseudoneuritis. It is very important to differentiate vestibular pseudoneuritis from common vestibular disorder because of requiring different management and avoiding severe complication. Previous studies reported that head impulse test is one of bedside tests which represents unilateral vestibular hypofunction. Most patients of the vestibular neuritis shows positive head impulse test. However the head impulse test can be positive in central origin vertigo. So it is necessary to interpret the results of the test with caution. We report 2 cases of vestibular pseudoneuritis which showed positive head impulse test with a review of the related literatures.
Emergencies ; Head ; Humans ; Neurologic Manifestations ; Stroke ; Vertigo ; Vestibular Neuronitis

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the localizations of beta1- and beta2-adrenergic receptors (ARs) in rat vestibular nuclei by immunohistochemical staining procedure. MATERIALS AND METHODS: Twelve male Sprague-Dawley rats were used in this study. Primary antibodies for the beta1- and beta2-ARs were used. The sections were treated with a biotinylated goat anti-rabbit antibody. The sections were then incubated in avidin-biotin-peroxidase reagent and processed with immunoperoxidase using 3.3'-diaminobenzidine tetrahydrochloride. RESULTS: beta1-AR and beta2-AR immunopositive neurons were found to be distributed throughout the four major vestibular nuclei. Both receptors were primarily detected in neuronal somata and their proximal dendrites. beta1-AR and beta2-AR were moderately expressed in the superior vestibular nucleus, lateral vestibular nucleus, medial vestibular nucleus, and spinal vestibular nucleus. CONCLUSION: The present study demonstrates, for the first time, that beta1-AR and beta2-AR receptors are localized in rat vestibular nuclei. Furthermore, this study may provide additional speculation into the role of ARs during vestibular signal processing. Further studies are needed to clarify the roles played by beta1-ARs and beta2-ARs through physiologic and functional studies.
Animals ; Antibodies ; Dendrites ; Goats ; Humans ; Male ; Migraine Disorders ; Neurons ; Rats ; Rats, Sprague-Dawley ; Receptors, Adrenergic ; Vertigo ; Vestibular Nuclei ; Vestibular Nucleus, Lateral

PURPOSE: To assess the effectiveness of alpha-1 adrenergic receptor blockers (α1-blockers) in the treatment of female lower urinary tract symptoms (LUTS). METHODS: A literature search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases. Fourteen studies with 1,319 patients were ultimately included. The study comprised 2 analyses: a comparison of urinary symptom scores, maximal flow rate (Qmax), and postvoid residual (PVR) urine volume before and after α1-blocker administration in 8 prospective, open-label studies and 5 randomized clinical trials (RCTs); and an evaluation of the same variables in α1-blocker and placebo groups in 4 RCTs.
Female ; Humans ; Lower Urinary Tract Symptoms ; Prospective Studies ; Receptors, Adrenergic, alpha-1

OBJECTIVES: Pyrethroids are commonly used pesticides, and acute human poisoning by these insecticides is common in Korea. It has a high affinity to the sodium channel on cell membranes causing blockage, which results in neurotoxicity, hyperexcitation, and death. The purpose of this study was to analyze the clinical characteristics of acute pyrethroid poisoning. METHODS: To evaluate the clinical characteristics (age, sex, causative agents, cause of ingestion, severity of poisoning and its clinical feature, prognosis, complication and results of the treatment), we analyzed the clinical reports of 30 patients with pyrethroid poisoning who were admitted to Soonchunhyang Chunan hospital from January 1992 to July 1997. RESULTS: 1) 18 out of 30 patients with pyrethroid poisoning were male and the largest age group was above 60 years old. 2) The most common cause of ingestion was suicide, in 24 cases (80%). 3) There were 7 classes of causative agents of poisoning and all of these were classified into 2 grades according to the degree of WHO toxicity. Fenvlaerate and cypermethrin were the most common agents. 4) The degree of severity was classified into three groups - mild, moderate and life -threatened. Of these groups, mild poisonig was the most common. There was no significant difference in the age, type of pyrethoid and interval between pyrethroid ingestion and arriving at the emergency room between the three groups. However, the amount of ingestion was significantly higher in the life-threatened group. 5) The most common symptom of the patients was vomiting, in 19 patients. The classification were of three types (5 type I, 11 type II and 1 intermediate type) according to clinical characteristics. 6) There is no specific antidote, therefore therapy is generally supportive. There were three deaths, and the cause of death was respiratory failure. 7) The most common complication was pneumonia, in 3 cases (10%), which occured in almost all patients in the life-threatened group. CONCLUSIONS: The most common age group of poisoing was over 60 years old, and suicide was the most common cause of ingestion. Treatment is supportive, and most causal exposures require only decontamination. There were three deaths, and the cause of death was respiratory failure in each case. The most common complication was pneumonia.
Cause of Death ; Cell Membrane ; Chungcheongnam-do ; Classification ; Decontamination ; Eating ; Emergency Service, Hospital ; Humans ; Insecticides ; Korea ; Male ; Middle Aged ; Pesticides ; Pneumonia ; Poisoning* ; Prognosis ; Pyrethrins* ; Respiratory Insufficiency ; Sodium Channels ; Suicide ; Vomiting

Background: During the coronavirus disease 2019 (COVID-19) pandemic, patients with myasthenia gravis (MG) were more susceptible to poor outcomes owing to respiratory muscle weakness and immunotherapy. Several studies conducted in the early stages of the COVID-19 pandemic reported higher mortality in patients with MG compared to the general population. This study aimed to investigate the clinical course and prognosis of COVID-19 in patients with MG and to compare these parameters between vaccinated and unvaccinated patients in South Korea. Methods: This multicenter, retrospective study, which was conducted at 14 tertiary hospitals in South Korea, reviewed the medical records and identified MG patients who contracted COVID-19 between February 2022 and April 2022. The demographic and clinical characteristics associated with MG and vaccination status were collected. The clinical outcomes of COVID-19 infection and MG were investigated and compared between the vaccinated and unvaccinated patients. Results: Ninety-two patients with MG contracted COVID-19 during the study. Nine (9.8%) patients required hospitalization, 4 (4.3%) of whom were admitted to the intensive care unit. Seventy-five of 92 patients were vaccinated before contracting COVID-19 infection, and 17 were not. During the COVID-19 infection, 6 of 17 (35.3%) unvaccinated patients were hospitalized, whereas 3 of 75 (4.0%) vaccinated patients were hospitalized (P < 0.001). The frequencies of ICU admission and mechanical ventilation were significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.019 and P = 0.032, respectively). The rate of MG deterioration was significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.041). Logistic regression after weighting revealed that the risk of hospitalization and MG deterioration after COVID-19 infection was significantly lower in the vaccinated patients than in the unvaccinated patients. Conclusion This study suggests that the clinical course and prognosis of patients with MG who contracted COVID-19 during the dominance of the omicron variant of COVID-19 may be milder than those at the early phase of the COVID-19 pandemic when vaccination was unavailable. Vaccination may reduce the morbidity of COVID-19 in patients with MG and effectively prevent MG deterioration induced by COVID-19 infection.