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.
Caloric Tests ; Humans ; Medical Records ; Paresis ; Retrospective Studies ; Sensitivity and Specificity ; Vestibular Neuronitis

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: 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 degrees/s, 9.5+/-9.9 degrees/s in the lesioned side; 28.4+/-19.1 degrees/s, 24.5+/-11.6 degrees/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 degrees/s, 10.3+/-8.2 degrees/s in the lesioned side; 19.8+/-10.3 degrees/s, 18.8+/-9.9 degrees/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.
Caloric Tests ; Cold Temperature ; Compensation and Redress ; Eye ; Eye Movements ; Follow-Up Studies ; Head ; Humans ; Outpatients ; Reflex, Vestibulo-Ocular ; Vestibular Neuronitis ; Vestibular Nuclei

BACKGROUND AND PURPOSE: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists. METHODS: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively. RESULTS: The mean values and range of the X, Y and Z are as follows: X=7.56+/-4.34, 1< or =X< or =15; Y=3.43+/-1.37, 0< or =Y< or =6; Z=6.51+/-3.91, 0< or =Z< or =12.5. CONCLUSIONS: The distribution of all the MRI lesions was 0< or =|Y|< or =6 (mm), 0< or =|Z|< or =12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.
Axis, Cervical Vertebra ; Brain ; Cerebral Aqueduct ; Humans ; Infarction ; Magnets ; Mesencephalon ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Considering saccular receptors are coupled physically with the auditory receptors, VEMP test may provide the information that in the noise induced hearing loss with or without dizziness, damage to the vestibular system, especially saccule is a potential organ with cochlear damage. MATERIAL AND METHODS: 11 patients (22 ears) with HF-SNHL greater than 55dB and 10 patients (10 ears) with sudden hearing loss of varying degree HL as positive control but without clinical manifestations of vestibular pathology tested for vestibular function test was enrolled. VEMP test was done. The results were compared with those of 9-healthy referents (18 ears) examined in the same way. RESULTS: VEMP wave was significantly abolished as twelve of 22 (54.5%) with HF-SNHL, five of 13 (38.5%) and Control group (100%). Though there was no statistically significant relation with P13, N23 latency delay in each group, NIHL showed P13, N23 latency delay trend compared with controls. CONCLUSIONS: Patients with noise induced hearing loss showed significantly more saccular deterioration, estimated as negative VEMP responses than did the controls. This suggests subclinical disturbances of the vestibular system especially of the saccule in noise induced hearing loss.
Dizziness ; Hearing ; Hearing Loss ; Hearing Loss, Sudden ; Humans ; Noise ; Saccule and Utricle ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: Unilateral vestibular loss can be induced by intratympanic gentamicin instillation. Despite accumulated reports on the morphologic changes after gentamicin treatment, there are limited reports regarding the effects of gentamicin ototoxicity on the vestibulo-ocular reflex (VOR), in especially unilateral vestibular deficit by local gentamicin instillation. Aim of this study is to provide the functional changes after local gentamicin application in guinea pigs. MATERIALS AND METHODS: Ten white guinea pigs (5 each for control and gentamicin treatment group) were used. Following surgical exposure of the left bulla, 0.9% saline solution or 40 mg/ml of gentamicin soaking gelfoam were applied on the round window. Horizontal vestibulo-ocular reflex (hVOR) was tested during earth vertical axis (EVA) sinusoidal harmonic acceleration rotation at 4 frequencies (0.04, 0.08, 0.16 and 0.32 Hz, 60 deg/sec of peak velocity). In one gentamicin treated animal, hVOR was tested during step velocity off-vertical axis rotation (OVAR) to clockwise and counterclockwise direction (30 degrees forward tilt from EVA with constant velocity of 100 deg/sec). Every test was repeated before treatment and at 2 days, 5 days and 7 days after treatment. RESULTS: The hVOR gain was significantly lowered after gentamicin treatment at all tested frequencies (p<0.05), while the gain does not change over time in control animals. Loss of bias component was evident and some decrease of modulation component was observed in counter-clockwise (lesion side) rotation after gentamicin treatment. CONCLUSION: This study provides characteristics of hVOR during EVA rotation and OVAR in unilateral vestibular deficit animal model by intrabullar gentamicin application.
Acceleration ; Animals ; Axis, Cervical Vertebra ; Bias (Epidemiology) ; Blister ; Extravehicular Activity ; Gelatin Sponge, Absorbable ; Gentamicins ; Guinea ; Guinea Pigs ; Humans ; Models, Animal ; Reflex, Vestibulo-Ocular ; Sodium Chloride

BACKGROUND:Acute vestibular neuronitis is the disease of which the etiology and pathophysiology are largely unknown . But the viral infection and ischemia of the labyrinth and the vestibular nerve are considered as general etiology. This study was performed to support the viral infection rather than the ischemic theory. MATERIALS & METHODS:We studied seventy years old female patient who showed painful vesicles on left auricle and vertigo with spontaneous nystagmus to the right side. We performed physical examination, serologic test, ENG test, pure tone audiogram, brain magnetic resonance imaging and polymerase chain reaction. RESULTS:We found small vesicles and vascular injection in left EAC, herpes zoster IgG positive, spontaneous right beating in electronystagmograpy, 54% left canal paresis in Caloric test , decreasing left side Tc in velocity step rotatory test, decresed gain, deviation to left in symmetry and phase lead in sinusoidal harmonic acceleration test, normal range hearing in pure tone audiogram, microangiopathy on cortex in brain MRI and negative PCR. CONCLUSION:This case supports viral infection etiology rather than ischemia in vestibular neuritis. But more studies to find the etiology of vestibular neuronitis are required.
Acceleration ; Brain ; Caloric Tests ; Ear, Inner ; Female ; Hearing ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Immunoglobulin G ; Ischemia ; Magnetic Resonance Imaging ; Paresis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Serologic Tests ; Vertigo ; Vestibular Nerve ; Vestibular Neuronitis

A case is reported of downbeat nystagmus associated with compression of the root of vestibulocochlear nerve by vertebral arteries, which was revealed by magnetic resonance imaging. Chief complain of the patient was positional vertigo, which aggrevated at left decubitus position. Downbeat nystagmus was increased in left Dix-hall pike test. Tetsuo et al, reported downbeat nystagmus with compression of dolichoectatic vertebral arteries to the medulla oblongata and surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred.
Decompression ; Esocidae ; Humans ; Magnetic Resonance Imaging ; Medulla Oblongata ; Nystagmus, Pathologic ; Vertebral Artery* ; Vertebrobasilar Insufficiency ; Vertigo ; Vestibulocochlear Nerve*

Canalith repositioning maneuver is effective to treat benign paroxysmal positional vertigo(BPPV). This case showed complicated form of the BPPV such as changes of canalolithiasis to cupulolithiasis, involvement of one canal to two canals and from unilateral to bilateral involvement during the reposition maneuver. This patient was diagnosed as left lateral canalolithiasis at first. After left barbecue maneuver, the type was changed to the right posterior cupulolithiasis. Semont maneuver was performed and then the type of BPPV was changed to combined type with right posterior canalolithiasis and left lateral canalolithiasis. We performed left barbecue maneuver and right Epley maneuver. Then the type of BPPV was changed to left lateral cupulolithiasis. After Brandt-Daroff maneuver and left barbecue maneuver, nystagmus and dizziness disappeared finally.
Dizziness ; Humans

When doctors evaluate the complaints of dizziness, they often perform a series of clinical tests to look for the evidence of a vestibular dysfunction. A useful procedure is to ask the patient to take deep breaths and observe the gaze behind Frenzel goggles. If hyperventilation-induced nystagmus(HIN) is detected, it is the evidence for an underlying vestibular imbalance. The authors evaluated nystagmus with electronystagmography after hyperventilation for 50 seconds. Brain imaging was performed to search the responsible lesion for dizziness. Brain MRI revealed a brain tumor suggesting vestibular schwannoma in the left cerebellopontine angle. After hyperventilation, dizziness and the right beating horizontal nystagmus with Alexander law could be detected. By precisely measuring the HIN, we determined that inputs arising from the horizontal semicircular canal were mainly responsible. The contralaterality of the direction of the horizontal component of the nystagmus was detected. We suggest that clinicians should routinely check the nystagmus after hyperventilation, when they evaluate patients complaining of dizziness.
Brain ; Brain Neoplasms ; Cerebellopontine Angle ; Dizziness ; Electronystagmography ; Eye Protective Devices ; Humans ; Hyperventilation* ; Jurisprudence ; Magnetic Resonance Imaging ; Neuroimaging ; Neuroma, Acoustic* ; Nystagmus, Pathologic ; Semicircular Canals