A 60-year-old man with hypertension presented with an acute onset of an isolated sudden deafness with vertigo. On admission, initial brain MRI, including diffusion images, was normal. During admission, the patient presented with an exacerbation of vertigo. A follow-up MRI revealed new infarcts involving the right middle cerebellar peduncle, the right dorsolateral pons, and right anterior cerebellum. In this patient, an acute onset of an isolated sudden deafness with vertigo may be a heralding manifestation of the pontocerebellar infarction.
Brain ; Cerebellum ; Diffusion ; Follow-Up Studies ; Hearing Loss, Sudden* ; Humans ; Hypertension ; Infarction ; Magnetic Resonance Imaging ; Middle Aged ; Pons ; Vertigo*

An isolated nodular infarction presenting as an isolated vertigo with unidirectional, gaze-fixed nystagmus has not been previously reported. We reported a patient with cerebellar infarction who presented with purely isolated vertigo, ipsilesional, spontaneous nystagmus, and contralesional axial lateropulsion without usual symptoms or signs of cerebellar dysfunction. An MRI of the brain showed a small infarct selectively involving the nodulus. A pure vestibular syndrome in our patient may be explained by an ipsilateral involvement of nodulo-vestibular inhibitory projection to vestibular nucleus. Clinicians should be aware of the possibility of a nodulus infarction in patients with an acute vestibular syndrome, even if the pattern of nystagmus and lateropulsion is typical of vestibular neuritis.
Brain ; Cerebellar Diseases ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Vertigo ; Vestibular Neuronitis*

Besides meningism, dizziness has also been frequently reported as a neurologic manifestation of Vogt- Koyanagi-Harada(VKH) syndrome. These neurotologic symptoms usually develop just before or after ocular involvement. We report the patient with VKH syndrome who showed recurrent peripheral vertigo. The characteristic opthalmological symptoms developed later in this case.
Dizziness ; Humans ; Meningism ; Neurologic Manifestations ; Uveomeningoencephalitic Syndrome* ; Vertigo*

No abstract available.
Oculomotor Nerve* ; Paralysis* ; Tolosa-Hunt Syndrome*

Ocular contrapulsion refers to a syndrome of static ocular deviation and saccadic hypermetria toward the intact side, and saccadic hypometria and impaired smooth pursuit toward the lesion side. It has been reported in patients with lesions in the rostral cerebellum and caudal medullary hemorrhge. We report a 60-year-old man who showed ocular contrapulsion with unilateral upper medial medullary infarction. Ocular contrapulsion may be a sign of medial medullary infarction. In our patient, the climbing fibers may be damaged before crossing the midline in the upper medulla.
Cerebellar Ataxia ; Cerebellum ; Humans ; Infarction* ; Middle Aged ; Pursuit, Smooth

Intralabyrinthine schwannomas are rare benign tumors that arise from the terminal ends of the eighth cranial nerve. These may involve the cochlea, vestibule, or semicircular canals. These tumors are uncommon, and were diagnosed incidentally either during labyrinthectomy or at autopsy. The increasing use of the MRI in the diagnostic assessment of patients with unilateral sensorineural hearing loss or tinnitus has led to the diagnosis of intralabyrinthine schwannomas. Because the clinical symptoms of intralabyrinthine schwannomas and other otologic disorders, particularly Meniere's disease, are so similar, diagnosis of intralabyrinthine schwannomas is challenging. We report a patient with intralabyrinthine schwannoma, who had been misdiagnosed as having Meniere's disease. With the aid of MRI, intralabyrinthine schwannoma was detected and removed successfully by translabyrinthine approach.
Autopsy ; Cochlea ; Diagnosis ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Imaging ; Meniere Disease* ; Neurilemmoma* ; Semicircular Canals ; Tinnitus ; Vestibulocochlear Nerve

OBJECTIVES: The aim of this study was to observe the nystagmus of totally unilateral vestibular function loss on galvanic vestibular stimulation and the diagnostic value of galvanic vestibular stimulation. Additionally we wanted to evaluate which portions may be stimulated by galvanic vestibular stimulation. MATERIALS AND METHODS: We evaluated the three parameters of galvanic stimulation in fourteen patients with totally unilateral vestibular function loss, 1)spontaneous nystagmus, 2)galvanic stimulating nystagmus, 3)Post galvanic stimulating nystagmus through 3-dimensional video-oculography technique. RESULTS: When negative electrode was attached to the intact side, The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side in all patients and post galvanic stimulating nystagmus was directed to the opposite side but on functional loss side, we couldn't detect any nystagmus on galvanic vestibular stimulation and in 10 patients, post galvanic stimulating nystagmus was observed and directed to the intact side. CONCLUSIONS: Galvanic vestibular stimulation is very useful for evaluating the vestibular function and for diagnosing the vestibular disease.
Electrodes ; Humans ; Vestibular Diseases

BACKGROUND AND OBJECTIVES: The patient presenting to the emergency department with the complaint of dizziness is one of the most common as well as most challenging problems confronting the emergency physician today. Dizziness is a vague symptom of disease ranging from serious to benign. The differential diagnosis and proper management of dizziness in a department of emergency medicine are the most important things. We undertook this study to evaluate the character and clinical analysis of the dizzy patients and to discuss the significance and necessity of primary care in a department of emergency medicine. MATERIALS AND METHOD: From September 1999 to October 2003, we sampled the 1,371 dizzy patients who visited the Emergency Department(ED). Of these patients, the 650 patients performed electronystagmography(ENG) and rotatory chair test were selected, except for the patients with loss of consciousness, known psychiatric disease or direct brain injury. RESULTS: The 650 patients were attributed to acute peripheral vestibulopathy in 88.5% (575 patients) of patients, benign paroxysmal positional vertigo in 9.5% (62 patients) of patients, central origin in 1.4% (9 patients) of patients, other organic origin in 0.6% (4 patients) of patients. In a retrospective analysis of patients with central origin, the symptoms estimated at central origin, for example, persistent headache, were found. CONCLUSION: The exact diagnosis and management for the dizzy patients in a department of emergency medicine require the primary physician's concern and understanding for dizziness.
Brain Injuries ; Diagnosis ; Diagnosis, Differential ; Dizziness ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Headache ; Humans ; Primary Health Care ; Retrospective Studies ; Unconsciousness ; Vertigo ; Vestibular Neuronitis

BACKGROUND AND OBJECTIVES: Ramsay Hunt syndrome is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We tried to show that Ramsay Hunt symdrome should be recognized as a cranial polyneuropathy characterized by damage to cranial nerves, especially the facial nerve and the auditory-vestibular nerve. MATERIALS AND METHOD: 11patients suffered from auricular vesicles, otalgia, facial palsy, and vertigo. Group A included 8 patients of acute peripheral vestibulopathy with Ramsay Hunt syndrome. Group B included only 3patients of Ramsay Hunt syndrome. Each patient received a battery of tests, including neurological examination, audiometry, vestibular function test. RESULTS: The lesion site of Ramsay HHhhunt syndrome was right in 5cases and left in 6cases. Electronystagmography showed 3cases of right acute peripheral vestibulopathy, 5cases of left, and 3cases of disequilibrium. Site of Ramsay hunt syndrome and that of vestibulopathy was same in 8cases of Group A. 3cases was observed in Ramsay Hunt syndrome patients that hearing loss and vestibulopathy was same site. Facail nerve palsy improved without recovery of vestibular function. Cranial examination and imaging study like brain CT or temporal MRI showed no abnormal finding. CONCLUSION: Although Ramsay Hunt syndrome usually presents with the classical triad of pain, vesicles and facial nerve paralysis, it must be kept in mind that it is a cranial polyneuropathy. In our study, there was few association between facial nerve palsy recovery and acute peripheral vestibulopathy.
Audiometry ; Brain ; Cranial Nerves ; Earache ; Electronystagmography ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Herpes Zoster ; Herpes Zoster Oticus* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Paralysis ; Polyneuropathies ; Vertigo ; Vestibular Function Tests ; Vestibular Neuronitis

BACKGROUND AND OBJECTIVES: Labyrinthine fistula is one of the common complication of the chronic otitis media with cholesteatoma. Disruption of the labyrinthine bone can lead to hearing loss and/or vestibular disturbance. This study aimed to evaluate postoperative vertigo result in patient with labyrinthine fistula and efficacy of vestibular function test for diagnosis. MATERIALS AND METHOD: A retrospective study of the clinical records of 13 patients who were operated for chronic otitis media with cholesteatoma, suspected to have secondary labyrinthine fistula, from January 2001 through June 2003 in Gachon medical school Gil hospital. All patients were evaluated by Fistular test, Vestibular function test, high resolution Temporal bone CT, Pure tone audiometry preoperatively. Vertigo was assessed by Disability Scale. RESULTS: Canal wall down mastoidectomy were applied in all ears. Labyrinthine fistulas were confirmed in 8 patients during operation. Fistular group had higher rate of peripheral vestibular injury than no-fistular group's in vestibulo-ocular reflex. Fistula cases have high average score (2.9) than non-fistula's (1.6) in Vertigo scale preoperatively. In post-operation, the average score was 0.25 in fistular cases and 0.4 in non-fistula cases. 2 cases presented positive fistular test result (25.0%) CONCLUSION: Although Vertigo was more severe in patients who had fistula, in post-operation, symptoms could be relieved a lot. Vestibular function test had efficacy for diagnosis of labyrinthine fistula in preoperative.
Audiometry ; Cholesteatoma* ; Diagnosis ; Ear ; Fistula* ; Hearing Loss ; Humans ; Otitis Media ; Reflex, Vestibulo-Ocular ; Retrospective Studies ; Schools, Medical ; Temporal Bone ; Vertigo* ; Vestibular Function Tests