Dandy-Walker syndrome is congenital malformation characterized by cystic enlargement of the fourth ventricle and agenesis or hypogenesis of the cerebellar vermis. The major clinical symptoms of the disease are hydrocephalus, weakening of physical strenth and athletic abilities, macrocephaly, cerebellar disorders like ataxia, nystagmus and irritability, vomiting from IICP. The syndrome usually occurs in early infancy and is barely diagnosed in adult. A fifty six aged female patient whose chief complaints were dizziness with right nystagmus and right hearing disturbance visited our outpatient clinic and showed ninety three/fifty six dB in right pure tone audiometry. So we prescribed PO medication on the assumption that she had right sudden sensoryneural hearing loss with vertigo, however left nystagmus was seen in her physical examination after discharge. We present this case that she was diagnosed as Dandy-Walker syndrome in brain MRI after all.
Adult ; Ambulatory Care Facilities ; Ataxia ; Audiometry ; Brain ; Cerebellar Diseases ; Dandy-Walker Syndrome* ; Dizziness ; Female ; Fourth Ventricle ; Hearing ; Hearing Loss ; Humans ; Hydrocephalus ; Macrocephaly ; Magnetic Resonance Imaging ; Physical Examination ; Sports ; Vertigo ; Vestibular Neuronitis* ; Vomiting

Usual presentations of bilateral vestibular loss are ataxia and oscillopsia. However, fluctuating dizziness is also observed in bilateral vestibulopathy patient. Fluctuating vestibular function in bilateral vestibular loss patients may suggest asymmetric progression of functional loss after compensation is partially accomplished. Because labyrinthine lesion causing vestibular loss is a predisposing factor of benign paroxysmal positional vertigo (BPPV), secondary BPPV can also be developed in bilateral vestibular loss patients. However, BPPV has been hardly noticed in bilateral vestibulopathy patients as a cause of fluctuating dizziness. Authors experienced two cases of BPPV developed in bilateral vestibular loss, one of which showed complete dead labyrinth on ice water caloric test and no significant vestibule-ocular reflex on rotation test. These cases show recurrent BPPV can be the cause of recurrent vertigo in bilateral vestibular loss patients.
Ataxia ; Caloric Tests ; Causality ; Compensation and Redress ; Dizziness ; Ear, Inner ; Humans ; Ice ; Reflex ; Vertigo* ; Vestibular Diseases ; Vestibular Function Tests ; Water

BACKGROUND AND OBJECTIVES: Romberg test has been regarded as simple and efficient bedside modality to evaluate the vestibulospinal reflex in patients with balance disorders. we compared the direction of fall and that of yaw head rotation during Romberg test to evaluate its lateralizing value in acute unilateral vestibular neuritis. MATERIALS AND METHODS: Forty three patients (n=43) with acute unilateral vestibular neuritis were included. We did Romberg test in three different head positions: with a head looking straight ahead (Romberg test1), turned to the right by about 90 degrees (Romberg test2) and turned to the left by about 90 degrees (Romberg test3) in yaw. Affected side of the vestibular neuritis was decided by the direction of nystagmus and the side of canal paresis. We compared the falling direction in each Romberg test, direction of nystagmus and canal paresis. RESULTS: During Romberg test, 19 out of 43 fell to the lesion side (44%) and during modified Romberg test, 18 out of 43 fell to the lesion side (42%). On modified Romberg test, fallings to the side of affected labyrinth showed 14/18 (78%) in the Romberg test 2 and 15/18 (83%) in the Romberg test 3. The direction of falling in each maneuvers correlated statistically to the side of the affected labyrinth (p<0.05). Direction of nystagmus and the side of the canal paresis also showed correlation to the direction of falling in modified Romberg test. CONCLUSION: Romberg and Modified Romberg tests are helpful to decide the affected side in vestibular neuritis to some extents.
Ear, Inner ; Head ; Humans ; Paresis ; Reflex ; Vestibular Neuronitis*

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. MATERIALS AND METHODS: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. RESULTS: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. CONCLUSION: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.
Academic Medical Centers ; Caloric Tests ; Craniocerebral Trauma ; Dizziness ; Humans ; Paresis* ; Pathology ; Rehabilitation ; Retrospective Studies ; Vertigo* ; Vestibular Neuronitis

Acute hypotension induced excitation of electrical activities and expression of c-Fos protein and pERK in the vestibular nuclei. In this study, to investigate the excitatory signaling pathway in the vestibular nuclei following acute hypotension, expression of NR2A and NR2B subunits of glutamate NMDA receptor and GluR1 subunit of glutamate AMPA receptor was determined by RT-PCR and Western blotting in the medial vestibular nucleus 30 min after acute hypotension in rats. Acute hypotension increased expression of NR2A, NR2B, and pGluR1 in the medial vestibular nuclei. These results suggest that both of NMDA and AMPA glutamate receptors take part in transmission of excitatory afferent signals following acute hypotension.
alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Animals ; Blotting, Western ; Glutamic Acid* ; Hypotension* ; N-Methylaspartate ; Rats ; Receptors, AMPA ; Receptors, Glutamate* ; Vestibular Nuclei*

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potentials (VEMP) have become a good diagnostic tool to evaluate the integrity of the vestibulocollic reflex. To investigate the standard recording of VEMP response in normal hearing subjects, the authors studied the effects of test positions and different acoustic stimulations on the VEMP. SUBJECTS AND METHOD: We performed VEMP on both ears of thirty normal hearing volunteers. Three acoustic stimulations (clicks and 500 Hz and 1,000 Hz short tone bursts) and four test positions were presented alternately to evoke VEMP. The latencies of peak p13 and n23, p13n23 interpeak latency (IPL) and amplitude were measured by EMG equipment and compared by statistical program. We also made up questions for the compliance of the test positions. RESULTS: The effects of test positions p13 latency had no significant difference on all test positions except between test position 2 and 4, n23 latency and p13n23 IPL had shortest waveform on test position 2, p13n23 amplitude had the largest waveform in test position 4. Acoustic stimulations on all test positions were influenced that clicks had shorter waveform about 2-3 ms than STBs on p13 latency and n23 latency, STBs had larger waveform than clicks on p13n23 amplitude. And the compliance of the test positions exhibited highest comfort in test position 1. CONCLUSION: Test position 1 had higher VEMP response rates and compliance, 500 Hz STB had a largest p13n23 amplitude. Therefore we recommend that the ideal conditions were position 1 and 500 Hz STB for acoustic stimulations to evoke VEMP.
Acoustics* ; Compliance ; Ear ; Hearing ; Reflex ; Vestibular Evoked Myogenic Potentials* ; Volunteers

BACKGROUND AND OBJECTIVES : Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness, and gait ataxia. There have been few reports on deafness associated with the AICA infarction. Furthermore, previous neurological reports have not emphasized the inner ear as a localization of sudden deafness. The aim of this study was to investigate the incidence of deafness associated with the AICA infarction and the sites predominantly involved in deafness. MATERIALS AND METHOD : During two years we prospectively identified 12 consecutive patients with unilateral AICA infarction diagnosed by brain MRI. Pure tone audiogram, speech discrimination testing, stapedial reflex testing, and auditory brainstem responses were performed to localize the site of lesion in the auditory pathways. Electronystagmography was also performed to evaluate the function of the vestibular system. RESULTS :The most common affected site on brain MRI was the middle cerebellar peduncle (11). Four patients had vertigo and/or acute auditory symptoms such as hearing loss or tinnitus as an isolated manifestation from 1day to 2 months prior to infarction. Audiological testings confirmed sensorineural hearing loss in 11 (92%) patients, predominantly involved the cochlea in 6 and retrocochlear in 1. The other 4 patients had a severe to profound hearing loss most likely of cochlear origin. Electronystagmography demonstrated no response to caloric stimulation in 10 (83%) patients. CONCLUSIONS : In our series, sudden deafness was an important sign for the diagnosis of the AICA infarction. Audiological examinations suggest that sudden deafness in AICA infarction is usually due to dysfunction of the cochlea, resulting from ischemia to the inner ear.
Arteries* ; Auditory Pathways ; Brain ; Cochlea ; Deafness ; Diagnosis ; Ear, Inner ; Electronystagmography ; Evoked Potentials, Auditory, Brain Stem ; Gait Ataxia ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Humans ; Incidence ; Infarction* ; Ischemia ; Magnetic Resonance Imaging ; Prospective Studies ; Reflex ; Speech Discrimination Tests ; Stroke ; Tinnitus ; Vertigo

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of peripheral vestibular disorder and canalith repositioning procedure (CRP) has been popularly used as its treatment. While CRP has been advocated by some as a treatment of choice for BPPV, others have had less uniform results for this disorder. The purpose of this study is to evaluate the effectiveness of the CRP and to define the role of the CRP in BPPV. MATERIALS AND METHODS: From January, 1999 to September, 2001, 123 patients diagnosed as BPPV were included in this study. Each patient was undergone by personal history taking and Dix-Hallpike maneuver and supine head turning test for diagnosis. CRP was applied on all the patients and the patients visited OPD 1week later for evaluation. RESULTS: The mean age was 51.8 year old in males, and 52.7 year old in females. The most common cause of the disorder was idiopathic and the second common cause was post-traumatic. Posterior semicircular canal was the most common involved site and horizontal, anterior semicircular canal in order. After the initial CRP, successful results were obtained in 90 of the 123 patients (75.6%). Recurrence rate was 31 of the 123 patients and among them, 3 patients recurred in different canal. CONCLUSION: Careful observation of the nystagmus is necessary for correct identification of the canal which is involved, and that to perform the appropriate treatment. Although BPPV is known as a self-limited disorder, CRP can help to induce remission of the vertiginous symptoms in short period.
Diagnosis ; Female ; Head ; Humans ; Male ; Recurrence ; Semicircular Canals ; Vertigo*

BACKGROUND AND OBJECTIVES : Ageotrophic nystagmus in the horizontal canal BPPV has been explained as a result of cupulolithiasis theory, and has been reported to have the less therapeutic response to conservative rehabilitations than the other type BPPV . Though methods to detach the debris with vibrator have been introduced, the effect has been questioned and it's not physiologic. MATERIALS AND METHOD : We introduce a new head shaking-forced prolonged position method as a more convenient method, and report typical 2 cases of ageotrophic horizontal canal BPPV managed with it and analyzed results of 25 cases all told. RESULTS AND CONCLUSION : The average number of rehabilitation was less than two, and loss of direction changing positional nystagmus could be observed immediately after rehabilitation.
Head ; Nystagmus, Physiologic ; Rehabilitation ; Vertigo*

BACKGROUND AND OBJECTIVES: Vestibulo-ocular reflex and vestibulo-spinal reflex are induced by transmatoid galvanic stimulation of vestibular system. Nystagmus and body sway are result of each reflex. Recently, videooculograph possible to record a minute ocular movement was commonly used, vestibulo-ocular reflex induced by galvanic simualtion is easily documented. The purposes of this study are to evaluate the galvanic nystagmus in nomal persons in order to better understand the physiology of the vestibular system. MATERIALS AND METHODS: Eye movement of 20 neurootologic normal subjects by both side transmstoid galvanic stimulation (40cases) were analyzing by videonystagmography. RESULT: The direction of nystagmus in fast phase was to the negative electrode. Galvanic nystagmus was occured all normal subjects when stimulus intensity was more than 2mA. There was positive correlation between slow phase velocity(SPV) and electric current but negative correlation was noted between asymmery of SPV and electric current. CONCLUSION: It is suggested that the galvanic nystagmus test could be a new diagnostic tool for evaluation of vestibular status.
Electrodes ; Eye Movements ; Humans ; Physiology ; Reflex ; Reflex, Vestibulo-Ocular