BACKGROUND: Horizontal canal benign positional vertigo (BPV) is characterized by direction-changing nystagmus beating to the lowermost ear (geotropic) or to the uppermost ear (apogeotropic) induced by head turning while the patient is lying down. The clinical features of horizontal canal BPV has rarely been studied in a large group of patients in Korea. METHODS: Ninety-seven patients with horizontal canal BPV were recruited from September 2000 to August 2003. The diagnosis of BPV was based on the typical nystagmus concurrent with vertigo elicited by positioning maneuvers. The type was divided into geotropic or apogeotropic. The demographic features, spontaneous nystagmus, positional nystagmus, results of head thrusting and head shaking, and nystagmus induced by lying down were analyzed. RESULTS: The patients included 68 (70.1%) women and 29 (29.9%) men. Mean age of the patients was 61.1 +/- 13.8 with no difference between women and men. They were divided into 54 (55.7%) geotropic and 43 (44.3%) apogeotropic types. The horizontal nystagmus was also provoked by Hallpike maneuver in 15 cases. Horizontal nystagmus was also induced by lying down from sitting to supine position in 7 patients; 3 apogeotropic and 4 geotropic. The nystagmus was ipsilesional in 2 of apogeotropic cases and contralesional in 2 of geotropic cases. CONCLUSIONS: In horizontal canal BPV, horizontal nystagmus may be induced by Hallpike maneuver or lying down as well as head turning in supine position. The direction of nystagmus induced by lying down may help deciding the side of the canal involved.
Deception ; Diagnosis ; Ear ; Female ; Head ; Humans ; Korea ; Male ; Nystagmus, Pathologic ; Nystagmus, Physiologic ; Supine Position ; Vertigo*

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is the most common disease of the peripheral vestibular disorders. Canalithiasis theory of the posterior semicircular canal is widely accepted as the pathophysiologic mechanism of BPPV. Recently, some authors reported that geotropic direction-changing horizontal nystagmus is attributed to the BPPV of the horizontal semicircular canal. The purpose of this study is to aid in the understanding and diagnosis of this disease through the analysis of the clinical features and electronystagmographic (ENG) results. MATERIALS AND METHODS: Nine patients who showed geotropic direction-changing horizontal nystagmus were included in this study. Supine head turning test was performed to induce positional nystagmus. Various findings of the nystagmus were recorded with ENG. Other ENG tests (visual tracking tests and bithermal caloric test) and MRI (4 cases) were checked to exclude the possibility of the central origin. RESULTS: All patients showed geotropic direction-changing horizontal nystagmus in supine head turning test. The nystagmus had a short latency, no fatigabilily and long duration (>1 min). The nystagmus was more intense in diseased ear of down position and changed its direction spontaneously (secondary nystagmus) in 7 cases. CONCLUSION: All patients complaining of paroxysmal positional vertigo should undergo two positional tests: Dix-Hallpike test and supine head turning test. Characteristics of nystagmus can be explained by canalithiasis theory of the horizontal semicircular canal.
Diagnosis ; Ear ; Head ; Humans ; Magnetic Resonance Imaging ; Nystagmus, Pathologic ; Nystagmus, Physiologic ; Semicircular Canals* ; Vertigo*

To investigate the changes of vedionystamography(VNG)in patients with posterior circulation ischemia vertigo(PCIV).Fifty patients who complained of vertigo and imbalance with PCI were selected as experimental group for testing of visual nystamography(VNG).Thirty normal subjects were chosen as control group.The result was analyzed.The results of VNG in PCIV group and the control group were compared.The abnormal ratio were as follows:(4%,0;>0.05)for Spontaneous nystagmus,(68%,10%;<0.01)for Saccade Test,(42.0%,6.7%;<0.01)for Tracking Test,(44%,0;<0.01)for Optokinetic Test,(78%,10%;<0.01)for Positional Test,respectively.The intensity of positional nystagmus in those patients was(4.12±3.46)°/s,which was much higher than that of the control group(<0.01).One or more abnormal findings for visual-oculomotor system examination were shown in 37 patients(74%).Both vestibular central and peripheral system can be involved in PCIV.VNG test has clinical significance in differential diagnosis and lesion location.The abnormal ratio of visual nystamography in PCIV group reaches 92%(46/50).These results suggest that VNG be used as an important accessory diagnostic tool for patients with PCIV.
Humans ; Nystagmus, Pathologic ; Nystagmus, Physiologic ; Vertigo ; diagnosis ; Vestibular Function Tests ; Vestibule, Labyrinth

OBJECTIVES: The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders. METHODS: This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p<0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups. CONCLUSION: Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.
Benign Paroxysmal Positional Vertigo ; Caloric Tests ; Diagnosis ; Head ; Humans ; Migraine Disorders ; Nystagmus, Pathologic ; Nystagmus, Physiologic ; Retrospective Studies ; Semicircular Canals ; Vertigo

OBJECTIVETo discuss the objective characteristics and mechanism of nystagmus direction, intensity and time in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) .

METHODSA total of 233 patients with HSC-BPPV, whereas 179 horizontal semicircular canalithasis (HSC-Can) and 54 horizontal semicircular cupulolithiasis (HSC-Cup) were involved respectively. The induced nystagmus in roll tests recorded by video-nystagmograph(VNG) , whose direction, intensity and time characteristics were compared in various BPPV.

RESULTSHorizontal nystagmus was both induced by turning left or right in HSC-BPPV roll tests. The direction of the induced nystagmus was the same with turning in HSC-Can. The latency, duration time and intensity ([AKx(-)D] ± s) turning to lesion and normal side were (1.922 ± 1.501)s and (1.447 ± 0.855)s, (25.620 ± 10.409)s, and (22.110 ± 10.931)s, (56.441 ± 33.168)°/s and (24.239 ± 13.892) °/s in HSC-Can. The latency, duration time and intensity turning to lesion side were larger than normal side (t = 3.715, 15.219 and 4.070, P < 0.01) , the difference was statistically significant, and the intensity rate was about 2: 1. The direction of the induced nystagmus was opposite to turning in HSC-Cup. The intensity turning to normal side was larger than lesion side obviously. The intensity rate was about 2: 1, the difference was statistically significant (t = -7.634, P < 0.01) . While the latency and intensity of turning to lesion side in HSC-Can were larger than turn to normal side in HSC-Cup, and the difference detected no statistically significant difference (t = 1.554 and 0.305, P > 0.05).

CONCLUSIONSThe induced nystagmus intensity of head to two sides in roll tests for HSC-BPPV both follow Ewald's law, and the ratio between stronger and weaker are both 2: 1. These nystagmus parameters of VNG in roll tests are an objective guideline for BPPV diagnosis.

Benign Paroxysmal Positional Vertigo ; complications ; diagnosis ; Electronystagmography ; Head ; Humans ; Nystagmus, Pathologic ; complications ; diagnosis ; Semicircular Canals ; Vertigo

PURPOSE: To investigate clinical findings, diagnostic criteria and management for patients with congenital periodic alternating nystagmus (PAN). METHODS: A retrospective analysis of clinical findings and electrooculography (EOG) of patients with congenital PAN was performed. Thirteen patients diagnosed with congenital PAN from March 1992 to December 2002 were included. RESULTS: Of 13 patients, the median age at initial visit was 7 years old (range: 1 to 30 years). Eight patients had abnormal head posture. The mean value for the period of alteration was 265.7 seconds. Six patients who received either the modified Kestenbaum-Anderson procedure or four rectus muscle recession showed a significant decrease in amplitude and/or frequency of nystagmus, and showed statistically significant improvement in visual acuity in LogMAR after the procedures by 0.33+/-0.09 in right eye, 0.34+/-0.11 in the left eye, compared with preoperative acuities of 0.43+/-0.19 and 0.38+/-0.09 respectively. CONCLUSIONS: Congenital PAN requires the evaluation of nystagmus along with a thorough evaluation of eye movement and EOG. Close follow is necessary to evaluate the pattern of nystagmus. Also, either modified Kestenbaum-Anderson procedure or four rectus muscle recession could be effective, depending on the presence of abnormal head posture.
Child ; Diagnosis* ; Electrooculography ; Eye Movements ; Head ; Humans ; Nystagmus, Pathologic* ; Posture ; Retrospective Studies ; Visual Acuity

Objective:To investigate the classification of head shaking nystagmus（HSN） and its clinical value in vestibular peripheral diseases. Methods:Clinical data of 198 patients with peripheral vestibular disorders presenting with HSN were retrospectively analyzed. Video Nystagmograph（VNG） was applied to detect spontaneous nystagmus（SN）, HSN, and Caloric Test（CT）. The intensity and direction of SN and HSN as well as the unilateral weakness（UW） and direction preponderance（DP） values in caloric test was analyzed in patients. Results:Among the 198 patients with vestibular peripheral disease, there were 105 males and 93 females, with an average age of（49.1±14.4） years （range: 14-87 years）. One hundred and thirty seven patients were diagnosed as Vestibular Neuritis（VN）, 12 as Meniere's Disease（MD）, 41 as sudden deafness（SD） and 8 as Hunt's syndrome accompanied by vertigo. Among them, there were 116 patients in the acute phase, including 68 cases（58.6%） with decreased HSN, 4 cases（3.4%） with increased HSN, 5 cases（4.3%） with biphasic HSN, 38 cases（32.8%） with unchanged HSN, and 1 case（0.9%） with perverted HSN. There were 82 cases in the non-acute phase, 51 cases（62.2%） with decreased HSN, 3 cases（3.6%） with increased HSN, 9 cases（11.0%） with biphasic HSN, and 19 cases（23.2%） with unchanged HSN. In biphasic HSN, the intensity of phase I nystagmus was usually greater than that of phase II, and the difference was statistically significant（P<0.01）. There was no correlation between HSN type and course of disease or DP value. The intensity of HSN was negatively correlated with the course of disease（r=-0.320, P<0.001） and positively correlated with DP value（r=0.364, P<0.001）, respectively. The intensity of unchanged nystagmus and spontaneous nystagmus were（8.0±5.7） °/s and（8.5±6.4）°/s, respectively. There was no statistically significant difference in the intensity of nystagmus before and after shaking the head. Conclusion:HSN can be classified into five types and could be regarded as a potential SN within a specific frequency range （mid-frequency）. Similarly, SN could also be considered as a common sign of unilateral vestibular impairment at different frequencies. HSN intensity can reflect the dynamic process of vestibular compensation, and is valuable for assessing the frequency of damage in peripheral vestibular diseases and monitoring the progress of vestibular rehabilitation.
Male ; Female ; Humans ; Adult ; Middle Aged ; Vestibular Function Tests ; Retrospective Studies ; Nystagmus, Pathologic/diagnosis* ; Vertigo/diagnosis* ; Electronystagmography ; Vestibular Diseases/diagnosis*

OBJECTIVE: To study the changes of visual nystagmography(VNG) in patients with vertebrobasilar transient ischemic vertigo(VBTIV), explore their clinical value in diagnosis of the patients with VBTIV. METHOD: Thirty-eight patients who complained vertigo and imbalance with VBTIV were selected as experimental group for testing of visual nystagmography (VNG). Twenty normal persons were chosen as control group. The result was analyzed. RESULT: In the experimental group, there was one case that had spontaneous nystagmus and 29 cases (76.3%) with positional nystagmus. The positional nystagmus intension in those patients was (4.08+/-3.18) degrees/s, which was much higher as compared with the control group( P <0.01). The incidence was 39.5% for positioning test. One or more abnormal findings for visual-oculomotor system examination were shown in 28 patients (73.7%). These abnormal findings included saccade test in 26 cases (68.4%), eye tracking test type III in 13 cases and type IV in 3 cases in all 16 cases (42.1%), optokinetic nystagmus in 17 cases (44.7%). There was none with gaze nystagmus. Caloric test showed canal paresis in 19 cases (50.0%) and directional preponderance in 6 cases (15.9%). In Amount distributing of the general slow phase velocity there is a difference between test group and control group. CONCLUSION Not only vestibular centrum but also peripheral system was involved in patients with VBTIV. These results suggest that VNG be used as important diagnostic test for patients with VBTIV and might be helpful for the location diagnosis of VBTIV.
Adult ; Case-Control Studies ; Electronystagmography ; Female ; Humans ; Male ; Middle Aged ; Nystagmus, Optokinetic ; Nystagmus, Pathologic ; complications ; diagnosis ; Vertebrobasilar Insufficiency ; complications ; physiopathology ; Vertigo ; etiology ; physiopathology ; Vestibular Function Tests

An extraordinary eye movement was seen in a vegetative patient. His eyeballs were exotropic in the primary position and showed dissociated nystagmus which appeared alternately in each eye every few seconds. He also had palatal myoclonus quite asynchronous with the nystagmus. To our knowledge, there has been no such nystagmus documented in the literature. We report the new nystagmus with his EOG and brain MRI.
Electrooculography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myoclonus/*complications/diagnosis ; Nystagmus, Pathologic/*complications/diagnosis ; Palatal Muscles

Internuclear ophthalmoplegia(INO) is characterized by the adduction deficit on lateral gaze associated with dissociated nystagmus of an abducting eye and caused by the lesion in the medial longitudinal fasciculus(MLF). It occurs unilaterally or bilaterally in infarction of brain stem and multiple sclerosis. Ocular myasthenia is a localized form of myasthenia involving extraocular, levator palpebrae perioris, and/or orbicularis oculi muscles. It is frequently confused with a variety of ocular mortility disorders including INO. We experienced 2 patients who had bilateral wall-eyes and diplopia. One was a true bilateral INO due to hypertensive brain stem infarction(Wall-eyed bilateral INO) and the other was a myasthenic bilateral pseudo-INO. Diagnosis was made by Tensilon test, repetitive nerve stimulation test of orbicularis oculi muscles, and serum antibody assay in latter case.
Brain Stem ; Diagnosis ; Diplopia ; Edrophonium ; Exotropia* ; Humans ; Infarction ; Multiple Sclerosis ; Muscles ; Nystagmus, Pathologic ; Ocular Motility Disorders ; Ophthalmoplegia*