BACKGROUND AND OBJECTIVES: Cervical vestibular evoked myogenic potentials (cVEMP) test has been widely used to assess the function of the saccule and inferior vestibular nerve. Electrode location and stimulating sound are important factors which might affect the test results. Today those parameters are usually selected to maximize the waveform response. In this study, we tried to find the optimal condition to minimize the range of normal value of cVEMP. SUBJECTS AND METHOD: Thirteen normal subjects (26 ears) were included. We placed electrodes at five different locations over the sternocleidomastoid muscle (SCM) and used four different stimulation sounds. Variances of parameters, including interpeak amplitude, interaural difference (IAD) and normal value were analyzed and compared. RESULTS: When using the classical condition (mid point of SCM and 500 Hz) without rectification, IAD ratio was 20.8+/-14.2% and the range of normal value was 39%. When we used 2000 Hz tone burst sound at the classical electrodes site, IAD ratio and normal value were minimized, resulting in 18.7+/-14.3% and 31% respectively. After the rectification, when using the classical condition, IAD ratio was 26.4+/-22.3% and the range of normal value was 49%. The minimum IAD ratio was measured as 17.4+/-13.7% when we used click sound at SCM at the level of mandibular angle. And the minimum normal value of 32% was measured when we used 1000 Hz tone burst sound at SCM at the level of mandibular angle. CONCLUSION: Although the condition was not optimal for maximizing the interpeak amplitude, we could alternatively use the condition to minimize the normal value.
Electrodes ; Reference Values ; Saccule and Utricle ; Vestibular Evoked Myogenic Potentials* ; Vestibular Nerve

We report a case of Mumps deafness with acute vestibular symptoms in a 13-year-old boy, who developed both parotid swelling preceded by acute right hearing loss and vertigo with spontaneous nystagmus. He was diagnosed as Mumps when the antibody of Mumps virus was detected in the serum. To our knowledge, this is the first case of Mumps infection, where parotitis was preceded by hearing loss and vertigo. This study indicates that the first symptom of Mumps virus infection could be hearing loss or vertigo.
Adolescent ; Deafness ; Hearing Loss* ; Humans ; Male ; Mumps virus ; Mumps* ; Parotitis* ; Vertigo*

BACKGROUND AND OBJECTIVES: ZLow frequency hearing loss is known to be the most common hearing loss form in Meniere's disease (MD) and episodic dizziness with low frequency sensorineural hearing loss is considered a very crucial symptom for the diagnosis of MD. However, flat or high frequency hearing loss is also commonly encountered in the Ear, Nose and Throat clinic. The aim of this study is to investigate the differences in clinical manifestation between episodic dizzy patients with low frequency hearing loss (LFHL) group and non-low frequency hearing loss (non-LFHL) group. SUBJECTS AND METHOD: We reviewed medical records of 78 patients (36 of LFHL group and 42 of non-LFHL group) who had episodic dizziness with unilateral hearing loss and analyzed clinical characteristics according to hearing loss pattern. RESULTS: The clinical features of LFHL include a predominance of female sufferers, high incidence of tinnitus and short duration of dizziness. There was no significant difference in frequency, nature of dizziness, and results of vestibular function test. Although the proportion of patients diagnosed with definite MD was higher in LFHL group at initial and final diagnosis, there were no statistically significant differences between two groups. CONCLUSION: Therefore, when episodic dizziness is accompanied with unilateral hearing loss, not only low frequency but flat or high frequency hearing loss could be considered as a critical sign for possible progression to Meniere's disease and careful observation should be taken.
Diagnosis ; Dizziness* ; Ear ; Female ; Hearing Loss* ; Hearing Loss, Sensorineural ; Hearing Loss, Unilateral* ; Humans ; Incidence ; Medical Records ; Meniere Disease ; Nose ; Pharynx ; Tinnitus ; Vestibular Function Tests

Angiosarcomas are rare, but aggressive malignancies. Reports of brain metastasis are uncommon. In this report, we describe the clinical features of a 62 year-old man who presented with hemoptysis and right-sided weakness. Chest computed tomography showed multiple ill-defined part solid nodules in both lungs and brain magnetic resonance imaging showed multiple hemorrhagic bran masses. The patient underwent whole body proton emission tomography to identify biopsy site and showed multiple bone lesions. A right acetabulum biopsy in confirmed the diagnosis of angiosarcoma.
Acetabulum ; Biopsy ; Brain ; Diagnosis ; Hemangiosarcoma ; Hemoptysis ; Humans ; Lung ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Protons ; Thorax

Reversible cerebral vasoconstriction syndrome (RCVS) has several trigger factors, including physical exertion, pregnancy, and the intake of vasoconstrictive agents. These triggers activate the sympathetic nervous system and induce vasoconstriction, thereby leading to an ischemic or hemorrhagic stroke. In this study, we describe case of RCVS in a 73-year-old woman who complained of sudden bilateral leg weakness after taking cyclophosphamide for anti-neutrophil cytoplasmic antibody associated vasculitis. She was diagnosed with concurrent cerebral hemorrhage and cerebral infarction with multiple intracranial vasoconstrictions on imaging analyses.

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a distinct subset of cerebral amyloid angiopathy characterized by the auto-inflammatory response to amyloid-laden small arteries of cerebral cortex and leptomeninges. Clinical features include cognitive-behavioral change, headache, focal neurologic deficits and seizure. Because anti-inflammatory treatments can rapidly relieve neurologic symptoms, early diagnosis is critical. Herein, we report a CAA-RI case with distinct laboratory findings of a decreased cerebrospinal fluid amyloid beta 1-42 level and relatively reduced florbetaben uptake in the focal inflammatory lesion during the acute phase of CAA-RI.

Reversible cerebral vasoconstriction syndrome (RCVS) has several trigger factors, including physical exertion, pregnancy, and the intake of vasoconstrictive agents. These triggers activate the sympathetic nervous system and induce vasoconstriction, thereby leading to an ischemic or hemorrhagic stroke. In this study, we describe case of RCVS in a 73-year-old woman who complained of sudden bilateral leg weakness after taking cyclophosphamide for anti-neutrophil cytoplasmic antibody associated vasculitis. She was diagnosed with concurrent cerebral hemorrhage and cerebral infarction with multiple intracranial vasoconstrictions on imaging analyses.

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a distinct subset of cerebral amyloid angiopathy characterized by the auto-inflammatory response to amyloid-laden small arteries of cerebral cortex and leptomeninges. Clinical features include cognitive-behavioral change, headache, focal neurologic deficits and seizure. Because anti-inflammatory treatments can rapidly relieve neurologic symptoms, early diagnosis is critical. Herein, we report a CAA-RI case with distinct laboratory findings of a decreased cerebrospinal fluid amyloid beta 1-42 level and relatively reduced florbetaben uptake in the focal inflammatory lesion during the acute phase of CAA-RI.

Antiphospholipid antibody syndrome(APS) is a well-known clinical syndrome characterized by recurrent arterial or venous thromboses, recurrent fetal loss, thrombocytopenia, together with high titers of sustained anticardiolipin antibody(aCL) or lupus anticoagulant(LA). Although systemic lupus erythematosus(SLE) and APS may coexist, a high proportion of patients manifesting the APS do not suffer from classical lupus or other connective tissue disease. The patient has been defined as having a primary antiphospholipid antibody syndrome. We experienced one case of primary APS with recurrent fetal loss, recurrent cerebral infarctions, positive anticardiolipin antibody IgG and fluttering vegetation on the mitral valve, without other connective tissue diseases including SLE. Forty-three old female had 2 out of 11 criteria for the diagnosis of SLE, such as thrombocytopenia and positive antinuclear antibody, but did not meet whole criteria. The patient was treated with ticlopidine, and anticoagulant therapy was recommended.
Antibodies, Anticardiolipin ; Antibodies, Antinuclear ; Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome* ; Cerebral Infarction ; Connective Tissue Diseases ; Diagnosis ; Echocardiography* ; Female ; Humans ; Immunoglobulin G ; Mitral Valve* ; Thrombocytopenia ; Ticlopidine ; Venous Thrombosis

BACKGROUND AND OBJECTIVES: We identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) followed by therapeutic hypothermia on survival and neurologic outcome in patients with prolonged refractory in-hospital cardiac arrest (IHCA). METHODS: We enrolled 16 adult patients who underwent ECPR followed by therapeutic hypothermia between July 2011 and December 2015, for IHCA. Survival at discharge and cerebral performance category (CPC) scale were evaluated. RESULTS: All patients received bystander cardiopulmonary resuscitation (CPR); the mean CPR time was 66.5±29.9 minutes, and the minimum value was 39 minutes. Eight patients (50%) were discharged alive with favorable neurologic outcomes (CPC 1–2). The mean follow-up duration was 20.1±24.3 months, and most deaths occurred within 21 days after ECPR; thereafter, no deaths occurred within one year after the procedure. CONCLUSION: ECPR followed by therapeutic hypothermia could be considered in prolonged refractory IHCA if bystander-initiated conventional CPR is performed.
Adult ; Cardiopulmonary Resuscitation* ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart Arrest* ; Humans ; Hypothermia, Induced*