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

BACKGROUND AND OBJECTIVES: Vestibular rehabilitation has been recommended as the treatment of choice for patients with persisting dizziness due to vestibular dysfunction, since surgery is seldom appropriate and the available pharmacological treatments are not curative and can have undesirable side-effects. This study investigated the effects f vestibular rehabilitation therapy on recovery following acute unilateral vestibular loss. MATERIALS AND METHODS: Twenty-four patients were randomly assigned to two groups of either with-treatment or without treatment. The outcome measures included equilibrium scores in dynamic posturography, motion sensitivity quotient (MSQ), and dizziness handicap inventory (DHI). RESULTS: When individual comparison measures were compared, equilibrium score results at the end of the 8-week treatment period revealed improvement of postural control in the group who received vestibular rehabilitation therapy. The DHI and MSQ results revealed less motion sensitivity and dizziness handicap, but not the acquired statistical significance compared with the non-treatment group. CONCLUSION: This results suggest that after acute unilateral vestibular loss, most patients can effectively utilize the central compensation mechanisms to recover from such an injury, but the vestibular rehabilitation therapy could provide a more rapid and complete recovery for these patients.
Compensation and Redress ; Dizziness ; Humans ; Outcome Assessment (Health Care) ; Rehabilitation*

Biliary papilloma usually consists of single or multiple papillary adenomas in the biliary tract and has a potential for recurrence and malignant transformation. We described herein a case of papillary adenoma of intrahepatic duct that transformed into papillary adenocarcinoma. A 49-year-old male patient was admitted to our hospital because of right upper quadrant pain. A CT scan revealed marked dilatation of S7 segmental duct and cholangioscopy and biopsy revealed mucin-secreting papillary adenoma in the right intrahepatic duct. Three years later, a follow up of CT scan showed aggravated S7 ductal dilatation and inner ill-defined mass. Cholangioscopy revealed multiple papillary mucosal projections with large amount of mucin in the right intrahepatic duct and biopsy revealed well differentiated papillary adenocarcinoma. The patient underwent right lobectomy, the papillary adenocarcinoma was extended in the dilated right intrahepatic duct and also showed hepatic parenchymal invasion.
Adenocarcinoma, Papillary* ; Adenoma* ; Biliary Tract ; Biopsy ; Dilatation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucins ; Papilloma ; Recurrence ; Tomography, X-Ray Computed

We performed three kinds of problem-based learning (PBL) formulas in all of forty-one 3rd grade students after the final examination of the first semester from June 28, 1999 to July 9, 1999 at Konkuk University College of Medicine to investigate which formula is the most efficient and helpful in medical education and polyclinic course. The PBL formulas applied were the typical face-to-face PBL accompanied by mini-lecture (Type I) or by distribution of the guidelines without lecture (Type II) and cyber PBL using web-based module and discussion over cyber space (Type III). Response of students was surveyed using some questionnaires and the evaluation results of each PBL were analyzed with Pearson's correlation test. All participating students were satisfied with the face-to-face PBL especially in applying time of PBL, using discussion to solve the problem, and studying with tutors. In cyber PBL, in spite of excellency of the contents, limitations in discussion over cyber space and computer skills, misunderstanding of computer system, and additional cost for private PC rent seemed to decrease the satisfaction with this PBL. Experience in Type II PBL was turned out to be the most helpful and discussion among fellow students in PBL to be the most useful experience for incoming polyclinic course. There were no significant correlations between the evaluation results of face-to-face PBL and cyber PBL or between the evaluation results of each type of PBL and the average credit of that semester, suggesting that evaluation of the newly acquired knowledge through PBL using tools such as Triple Jump, OSCE (objective structured clinical examination), and MEQ (modified essay question) should be included in assesment of academic achievement in addition to the evaluation of activities during PBL.
Computer Systems ; Education, Medical ; Equidae ; Humans ; Problem-Based Learning* ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: The saccadic eye movement means rapid eye movement in order to fixate an intended target with fovea. Frontal lobe, brain stem and paramedian pontine reticular formation operate the saccade movement in the central nervous system. Although saccadic abnormalities were usually seen in the CNS lesion(most commonly in the cerebellar lesion) some normal individuals consistently undershoot or overshoot the target(corrective saccade). Because there are several possibilities for serious error when interpreting the saccade test, clinical usefulness of saccade test may be uncertain. We study the saccade movement in out dizzy patients to find out the definite usefulness of saccadic abnormality and cause of dizziness according to the saccadic abnormalities. MATERIAL AND METHOD: For 4 years, 1994.1.-1997.12, 53 patients showed saccade abnormalities and they were classified into 5 categories-undershoot, overshoot, slow velocity of saccade, impaired saccade and fail of saccade. Spontaneous nystagmus, gaze nystagmus, pursuit test and optokinetic test were also performed. We analyzed the cause of saccade abnormality and other associated eye movement disorders. RESULTS: Almost all saccade abnormalities were seen in central disease(71%), but some could be seen in specific cases of peripheral disease(11%) and in other conditions(18%). In peripheral lesion, only saccade undershoot was seen without other abnormal eye movement. In central lesion, all kinds of saccade movement were seen with or without other abnormal eye movement disorders, but there was no correlation between the sites of lesion and types of saccade. Spontaneous nystagmus was seen in 6 patients, but there was no correlation between the causes of vertigo and the types of saccade abnormality. CONCLUSION: Saccade test must be clinically useful for differentiating between the central and peripheral lesion using the types of saccade abnormality and other abnormal eye movement. But many factors that affect saccade movement should be considered when interpreting the test results.
Brain Stem ; Central Nervous System ; Dizziness ; Eye Movements ; Frontal Lobe ; Humans ; Ocular Motility Disorders ; Reticular Formation ; Saccades* ; Sleep, REM ; Vertigo

BACKGROUND AND OBJECTIVES: There is still a controversy surrounding lesion side differentiation and treatment of the lateral canal cupulolithiasis. The purpose of this study is to understand side differentiation, and study the treatment of this disease through analyses of clinical features, electronystagmographic (ENG) results, treatment maneuvers and its effectiveness. MATERIALS AND METHODS: Twenty three patients who showed ageotropic direction-changing horizontal positional nystagmus were included in this study. A supine head turning test was performed to induce positional nystagmus. Clinical findings and typical features of the nystagmus were recorded. Neurologic examinations, ENG tests, and MRI (6 cases) were checked to exclude the possibility of any central lesions. Cupulolith Repositioning Maneuver (CuRM) was applied on the patients and these patients were instructed to keep the healthy side at the lateral decubitus position while sleeping. RESULTS: The nystagmus had a short latency, no fatigability, and persistency in character. In one patient, nystagmus was resolved spontaneously, so we could not decide the lesion side. However, seventeen out of 22 patients showed significant differences between the intensity of each side nystagmus, and all of them showed stronger nystagmus when the head was rotated to the unaffected side. In five patients who showed no significant difference between the intensity of each side nystagmus, two cases showed same results and three cases showed opposite results. Typical nystagmus and spinning sensation in the supine head-turning test had completely subsided after physical therapy. CONCLUSION: In the cupulolithiasis of lateral semicircular canal, ageotropic nystagmus was stronger when the pathological ear was at the uppermost position, and this excitatory nystagmus beat to the lesion side. But, if there was no significant difference between the intensity of each side nystagmus, associated canal paresis, other types of BPPV, past history of acute vestibuloneuritis, and Meniere's disease, etc. might be helpful to localize the lesion side. CuRM and post- treatment lateral decubitus position kept during the night (while sleeping on the day of treatment) were effective in treating the cupulolithiasis of lateral semicircular canal.
Ear ; Head ; Humans ; Magnetic Resonance Imaging ; Meniere Disease ; Neurologic Examination ; Nystagmus, Physiologic ; Paresis ; Semicircular Canals* ; Vertigo

Acute cerebellitis occurrs in the absence of cerebral hemispheric involvement and is exceptionally rare. It is charac-terized by an acute onset of cerebellar dysfunction following a respiratory, gastrointesitnal infection or skin rash. However, almost all patients show good prognosis. We experienced two cases of acute cerebellitis in young adults. One patient was admitted due to gait ataxia and dysarthria. The immunological laboratory findings revealed an acute Ebstein Barr virus infection and an electronystagmogram showed a periodic alternating nystagmus. The other patient was admitted due to severe gait ataxia, with no identification of any organism. CSF examinations revealed elevated protein and brain magnetic resonance images showed cerebellar foliae enhancement bilaterally. Both patients recovered without any disabilities.
Brain ; Cerebellar Diseases ; Dysarthria ; Exanthema ; Gait Ataxia ; Herpesvirus 4, Human ; Humans ; Nystagmus, Pathologic ; Prognosis ; Young Adult

BACKGROUND AND OBJECTIVE: It is well known that compensation begins after acute unilateral peripheral vestibular function loss. The change of vestibulo-ocular reflex (VOR) is variable and affected by many factors. But there is no studies reported on the changes of individuals with the lapse of time. Using the rotation chair test and caloric test, we wanted to know the individual compensatory process of VOR as time progresses following an acute unilateral peripheral vestibular loss. MATERIALS AND METHODS: Subjects were patients of acute peripheral vestibular neuritis (n=19) whose nystagmus showed more than 24 hours. The follow up period was 10 weeks until the head shake nystagmus (HSN) disappeared. We measured the duration of each spontaneous nystagmus (SN) and HSN. Sinusoidal harmonic acceleration (SHA) was tested at 0.04 and at 0.08 Hz level, with the step velocity of 100 degrees per second. We also performed caloric test after HSN disappeared. RESULTS: SN and HSN each lasted 25 days and 50 days. VOR changes had an irregular pattern among individuals with gain increasing after decrement and phase lead decreasing after increment. Furthermore, the gain asymmetry was more irregular and lasted longer as well at the step velocity. Even though compensation has been reached, the caloric test revealed continuous abnormal values, which is quite different from the recovery of VOR in the rotatory test. CONCLUSION: During the early compensation period, we could recognize that the individual VOR changes recovered with a irregular pattern. On the other hand, the caloric test was not altered even after compensation.
Acceleration ; Caloric Tests ; Compensation and Redress ; Follow-Up Studies ; Hand ; Head ; Humans ; Reflex, Vestibulo-Ocular* ; Vestibular Neuronitis

BACKGROUND AND OBJECTIVES: The etiology and pathophysiology of acute vestibular neuritis are largely unknown and its diagnostic criteria and clinical course also have not been established definitely. This study was performed to provide a basis for creating the classification system and diagnostic criteria of vestibular neuritis. MATERIALS AND METHODS:We studied sixty-seven patients who showed no subjective auditory symptoms, and who showed spontaneous nystagmus for more than 24 hours under ENG (Electronystagmography) after the onset of vertigo. We evaluated the frequency of nystagmus and the site of lesion, and looked for the presence of any combined infectious diseases. Eye tracking test with ENG and auditory test were performed. Bithermal caloric test was performed after disappearance of sponteneous nystagmus and canal paresis was calculated. RESULTS: We found 52 cases (78%) of unilateral single attack, 10 cases (15%) of unilateral recurrent attack, 4 cases (6%) of opposite recurrent attack and one case (1%) of bilateral simultaneous attack. For the presence of combined infectious diseases, we found 24 casees (36%) with URI, one case (2%) with mumps and three cases (5%) with Ramsay-Hunt syndrome. Ipsilateral sensorineural hearing loss at 8000 Hz was found in 10 cases (24%). Neurologic abnormality was found in 14 cases (21%), but not found in 53 cases (79%). The canal paresis on bithermal caloric response was more than 50% for 30 cases (68%), 26%-50% for 4 cases (9%), and in the normal range for 10 cases (23%). CONCLUSION: There are some cases of the acute vestibular neuritis that showed atypical clinical features (recurrent attack, bilateral attack), which is inconsistent with the Coates criteria. Appropriate classification system and diagnostic criteria for acute vestibular neuritis, including recurrent attack and bilateral attack, are required.
Caloric Tests ; Classification ; Communicable Diseases ; Hearing Loss, Sensorineural ; Humans ; Mumps ; Paresis ; Reference Values ; Vertigo ; Vestibular Neuronitis*

BACKGROUND AND OBJECTIVES: Clinical features of positional nystagmus may be different according to the etiology. Thus, efforts have been made to find out etiologies of various positional nystagmus. Until recently, positional vertigo was thought to arise from lesions of central nervous system. However, more recent investigations suggest that the peripheral lesion may be the main cause. Moreover, there have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the lateral semicircular canal. The objectives of the study were to investigate the etiologies and clinical aspects of DCPN (direction changing positional nystagmus) from canalolithiasis and cupulolithiasis of the lateral semicircular canal, and to assess the effectiveness of the treatment. MATERIALS AND METHODS: Among 15 patients with DCPN, 9 patients showed nystagmus compatible with canalolithiasis of lateral semicircular canal and 6 patients with cupulolithiasis of lateral semicircular canal. Patients with cupulolithiasis and canalithiasis of the lateral semicircular canal did not respond to physical therapy for posterior semicircular canal. However, they were completely recovered by reposition maneuver for the lateral semicircular canal with or without using vibrator although 3 of them had recurred symptom. Four patients had BPPV of the posterior semicircular canal prior to the development of DCPN and 3 patients underwent the treatment of previous Meniere's disease. CONCLUSION: The patients with DCPN were due to canalithiasis and cupulolithiasis of the lateral semicircular canal, and physical therapy for lateral semicircular canal was rewarding.
Central Nervous System ; Humans ; Meniere Disease ; Nystagmus, Physiologic* ; Reward ; Semicircular Canals* ; Vertigo