Research in Vestibular Science

Understanding of dizziness: Sung Ki-Bum, M.D.; J Korean Bal Soc. 2002;1(2):157-164.

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Morphophysiology of primary vestibular afferents and synaptic transduction recorded from an in vitro mouse: Heung-Youp Lee; J Korean Bal Soc. 2002;1(2):165-165.

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Physicophysiological Characteristics of the Peripheral Vestibular Receptor: Byung Rim Park; J Korean Bal Soc. 2002;1(2):169-175.

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Anatophysiology of central vestibular system: Byung-Kun Kim, M.D.; J Korean Bal Soc. 2002;1(2):176-183.

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Clinical evaluation of vestibulo-ocular reflex: Won-Ho Chung, M.D.; J Korean Bal Soc. 2002;1(2):184-190.

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Laboratory evaluation of the canal-ocular reflex: Seung-Chul Lee, M.D.; J Korean Bal Soc. 2002;1(2):191-203.

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Evaluation of otolithic function: Ji Soo Kim, M.D.; J Korean Bal Soc. 2002;1(2):204-214.

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Abstract PDF: The vestibular system detects both linear and angular acceleration of the head. While the semicircular canal senses angular acceleration, the otolithic organs, the saccule and the utricle, sense linear acceleration. Several ways of testing otolith function have been proposed. Clinical evaluation includes measurement of the ocular tilt reaction and tilt of the subjective visual vertical. Linear acceleration has been induced by using swings, sleds, centrifuges, tilt-chairs, and barbeque-spits. The vestibular-evoked myogenic potentials are believed to arise from stimulation of the saccule. Generally the subjective visual vertical and vestibular-evoked myogenic potentials are simple and robust tests of otolith dysfunction

Vestibulospinal System : Balance and Posture: Kim Jae-Il, M.D., Ph; J Korean Bal Soc. 2002;1(2):215-219.

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Effect of vestibular end-organs on expression of cFos and FosB injury in the hippocampal formation of rats: Min Sun Kim, Myoung Ae Choi, Dong Ok Choi, Byung Gon Cho, Yuan Zhe Jin, Jae Hyo Kim, Davy Kry, Byung Rim Park; J Korean Bal Soc. 2002;1(2):223-234.

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Abstract PDF: It is well known that the hippocampal formation requires primary vestibular sensory information to generate spatial memory during self motion in human. The purpose of the present study was to evaluate the effect of unilateral deafferentation of vestibular sensory information on cFos and FosB proteins, a family of immediate early gene-related proteins known as metabolic marker for neural excitation in the hippocampal formation of rats. Adult Sprague-Dawley rats weighing 250 - 300 g were surgically ablated of the peripheral vestibular system in the inner ear and sacrificed at 2, 6, 24, 48, 72 hours after surgical operation. Immunohistochemical staining and Western blot method were adapted to see change in expression of cFos and FosB proteins in the hippocampal formation. A significant change of Fos B immunoreactivity was observed in granular cell layer of the dentate gyrus, CA1 subfield of the hipocampus at 2 hours after unilateral labyrinthectomy. Thereafter, the number of FosB like immunoreactive neurons in these areas increased rapidly, peaked at 48 hours post operatively time. Western blot for FosB protein supported further time-dependent change of FosB revealed by immunohistochemical staining. In addition, granular cell layer showed more significant expression of FosB LI neurons in the caudal dentate gyrus than the rostral one. In contrast, moderate number of cFos LI neurons was detected in polymorphic cell layer of the dentate gyrus, pyramidal cell layer of CA1, and subiculum but not in granular cell layer of the dentate gyrus at 2 hours after labyrinthectomy. The number of cFos LI neurons in the hippocampal formation was rapidly decreased at 6 hours and then returned to basal value 24 hours after operation. These results suggest that unilateral ablation of the peripheral vestibular sensory information elicit spatio-temporal differences of cFos and FosB expressions in the hippocampal formation of rats.

Positional Downbeating Nystagmus : Tips from the Transitions: Ji Soo Kim; J Korean Bal Soc. 2002;1(2):235-239.

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Abstract PDF: Objective : To describe transitions of positional downbeating nystagmus (PDN) to or from the benign positional vertigo (BPV) involving the posterior (PC) or horizontal semicircular canal (HC). Background : PDN occasionally occurs during Hallpike maneuver, and has been ascribed to BPV involving the anterior semicircular canal (AC-BPV).
Method
: Of the 168 patients diagnosed as having BPV in the Dizziness Clinic of Cheju National University Hospital over the past 2 years, three showed transitions of PDN which occurred during Hallpike maneuver. All the patients received full neurotological examinations. The diagnosis of BPV was based on the typical nystagmus concurrent with vertigo elicited by positional maneuvers. The nystagmus was observed by using Frenzel glasses. Nystagmus was also analyzed by using a video camera or video-oculography, as needed.
Result
: Two patients initially presented with torsional downbeating nystagmus during Hallpike maneuver. The torsional component beat toward the uppermost ear. Both patients later developed the PC or HC type of BPV in the uppermost ear. Another patient developed torsional upbeating nystagmus during Hallpike maneuver, consistent with right PC-BPV, following a motor vehicle accident. After Epley maneuver, the nystagmus was transformed into PDN which was observed during Hallpike maneuver to either side and during central head hanging. During Hallpike maneuver, the PDN was more prominent when the involved ear was lowermost.
Conclusion
: These transitions suggest that AC-BPV may involve the uppermost or lowermost ear during Hallpike maneuver. In patients with AC-BPV, the direction of torsional nystagmus may play a crucial role in deciding the affected ear during Hallpike maneuver.

Migraine and idiopathic recurrent vertigo: Hyung Lee, Sung Il Sohn, Yong Won Cho; J Korean Bal Soc. 2002;1(2):240-244.

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Abstract PDF: Background
and Objectives: Chronic recurrent attacks of vertigo, not associated with any auditory or neurological symptoms, are a common reason for referral to our neurotology clinic. Even after an extensive neurotological evaluation, some cases remain undiagnosed. We have performed this study to assess the prevalence of migraine in patients with idiopathic isolated recurrent vertigo as compared with controls, and to identify the clinical features and abnormalities of vestibular testing in patients with isolated recurrent vertigo. Materials and methods: We prospectively evaluated 72 consecutive patients who presented to the clinic with isolated recurrent vertigo of unknown cause. All patients underwent diagnostic evaluation to exclude identifiable causes of isolated recurrent vertigo. We compared the prevalence of migraine, according to the International Headache Society (IHS) criteria, in the isolated recurrent vertigo group, with a sex- and age-matched control group of orthopaedic patients. Results: The prevalence of migraine according to IHS criteria was higher in the isolated recurrent vertigo group (61.1 %) than in the control group (10 %; p<0.01). Only 16.7 % of patients had an abnormal vestibular function test. The most common abnormal finding was a unilateral vestibular weakness to caloric stimulation. Conclusions: Our results suggest that migraine should be considered in the differential diagnosis of isolated recurrent vertigo of unknown cause.

Vertebrobasilar Pathology of Acute Isolated Vertigo: A Case-Control Study: Hee Joon Bae, Byung Kun Kim; J Korean Bal Soc. 2002;1(2):245-252.

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Abstract PDF: Background
: Till now, several studies advocated the vascular etiology as a cause of acute isolated vertigo without relevant lesions on magnetic resonance imaging (MRI). However, most of them were case series and ,even in a few case-control studies, inclusion criteria were obscure and vascular risk factors were not considered. Objectives: To investigate the clinical significance of vertebrobasilar artery (VBA) pathology in acute isolated vertigo without relevant lesions on MRI. Methods : 84 patients (26 male, 59 female; 62.5±10.2 years) with acute isolated vertigo who had no lesions on MRI were gathered. Seventy nine controls (30 male, 49 female; 58.4±10.1 years) consisted of subjects with clinically definite BPPV, epilepsy, tension headache, or lacunar infarction. All the subjects underwent MRI and magnetic resonance angiography (MRA). The vascular pathology of VBA and anterior circulation were examined and graded by the findings of MRA. Focal stenosis more than 50%, non- or faint-visualization, or dolichoectasia of VBA were regarded as significant. Risk factors of atherosclerosis were investigated and the severity of small vessel disease on MRI were ranked. Results : Significant vascular pathology of VBA was found more frequently in patients with acute isolated vertigo (32.1%) than in controls (16.5%) (p<0.05). Among the risk factors of atherosclerosis, hypertension was more common in patients (44.0%) than in controls (29.1%) (p<0.05) and the others were not different between two groups. Significant vascular pathology of anterior circulation and SVD were not different, too (P>0.05). Multivariate analysis including all the possible variables investigated confirmed the significant correlation between VBA pathology and acute isolated vertigo in our subjects (p<0.05). Conclusion : This study demonstrates that there is a signficant correlation between VBA pathology and acute isolated vertigo without lesions on MRI. It can support the importance of VBA pathology as a a cause of acute isolated vertigo.

The Significance of Head-Shaking Nystagmus in the Vestibular Evaluation of the Chronic Dizzy Patient: Si Ho Yang, Gyu Cheol Han; J Korean Bal Soc. 2002;1(2):253-258.

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Abstract PDF: Objectives
: Nystagmus after rapid head-shaking (head-shake nystagmus) is transient horizontal nystagmus which is observed after passive horizontal headshake by yaw axis. It has been used for the evaluation of the remnant vestibular function. This study compared one patient group complaining of chronic vertigo with another normal group with no symptom. We tried to confirm the efficacy as a tool for the evaluation of the vestibular function in the old who had less knowledge of diasease itself, by searching the occurrence rate of head-shake nystagmus by age. Materials and Methods : Of dizzy patients under Vertigo Index III, 19 patients with normal ENG and 20 patients showing only the decrease of the gain on the rotatory test were selected, and head-shake nystagmus was evaluated. Normal control (n=12) were all the heathy patients without any history of the otologic illness after consideration of their age. Eye movement was recorded with ENG testing and Frenzel glasses for 1minute in the dark room after vigorous head shaking at a frequency of 2Hz. Presence or absence of the head-shake nystagmus was judged by two otolaryngologist.
Results
: Only 41% (16/39) of the dizzy patients showed headshake nystagmus. On the other hand, 8% (1/12) of normal control group revealed headshake nystagmus(p < 0.03). 50% (10/20) of the patient group showing the decrease of the gain, and 31% (6/19) of the another group with normal vestibular function revealed headshake nystagmus. When the detection rate of the nystagmus is compared according to the testing methods, it is 33% (17/51) by ENG testing, 12% (6/51) by Franzel glass test. Incidence rate of the headshake nystagmus by age is 25% (5/20) in the dizzy patient group under 50 years old, 58% (11/19) in the group over 50 years old(p < 0.03).
Conclusion
: Head-shake nystagmus showed some difference according to the vestibular compensatory periods, but Its sensitivity was 41% and it is thought to be used convenient just in the old. However, attention should be paid to observe the nystagmus in case of using the Frenzel glasses.

The clinical characteristics of dizzy patients with normal vestibular function tests: Won Ho Chung, Eun Guk Bang, Sung Hwa Hong, Chi Kyou Lee, Hyun Seok Lee; J Korean Bal Soc. 2002;1(2):259-265.

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Abstract PDF: Background
and Objectives : Dizziness is a very common complaint in every day practice. The prevalence of dizziness ranges from 1.8 % in young adults to 30% in the elderly. The sensitivity of vestibular function tests is limited. It was reported that the sensitivity of electronystagmography for diagnosing peripheral vestibular disorders was variable, ranging from 46 to 74%. The objective of this study is to analyse the causes and clinical characteristics of dizzy patients who show normal vestibular function tests. Materials and methods : From January 1999 to June 2001, 375 dizzy patients with normal vestibular function tests(mean age, 49.7 years; range, 8 to 79 years) were assessed with the medical records and typed questionnaires about dizziness.
Results
: Dizzy patients with normal vestibular function tests were attributed to an unknown cause in 20.0% of patients, benign paroxysmal positional vertigo in 19.5%, migrainous dizziness in 11.7%, psychogenic dizziness in 10.4%, Meniere's disease in 9.6% and vertebrobasilar insufficiency in 7.2%.
Conclusion
: Dizzy patients with normal vestibular function tests can be evaluated by careful history taking and combined multidisciplinary approach with neurologist, psychiatrist and cardiologist and strict diagnostic criteria are necessary.

Expression of Immediate-Early Gene Products by Occlusion of Anterior Cerebellar Artery in Vestibular Nuclear Complex of Sprague-Dalwey Rats: Min Sun Kim*; J Korean Bal Soc. 2002;1(2):269-269.

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Abstract PDF: The purpose of this study was to evaluate expression of immediate-early gene products, metabolic marker of neural excitation in neuronal cells, in the vestibular nuclear complex by occlusion of anterior cerebellar artery(AICA) in adult Sprague-Dalwey rats. After chloral hydrate anesthesia all animals were received unilateral occlusion of AICA by using microsurgical clamp for 30 min to induce temporally ischemia in brain stem and inner ear. Immunohistochemical staining and image analysis for cFos, FosB, Krox-24, and JunB proteins were performed 2 hours after occlusion of AICA. There was high expression of cFos protein in bilateral medial medial and inferior vestibular nuclei 2 hours after unilateral occlusion of anterior cerebellar artery(AICA). But AICA occlusion induced minimal change in cFos expression in lateral and superior vestibular nuclei. Mild to moderate expression of FosB and Jun B protein was observed 2 hour ischemic injury in brain stem and inner ear. A few neurons in vestibular complex showed immunoreactivity for Krox-24 protein following AICA occlusion. Furthermore pretreatment of bilateral labyrinthectomy resulted in significant reduction of immunoreactivity for cFos, FosB, and JunB proteins in medial and vesitbular expressions 2 hours after unilateral occlusion of AICA. These results suggest that ischemia of peripheral vestibular apparatus play a major role in expression of immediate-early gene products in medial and inferior vestibular nuclei of rats.

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