Research in Vestibular Science

Volume 13 (2); June 2014

Review

Surgical Treatments of Benign Paroxysmal Positional Vertigo: Shin Hye Kim, Hyun Seok Choi, Ja Won Koo; Res Vestib Sci. 2014;13(2):29-33.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular disorder. Although it is easily cured with canal repositioning maneuvers for the majority of patients, it can be disabling in rare cases. For these patients, surgical treatments may be proposed. The aim of this article is to discuss their indication in intractable BPPV and review the surgical treatments used, the reported cases in the literature. All the articles from 1972 to 2013 that discussed specific surgical treatments in BPPV were reviewed. Many of them reported cases of operated patients and described original techniques. Some others are studies that discussed the three techniques used: singular neurectomy, posterior semicircular canal occlusion and intratympanic injection of gentamicin. Singular neurectomy and posterior semicircular canal occlusion are the two specific techniques used in intractable BPPV. A very small population of patients requires surgical treatments of BPPV. These procedures are difficult and risk compromising hearing. The intratympanic injection of gentamicin can be useful procedure in BPPV associated with Meniere disease. The surgical treatments of BPPV appear to be limited to exceptional cases. When good examination and appropriate treatment fail to cure patients with intractable BPPV, central positional vertigo should be ruled out before irreversible surgical procedures.

Original Articles

Predictors of Cerebrovascular Causes in the Emergency Department Patients with Dizziness: Application of the ABCD² Score: Hyung Jun Kim, Su Ik Kim, Ji Hun Kang, Ki Bum Sung, Tae Kyeong Lee, Ji Yun Park; Res Vestib Sci. 2014;13(2):34-40.

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Abstract PDF: Background and Objectives: Dizziness is a common presenting complaint in the emergency department (ED) that had various pathologic causes. Most of dizziness can be caused by benign origin but identifying cerebrovascular causes among ED patients with dizziness is a diagnostic challenge. ABCD² score is clinical prediction tool for assessing the risk of stroke after a transient ischemic attack (TIA). We evaluated predictors of cerebrovascular causes and whether ABCD² score would identify cerebrovascular events among ED patients with dizziness. Materials and Methods: We analyzed 180 patients (≥20 years old) with dizziness in ED, Presbyterian Medical Center (single-center prospective observational study) for 2 months. Type of dizziness, associated symptoms, past medical history, ABCD² score (0−7), neuro-otologic examination, diagnosis were recorded. Results: The incidence of dizziness is 3.6% (192/5,374). After excluding 12 patients, 180 patients (56% female, mean 59 years) met our eligibility criteria and were included in the final analysis. Cerebrovascular causes of dizziness were found in 10% (18/180): 3 vertebrobasilar insufficiency, 9 cerebellar infarction, 1 right middle cerebral artery (MCA) infarction, 1 right MCA giant aneurysm, 1 lateral medullary infarction, 1 posterior limb of internal capsule infarction, 1 intracerebral hemorrhage of cerebellum. Patients with cerebrovascular cause were males and had more hypertension, diabetes mellitus, imbalance, abnormal neuro-otologic findings and ABCD² score. Conclusion: Several clinical factors (hypertension, diabetes, abnormal neuro-otologic findings ABCD² scores) favored a diagnosis of central neurological causes of dizziness. ABCD² score is a simple and easily applied tool for distinguishing cerebrovascular from peripheral causes of dizziness in ED.

Results of High-Frequency and High-Acceleration Rotary Chair Test in Patients with Acute Unilateral Vestibular Neuritis: Hwan Seo Lee, Jun Woo Park, Chang Wook Lee, Chan Il Song, Myung Hoon Yoo, Hong Ju Park; Res Vestib Sci. 2014;13(2):41-46.

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Abstract PDF: r neuritis. Materials and Methods: Twenty-four patients who were diagnosed as acute vestibular neuritis and underwent rotational chair and caloric tests during March 2012 to March 2013 were included. Slow harmonic acceleration (SHA) test was performed at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz. Step velocity tests at the peak velocity of 100o/sec (low-acceleration) and 240o/sec (high-acceleration) were performed. Gains and phases in SHA test and gains and time constants (Tc) in step velocity test were analyzed. Results: In SHA test, decreased gain and phase lead was observed mostly in low frequencies. Gains (phases) at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz were 0.2±0.1 (62.2±15.4), 0.3±0.2 (24.5±13.0), 0.4±0.2 (7.2±18.8), 0.5±0.1 (7.2±11.3), 0.7±0.2 (11.0±7.5), and 0.8±0.3 (4.4±14.4), respectively. In step velocity (SV) test, gains stimulating the lesion side were significantly lower than those stimulating the intact side in both low- and high-acceleration SV test (p＜0.05) and per-rotatory gain stimulating the lesion side in high-acceleration SV test was significantly lower than that in low-acceleration SV test. Tc stimulating the lesion side were significantly shorter than those stimulating the intact side in low- acceleration SV test (p＜0.05) but not in high-acceleration SV test. Per- and post-rotatory Tc in high-acceleration SV test stimulating the intact side was significantly lower than those in low-acceleration SV test (p＜0.05). Conclusion: At high-frequency SHA test, gain was pretty normal and phase lead was observed in some patients. High-acceleration SV test showed shortened Tc regardless of the sides, suggesting that high-acceleration SV test can reveal the impaired velocity storage system in patients with vestibular neuritis more frequently than low-acceleration SV test.

Analysis of Clinical Features in Patients Showing Bilateral Vestibulopathy with Vestibular Function Test: Dong Hyun Kim, Jeong Hyun Lee, Bong Jik Kim, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2014;13(2):47-52.

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Abstract PDF: Background and Objectives: Caloric test and rotatory chair test have been adopted in diagnosing bilateral vestibulopathy. However, most of patients who were confirmed by the diagnostic testing not complained typical symptoms of bilateral vestibulopathy such as ossilopsia and ataxia. Patients who do not have typical symptoms of bilateral vestibulopathy, were often diagnosed with bilateral vestibulopathy by caloric test and slow harmonic acceleration test (SHA). The aim of this study is to assess the clinical features between groups classified according to the caloric test and SHA test, and possibly to investigate the representative test in the diagnosis of bilateral vestibulopathy. Materials and Methods: Seventy-five patients were divided into three groups: (A) patients diagnosed with the caloric test only, (B) patients diagnosed with SHA test only, (C) patients satisfying the diagnostic criteria of both tests. Clinical characteristics, the results of physical examination, hearing test and vestibular function test (VFT) were compared among three groups. Results: There was no difference in clinical characteristics and results of physical examination among three groups. Regarding VFT results, only in step velocity test, The proportion of patients who showed low gain value on both sides were higher in group C than that of group A and B. No difference was observed in the other VFT results among three groups. Conclusion: We could not predict the clinical features of bilateral vestibulopathy by the results of VFT, and could not find preferable test in diagnosing bilateral vestibulopathy.

A Case of Creutzfeldt-Jakob Disease Presenting Mainly with Abnormal Eye Movements: Yeo Jeong Kang, Jun Hyun Kim, Tae Eun Kim, Sun Ah Park, Tae Kyeong Lee; Res Vestib Sci. 2014;13(2):53-56.

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Abstract PDF: Creutzfeldt-Jakob disease (CJD) is a human prion disease with rapidly progressive neurodegeneration. The major clinical manifestations of CJD include mental deterioration, myoclonus, cerebellar dysfunction, and neuro-ophthalmic symptoms and signs. However, abnormal eye movements as an early sign of CJD are rare. We report a 49-year-old man with periodic alternating nystagmus in early disease course.

Case Report

Two Cases of Central Vertigo Presenting as Apogeotropic Direction Changing Positional Nystagmus: Min Chul Park, Jin Su Park, Min Beom Kim, Jae Ho Ban; Res Vestib Sci. 2014;13(2):57-62.

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Abstract PDF: Positional vertigo and nystagmus without focal neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). And the apogeotropic positional nystagmus can be diagnosed as cupulolithiasis of the horizontal semicircular canal. However, cerebellar lesion involving especially nodulus could be initially presented as positional vertigo like a BPPV without other neurologic signs. In most of the patients with cerebellar involvement, initial presentation shows dysarthria, ataxia, headache, nausea, vomiting and unsteadiness. But in some central lesions, positional nystagmus might be observed in head roll test as if BPPV was presented. It is very important for clinicians of dizziness care unit to differentiate central positional vertigo (CPV) from BPPV. But it is difficult to diagnose CPV at initial visit by history and physical exam only. Therefore, we introduce two cases with cerebellar infarction and hemorrhage initially presenting isolated positional vertigo mimicking BPPV.

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