Research in Vestibular Science

Endolymphatic Hydrops in Vestibular Migraine Associated with Menière’s Disease: A Report of Two Cases: Bit Na Lee, Seung-Bae Hwang, Jin-ju Kang, Sun-Young Oh; Res Vestib Sci. 2021;20(4):156-160. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.156

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Vestibular migraine and Menière’s disease have similar clinical features which are recurrent dizziness or auditory symptoms, so it is challengeable to establish the correct diagnosis. Herein, a 31-year-old male and a 56-year-old female showed recurrent dizziness with auditory symptoms and suffered from vestibular migraine. They met the diagnostic criteria for vestibular migraine, but the Menière’s diagnostic criteria were not satisfied as there was no hearing loss. Delayed intravenous gadolinium enhanced magnetic resonance imaging of the inner ear was taken to find out of correlation of the inner ear and revealed endolymphatic hydrops. This case can improve the understanding of the pathophysiology of a vestibular migraine associated Menière’s disease.

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Functional and Molecular Markers for Hearing Loss and Vertigo Attacks in Meniere’s Disease
Chao-Hui Yang, Ming-Yu Yang, Chung-Feng Hwang, Kuang-Hsu Lien
International Journal of Molecular Sciences.2023; 24(3): 2504. CrossRef

Two Cases of Myasthenia Gravis Showing Fatigibility Presenting with Decreased Gain of Smooth Pursuit: Ju-Hee Chae, Hyun-June Shin, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2019;18(2):54-58. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.54

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Abstract PDF

Myasthenia gravis (MG) is an autoimmune disease caused by autoantibodies to the acetylcholine receptors of the neuromuscular junction characterized by weakness and abnormal fatigability of the muscles. Therefore, the diagnosis of MG depends on the recognition of this distinctive pattern of fatigable weakness. Previous studies presented the diagnostic efficacy of saccadic eye movements in patients with ocular MG. We here in report 2 patients of ocular MG showing the fatigue effects during repetitive sustained smooth pursuit, and the effects of the administration of edrophonium on myasthenic smooth pursuit. Changes in smooth pursuits reflecting peripheral and secondary central mechanisms were demonstrated.

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Tracking Eye Movements for Diagnosis in Myasthenia Gravis: A Comprehensive Review
Minh N. L. Nguyen, Anneke van der Walt, Joanne Fielding, Meaghan Clough, Owen B. White
Journal of Neuro-Ophthalmology.2022; 42(4): 428. CrossRef

원활추종운동 이득감소로 근피로도를 확인한 중증근무력증 2예: Ju-Hee Chae, Hyun-June Shin, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Received April 9, 2019 Accepted June 3, 2019 Published online June 3, 2019; [Accepted]

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Abstract: Myasthenia Gravis (MG) is an autoimmune disease caused by autoantibodies to the acetylcholine receptors of the neuromuscular junction characterized by weakness and abnormal fatigability of the muscles. Therefore, the diagnosis of MG depends on the recognition of this distinctive pattern of fatigable weakness. Previous studies presented the diagnostic efficacy of saccadic eye movements in patients with ocular MG. We here in report two patients of ocular MG showing the fatigue effects during repetitive sustained smooth pursuit, and the effects of the administration of edrophonium on myasthenic smooth pursuit. Changes in smooth pursuits reflecting peripheral and secondary central mechanisms were demonstrated.

Visuospatial Dysfunction in Patients With the Right Vestibular Neuritis: Seung-Ho Jeon, Ko-Woon Kim, Hyun-June Shin, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2019;18(1):19-23. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.19

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Abstract PDF

Acute vestibular neuritis (VN) is characterized by acute/subacute vertigo with spontaneous nystagmus and unilateral loss of semicircular canal function. Vestibular system in human is represented in the brain bilaterally with functional asymmetries of the right hemispheric dominance in the right handers. Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time which is also known as the right hemispheric dominance. Three patients (patient 1, 32-year-old female; patient 2, 18-year-old male; patient 3, 63-year-old male) suffered from acute onset of severe vertigo, nausea and vomiting. Patients 1 and 2’s examination revealed VN on the right side showing spontaneous left beating nystagmus and impaired vestibular ocular reflex on the right side in video head-impulse and caloric tests. Patient 3’s finding was fit for VN on the left side. We also evaluated visuospatial memory function with the block design test in these 3 VN patients which discovered lower scores in patients 1 and 2 and the average level in patient 3 compare to those of healthy controls. Follow-up block design test after resolved symptoms showed within normal range in both patients. Our cases suggest that the patients with unilateral peripheral vestibulopathy may have an asymmetrical effect on the higher vestibular cognitive function. The right VN can be associated with transient visuospatial memory dysfunction. These findings add the evidence of significant right hemispheric dominance for vestibular and visuospatial structures in the right-handed subjects, and of predominant dysfunction in the hemisphere ipsilateral to the peripheral lesion side.

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The Differential Effects of Acute Right- vs. Left-Sided Vestibular Deafferentation on Spatial Cognition in Unilateral Labyrinthectomized Mice
Thanh Tin Nguyen, Gi-Sung Nam, Jin-Ju Kang, Gyu Cheol Han, Ji-Soo Kim, Marianne Dieterich, Sun-Young Oh
Frontiers in Neurology.2021;[Epub] CrossRef

Visuospatial dysfunction in patients with the right vestibular neuronitis: Seung-Ho Jeon, Sun-Young Oh, Ko-Woon Kim, Hyun-June Shin, Byoung-soo Shin, Man-Wook Seo; Received August 3, 2018 Accepted October 1, 2018 Published online October 1, 2018; [Accepted]

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Abstract: Acute vestibular neuritis is characterized by acute/subacute vertigo with spontaneous nystagmus and unilateral loss of semicircular canal function. Vestibular system in human is represented in the brain bilaterally with functional asymmetries of the right hemispheric dominance in the right handers. Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time which is also known as the right hemispheric dominance. Three patients (Pt 1, 32-year-old female; Pt 2, 18-year-old male; Pt 3, 63-year-old male) suffered from acute onset of vertigo. Pt 1 and 2’s examination revealed vestibular neuritis (VN) on the right side showing spontaneous left beating nystagmus and impaired vestibular ocular reflex (VOR) on the right side in video head-impulse and caloric tests. Pt 3’s finding was fit for VN on the left side. We also evaluated visuospatial memory function with the block design test in these three VN patients which discovered lower scores in Pt 1 and 2 and the average level in Pt 3 compare to those of healthy controls. Follow up block design test after resolved symptoms showed within normal range in both patients. Our cases suggest that the patients with unilateral peripheral vestibulopathy may have an asymmetrical effect on the higher vestibular cognitive function. The right VN can be associated with transient visuospatial memory dysfunction. These findings add the evidence of significant right hemispheric dominance for vestibular and visuospatial structures in the right-handed subjects, and of predominant dysfunction in the hemisphere ipsilateral to the peripheral lesion side.

Classification of Chronic Dizziness in Elderly People and Relation with Falls: Dong-Suk Yang, Da-Young Lee, Sun-Young Oh, Ji-Yun Park; Res Vestib Sci. 2018;17(1):13-17. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.13

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Abstract PDF: Objectives
Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness.
Methods
We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or out patient department follow-up for 6 months.
Results
Thirty-four patients were enrolled and all completed follow-up for 6 months. Nine patients classified as the falling groups and 34 patients as nonfalling group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%), and vestibular migraine (n=3, 9%) were more frequent in nonfall group.
Conclusions
The presence of dizziness in the elderly is a strong predictor of fall, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.

Classification of chronic dizziness in elderly people and relation with falls: Dong-Suk Yang, Da-Young Lee, Sun-Young Oh, Ji-Yun Park; Received February 26, 2018 Accepted March 8, 2018 Published online March 8, 2018; [Accepted]

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Abstract: Purpose
Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness.
Methods
We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test.. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or OPD follow-up for 6 months.
Results
34 patients were enrolled and all completed follow-up for 6 months. Nine patients in the fall group and 34 patients in the non - fall group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%) and vestibular migraine (n=3, 9%) were more frequent in non-fall group.
Conclusion
The presence of dizziness in the elderly is a strong predictor of falls, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.

Brain Hypometabolism in Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome: Byoung-Min Jeong, Byoung-Soo Shin, Man-Wook Seo, Ji-Yun Park, Hwan-Jeong Jeong, Sun-Young Oh; Res Vestib Sci. 2017;16(4):156-160. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.156

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Abstract PDF: Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a slowing progressive ataxic disorder characterized by bilateral vestibulopathy, cerebellar ataxia and somatosensory impairment. Autonomic dysfunction is recently considered as a core feature in CANVAS in addition to these symptoms. In most cases, patients with CANVAS show cerebellar atrophy in brain imaging, but some cases show minimal or no atrophy of cerebellum. Brain (18F)-fluoro-2-deoxy-D-glucose positron emission tomography (¹⁸F-FDG PET) study can be a complimentary tool to diagnosis CANVAS in cases of no structural abnormality such as cerebellar atrophy. Hereby, we present a case of CANVAS with minimal atrophy of cerebellum but showing a prominent hypometabolism in cerebellum, thalamus and posterior cingulate cortex in ¹⁸F-FDG PET.

Clinical Significance of Perverted Head-Shaking Nystagmus: Tae-Ho Yang, Byung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(4):119-128. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.119

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Abstract PDF: Objectives
We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. Methods: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. Results: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. Conclusions: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.

Cerebellar ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS) 환자에서 뇌 대사감소: Byoung-Min Jeong, Byoung-Soo Shin, Man-Wook Seo, Ji-Yun Park, Hwan-Jeong Jeong, Sun-Young Oh; Received November 4, 2017 Accepted November 29, 2017 Published online November 29, 2017; [Accepted]

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Abstract: Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a slowing progressive ataxic disorder characterized by bilateral vestibulopathy, cerebellar ataxia and somatosensory impairment. Autonomic dysfunction is recently considered as a core feature in CANVAS in addition to these symptoms. In most cases, patients with CANVAS show cerebellar atrophy in brain imaging, but some cases show minimal or no atrophy of cerebellum. Brain 18F-FDG PET study can be a complimentary tool to diagnosis CANVAS in cases of no structural abnormality such as cerebellar atrophy. Hereby, we present a case of CANVAS with minimal atrophy of cerebellum but showing a prominent hypometabolism in cerebellum, thalamus and posterior cingulate cortex in 18F-FDG PET.

A Case of Partial Oculomotor Nerve Palsy Caused by Vascular Compression in Idiopathic Intracranial Hypertension: Seol-Won Lee, Seung-Bae Hwang, Byoung Soo Shin, Man Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(3):97-100. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.97

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Abstract PDF: Pupil-involving oculomotor nerve palsy (ONP) is frequently associated with compressive lesion such as intracranial aneurysm originating from the posterior communicating arteries. Vascular variant of posterior intracranial circulation is regarded as an uncommon cause and association between these vascular variants and intracranial hypertension has not been reported. We present an 18-year-old girl with pupil-involving ONP combined with idiopathic intracranial hypertension who revealed compression of oculomotor nerve by a vascular variant of superior cerebellar artery (SCA). This is a rare case of an ONP attributed to compressive effect from an aberrant SCA affected by intracranial hypertension.

A case of partial oculomotor nerve palsy caused by vascular compression in idiopathic intracranial hypertension: Seol-Won Lee, Seung-Bae Hwang, Byoung Soo Shin, Man Wook Seo, Sun-Young Oh; Received May 25, 2017 Accepted August 9, 2017 Published online August 9, 2017; [Accepted]

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Abstract: Pupil-involving oculomotor nerve palsy (ONP) is frequently associated with compressive lesion such as intracranial aneurysm originating from the posterior communicating arteries. Vascular variant of posterior intracranial circulation is regarded as an uncommon cause and association between these vascular variants and intracranial hypertension has not been reported. We present an 18-year old girl with pupil-involving ONP combined with idiopathic intracranial hypertension who revealed compression of oculomotor nerve by a vascular variant of superior cerebellar artery (SCA). This is a rare case of an ONP attributed to compressive effect from an aberrant SCA affected by intracranial hypertension.

Four Cases of Wernicke’s Encephalopathy with Impaired Horizontal Vestibular Ocular Reflexes: Hyuk-Su Jang, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(2):57-63. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.57

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Abstract PDF: Wernicke’s encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency which is characterized by encephalopathy, gait ataxia, and variant ocular motor dysfunction. In addition to these classical signs of WE, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we report four cases of WE initially presented with impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.

Four Cases of Wernicke’s Encephalopathy with Impaired Horizontal Vestibular Ocular Reflexes: Hyuk su Jang, Sun-Young Oh, Byoung-Soo Shin, Man-Wook Seo; Received April 24, 2017 Accepted June 2, 2017 Published online June 2, 2017; [Accepted]

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Abstract: Wernicke's encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency. It is characterized by encephalopathy, gait ataxia, and some variant of oculomotor dysfunction which are the classic triad of WE. However, a complicating factor of WE identification may not be associated with the classical clinical triad in up to 90% of patients. In recent years, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we describe four cases of WE presented mainly impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.

Treatment of Horizontal Canal Benign Paroxysmal Positional Vertigo: Sun-Young Oh; Res Vestib Sci. 2013;12:S77-S81. Published online June 1, 2013

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Abstract PDF: Several methods of physiotherapy have been advanced for benign paroxysmal positional vertigo involving horizontal semicircular canal (HC-BPPV). In this review article, the diagnosis and therapeutic maneuvers for HC-BPPV including recently published several randomized controlled trials are described.

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