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Periodic Alternating Nystagmus in Patients with Cerebellar Abscess
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Hyung Lee, Hyun Ah Kim
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Res Vestib Sci. 2016;15(1):27-29.
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 Abstract
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- Periodic alternating nystagmus (PAN) is characterized by a periodical reversal
in the direction of the nystagmus. Acquired PAN is caused by lesions of the
inferior cerebellar vermis, causing disinhibition of the velocity storage mechanism,
which is mediated by the vestibular nuclei. An eighty-year-old woman with
abscess in midline cerebellum experienced dizziness and imbalance. We observed
short period PAN with 7?8 seconds.
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Vestibular Rehabilitation in Central Dizziness
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Byung In Han, Pan Woo Ko, Ho Won Lee, Hyun Ah Kim, Hyung Lee
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Res Vestib Sci. 2015;14(4):97-100.
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Abstract
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- Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program
designed to promote vestibular adaptive and compensatory mechanisms already
existing in the human brain. Although the evidence is sparse for improvement
in subjects with central vestibular dysfunction following VRT, it improves
postural stability in cerebellar diseases and reduces subjective complaints and fall
risk in Parkinson disease. Possible mechanisms of recovery after central nervous
system lesions may include neural sprouting, vicarious functions, functional
reorganization, substitution, and plasticity. VRT regimens for patients with central
causes should include balance and gait training, general strengthening and
flexibility exercises, utilization of somatosensory and vision and utilization of
alternate motor control strategies. VRT would be an option to relieve the symptoms
of the many patients who have central dizziness.
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Unilateral Peripheral Vestibulopathy associated with Cerebral Venous Infarction
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Hyun Ah Kim, Hyung Lee, Byung Rim Park
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J Korean Bal Soc. 2006;5(2):285-287.
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Abstract
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- Cerebral venous infarction is associated with a wide variety of clinical symptoms and signs, which may often delay appropriate diagnosis. Unilateral vestibular deficit as a presenting sign of cerebral venous infarction has rarely been reported. We report a patient with cerebral venous infarction who had severe prolonged vertigo, vomiting, occipital headache, positive head thrust testing, and unilateral caloric weakness as main clinical features. Although the patient had occipital headache, overall symptoms and signs closely mimicked those of acute peripheral vestibulopathy.
Key Words : Peripheral vestibulopathy, Brain infarction
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Vestibular Neuritis of Vascular Cause
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Hyun Ah Kim, Hyung Lee, Byung Rim Park
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J Korean Bal Soc. 2006;5(2):277-280.
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Abstract
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- Vestibular neuritis (VN) is an idiopathic peripheral vestibular syndrome characterized by acute isolated prolonged vertigo. In most cases, it results from inflammation of the vestibular nerve presumably of viral origin. There has been no previous report of VN associated with a vascular cause. We here report a patient with VN of vascular origin who presented with acute onset of prolonged isolated vertigo, a unilateral decreased caloric response, and simultaneously with acute infarcts on brain MRI that were unrelated to patient's vertigo.
Key Words : Vestibular neuritis, Cerebral infarction
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Body Lateropulsion as an Isolated or Predominant Symptom of a Pontine Infarction
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Hyun Ah Kim, Hyung Lee, Byung Rim Park
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J Korean Bal Soc. 2006;5(2):224-228.
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Abstract
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- Background
and Objectives: Body lateropulsion with falling to one side is a well-known clinical feature of stroke in the posterior circulation. Body lateropulsion as an isolated or predominant manifestation of a pontine stroke has not previously been reported. To elucidate the possible mechanisms of patients presenting with body lateropulsion as an isolated or predominant symptom of isolated pontine infarction.
Materials and Method: Between May 2004 and February 2006, out of 134 admitted patients with an isolated pontine stroke we identified 8 consecutive patients (6.0%) in the Keimyung University Stroke Registry who had body lateropulsion as the main presenting symptom.
Results
All lesions were localized to the paramedian tegmentum just ventral to the 4th ventricle. All except 1showed a uniform pattern of body lateropulsion, in which the direction of falling was away from the side of infarct. In 2 patients, body lateropulsion was the sole clinical manifestation, whereas the other patients had other neurological signs. All but 1 had contraversive tilting of the subjective visual vertical (SVV). In all cases, the direction of SVV tilt corresponded to the direction of body lateropulsion. The mean net tilt angle was 6.1
Conclusion
Based on the known anatomy of ascending vestibular pathways, the SVV tilting, and MRI findings, body lateropulsion probably results from damage to the graviceptive pathway ascending through paramedian pontine tegmentum.
Key Words : Pons, Infarction
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Sleep and Vestibular Neuritis
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Hyun Ah Kim, Hyung Lee
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J Korean Bal Soc. 2006;5(1):44-48.
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Abstract
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- Background
and Objectives: While it is known that sleep have influence on emergence of rapid eye movements(REMs), namely saccades including fast component of nystagmus, whether spontaneous nystagmus due to vestibular imbalance presents during sleep is still unclear. The purpose of our study was to investigate whether tonic vestibular imbalance appeared as spontaneous nystagmus during the wakeful state could present during REM sleep.
Materials and Method: Overnight polysomnography (PSG) was performed in 7 patients with spontaneous nystagmus due to vestibular neuritis (VN) and 7 control patients without dizziness or any nystagmus. The numbers of horizontal saccades were counted, during 3 minutes samples of the alert state before and after the PSG and the first and last REM sleep.
Results
All patients with VN showed significantly more saccades (fast phases of spontaneous nystagmus) towards the side contralateral to their vestibular lesion in the awake state before and after the PSG compared with control group.
By contrast, during REM sleep the patients with VN showed no preponderance in saccade direction (p<0.05). Some brief nystagmoid jerks showed during REM sleep in both patients and controls equally and also had no preponderance in direction.
Conclusion
The tonic vestibular imbalance at peripheral level observed during alert state does not appear at the brainstem level during REM sleep. It is suggested that a de-afferentation of the peripheral vestibular input to the REM sleep generating areas may explain an absence of nystagmus during REM sleep in patients with VN.
Key Words : Vestibular imbalance, Nystagmus, REM sleep
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