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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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- 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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Neuro-otological aspects of cerebellar stroke
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Hyung Lee
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J Korean Bal Soc. 2008;7(2):227-227.
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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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- 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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- 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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Otologic Causes of Drop Attacks in Elderly Patients
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Hyung Lee, Hyon Ah Yi, Jeong Geung Lim, Byung Hoon Ahn, Byung Rim Park
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J Korean Bal Soc. 2004;3(2):372-378.
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Abstract
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- Background
and Objectives : Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We performed this study to investigate the clinical features and results of quantitative audiovestibular tests in six elderly patients (≥65 years of age) who presented with drop attacks attributable to an inner ear pathology.
Materials and Method : Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed.
Results
: Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases.
Conclusions
: Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.
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Clinical implication of an isolated sudden deafness with vertigo of vascular origin from a neurologist's standpoint
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Hyung Lee, Yong Won Cho
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J Korean Bal Soc. 2003;2(2):241-243.
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- A 60-year-old man with hypertension presented with an acute onset of an isolated sudden deafness with vertigo. On admission, initial brain MRI, including diffusion images, was normal. During admission, the patient presented with an exacerbation of vertigo. A follow-up MRI revealed new infarcts involving the right middle cerebellar peduncle, the right dorsolateral pons, and right anterior cerebellum. In this patient, an acute onset of an isolated sudden deafness with vertigo may be a heralding manifestation of the pontocerebellar infarction.
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Isolated nodular infarction and vestibular neuritis
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Hyung Lee, Yong Won Cho
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J Korean Bal Soc. 2003;2(2):237-240.
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Abstract
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- An isolated nodular infarction presenting as an isolated vertigo with unidirectional, gaze-fixed nystagmus has not been previously reported. We reported a patient with cerebellar infarction who presented with purely isolated vertigo, ipsilesional, spontaneous nystagmus, and contralesional axial lateropulsion without usual symptoms or signs of cerebellar dysfunction. An MRI of the brain showed a small infarct selectively involving the nodulus. A pure vestibular syndrome in our patient may be explained by an ipsilateral involvement of nodulo-vestibular inhibitory projection to vestibular nucleus. Clinicians should be aware of the possibility of a nodulus infarction in patients with an acute vestibular syndrome, even if the pattern of nystagmus and lateropulsion is typical of vestibular neuritis.
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Acute hearing symptoms as a prodrome of anterior inferior cerebellar artery infarction
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Hyung Lee, Yong Won Cho, Sung Il Sohn
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J Korean Bal Soc. 2003;2(1):95-102.
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Abstract
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- Objectives
An acute auditory symptom (AAS) without any other neurological symptoms or signs suggests a lesion in the peripheral auditory system. Blood supply to the peripheral auditory system arises from the internal auditory artery, ordinarily a branch of the anterior inferior cerebellar artery (AICA), therefore a partial ischemia in the AICA distribution may manifest with an AAS and/or vertigo. The aim of this study was to investigate the clinico-radiologic features of patients who presented with an AAS as a prodromal symptom of the AICA infarction.
Methods
Sixteen consecutive cases of the AICA infarction diagnosed by brain MRI completed a standardized audiovestibular questionnaire and underwent a neurotological evaluation by an experienced neurotologist.
Results
Five patients (31%) had an AAS as a prodrome of the AICA infarction 1-10 days prior to onset of other brainstem and/or cerebellar symptoms. Two types of AAS were found: recurrent transient hearing loss and/or tinnitus (n=3) or a single episode of prolonged hearing loss and/or tinnitus (n=2). The episodic symptoms were brief, lasting only minutes. The tinnitus preceding infarction was identical to the tinnitus experienced at the time of infarction. At the time of the infarction, all patients developed hearing loss, tinnitus, vertigo, and an ipsilateral hemiataxia. The most common affected site was the middle cerebellar peduncle (n=5). Four of 5 patients had an incomplete hearing loss and all patients had an absence of vestibular function to caloric stimulation on affected side, respectively.
Conclusions
AAS may be a warning sign of an impending pontocerebellar infarction in the distribution of the AICA. The AAS preceding an AICA infarction may result from an ischemia of the inner ear or the vestibulocochlear nerve.
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Migraine and idiopathic recurrent vertigo
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Hyung Lee, Sung Il Sohn, Yong Won Cho
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J Korean Bal Soc. 2002;1(2):240-244.
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Abstract
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- 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.
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Sudden Deafness and Anterior Inferior Cerebellar Artery Infarction
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Hyung Lee, Sung Il Sohn, Doo Kyo Jung, Yong Won Cho, Jeong Geung Lim, Sang Doe Yi
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J Korean Bal Soc. 2002;1(1):124-131.
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Abstract
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- Background
and objectives : Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness, and gait ataxia. There have been few reports on deafness associated with the AICA infarction. Furthermore, previous neurological reports have not emphasized the inner ear as a localization of sudden deafness. The aim of this study was to investigate the incidence of deafness associated with the AICA infarction and the sites predominantly involved in deafness.
Materials and method : During two years we prospectively identified 12 consecutive patients with unilateral AICA infarction diagnosed by brain MRI. Pure tone audiogram, speech discrimination testing, stapedial reflex testing, and auditory brainstem responses were performed to localize the site of lesion in the auditory pathways. Electronystagmography was also performed to evaluate the function of the vestibular system.
Results
: The most common affected site on brain MRI was the middle cerebellar peduncle (11). Four patients had vertigo and/or acute auditory symptoms such as hearing loss or tinnitus as an isolated manifestation from 1day to 2months prior to infarction. Audiological testings confirmed sensorineural hearing loss in 11 (92%) patients, predominantly involved the cochlea in 6 and retrocochlear in 1. The other 4 patients had a severe to profound hearing loss most likely of cochlear origin. Electronystagmography demonstrated no response to caloric stimulation in 10(83%) patients.
Conclusions
: In our series, sudden deafness was an important sign for the diagnosis of the AICA infarction. Audiological examinations suggest that sudden deafness in AICA infarction is usually due to dysfunction of the cochlea, resulting from ischemia to the inner ear.
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