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Vestibular Dysfunctions in Vestibular Migraine Evaluated by Rotatory
Chair Test
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Ji Yun Park, Byeong Cheo Oh, Tae Kyeong Lee, Ki Bum Sung
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Res Vestib Sci. 2015;14(4):123-131.
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 Abstract
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- Objective: There have been several efforts to elucidate the pathophysiology of the
vestibular migraine (VM). But, there is no consistent result. This study was to identify
the possible pathophysiology of VM by comparing vestibulo-ocular reflex (VOR) parameters
between VM, and the tension type headache (TTH) patients. In addition, we
compared VOR parameters between ictal and interictal period in the VM group.
Methods
Seventy eight patients were included: 44 having VM and 34 TTH. Three
parameters (gain, asymmetry, and phase) of the horizontal VOR rotating at 60 degrees
were measured. In 10 VM patients VOR parameters were obtained twice sequentially
first in the ictal and second in the interictal period.
Results
Although the average of the VOR gain in VM group was lower than that
of TTH group but there was no statistical significance. An asymmetry of the VOR
was significantly higher in VM group. There were various changes in other VOR
parameters between ictal and interictal periods with no consistent trends.
Conclusion
We could deduce that VM patients might have subclinical vestibular
dysfunction from the reduced gain and increased asymmetry of the VOR in the interictal
period. Dynamic changes of the VOR in the ictal period could be responsible for
dizziness in VM patients, which are caused by the pathological alteration of the
physiologic plasticity of the VOR.
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Predictors of Cerebrovascular Causes in the Emergency Department Patients with Dizziness: Application of the ABCD2 Score
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Hyung Jun Kim, Su Ik Kim, Ji Hun Kang, Ki Bum Sung, Tae Kyeong Lee, Ji Yun Park
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Res Vestib Sci. 2014;13(2):34-40.
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Abstract
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- 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.
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The Relations of Otholith Function Tests and Risk Factors of Benign Paroxysmal Positional Vertigo
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Jae Hoon Joung, Ji Yun Park, Hyeon Mi Park, Tae Kyeong Lee, Ki Bum Sung
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Res Vestib Sci. 2012;11(1):23-28.
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Abstract
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- Background and Objectives: Since the liberated otoconia from the degenerated utricle has been postulated as the cause of the benign paroxysmal positional vertigo (BPPV), the relationship of the utricular function and the generation of BPPV have been studied. In addition, abnormal bone metabolism and vascular risk factors resulting insufficient circulation to utricle has been reported to be related to the utricular degeneration in BPPV. We investigated the relationship between the vascular risk factors, bone mineral density (BMD) and recurrence for the BPPV and otholith function tests of BPPV. Materials and Methods: Consecutive patients 84 with BPPV were recruited in a dizziness clinic. Caloric test, ocular vestibular evoked myogenic potentials (oVEMPs) were tested in all the patients in acute phase of BPPV. At the same time, vascular risk factors and BMD were performed. Vascular risk factors were history of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease. All the data were analyzed for the relationship between abnormal results of vestibular function tests and the risk factors. Results: Patients 58 (69%) showed abnormal cervical VEMPs that were related to decreased bone density, having more than one vascular risk factor, and older age (>55 years). Abnormal oVEMPs were showed in 53 patients (63%) that were related to older age and vascular risk factors, but not statistically related to bone mineral density. Caloric tests failed to show any statistically significant results. Conclusion: We found abnormal results of cVEMPs and oVEMPs is related to the BMD, vascular risk factors and age. VEMPs could be used for the demonstration of presumptive otolith degeneration in BPPV.
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Prognosis of Hearing According to the Presence of Recurrent Vertigo in Meniere’s Disease
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Chan Goo Lee, Moo Kyun Park, Jong Dae Lee, Ji Yun Park, Tae Kyeong Lee, Ki Bum Sung
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Res Vestib Sci. 2011;10(4):134-137.
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Abstract
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- Background and Objectives: In Meniere’s disease, the relationship between the vertigo attacks and prognosis of hearing remains unclear. Our study aimed to elucidate the possible role of recurrent vertigo in the prognosis of hearing in Meniere’s disease. Materials and Methods: The medical records of 53 patients with definite Meniere’s disease over 2 years follow-up were analyzed retrospectively and we analyzed the changes of vertigo and hearing over time. Results: While 49% of patients who were treated conservatively experienced recurrent vertigo attacks, 40% of patients did not have an episode of vertigo during the follow-up. Worsening of hearing and fluctuation were found in about 30% and 26%, respectively. There is no obvious coincidence in the course of vertigo and hearing. Conclusion: The prognosis of hearing dose not depend on the the presence of recurrent vertigo in Meniere’s disease.
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Relationship Between Clinical Features and Recurrence in Benign Paroxysmal Positional Vertigo of Posterior Semicircular Canal
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Ji Yun Park, Tae Kyeong Lee, Du Shin Jeong, Ki Bum Sung
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Res Vestib Sci. 2011;10(2):63-67.
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Abstract
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- Background and Objectives: The aim of this study is to evaluate the relationship between the recurrence and clinical features of posterior canal benign paroxysmal positional vertigo (p-BPPV). Materials and Methods: Eighty one consecutive patients with p-BPPV in 1 year period were selected and traced for 2 years by telephone interview and chart review. We reviewed the clinical chart to confirm the lesional side of semicircular canals when 13 patients of the recurrent groups had readmitted. We compared clinical characters between the recurrent group and the nonrecurrent group. Results: The recurrence rate after the successful treatment in the p-BPPV is 28% (23/81) patients. There was no difference in the age, sex, and days prior to visit between the recurrent group and the nonrecurrent group (72%, 58/81). The interval to recurrences were ranged from 8 days to 24 months. In the patients we could confirm the side of recurrences (13/23), there was a tendency of recurring on the same side in the early recurrences (within 14 days) (4/13). Conclusion: In considering the causes, the fact that early recurrences tend to be on the same side may be related to unilateral otolith dysfunction as the cause of recurrences in p-BPPV. But the late recurrence may be related to systemic condition because recurrent BPPV developed equally on both sides.
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A Case of Sjögren’s Syndrome Presented with Vertigo as a Initial Manifestation
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Ji Yun Park, Jong Dae Lee, Tae Kyeong Lee, Ki Bum Sung
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Res Vestib Sci. 2009;8(1):70-73.
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Abstract
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- Sjögren’s syndrome (SS) can shows various neurologic symptoms as it involves the central, peripheral and autonomic nervous system. However, CNS involvement as a initial manifestation is rare. We report a 21-year old woman who presented with vertigo, gait ataxia, and hiccup lasted about one month due to a discrete dosal medullary lesion in primary SS. The symptoms and lesions improved by the intravenous methylprednisolone therapy.
Key Words: Sjogren’s Syndrome; Nystagmus, Physiologic; Nervous System Diseases
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A Case of Lateral Medullary Syndrome with Ipsilesional Nystagmus due to Intramedullary Hemorrhage
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Ki Bum Sung, Ji Yun Park, Sun Ah Park, Tae Kyeong Lee
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Res Vestib Sci. 2009;8(1):52-55.
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- We report a rare case of primary dorsal medullary hemorrhage showing lateral medullary syndrome with ipsilesional nystagmus. A 41-year woman, presented with the first degree horizontal vestibular nystagmus and ocular tilt reaction to the left in lateral medullary hemorrhagic lesion. Primary medullary hemorrhage is rare and details of the abnormal eye movement in the lesion have never been described well. While most of the reported vestibular nystagmus in the lateral medullary infarction was contralesional., the nystagmus in this case was ipsilesional. This ipsilesional beating of the nystagmus might be explained that either destruction of the rostral part of vestibular nuclei or irritative effect of blood to vestibular nuclei is responsible. In addition, ocular tilt reaction (OTR) can be more important in deciding the side of the lesion in medullary hemorrhage.
Key Words: Lateral medullary syndrome; Medulla oblongata, Hemorrhage; Nystagmus, Pathologic
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