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Assessment of Vestibular Functional Recovery Using Video Head
Impulse Test in Vestibular Neuritis
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Jun Hyun Kim, Tae Kyeong Lee, Sang Woo Lee, Nari Choi, Seungcheol Lee, Ki Bum Sung
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Res Vestib Sci. 2015;14(4):132-138.
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- Objective: The video head impulse test (vHIT) is useful for evaluation of high
frequency vestibulo-ocular reflex. There are a few reports regarding the recovery of
head impulse test in vestibular neuritis (VN) but the factors for the recovery were not
studied. The study aimed to identify the recovery patterns of vHIT in VN and the
factors influencing the recovery.
Methods
Among 31 patients with acute VN, 18 patients with identified recovery
pattern were selected. We conducted serial checks of subjective vertigo and spontaneous
nystagmus until discharged (1?8 days), and scheduled vHITs. We found three patterns
in serial vHITs during follow-ups and analyzed the relationship of initial vestibular
function tests, serial check-ups of subjective vertigo, bedside neuro-otologic tests, and
vHITs.
Results
Five patients showed normal vHIT gain in acute stage (non-damaged pattern)
and 8 patients’ gains were recovered after 30 days after symptom onset (early recovered
pattern). Poor recovery pattern was found in 5 patients (poorly recovered pattern). There
were relationship between vHIT recovery patterns and the severity of vestibular dysfunctions.
Duration of spontaneous nystagmus (until grade 1), degree of subjective
visual vertical tilt, ocular vestibular myogenic potential abnormalities, and abnormality
of rotatory chair test were all related to poorly recovered vHIT patterns. All poor
recovery patients had residual symptom at 30 days after symptom onset.
Conclusion
The vHIT may give clinicians useful hints in predicting prognosis in VN,
and the recovery of vHIT would be delayed if the damage were more extensive.
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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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- 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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Comparison of Audiovestibular Dysfunction in Patients of Acute Unilateral Peripheral Vestibulopathy with and without Vascular Risk Factors
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Jun Hyun Kim, Tae Kyeong Lee, Ki Bum Sung
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Res Vestib Sci. 2014;13(4):96-101.
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- Background
and Objectives: Etiology of acute unilateral peripheral vestibulopathy
(AUPV) includes virus, ischemia, and autoimmune. As anatomical distribution is
similar between vasculature and innervation, AUPV with vascular risk factors
could be ischemic origin. We investigated the pattern of audiovestibular
dysfunction to explore the influence of risk factors on AUPV. Materials and
Methods
We collected records of 162 AUPV patients from 2011 to 2013 who
were admitted within 7 days from vertigo onset and diagnosed as AUPV by caloric
test and neuro-otologic examination. Vascular risk factors are stroke history,
hypertension, diabetes, body mass index ＞25, age ＞60, and vertebrobasilar
stenosis. Bedside examination includes spontaneous nystagmus grade, head
impulse test, head shaking test. Results of rotatory chair test (n=125), caloric test
(n=162), cervical (n=33) and ocular (n=23) vestibular evoked myogenic potential
(VEMP), subjective visual vertical (SVV) (n=91), and pure tone audiometry (PTA)
(n=62) are collected. Results: Abnormalities of PTA are found more in patients
with vascular risk factor than without any risk factor. Specifically, hypertension
(p=0.008) and old age (p=0.025) are associated with PTA abnormality (p=0.006).
Tilt angle of vertical is larger in risk factor group (p=0.019). The number of
vascular risk factor correlates with abnormalities of PTA (p=0.025) and tilt angle
of SVV. Results of bedside examination, rotatory chair test, caloric test, cervical
and ocular VEMP are not associated with vascular risk factors. Conclusion: AUPV
patients with vascular risk factors have more extensive involvement of
audiovestibular function. Ischemic etiology may contribute to pathogenesis of
extensive AUPV.
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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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- 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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Pathophysiology of Nystagmus in Benign Paroxysmal Positional Vertigo
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Tae Kyeong Lee, Ki Bum Sung
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Res Vestib Sci. 2013;12(1):1-15.
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Abstract
- Benign paroxysmal positional vertigo (BPPV) is easily diagnosed when the specific pattern of nystagmus is demonstrated by adequate provoking maneuver. Therefore, recognizing the pattern of nystagmus is important to determine the affected ear and whether the otoconia is free-floating in the canal or attached to the cupula. However, the latency and the duration of nystamus can be various depending on the type of otoconia and even the direction of nystagmus is atypical in some cases. In addition, not all the positionally-induced nystamus are ascribed to benign semicircular canal pathology. Atypical pattern and refractory for the canalith repositioning maneuver can raise the possibility for the central positional vertigo or nystagmus. Physicians are often perplexed if the pattern of nystagmus by positioning maneuver is not the expected one. For those account, physicians should be well equipped with the knowledge of the pathophysiology of nystamus in BPPV. The pathophysiology and the various patterns of nystagmus in BPPV are discussed in this review.
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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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- 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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- 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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- 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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Clinical Features and Treatment Pattern of Migrainous Vertigo in Korea: A Nationwide Prospective Multicenter Study
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Seong Ki Ahn, Kyusik Kang, Ja Won Koo, Kyu Sung Kim, Beom Gyu Kim, Byung Kun Kim, Ji Soo Kim, Kyoung Ho Park, Shi Nae Park, Eun Ho Park, Hong Ju Park, Jae Yong Byun, Myung Whan Suh, Ki Bum Sung, Sun Young Oh, Chung Ku Rhee, Tae Kyeong Lee, Seong Hae Jeong, Won Ho Chung, Chang Il Cha, Sung Won Chae, Eui Kyung Goh
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Res Vestib Sci. 2009;8(2):122-131.
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- Background and Objectives It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. Materials and Methods Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. Results Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as-sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. Conclusions The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.
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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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- 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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A Case of Selective Inferior Vestibular Neuritis Showing Normal Caloric Test
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Eun Goo Kang, Kyu Rin Hwang, Jong Dae Lee, Ki Bum Sung
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Res Vestib Sci. 2009;8(1):45-48.
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- Vestibular neuritis is commonly diagnosed by demonstrating of peripheral vestibular failure as a unilateral loss of the caloric response. It is a sudden, spontaneous, unilateral loss of vestibular function without simultaneous hearing loss or brainstem signs. In most patients with vestibular neuritis, the process is thought to involve the superior vestibular nerve. Very rarely, vestibular neuritis involves only the inferior vestibular nerve. We experienced a 56-year-old male with inferior vestibular neuritis. The patient had vertigo and spontaneous nystagmus, but a normal caloric test. Brain magnetic resonance imaging was normal, while vestibular evoked myogenic potentials had absent amplitudes on the lesion side. The patient was thought to suffer from pure inferior nerve vestibular neuritis.
Key Words: Vestibular neuronitis; Vestibular function tests
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Disequilibrium without Vertigo
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Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2008;7(2):253-259.
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- No abstract available.
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3-D Model of The Oculomotor Fascicular Arrangement Within The Midbrain Using Brain MRI
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Jeong Ho Park, Du Shin Jeong, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2008;7(1):22-32.
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- Background and Purpose: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists.
Methods: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively.
Results: The mean values and range of the X, Y and Z are as follows: X=7.56±4.34, 1≤X≤15; Y=3.43±1.37, 0≤Y≤6; Z=6.51±3.91, 0≤Z≤12.5.
Conclusions: The distribution of all the MRI lesions was 0≤|Y|≤6 (mm), 0≤|Z|≤12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.
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A Case of Bilateral Vestibulopathy Caused by Varicella-Zoster Meningitis
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Young Hun Yun, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2007;6(2):230-233.
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- Among various etiologies of bilateral vestibulopathy, meningitis has rarely been reported and no case by varicellazoster meningitis. We experienced a case of bilateral vestibulopathy and aseptic meningitis developed in a 22-year old woman who was previously affected by chicken pox. She had oscillopsia and unsteadiness of gait when the typical skin lesion of chicken pox was improving. Neurootologic examination, bithermal caloric irrigation, and rotary chair test showed the result compatible with complete bilateral vestibulopathy. With mild headache and nausea, her CSF finding revealed aseptic meningitis and the serum antibody for varicella-zoster virus (VZV) was elevated. On the contrary of previous report that associated with bilateral vestibulopathy tend to poorly improved, this patient showed a favorable outcome with recovery of symptoms and caloric test.
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A Case of Benign Paroxysmal Positional Vertigo and Sudden Hearing Loss during Recovery Phase of Vestibular Neuritis
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Jong Dae Lee, Shi Chan Kim, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2007;6(2):222-225.
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- Although vestibular neuritis is defined as acute peripheral vestibulopathy without associated hearing loss, a handful of cases reported sudden hearing loss without concurrent vertigo during follow-up of vestibular neuritis. In addition, some patients show benign paroxysmal postional vertigo(BPPV) ipsilateral to the lesion side with various interval after vestibular neuritis, and they are considered to be “secondary” BPPV. Viral and vascular etiologies have been assumed for the vestibular neuritis but, both of those failed to explain exact pathomechanism so far. Authors experienced a case of sudden hearing loss with simultaneous ipsilateral BPPV after vestibular neuritis. There has been no report of concurrent of BPPV and sudden hearing loss after vestibular neuritis. Sequential viral activations are considered to be responsible for this case.
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Lateralizing Value of Romberg Test and Modified Romberg Test in Acute Unilateral Vestibular Neuritis
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Won Hee Chung, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2007;6(1):41-49.
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- Background and objectives: Romberg test has been regarded as simple and efficient bedside modality to evaluate the vestibulospinal reflex in patients with balance disorders. we compared the direction of fall and that of yaw head rotation during Romberg test to evaluate its lateralizing value in acute unilateral vestibular neuritis.
Materials and methods: Forty three patients (n=43) with acute unilateral vestibular neuritis were included. We did Romberg test in three different head positions: with a head looking straight ahead (Romberg test1), turned to the right by about 90 degrees (Romberg test2) and turned to the left by about 90 degrees (Romberg test3) in yaw. Affected side of the vestibular neuritis was decided by the direction of nystagmus and the side of canal paresis. We compared the falling direction in each Romberg test, direction of nystagmus and canal paresis.
Results: During Romberg test, 19 out of 43 fell to the lesion side (44%) and during modified Romberg test, 18 out of 43 fell to the lesion side (42%). On modified Romberg test, fallings to the side of affected labyrinth showed 14/18(78%) in the Romberg test 2 and 15/18 (83%) in the Romberg test 3. The direction of falling in each maneuvers correlated statistically to the side of the affected labyrinth (p<0.05). Direction of nystagmus and the side of the canal paresis also showed correlation to the direction of falling in modified Romberg test.
Conclusion: Romberg and Modified Romberg tests are helpful to decide the affected side in vestibular neuritis to some extents.
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Biphasic Head-Shaking Nystagmus in a Patient with Anterior Inferior Cerebellar Artery Infarction
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Won Hee Chung, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):317-319.
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- Head-shaking test is a sensitive screening tool for a detection of peripheral and central vestibular system disease. Biphasic head-shaking nystagmus (b-HSN) is a rather uncommon phenomenon which was a combination of the paretic nystagmus and recovery nystagmus. We report characteristics of b-HSN in a patient with anterior inferior cerebellar artery infarction, whose only complaint was recurrent vertigo.
Key Words : Nystagmus, Anterior inferior cerebellar artery infarction
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A Case of Carotid Cavernous Fistula Presenting with “Delayed Red-Eyed Shunts”
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Ki Bum Sung, Won Hee Chung, Jeong Ho Park, Dae Ho Kim
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J Korean Bal Soc. 2006;5(2):307-310.
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- Presenting symptoms of carotid cavernous fistulas (CCF) may vary according to the draining vessels. Prominent external orbito-ocular signs such as red eye, proptosis, ocular bruit occur, when the shunt drains anteriorly (“red-eyed shunts”), whereas an isolated ocular motor nerve palsy and headache can be the only presenting symptoms when it drains posteriorly (“white-eyed shunts”). Turning the eyes red from white eyed-shunt weeks to months (“delayed red-eyed shunts”) suggest the direction of fistula drainage shifted anteriorly; it has rarely been reported. We report a patient with delayed red-eyed shunts whose red eye resolved after chemical embolization of draining vessels.
Key Words : Carotid cavernous sinus fistula, Ocular motor nerve palsy
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Specific MRI and MRA findings of Dural Carotid Cavernous Sinus Fistula -A Case Report-
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Won Hee Chung, Jong Se Lee, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):296-298.
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- Dural carotid-cavernous sinus fistula (d-CCF) is a rare cause of ophthalmoplegia, and it may be overlooked when the prominent external orbito-ocular sign is lacking. Conventional angiography is the gold standard in the diagnosis of d-CCF. Recently, the specific MR findings of d-CCF have increasingly been reported. We report a patient with spontaneous d-CCF presenting with an isolated fourth-nerve palsy in whom magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) demonstrated d-CCF.
Key Words : Carotid cavernous sinus fistula, Ophthalmoplegia, Angiography, Magnetic resonance imaging, Magnetic resonance angiography
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Partial Oculomotor Nerve Palsy due to Different Fascicular Involvements in Recurrent Midbrain Infarctions
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Jeong Ho Park, Won Hee Chung, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):292-295.
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- We experienced a patient with partial oculomotor palsy who had initially manifested pupillary mydriasis and inferior rectus palsy which were attributed to an ipsilateral fascicular lesion in midbrain. She developed ipsilateral ptosis and monocular elevation palsy due to a new lesion on MRI one month later. This case could be the first neuroimaging evidence which support the hypothesis that fascicles of the oculomotor nerve for inferior oblique, superior rectus, and levator palphebrae muscle fibers are located more laterally and caudally than fascicles for pupil and inferior rectus muscle within midbrain tegmentum.
Key Words : Oculomotor nerve, Infarction, Midbrain
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A Rostro-Caudal Arrangement of the Oculomotor Fascicles Based on MR Findings of Midbrain Infarctions in Two Cases
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Jeong Ho Park, Won Hee Chung, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):281-284.
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- A rostro-caudal topography of the oculomotor nerve fascicles is relatively well known in animal but not in human. We experienced two cases of midbrain infarctions presenting with isolated oculomotor nerve palsies. The MRI of the patient who had monocular elevation palsy with ptosis revealed a lesion in the middle to lower midbrain, whereas that of the other who had monocular depression and adduction palsy with pupillary mydriasis showed a discrete lesion in the upper to middle midbrain. We present the rostro-caudal arrangement of the oculomotor fascicles within midbrain based on MRI findings.
Key Words : Oculomotor nerve palsies, Magnetic resonance imaging
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A Case of Isolated Unilateral Abducens Nerve Palsy Caused by Clival Metastasis from Rectal Cancer
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Won Hee Chung, Jeong Ho Park, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):78-80.
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- A wide variety of abnormalities, both primary to the nerve itself and secondarily involving the nerve, can cause isolated abducens nerve palsy. Skull base lesions are also regarded as possible causes of isolated abducens nerve palsy but clival metastasis from systemic malignancy has rarely been reported. We report a case of isolated abducens nerve palsy caused by clival metastasis from rectal cancer.
Key Words : Abducens nerve palsy, Metastasis, Skull base, Rectal neoplasm
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A Case of Tolosa-Hunt Syndrome with Serial MRI Findings
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Jeong Ho Park, Won Hee Chung, Dae Ho Kim, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):74-77.
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- To diagnosis Tolosa-Hunt syndrome (TSH) used to be difficult because some other diseases like tumors, sarcoids, vasculitises or other inflammatory masses simulate the clinical manifestations, including steroid responsiveness and radiologic findings. According to the international classification of headache disorders 2nd edition, the diagnosis of THS requires demonstration of granuloma by MRI or biopsy. We performed MRI 4 times during 6 months in a patient who seemed to have THS. Initial MRI was normal but the second MRI showed granuloma which decreased gradually in size with steroid treatment.
Key Words : Tolosa-Hunt syndrome, Magnetic resonance imaging, Granuloma
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Isolated Abducens Nerve Palsy Caused by De Novo Pontine Cavernous Angioma
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Jeong Ho Park, Won Hee Chung, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):70-73.
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- Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Key Words : Cavernous angioma, Abducens nerve palsy
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A Case of Vogt-Koyanagi-Harada syndrome presenting initially with recurrent vertigo
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Tae Kyeong Lee, Sang Won Nam, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2003;2(2):234-236.
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Abstract
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- Besides meningism, dizziness has also been frequently reported as a neurologic manifestation of Vogt-Koyanagi-Harada(VKH) syndrome. These neurotologic symptoms usually develop just before or after ocular involvement. We report the patient with VKH syndrome who showed recurrent peripheral vertigo. The characteristic opthalmological symptoms developed later in this case.
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Neuro-Behcet's Disease Presenting with Foville Syndrome - A Case Report -
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Won Hee Chung, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2003;2(1):129-132.
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Abstract
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- A Foville syndrome is rare. A 46-year-old man with a 3-year history of Behcet's disease presented with a right facial palsy and a limitation in the rightward movements of the eyes. On neurologic examination, there was no movement of eyes in the right hemifield during all kinds of eye movements, including saccade, smooth pursuit, vestibulo-ocular reflex, and optokinetic nystagmus. However, all the eye movements were normal in the left hemifiled except for slowed saccades toward the right. Additional features were right infranuclear facial paresis and extensor plantar response on left side. Brain MRI revealed high signal intensity lesions in the right pons both in the dorsal tegmentum and in the basis. Neurological signs resolved gradually with steroid treatment. Different clinical features between abducens nucleus syndrome and paramedian pontine reticular formation syndrome are briefly discussed. To the authors' knowledge, this is the first case report of a Foville syndrome caused by neuro-Behcet's disease.
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KBS
