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Clinical Characteristics of Secondary BPPV
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Jae Ho Ban, No Hee Lee, Hyun Jin Choi, Su Mi Kim, Nam Hoon Lee, Sung Jin Lee
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J Korean Bal Soc. 2007;6(2):196-201.
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- pathic BPPV.
Results: The site of canal affected by idiopathic BPPV (M=119, F=183) showed that 138 (Lt=62, Rt=76) had a lateral canal, 157 (Lt=63, Rt=94) had a posterior canal, 7 had a multicanal. The involved canal by secondary BPPV (M=45, F=37) showed that 34 had a lateral canal, 43 in posterior canal, 1 in anterior canal and 4 in multicanal. 28 patients with idiopathic sudden sensory hearing loss developed BPPV within a few days (posterior=17, lateral=7, multicanal=4). 12 patients had a unilateral peripheral vestibulopathy and ipsilateral BPPV (posterior=11, lateral=1, anterior canal=1). 14 patients with meniere’s disease developed ipsilateral BPPV (Lateral=9, posterior=5). 28 patients with BPPV had a history of headtrauma which is considered to be cause of BPPV. The mean duration of treatment is 2.68 on idiopathic BPPV, 6.27 on BPPV with ISSHL, 6.75 on BPPV with unilateral vestibulopathy, 2.28 on BPPV with meniere’s disease and 2.4 on posttraumatic BPPV. There was no significant difference of recurrence among groups.
Conclusion: Secondary BPPV showed different prevalence of involved canal from idiopathic BPPV. The duration of treatment for BPPV with ISSHL or unilateral vestibulopathy take longer time than for other groups.
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Clinical Manifestations of Headache in Meniere’s Disease
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Jae Ho Ban, Hyun Jin Choi, Seung Suk Lee, Su Mi Kim, No Hee Lee, Hee Jun Kwon, Jong Kyu Lee
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J Korean Bal Soc. 2007;6(2):181-185.
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- Background and Objectives: A possible link between Meniere’s disease (MD) and headache was originally suggested by Prosper Meniere. We aimed to analyze the clinical manifestation of headache in definite MD compared with benign paroxysmal positional vertigo (BPPV) as a control group.
Materials and Methods: We examined headache in 67 patients with definite MD according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Sex- and age-matched 67 patients with BPPV served as a control group. Information was obtained concerning the prevalence, localization, severity, character, sequence of headache and response to therapy.
Results: Altogether 60 MD patients (90%) and 47 BPPV patients (70%) was reply the questionnaire. 46 MD patients (69%) and 15 BPPV patients (22%) reported headache. Headache was moderate to severe in 39 MD patients (85%) and as a whole more severe than that of the BPPV patients (P<0.05). Temporal area was the most frequently involved region in MD group, whereas posterior neck area was most frequent in BPPV group. The sequence of headache and vertigo attack was pre-(23%), intra-(33%), after-(44%). The 39 patients (89%) of headache in MD was response to the vestibular suppressants, diuretics, calcium channel blocker.
Conclusion: It is concluded that high incidence of headache and migraine in combination with MD seems to common pathophysiology with migraine. Therefore, our results could provide predictive value in the treatment and follow up of MD patients with headache.
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Clinical Manifestations of Cerebellar Infarction Mimicking Unilateral Vestibulopathy
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Seung Suk Lee, Jae Ho Ban, Chee Yeul Park, No Hee Lee, Jong Kyu Lee
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J Korean Bal Soc. 2006;5(2):229-234.
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- Background
and Objectives: Pseudo-labyrinthine symptom without any other accompanying neurologic symptoms or signs occur with cerebellar infarction. The prognosis and management of cerebellar infarction differ from those of vertigo associated with unilateral vestibulopathy. The objective of study was to analyze the clinical symptoms of cerebellar infarction mimicking unilateral vestibulopathy according to the infarction territory.
Materials and Method: Among 273 patients who showed pseudo-labyrinthine symptoms or signs, 28 patients were diagnosed cerebellar infarction on MRI between January 2003 and October 2006. Out of the 28 patients, 9 patients accompanying with focal neurologic symptoms or signs in early stage were excluded, and a retrospective analysis of total 19 patients was done through chart reviews. Using diffusion-weighted imaging, we divided 19 patients into two groups, AICA and PICA territory infarction. Clinincal features, outcome of audiologic and vestibular function test were compared between the groups.
Results
Among the 19 subjects, 10 were males and 9 were females, the mean age was 63.1±4.0. On MRI, 5 (26.3%) subjects showed infarction in unilateral AICA territory, 14(73.7%) in unilateral PICA territory. In the patients with AICA territory infarction, audiological tests confirmed unilateral sensorineuronal hearing loss in all 5 subjects. On V-ENG, 4/5 (80%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 4/5 (80%) had a canal paresis to caloric stimulation. In several days of hospital stay, 3/5 (60%) showed new neurologic signs, facial numbness. In the patients with PICA infarction, there was no hearing change. On V-ENG, 12/14(85.7%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 7/14 (50%) had a canal paresis to caloric stimulation. In several days of hospital stay, 10/14 (71.4%) accompanied with cerebellar ataxia.
Conclusion
Cerebellar infarction simulating unilateral vestibulopathy is more common than previously thought. Early recognition of the cerebellar infarction showing pseudo-vestibular symptom may allow specific management. Also taking into account that clinical features differ by infarction territory will assist in determining the patient’s status of the disease.
Key Words : Cerebellum, Infarction
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Monostotic Fibrous Dysplasia of the Temporal Bone with Unilateral Vestibular Weakness and Sensorineuronal Hearing Loss
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Jae Ho Ban, Chi Yeul Park, Jong Kyu Lee, No Hee Lee
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J Korean Bal Soc. 2005;4(1):58-62.
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- Fibrous dysplasia is an uncommon benign disorder of unknown etiology. The disease was first described by McCune and Albright in separate publications in 1937. The term, fibrous dysplasia was suggested by Lichtenstein in 1938. The disease has since been found to have 3 different variants: monostotic, polyostotic, and McCune-Albright syndrome. It is a slowly progressive bony disorder where normal bone is replaced by abnormal fibrosseous tissue. Involvement of fibrous dysplasia of the temporal bone is usually unilateral. The squama becomes thickened and the pneumatic system is obliterated. Because fibrous dysplasia shows a predilection for the facial and cranial bone, where it causes deformity
and dysfunction. In this paper, we report a case of fibrous dysplasia of the temporal bone. We discuss the characterisitic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of vertigo.
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