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Preserved Ocular Vestibular Evoked Myogenic Potential to Head Tap in
a Patient with Positive Head-Heave
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Seong Hae Jeong, Carol A Foster, Darcy Strong
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Res Vestib Sci. 2015;14(4):152-154.
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- Vestibular function can be evaluated using various clinical and laboratory
findings. Among these, head heave and vestibular evoked myogenic potential
(VEMP) represent the otolith-ocular response, which is dynamic rather than static.
There have been no reports of tap-evoked VEMP and head-heave in dizzy
patients. Here, we report dissociation between ocular VEMP to head tap and the
head heave test in acute vestibulopathy.
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Diagnosis and Differential Diagnosis of Migrainous Vertigo
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Seong Hae Jeong
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Res Vestib Sci. 2012;11(2):45-50.
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- Migrainous vertigo is one of common recurrent vestibular disorders. Because the diagnostic criteria have not been yet settled internationally, we have a difficulty in both diagnosis and research in migraineurs with vertigo. Literature about the diagnostic criteria of migrainous vertigo and its differential diagnosis were reviewed. Until now, the criteria proposed by Neuhauser et al. is regarded as most adequate in diagnosis of migrainous vertigo. Differential diagnosis of migrainous vertigo should be guided by distinction of vestibular symptoms and nonvestibular dizziness and consider the common causes of recurrent vertigo. Just like migraine itself, migrainous vertigo is diagnosed on the basis of history and exclusion of other vestibular disorders mimicking migrainous vertigo. Therefore, delicate history taking is the most important in diagnosis and management of patients with migrainous vertigo.
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Can Nitroglycerin Differentiate Benign Recurrent Vertigo From Vestibular Migraine? A Preliminary Study
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Jong Wook Shin, Seong Hae Jeong, Ji Eun Oh, Ae Young Lee, Jae Moon Kim, Ji Soo Kim
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Res Vestib Sci. 2012;11(1):8-13.
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- Background and Objectives: Nitroglycerin (NTG), a donor of nitric oxide, is known to provoke migraine attacks in patients with migraine. However, this effect was not explored in patients with benign recurrent vertigo (BRV). To infer the mechanism of BRV, we evaluated provocative effects of NTG in patients with vestibular migraine (VM) and BRV compared with normal controls. Materials and Methods: Thirteen patients with recurrent vertigo, 8 with VM and 5 with BRV, and 5 healthy controls received intravenous infusion of 0.5 μg/kg/min NTG over 20 minutes. Headache intensity (visual analog scale) and associated symptoms were recorded at baseline and every 10 minutes for an hour. And the subjects were also asked to complete a headache diary every hour for another 12 hours. Results: In contrast to normal controls (2/5, 40%, p=0.035) and the patients with BRV (1/5, 20%, p=0.007), all patients with VM (8/8, 100%) had migraine attacks after NTG injection. However, there was no difference in the proportion of the patients with migraine attacks after NTG injection between normal controls and the patients with BRV. Conclusion: In contrast to the patients with VM, patients with BRV are not sensitive to nitric oxide. These results suggest that the pathophysiology of BRV may be different from that of VM.
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Prediction of Successful Repositioning of Horizontal Canal Benign Positional Vertigo in Gufoni’s Maneuver: A Preliminary Study
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Jeong Soo Moon, Jong Wook Shin, Hyun Jung Kim, In Chul Baek, Eung Seok Oh, Ji Eun Oh, Kyung Jae Lee, Ji Hee Lee, Jae Moon Kim, Seong Hae Jeong
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Res Vestib Sci. 2010;9(3):108-113.
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- Background and Objectives: Although several methods of repositioning maneuver have been introduced for the benign paroxysmal positional vertigo involving horizontal canal (HC-BPPV), no study has investigated the nystagmus pattern during the repositioning maneuver and its correlation with the repositioning results. Therefore, we evaluated the predictive value of the nystagmus for successful repositioning by studying the nystagmus pattern during the position of the Gufoni’s maneuver.
Materials and Methods: Seventeen consecutive patients (age range=36~76 years, median age=64), with a diagnosis of HC-BPPV were recruited between July and August 2010. The Gufoni's maneuver for apogeotropic and geotropic nystagmus was performed. After 30 minutes, the treatment outcome was evaluated according to the nystagmus pattern at the individual stage of Gufoni’s maneuver. Successful treatment was defined by the resolution of positional vertigo in geotropic HC-BPPV and nystagmus shifted from apogeotropic to geotropic in apogeotropic HC-BPPV.
Results: In the successfully treated patients, 4 of 6 patients had the contralesional nystagmus between 1st and 2nd position of Gufoni’s maneuver. Ipsilesional nystagmus in 1st position of Gufoni’s maneuver was observed in 1 patient with apogeotropic nystagmus. And the other 1 patient with Geotropic HC-BPPV showed no nystagmus in 2nd position after contralesional nystagmus in 1st position of Gufoni’s maneuver. Unsuccessfully treated 11 patients had a conversion of nystagmus direction in 2nd position after 1st step.
Conclusion: During the 2nd position of the Gufoni’s maneuver, a nystagmus toward unaffected side predicts a successful repositioning, whereas reversed nystagmus is suggestive of poor response to repositioning.
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Effects of Galvanic Stimulation on Spontaneous Nystagmus in Meniere’s Disease and Vestibular Neuritis: A Preliminary Study
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Seong Hae Jeong, Ji Soo Kim
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Res Vestib Sci. 2010;9(2):64-69.
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- Background and Objectives Galvanic vestibular stimulation (GVS) is known to induce nystagmus, ocular torsion, a tilt of subjective visual vertical, and perceptual and postural shift. The aim of this study was to compare the findings of GVS among the patients with spontaneous nystagmus (SN) caused by Meniere’s disease (MD) or vestibular neuritis (VN).
Materials and Methods Three-dimensional video-oculography was performed without fixation in 4 patients with MD and 2 with VN, as diagnosed by history, independent vestibular function tests and neuroimaging. We recorded the eye-movements in response to bilateral, bipolar, and surface GVS (2.5~3 mA) for 30 seconds, and analyzed mean slow phase velocity of SN.
Results Of the 4 patients with MD, two exhibited a suppression of the left beating SN during anode stimulation of left mastoid and an augmentation of the nystagmus during cathode stimulation of left mastoid. The same patterns of galvanic modulation were observed in the other 2 patients with right beating SN due to MD. In contrast, the patients with VN showed an absent or decreased response to GVS.
Conclusion In MD, the responses to GVS were preserved while the responses were impaired in VN. These results suggest that the irregular vestibular fibers, which are sensitive to GVS, are relatively spared in MD. In contrast, both regular and irregular fibers appear to be damaged in VN. GVS may be helpful in discriminating MD from VN, especially when the patients presented without auditory symptoms.
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The Effect of Serum Uric Acid in Generating Idiopathic Benign Paroxysmal Positional Vertigo
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Seong Hae Jeong, Ji Soo Kim
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Res Vestib Sci. 2010;9(1):27-31.
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- Background and Objectives The causative role of serum uric acid has been controversial in Benign paroxysmal positional vertigo (BPPV). The aim of this study was vto determine the role of serum uric acid in developing idiopathic BPPV.
Materials and Methods We recruited 168 consecutive patients with a confirmed diagnosis of idiopathic BPPV. The patients comprised 116 women (age range: 29~70 years, mean±SD: 55.8±9.7 years) and 52 men (age range: 32~70 years, mean±SD: 55.2±10.9 years). The serum uric acid levels of the patients were compared with those of 194 controls (age range: 20~70 years, mean±SD: 55.5±7.8 years) without a history of dizziness.
Results The serum uric acid levels were decreased in patients with BPPV compared with those in normal controls (4.8±1.3 vs 5.3±1.3, p=0.001). However, multiple logistic regression analyses adjusted for age, sex, alcohol, smoking, hyperphosphatemia and osteopenia/osteoporosis did not demonstrate that the hypouricemia is an independent risk factor for BPPV.
Conclusion This study suggests that serum uric acid level is not a risk factor for developing idiopathic BPPV.
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Acute Sensorineural Hearing Loss with Simultaneous Ipsilateral Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Report of a Case and Review of the Literature
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Ji Hee Lee, Seong Hae Jeong, Eung Seok Oh, Eun Hee Sohn, Ae Young Lee, Jae Moon Kim
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Res Vestib Sci. 2009;8(2):156-160.
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- Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder. Advanced age, head or ear trauma, other inner ear disorders, female sex and osteopenia/osteoporosis are known predisposing factors for pSCC BPPV. An association with simultaneous ipsilateral sudden deafness remains to be elucidated. We report a 62-year old woman with sudden deafness and simultaneous ipsilateral pSCC BPPV.
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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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Motion Sickness
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Seong Hae Jeong
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Res Vestib Sci. 2009;8(1):95-99.
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Periodic Alternating Nystagmus in Vestibulocochlear Disorder
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Seong Hae Jeong, Eung Seok Oh, Ji Hee Lee, Jae Moon Kim
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Res Vestib Sci. 2009;8(1):49-51.
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- Periodic alternating nystagmus (PAN) is characterized by horizontal nystagmus that reverses direction periodically. PAN can occur in both congenital and acquired conditions. We report a 58-year old man with peripheral vertigo and hearing impairment showing PAN in darkness.
Key Words: Vertigo; Hearing loss; Nystagmus, Pathologic; Meniere Disease
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A Case of Apogeotropic Positional Nystagmus Associated With Anti-GD1b IgG Antibody
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Seong Hae Jeong, Gun Sei Oh, Dong Ick Shin, Ji Soo Kim
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J Korean Bal Soc. 2008;7(1):73-76.
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- The binding of anti-GD1b IgG antibody to the cerebellar granular area or spinocerebellar Ia fibers in the peripheral nerves may cause the prominent cerebellar ataxia, mild quadriparesis and sensory dominant neuropathy. A 31-year woman presented with severe cerebellar ataxia and prominent apogeotropic positional nystagmus/vertigo. Increased anti-GD1b antibody IgG in her serum was noted. 18F-flurodeoxyglucose positron emission tomography (FDG-PET) showed decreased uptake in cerebellum. It is the first case of central positional nystagmus with anti-GD1b IgG antibody.
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