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Benign Recurrent Vertigo: Clinical Manifestations And Vestibular Function Test
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Chang Hyo Kim, Kyu Sung Kim, Hoseok Choi, Yun Gun Jung, Seung Chul Lee
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J Korean Bal Soc. 2008;7(1):48-54.
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 Abstract
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- Background and Objectives: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed.
Materials and Methods: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis.
Results: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography.
Conclusions: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.
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Comparative Analysis of Vestibular Asymmetry Parameters in Acute Unilateral Peripheral Vestibulopathy
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Hoseok Choi, Kyu Sung Kim, Young Hyo Kim, In Kuk Hwang, Seung Yeon Jang, Seung Chul Lee
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J Korean Bal Soc. 2007;6(2):202-206.
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Abstract
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- Background and Objectives: There are known parameters that indicate vestibular asymmetry, such as directional preponderance (DP) on caloric test, asymmetry on slow harmonic acceleration (SHA) test, asymmetry of time constant (Tc) and slow cumulative eye position (SCEP) on velocity step test. Aim of this study is investigate the sensitivity and predictability of the vestibular asymmetry parameters among them.
Materials & Methods: Twenty six patients who were diagnosed as acute unilateral peripheral vestibulopathy were enrolled in this study. We compared each parameter with site of lesion based on the direction of spontaneous nystagmus and canal paresis (CP) which were totally correlated in this group of patients.
Results: Positive predictability of each parameter showed 58% in DP, 62% in SHA asymmetry, 62% in SCEP, 38% in Tc. In the cases that each parameter showed positive result, all of DP and SHA asymmetry indicated site of lesion, and showed high correlation coefficient(r=0.89). But in 27% of SCEP and 23% of Tc did not indicate site of lesion.
Conclusion: All parameters showed low sensitivity for identifying laterality of lesion even the tests were performed with in one week after vertigo attack. DP and VOR asymmetry showed high positive predictability for indicating lesion site.
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Comparison of Vestibule-ocular Reflex of Eccentric Rotation with Centric Rotation in Normal Subjects
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Byung Han Cho, Seung Yeun Jang, Ho Suk Choi, Seung Chul Lee, Kyu Sung Kim
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J Korean Bal Soc. 2004;3(2):351-335.
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Abstract
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- Background
and Objectives : Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. By placing subjects off from the axis of rotation, the otolithic organ may also be simultaneously stimulated by additional linear acceleration forces. In the present study, we compared the rotation with subjects placed on axis to those placed in an eccentric position.
Materials and Method : In the eccentric rotation, the head of subject was facing outward and placed eccentrically for 33cm on naso-occipital axis. Slow harmonic acceleration test and velocity step test were performed.
Results
: The sinusoidal eccentric rotation at 0.32, 0.64 Hz produced a significantly higher vestibulo-ocular reflex gain than did on axis rotation. In velocity step test, initial slow component velocity was significantly higher in eccentric rotation than in centric rotation.
Conclusion
: These finding suggest that the gain enhancement due to eccentric rotation is a result of tangentiallinear acceleration, probably sensed by the otolithic organ. This study raises the possibility of using eccentric rotation for the diagnosis of the patients with otolithic dysfunction.
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Analysis of Body Sway and Nystagmus with Galvanic Stimulation in Normal Subjects
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Myung Taek Lee, Ho Seok Choi, Jin Kim, Seung Yeon Jang, Seung Chul Lee, Kyu Sung Kim
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J Korean Bal Soc. 2004;3(1):156-160.
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Abstract
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- Background
and Objectives : The purpose of this study is to evaluate the possibility of clinical application of
‘vestibular function test by electrical stimulation’ measuring nystagmus and body sway which are generated by electrical
stimulation.
Materials and Methods : Twelve normal subjects for measurement of nystagmus and eight for body sway
volunteered to participate as subjects of the experiment. We used continuous direct current from 1mA to 3mA, and
its polarity could be switched through the surface electrode on the bilateral mastoid process. Videooculogram was used
to measure the nystagmus. Lateral body sway was recorded by using Computerized Dynamic Posturography.
Results
: When stimulating the positive electrode over the right mastoid, left nystagmus and body sway toward right
are observed. When stimulating the negative electrode over the right mastoid, right nystagmus and body sway toward
left are observed. The nystagmus occurred 42% at 1mA, 75% at 1.5mA, 92% at 2mA, and 100% at more than 2.5mA.
The slow phase velocity of the nystagmus were increased from an average of 1.9 deg/sec at 1mA to an average of
3.6 deg/sec at 3mA. However, they were variable from minimum of 0.1 deg/sec to maximum of 4.8 deg/sec even
stimulated with fixed amount of current. Also, the asymmetry of the nystagmus on the each direction was observed
over 27% at the stimulation of 2.5mA and 3mA. The body sway was observed on the 7 subjects except one. Among
them, body sway occurred on stimulation of 1mA in 5 subjects.
Conclusions
: Evaluation of nystagmus with galvanic stimulation revealed high right-left asymmetry in normal
subjects and needed more electrical stimulation. Evaluation of body sway with galvanic stimulation is more feasible as
a vestibular function test, because it has higher manifestation rate, less asymmetry, and it need less electrical amplitude
which cause less discomfort to the subjects.
Key Words : Eye movements, Posture
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The Clinical Significance of Head-shaking Nystagmus in the Patients with Acute Unilateral Peripheral Vestibular Loss
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Jun Sun Shin, Bo Young Kim, Kyu Sung Kim, Seung Chul Lee
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J Korean Bal Soc. 2003;2(2):181-186.
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Abstract
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- Background
and Objectives: In unilateral peripheral vestibular loss patients, head-shaking induce a bias from remaining asymmetric vestibular sensor and cause the imbalance in velocity-storage mechanisms. Head-shaking nystagmus(HSN) is the transient nystagmus induced by shaking the head in the horizontal plane, and have slow phases directed toward the side of vestibular loss. We evaluated the usefulness of the HSN in acute unilateral peripheral vestibular loss patient with reference to spontaneous nystagmus SN), bithermal caloric test, and slow harmonic acceleration(SHA) test.
Materials and Methods: 18 patients of acute unilateral peripheral vestibular loss who had SN and symptoms of acute prolonged vertigo were analyzed retrospectively. The examiner performed passive head rotation in 30 degree anteflexed position with eyes closed and oscillated about 60 degree to each side, 2 Hz for 20 cycles, and the nystagmus was observed with Frenzel glasses immediately after head was stopped. Prevalence and direction of HSN were analyzed with SN, caloric test and SHA test during the follow up period.
Results
The prevalence of HSN was 89%(16/18). During follow-up period, direction of nystagmus was changed 28%(13/18) in SN, but in HSN, direction was fixed in all subjects. SN and HSN directed toward the same side in 75%(12/16) but in four cases(25%), direction could not compared because the direction of SN was changed during follow up peroid. In 69%(11/16) of subjects, HSN persisted after the disappearance of SN. In comparison of HSN with bithermal caloric test, direction of CP was highly correlated with direction of HSN(92%) than SN(64%). HSN was more prevalent(92%) than DP(67%) in caloric test and asymmetry(78%) in SHA test.
Conclusions
HSN test, easily performed office maneuvers, is very useful method to identify the laterality of acute unilateral peripheral vestibular loss, especially in chronic stage.
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