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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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 Abstract
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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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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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Abstract
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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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A Case of Creutzfeldt-Jakob Disease Presenting Mainly with Abnormal Eye Movements
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Yeo Jeong Kang, Jun Hyun Kim, Tae Eun Kim, Sun Ah Park, Tae Kyeong Lee
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Res Vestib Sci. 2014;13(2):53-56.
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Abstract
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- Creutzfeldt-Jakob disease (CJD) is a human prion disease with rapidly progressive neurodegeneration. The major clinical manifestations of CJD include mental deterioration, myoclonus, cerebellar dysfunction, and neuro-ophthalmic symptoms and signs. However, abnormal eye movements as an early sign of CJD are rare. We report a 49-year-old man with periodic alternating nystagmus in early disease course.
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