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Multiple Cerebral Infarction in Cogan’s Syndrome
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Jae Deuk Seo, Jae Hwan Choi, Kwang Dong Choi
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Res Vestib Sci. 2014;13(3):85-88.
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- Cogan’s syndrome is a rare chronic inflammatory disease Characterized by non-syphilitic keratitis and vestibuloauditory dysfunction. Although the precise pathogenesis of Cogan’s syndrome is unknown, it is thought to develop from vasculitis involving multiple organ system. It can be accompanied with various systemic diseases including arthritis, lymphadenopathy, splenomegaly, and aortitis with insufficiency. We report a case of typical Cogan’s syndrome with multiple cerebral infarctions.
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Recurrent Vertigo in Vestibular Schwannoma Responsive to Oxcarbazepine
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Jae Hwan Choi, Min Ji Kim, Kwang Dong Choi, Dae Soo Jung
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Res Vestib Sci. 2013;12(2):58-61.
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- Vestibular schwannoma (VS) are benign neoplasms that arise from Schwann cells of the eighth cranial nerve. Although progressive unilateral hearing loss with dizziness or disequilibrium provides a high suspicion index of VS, vertigo is the symptom causing the most pronounced negative effect on quality of life in patients with VS. We report a 55-year-old woman with recurrent paroxysmal vertigo and hyperventilation-induced nystagmus due to VS, which improved by oxcarbazepine treatment. We suggest that episodic vertigo in VS may be ascribed to the ectopic paroxysmal neuronal discharge from the partially demyelinated vestibular nerve due to tumor compression.
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Isolated Body Lateropulsion as a Presenting Symptom of Lateral Medullary Infarction
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Jae Hwan Choi, Min Gyu Park, Kyung Pil Park, Kwang Dong Choi
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Res Vestib Sci. 2013;12(1):31-34.
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- Body lateropulsion is a common manifestation of lateral medullary infarction (LMI), and usually associated with vertigo, limb ataxia, sensory disturbance, and Horner’s syndrome. However, isolated body lateropulsion as a presenting symptom of LMI is rare, and the responsible lesion for lateropulsion remains uncertain. We report a 71-year-old woman who showed isolated body lateropulsion as a presenting symptom of LMI. Ipsilateral body lateropulsion in our patient may be ascribed to the involvement of the ascending dorsal spinocerebellar tract rather than the descending lateral vestibulospinal tract, which runs more ventromedially.
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A Case of Bilateral Horizontal Semicircular Canal Dysplasia with Normal Cochlea: Three Dimensional Volume Rendering Image Using MR CISS Sequence
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Jae Hwan Choi, Hak Jin Kim, Han Young Jung, Kwang Dong Choi
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Res Vestib Sci. 2011;10(1):38-41.
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- Congenital inner ear malformations are frequently found in patients with sensorineural hearing loss, but isolated vestibular anomalies with normal cochlear development have been rarely reported. We report a 20-year-old man with recurrent dizziness and disequlibrium without hearing impairment. Neuro-otological evaluations showed a left peripheral vestibulopathy with normal hearing function. Three dimensional volume rendering image using magnetic resonance constructive interference in steady state sequence demonstrated isolated vestibular anomalies involving bilateral horizontal semicircular canals. Isolated vestibular anomalies might not be as rare as previously thought among patients with recurrent dizziness, and should be carefully evaluated through various imaging techniques
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Hereditary Episodic Vertigo
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Kwang Dong Choi
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Res Vestib Sci. 2009;8(1):103-107.
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Bilateral Internuclear Ophthalmoplegia Following Spontaneous Subarachnoid Hemorrhage
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Se Jin Oh, Kwang Dong Choi, Dae Soo Jung
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J Korean Bal Soc. 2008;7(2):204-206.
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- A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage.
Key words: Bilateral internuclear ophthalmoplegia, Spontaneous subarachnoid hemorrhage, Vasogenic edema
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Tilt Suppression of the Post-rotatory Nystagmus in Cerebellar Nodular Lesions
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Sun Young Oh, Kwang Dong Choi, Jung Eun Kim, Ja Won Koo, Ji Soo Kim
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J Korean Bal Soc. 2007;6(2):161-166.
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- Background and Objectives: Head tilt at the end of step rotation about a vertical axis decreases the time constant (TC) of the post-rotatory nystagmus, which is known as tilt-suppression of the vestibulo-ocular reflex (VOR). Tilt suppression of the VOR is mediated by the cerebellar nodulus and ventral uvula and is eliminated after surgical ablation of those structures. However, studies on the tilt suppression of the VOR have been sparse in humans with cerebellar lesions.
Materials and Methods: Five patients with circumscribed cerebellar lesions involving the nodulusor ventral uvula underwent recording of spontaneous and positional nystagmus, and the VOR. To evaluate tilt suppression of the VOR, the participants pitched their head forward at the end of step rotation about a vertical axis both in the clockwise and counter-clockwise directions.
Results: The VOR gain was increased in a patient with infarction in the territory of the medial posterior inferior cerebellar artery while the gain of visually enhanced VOR was normal in all the patients. The time constants of perand post-rotatory nystagmus was increased in a patient with increased VOR gain and the tilt suppression of the post-rotatory nystagmus was impaired in two patients, either uni- or bilaterally. Spontaneous downbeat and central positional nystagmus were frequently accompanied.
Conclusions: Nodular lesion may impair tilt suppression of the VOR. Measurement of tilt suppressive effect of the VOR may provide a valuable tool for evaluating the nodular dysfunction.
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A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles
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Sun Young Oh, Kwang Dong Choi, Jae Moon Kim, Jei Kim, Seong Ho Park, Ji Soo Kim
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J Korean Bal Soc. 2006;5(1):35-43.
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Abstract
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- Background
and Objectives: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated.
Materials and Method: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points.
Results
The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV.
Conclusion
These results suggest that low level laser promotes hair cell viability in utricular explants.
Key Words : Organotypic culture, Low level laser, FM 1-43, Utricle
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Jerky Seesaw Nystagmus in Isolated Internuclear Ophthalmoplegia
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Kyungmi Oh, Jae Hong Chang, Kun Woo Park, Dae Hie Lee, Kwang Dong Choi, Ji Soo Kim
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J Korean Bal Soc. 2005;4(1):49-52.
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- The authors report jerky seesaw nystagmus, extorsional downbeating in the right eye and intorsional upbeating in the left eye, in a patient with right internuclear ophthalmoplegia (INO). This pattern of nystagmus may occur by disrupting pathways from contralateral posterior and anterior semicircular canals by a lesion in the medial longitudinal fasciculus. Depending on damage to the pathways from contralateral vertical canals, various patterns of dissociated torsional-vertical nystagmus may accompany INO.
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Convergence-Retraction Nystagmus: Analysis with 3-dimensional Oculography
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Ji Soo Kim, Kwang Dong Choi, Sun Young Oh
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J Korean Bal Soc. 2005;4(1):5-12.
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- Background
and Objectives : Convergence-retraction oscillations are rhythmic or arrhythmic jerks of dysjunctive eye movements associated with backward displacement of the eyeballs during the convergence phase. Oscillations in convergence-retraction oscillations have been proposed to be consisted of opposed adducting saccades immediately followed by slow abducting glissades without latency. However, dynamic characteristics of convergence oscillations accompanying retraction have not been studied, and pathomechanism of these eye movements remains to be elucidated. This study was to get insights on the pathomechanisms of convergence-retraction oscillations by using 3-dimensional recording of eye movements. In particular, we intended to clarify whether the nystagmus originates from instability of vergence eye movement or of saccades.
Materials and Method : Seven consecutive patients with convergence-retraction oscillations were recruited. All the patients received full neurological and neuro-ophthalmological evaluation by the senior author. Some of the patients underwent 3-dimensional recordings of convergence-retraction oscillations with video-oculography or magnetic search coil technique.
Results
: Wave forms of convergence-retraction oscillations were varied. The onset of convergent eye movements was either synchronous or asynchronous between both eyes. The initial directions of eye movement was same (conjugate) or opposite (disjunctive). In some, vergence eye movements occurred only in one eye (unilateral). Convergence phase of one eye was commonly consisted of multiple steps while the other eye attained final position with a single step. The following divergent eye movements commonly overshoot the orbital midposition and were followed by correcting convergent eye movements. The velocity-amplitude relationship of convergent eye movements, which was analyzed in typical pairs of vergence oscillations, did not differ between both eyes. Divergent eye movements are slower than convergent eye movements. The both convergent and divergent eye movements were slower than the microsaccades of similar amplitudes.
Conclusion
: Quantitative analyses of convergence-retraction oscillations revealed various patterns of wave forms. The amplitude-velocity relationships of the disjunctive eye movements suggest that the slowed saccades may be due to co-contraction of the agonist and antagonist, or due to enhanced vergence eye movements by the accompanying saccades.
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Possible Mechanism of Seesaw Nystagmus in Internuclear Ophthalmoplegia
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Ji Soo Kim, Kwang Dong Choi, Ja Won Koo, Kyungmi Oh, Jae Hong Chang, Kun Woo Park, Dae Hie Lee, Gyu Cheol Han
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J Korean Bal Soc. 2004;3(2):413-416.
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- The authors report jerky seesaw nystagmus, extorsional downbeating in the ipsilesional eye and intorsional upbeating in the contralesional eye, in a patient with internuclear ophthalmoplegia (INO) from focal pontine lesion. This pattern of nystagmus may occur by disrupting pathways from contralateral posterior and anterior semicircular canals by a lesion in the medial longitudinal fasciculus. Depending on the pathways involved, various patterns of dissociated
torsional-vertical nystagmus may accompany INO.
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Vestibular Evoked Myogenic Potential Generated by 500 Hz Tone Burst in Unilateral Peripheral Vestibulopathy
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Ja Won Koo, Dong Hwan Roh, Chang Hee Kim, Jin Young Kim, Ji Yeon Yu, Kwang Dong Choi, Ji Soo Kim
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J Korean Bal Soc. 2004;3(2):356-361.
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- Background
and Objectives : Vestibular evoked myogenic potential (VEMP) has become a valuable diagnostic tool evaluating the integrity of sacculocollic reflex and has been done using click sound in most previous clinical trials. This study aims to investigate VEMP responses generated by 500 Hz tone burst in unilateral peripheral vestibulopathy and compare the response with caloric test and subjective visual vertical (SVV).
Materials and Method : Clinical records of 37 patients (18 men and 19 women, aged 14-80 years) with unilateral peripheral vestibulopathy were reviewed. Diagnoses were Meniere's disease (n=13), vestibular schwannoma (n=4) and acute peripheral unilateral vestibulopathy (n=20). They underwent 500Hz tone burst VEMP, caloric test and SVV test. Thirteen healthy volunteers (26 ears, 8 men and 5 women, 25~41 years) with normal hearing were enrolled as control group.
Results
: VEMP response was present in every control ear using 500 Hz tone burst stimuli. In Meniere's disease, VEMPs were positive in 57% (4/7) of patients with abnormal caloric response group and 83% (5/6) with normal caloric response. In acute peripheral vestibulopathy, VEMPs were positive in 47% (9/19) of patients with abnormal caloric response, 0% (0/1) with normal caloric response. The average of CP (canal paresis) in positive VEMP group was
62.4% and that in negative VEMP group was 48.2% (P>0.05).
Conclusion
: Reliable and reproducible test results can be obtained using 500 Hz tone burst stimuli. VEMP results were not in concordance with other vestibular tests, which reflects the dynamic process of dizziness and variable extent of pathology in each case.
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Central Positional Nystagmus from Focal Brain Lesion
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Ja Won Koo, Kwang Dong Choi, So Young Moon, Seong Ho Park, Ji Soo Kim
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J Korean Bal Soc. 2004;3(1):129-135.
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- Department of Otolaryngology, Head and Neck Surgery1, and Neurology2, Seoul National University Bundang Hospital,
Seoul National University College of Medicine, Seongnam, Korea
Background and Objectives : Central positional nystagmus is induced by positional changes from brainstem or
cerebellar lesions. Differentiation central from peripheral positional nystagmus is important in clinical practice. To
delineate characteristics of the positional nystagmus observed in central lesions, we analyzed the parameters of
positional nystagmus from focal brain lesions.
Materials and Methods : Ten patients with central positional nystagmus were recruited from the dizziness clinic
of Seoul National University Bundang Hospital. All the patients had focal brainstem or cerebellar lesions documented
by magnetic resonance imaging. The nystagmus was observed with and without fixation by using Frenzel glasses or
Video Goggles. The nystagmus was videotaped or recorded with video-oculography. Provoking positional maneuvers,
direction, latency, duration, phase reversal, and fatigue phenomenon of the nystagmus were analyzed.
Results
: Of the 10 patients, seven had infarctions in the lateral medulla or inferior cerebellum while two
experienced cerebellar hemorrhage and remaining one showed a compression of the ventrolateral medulla by cavernous
malformation of the vertebral artery. The directions of the positional nystagmus were variable depending on the lesions
and provoking maneuvers. Most patients exhibited direction-changing nystagmus without latency, direction-reversal and
fatigue phenomenon. However, some of the patients also showed patterns of nystagmus characteristic of peripheral
positional nystagmus. In two of the four patients with infarction in the territory of medial posterior inferior cerebellar
artery, the positional nystagmus was the only abnormal findings.
Conclusions
: Central positional nystagmus may share many characteristics with peripheral type of positional
nystagmus. In individual cases, the patterns of nystagmus should be interpreted with caution in differentiating central
from peripheral positional nystagmus. Considering the isolated positional nystagmus in some patients with caudal
cerebellar lesions, systematic positional maneuvers should be applied to all the patients with vertigo
Key Words : Positional nystagmus, Medulla, Cerebellum
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Tonic inward and downward deviation of the eye
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Kwang Dong Choi, Dae Soo Jung, Ji Soo Kim
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J Korean Bal Soc. 2003;2(1):133-137.
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- Background
Tonic inward and downward deviation of the eyes ('peering at the tip of the nose') is regarded as a unique feature of thalamic hemorrhage, but the mechanisms of this ocular finding remain obscure.
Objective: To report on four patients who showed tonic inward and downward deviations of the eyes from either brainstem or thalamic lesions, and to discuss the possible mechanisms involved.
Design: Case report
Setting: Secondary and tertiary referral hospitals
Results
One patient developed alternating esotropia with downward ocular deviation from thalamic hemorrhage compressing the midbrain. Two patients showed multiple infarctions in the territory of the posterior circulation with or without the involvement of the thalamus. Another patient had lateral pontine hemorrhage extending up to the midbrain tegmentum. Ocular bobbing preceded or accompanied tonic ocular deviation in three patients.
Conclusion
Tonic inward and downward deviation of the eye may develop in thalamic or brainstem lesions. Irritation or destruction of the neural structures involved in the vergence and vertical gaze may cause this ocular sign in mesodiencephalic lesions. Skew deviation and esotropia from abduction deficit may be involved in some patients. Ocular bobbing and tonic downward deviation may share a common pathophysiology.
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