Research in Vestibular Science

Preventive medical treatment of vestibular migraine: a practical review: Jae-Hwan Choi, Kwang-Dong Choi, Eun Hye Oh, Seo-Young Choi; Res Vestib Sci. 2025;24(1):20-26. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.024

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Abstract PDF: This review explores the medical treatment options for vestibular migraine (VM), focusing on preventive strategies and their evidence-based efficacy. VM, characterized by recurrent dizziness associated with migraine, requires tailored management due to its distinct clinical features and pathophysiology. Most VM treatments are derived from migraine management protocols, utilizing medications such as BBs, CCBs, and antiepileptic drugs. Meta-analyses revealed that flunarizine, propranolol, and venlafaxine significantly reduced vertigo frequency and Dizziness Handicap Inventory scores, although the evidence was limited by small sample sizes and methodological inconsistencies. Flunarizine showed benefits in reducing vertiginous episodes but was less effective for headache. Venlafaxine demonstrated additional improvements in depressive symptoms. Observational studies also indicated potential efficacy for propranolol and valproate. Emerging therapies, such as calcitonin gene-related peptide monoclonal antibodies, showed promise in improving both vestibular and headache symptoms in small-scale trials, though further evidence is needed to establish their role in VM management. The selection of preventive medications for VM should be individualized, considering both the frequency and severity of vestibular and headache symptoms, as well as patient comorbidities and preferences. While existing migraine protocols offer some guidance, the need for VM-specific treatment strategies remains critical.

Dural Arteriovenous Fistula Presenting as Acute Unilateral Vestibulopathy: Won Jeong Son, Jieun Roh, Eun Hye Oh, Jae-Hwan Choi; Res Vestib Sci. 2023;22(4):127-131. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.127

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Abstract PDF: Intracranial dural arteriovenous fistula (dAVF) is characterized by an abnormal connection between branches of arteries and veins in the dura mater. Clinical manifestations of dAVF vary depending on their location, feeder arterial supply, amount of shunting, and most importantly, their venous drainage pattern. Acute vertigo has been rarely reported as an initial presentation of dAVF due to venous congestion in the brainstem. We report a patient who presented with acute right vestibulopathy without any brainstem signs in dAVF involving the transversesigmoid sinus. The patient showed abnormal caloric response but normal head impulse in the affected ear. Without any treatment, the patient’s symptoms gradually improved with a normalization of right canal paresis. Follow-up cerebral angiography also revealed a spontaneous regression of the shunt flow and reduction of venous drainage at the right transverse-sigmoid sinus. Based on the results of vestibular function tests and cerebral angiography, acute vertigo in our patient may be ascribed to impaired reabsorption of endolymph by focal venous congestion.

Visual Fixation-Induced Hemi-Seesaw Nystagmus: Hyun Sung Kim, Eun Hye Oh, Jae-Hwan Choi; Res Vestib Sci. 2023;22(1):19-22. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.19

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Abstract PDF Supplementary Material

Seesaw nystagmus (SSN) is characterized by conjugate torsional nystagmus with opposite vertical components in the two eyes. The waveform may be pendular or jerk (hemi-seesaw nystagmus, HSSN), in which the slow phase corresponds to one half-cycle and the quick phase to the other. Pendular SSN and HSSN have distinct clinical presentations and underlying causes. The pathophysiology of pendular SSN may be instability of visuovestibular interactions, while the underlying mechanism for HSSN may be related to the ocular tilt reaction or an imbalance in vestibular pathways. We report a patient with HSSN due to unilateral mesodiencephalic infarction that becomes apparent during visual fixation only.

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Midbrain lesion-induced disconjugate gaze: a unifying circuit mechanism of ocular alignment?
Maximilian U. Friedrich, Laurin Schappe, Sashank Prasad, Helen Friedrich, Michael D. Fox, Andreas Zwergal, David S. Zee, Klaus Faßbender, Klaus-Ulrich Dillmann
Journal of Neurology.2024;[Epub] CrossRef

The Head-Bending Test in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Sol-lim Choi, Hyun-Sung Kim, Jae-Hwan Choi, Eun Hye Oh; Res Vestib Sci. 2022;21(4):99-103. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.99

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Abstract PDF: Objectives
This study aimed to investigate clinical significance of a head-bending test in benign paroxysmal positional vertigo (BPPV) involving the posterior semicircular canal (PC-BPPV).
Methods
We retrospectively recruited 256 patients with unilateral PC-BPPV between January 2016 and December 2021, and assessed the clinical characteristics of patients showing head-bending nystagmus (HBN).
Results
Of 256 patients, 138 (53.9%) showed HBN. Most patients (n=136, 98.6%) had downbeat nystagmus with (n=38) or without (n=98) torsional component. The remaining two patients had pure upbeat and torsional nystagmus, respectively. The torsional component was directed to the contralesional side in all. Between patients with and without HBN, there were no significant differences in clinical characteristics such as age, lateralization, types of BPPV (canalolithiasis or cupulolithiasis), and success rate of repositioning maneuver.
Conclusions
Head-bending test may be useful in predicting the diagnosis and lateralization of PC-BPPV.

Dissociated Vertical-Torsional Nystagmus in Vestibular Nucleus Lesion: Hyun-Sung Kim, Eun Hye Oh, Jae-Hwan Choi; Res Vestib Sci. 2022;21(1):19-23. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.19

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Abstract PDF: Dissociated vertical-torsional nystagmus is a unique form of nystagmus characterized by conjugate torsional but disparate vertical components. It has been mainly reported in internuclear ophthalmoplegia or medial medullary lesion involving the medial longitudinal fasciculus (MLF). The patterns of the nystagmus may be explained by a disruption of vestibulo-ocular reflex pathways from vertical semicircular canal or utriculo-ocular reflex within the MLF, but it is debatable. We described a dissociated upbeat-torsional nystagmus in a patient with vestibular nucleus infarction without involvement of MLF.

Isolated Floccular Infarction with Impairment of High-Frequency Vestibulo-Ocular Reflex: A Case Report: Eun Hye Oh, Hyun-Sung Kim, Jae-Hwan Choi; Res Vestib Sci. 2021;20(4):147-150. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.147

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Abstract PDF: The flocculus plays a crucial role in control of eye movements. Based on animal experiment, it is suggested that the flocculus is important for governing vestibuleocular reflexes. In humans, an isolated floccular lesion is extremely rare. We report oculomotor abnormalities in a patient with unilateral infarction of the flocculus, and compare our results with those of previously reported patients with floccular lesion.

고주파 전정안구반사의 이상을 보인 단독 타래 경색: Eun hye Oh, Jae-Hwan Choi, Hyun-Sung Kim; Received November 8, 2021 Accepted November 22, 2021 Published online November 22, 2021; [Accepted]

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Abstract: The flocculus plays a crucial role in control of eye movements. Based on animal experiment, it is suggested that the flocculus is important for governing vestibule-ocular reflexes (VORs). In humans, an isolated floccular lesion is extremely rare. We report oculomotor abnormalities in a patient with unilateral infarction of the flocculus, and compare our results with those of previously reported patients with floccular lesion.

A Case of Spinocerebellar Ataxia Type 28: Jae-Hwan Choi, Eun Hye Oh, Seo Young Choi, Kwang-Dong Choi; Res Vestib Sci. 2021;20(1):33-36. Published online March 11, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.1.33

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Abstract PDF: Spinocerebellar ataxia type 28 (SCA 28) is characterized by young-adult onset, very slowly progressive gait and limb ataxia, dysarthria, nystagmus, ptosis, and ophthalmoplegia. It is caused by a heterozygous pathogenic mutation in the AFG3L2. So far, approximately 80 cases with genetically-confirmed SCA 28 have been reported in the literature. We report a patient with mild gait ataxia and dysarthria who carried a known pathogenic mutation in the AFG3L2. This is the first report of genetically-confirmed SCA 28 in Korea.

Cogan Syndrome Accompanied with Meningitis: Hyung-Keun Kim, Eun Hye Oh, Na-Yeon Jung, Jae-Hwan Choi; Res Vestib Sci. 2018;17(3):119-123. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.119

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Abstract PDF: Cogan syndrome is a rare inflammatory disease characterized by intraocular inflammation and vestibulo-auditory dysfunction. The exact etiology of Cogan syndrome is still unknown, but is currently thought to be an autoimmune disease. Cogan syndrome can be accompanied with various conditions including fever, arthritis, skin rash, aortitis, central or peripheral nerve system involvement, lymphadenopathy, splenomegaly and diarrhea. We report a case of Cogan syndrome accompanied with meningitis.

Cogan’s syndrome accompanied with meningitis: Hyung-Keun Kim, Eun Hye Oh, Na-Yeon Jung, Jae-Hwan Choi; Received July 17, 2018 Accepted August 17, 2018 Published online August 17, 2018; [Accepted]

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Abstract: Cogan’s syndrome is a rare inflammatory disease characterized by intraocular inflammation and vestibulo-auditory dysfunction. The exact etiology of Cogan’s syndrome is still unknown, but is currently thought to be an autoimmune disease. Cogan’s syndrome can be accompanied with various conditions including fever, arthritis, skin rash, aortitis, central or peripheral nerve system involvement, lymphadenopathy, splenomegaly, diarrhea. We report a case of Cogan’s syndrome accompanied with meningitis.

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