Research in Vestibular Science

Rare Neuro-Ophthalmological Manifestations of Focal Midbrain Infarction: Joong-Goo Kim, Ji-Hoon Kang, Jay Chol Choi, Hong Jun Kim, Chul-Hoo Kang; Res Vestib Sci. 2021;20(2):58-63. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.58

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Because numerous important nuclei and white matter tracts are concentrated in the narrow midbrain, the tiny lesion can result in various symptoms. The anatomy of the neural network and related structures in the midbrain is complex. The most frequent clinical manifestation of lesions involving the midbrain is an eye movement disorder associated with a nuclear or fascicular origin. We have described patients with acute midbrain stroke, characterized by rare neuro-ophthalmologic manifestations, which neurologists should consider during diagnostic investigations. Case 1 showed internuclear ophthalmoplegia with Horner syndrome. In case 2 showed isolated oculomotor palsy. The third patient presented Parinaud syndrome with an unusual lesion location. Notably, patients with midbrain infarction may present with specific signs and symptoms that are compatible with mesencephalic localization. The isolated or combined neuro-ophthalmologic signs and symptoms should be interpreted in the complex anatomical context described here and investigated by immediate brainstem neuroimaging analyses and careful neurologic examinations.

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A Improved Case of Post Cerebral Infarction Dizziness and Gait Discomfort after Treated with Korean Medicine Treatment and Vestibular Rehabilitation Practice
Hongmin Chu, Hyeon-Seo Lim, Kwangho Kim, Young-Ung Lee, Kyungtae Park, Jongwon Jang, Ho-sun Ryu, Su-hak Kim, Cheol-hyun Kim, Sangkwan Lee, Kang-keyng Sung
Journal of Korean Medicine Rehabilitation.2020; 30(4): 179. CrossRef

Vertical One-and-a-Half Syndrome Accompanying Contralateral Abduction and Incomplete Depression Palsy Due to Thalamo-Mesencephalic Infarction: Won Gu Lee, Meyung Kug Kim, Bong Goo Yoo; Res Vestib Sci. 2017;16(4):151-155. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.151

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Abstract PDF: Vertical gaze palsy is usually associated with lesions of the rostral midbrain and thalamo-mesencephalic junction. The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), the interstitial nucleus of Cajal, and the posterior commissure located in the midbrain are the critical area in supranuclear control of vertical eye movements. We describe a case of vertical one-and-a-half syndrome accompanying contralateral abduction and incomplete depression palsy due to thalamo-mesencephalic infarction. These vertical eye movement abnormalities are presumed to be caused by damage to the ipsilateral riMLF, interstitial nucleus of Cajal, and oculomotor fascicles.

Multiple Cerebral Infarction in Cogan’s Syndrome: Jae Deuk Seo, Jae Hwan Choi, Kwang Dong Choi; Res Vestib Sci. 2014;13(3):85-88.

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Abstract: 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.

Upbeat Nystagmus in Association with Wall-Eyed Bilateral Internuclear Ophthalmoplegia: Duck Su Park, Yeo Jeong Kang, Tae Kyeong Lee, Kwang Ik Yang; Res Vestib Sci. 2014;13(1):24-27.

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Abstract: A 54-year-old man presented with primary position upbeat nystagmus and wall-eyed bilateral internuclear ophthalmoplegia. He also showed bilateral limb ataxia and impaired horizontal gaze. Upbeat nystagmus obeyed Alexander’s law and attenuated by visual fixation and disappeared by convergence. Brain magnetic resonance imaging showed acute infarction in the bilateral paramedian midbrain involving the crossing of brachium conjunctivum. Multiple mechanisms including the interruption of central vestibulo-ocular projections from anterior canal may be postulated in upbeat nystagmus of this patient.

Acute Stroke in Patients With Isolated Vertigo: Jungmoo Nam, Curie Chung, Jung Ju Lee, Jong Moo Park, Ja Seong Koo, Ohyun Kwon, Byung Kun Kim; Res Vestib Sci. 2010;9(1):12-15.

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Abstract PDF: Background and Objectives Patients with isolated vertigo could have central or peripheral vestibular disorders. Although some differential points exist between the two conditions, sometimes it is not easy to differentiate central vertigo from that of peripheral vestibular origin, especially in patients with isolated vertigo. We performed this study to determine the frequency of acute infarction and predictors of vertigo associated with stroke in isolated spontaneous vertigo. Materials and Methods We prospectively evaluated 185 consecutive patients who were admitted to neurology department with acute isolated vertigo, after excluding the patients with benign paroxysmal positioning vertigo. Diffusion-weighted MRI (DWI) was obtained in 161 (87.0%) patients. Demographics, stroke risk factors, associated symptoms and signs were reviewed. Also, the locations and vascular territories of the lesions on DWI were investigated. Results Twenty three (14.3%) patients had acute infarction on DWI. Old age and male sex were the predictors of stroke using multivariate analysis (p=0.03 and 0.02). The lesions were located in the cerebellum in 17 patients, medulla in four, and pons in another four. Cerebellar lesions were in the territory of the posterior inferior cerebellar artery in all patients. ConclusionIsolated spontaneous vertigo may develop in posterior circulation stroke, especially in men of old age. The possibility of central origin should be considered in patients with isolated vertigo and DWI might be a good diagnostic tool.

Two Cases of Sudden Hearing Loss With Vertigo as an Isolated Symptom of Anterior Inferior Cerebellar Artery Infarction: See Young Park, Joong Wook Shin, Yong Jin Cho, Keun Sik Hong; J Korean Bal Soc. 2008;7(1):85-88.

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Abstract PDF: Isolated sudden hearing loss with vertigo is usually peripheral origin. We report two cases with anterior inferior cerebellar artery infarction (AICA) manifesting sudden hearing loss with vertigo as an isolated symptom. Patient 1 was a 64-year-old man presented with right sided sudden hearing loss and vertigo accompanying horizontal beating nystagmus to the left. He had no other neurologic symptoms. MRI showed right AICA infarction involving lateral pons and middle cerebellar peduncle. Patient 2 was a hypertensive 56-year-old man. Left sided sudden hearing loss with vertigo was as an initial manifestation. Two days later, left sided facial palsy developed and MRI showed acute infarction in left lateral pons, middle cerebellar peduncle, and cerebellum. AICA infarction can be presented the hearing loss and vertigo as an isolated symptom and mimic the syndrome of peripheral origin.

Vestibular Neuritis of Vascular Cause: Hyun Ah Kim, Hyung Lee, Byung Rim Park; J Korean Bal Soc. 2006;5(2):277-280.

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Abstract PDF: Vestibular neuritis (VN) is an idiopathic peripheral vestibular syndrome characterized by acute isolated prolonged vertigo. In most cases, it results from inflammation of the vestibular nerve presumably of viral origin. There has been no previous report of VN associated with a vascular cause. We here report a patient with VN of vascular origin who presented with acute onset of prolonged isolated vertigo, a unilateral decreased caloric response, and simultaneously with acute infarcts on brain MRI that were unrelated to patient's vertigo. Key Words : Vestibular neuritis, Cerebral infarction

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