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Ileok Jung, Seo-Young Choi, Hyo-Jung Kim, Ji-Soo Kim
Even though dizziness is a common symptom of heat illness, comprehensive evaluation of the vestibular function has not been available in this potentially life-threatening disorder. Three patients developed vertigo about a week after heat exposure. Evaluation showed bilateral impairments of the vestibulo-ocular reflex during head impulses and the signs of vestibulocerebellar dysfunction that included spontaneous downbeat nystagmus, gaze-evoked nystagmus, and positional downbeat nystagmus. Exposure to excessive heat may give rise to delayed vestibulopathy by damaging the vestibulocerebellum...
October 20, 2016: Journal of Neurology
Jeffrey Livezey, Thomas Oliver, Louis Cantilena
A 32-year-old male developed neuropsychiatric symptoms 2 weeks after starting mefloquine 250 mg/week for malaria prophylaxis. He continued to take the medication for the next 4 months. Initial symptoms included vivid dreams and anxiety, as well as balance problems. These symptoms persisted and progressed over the next 4 years to include vertigo, emotional lability, and poor short-term memory, which have greatly affected his personal and professional life. An extensive evaluation revealed objective evidence supporting a central vestibulopathy...
December 2016: Drug Saf Case Rep
Christopher McCrum, Katrin Eysel-Gosepath, Gaspar Epro, Kenneth Meijer, Hans H C M Savelberg, Gert-Peter Brüggemann, Kiros Karamanidis
Posturography is used to assess balance in clinical settings, but its relationship to gait stability is unclear. We assessed if dynamic gait stability is associated with standing balance in 12 patients with unilateral vestibulopathy. Participants were unexpectedly tripped during treadmill walking and the change in the margin of stability (MoSchange) and base of support (BoSchange) relative to non-perturbed walking was calculated for the perturbed and first recovery steps. The centre of pressure (COP) path during 30s stance with eyes open and closed, and the distance between the most anterior point of the COP and the anterior BoS boundary during forward leaning (ADist) were assessed using a force plate...
October 13, 2016: Journal of Applied Biomechanics
Jared R Levin, Olivera D Pekovic
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
M Strupp, K Feil, M Dieterich, T Brandt
The leading symptoms of bilateral vestibulopathy (BVP) are postural imbalance and unsteadiness of gait that worsens in darkness and on uneven ground. There are typically no symptoms while sitting or lying under static conditions. A minority of patients also have movement-induced oscillopsia, in particular while walking. The diagnosis of BVP is based on a bilaterally reduced or absent function of the vestibulo-ocular reflex (VOR). This deficit is diagnosed for the high-frequency range of the angular VOR by a bilaterally pathologic bedside head impulse test (HIT) and for the low-frequency range by a bilaterally reduced or absent caloric response...
2016: Handbook of Clinical Neurology
Hyo-Jung Kim, Seoyeon Kim, Jae Han Park, Ji-Soo Kim
Ocular and cervical vestibular-evoked myogenic potentials (VEMPs) evaluate the function of otolithic pathways in central as well as peripheral vestibular disorders. This study aimed to determine the associations and dissociations of otolithic dysfunction in lateral medullary infarction (LMI), the most well-known disorder of central vestibulopathy. At the Dizziness Clinic of a referral-based University Hospital, 45 patients with isolated LMI (28 men, mean age = 55.6 ± 12.5) had evaluation of the ocular tilt reaction (OTR), tilt of the subjective visual vertical (SVV), and ocular and cervical VEMPs from Janurary 2011 to August 2015 during the acute phase, 1-11 days from the symptom onset (median = 2 days)...
September 13, 2016: Journal of Neurology
Zeljka Calic, Cecilia Cappelen-Smith, Craig S Anderson, Wei Xuan, Dennis J Cordato
BACKGROUND AND PURPOSE: The diagnosis of cerebellar infarction (CBI) is often challenging due to non-specific or subtle presenting symptoms and signs. We aimed to determine whether a common syndromic cluster of symptoms, signs or vascular risk factors were associated with delayed presentation or misdiagnosis to an Emergency Department (ED). The degree of misdiagnosis between ED and neurology physicians and the influence of delayed presentation or misdiagnosis on outcome were also investigated...
August 27, 2016: Cerebrovascular Diseases
Roeland B van Leeuwen, Bart W Smits, Richard J Rodenburg, Baziel G van Engelen
In patients with a triad of sensory ataxic neuropathy, dysarthria, and ophthalmoparesis (SANDO), the presenting features are mainly ataxia or ptosis. SANDO patients often have impaired balance and gait, which is not surprising considering the combination of sensory ataxic neuropathy, and additional symptoms like cerebellar ataxia and limb girdle weakness. We describe a SANDO patient who noticed an increasingly impaired balance and gait, without any dizziness. Neurological investigation revealed an external ophthalmeplegia and a cerebellar ataxia; the head impulse test was not reliable because of eye movement disorders...
September 2016: Journal of Clinical Neuromuscular Disease
Alexander A Tarnutzer, Christopher J Bockisch, Elena Buffone, Stefan Weiler, Lucas M Bachmann, Konrad P Weber
OBJECTIVE: Bilateral vestibular loss (BVL) is often diagnosed with great delay and an underlying cause is only identified in 50-80%. We measured horizontal and vertical semicircular canal function using the video-head-impulse test (vHIT) and hypothesized that specific vHIT-patterns may be linked to certain etiologies. METHODS: We retrospectively analyzed 109 BVL-patients linked to aminoglycoside vestibulotoxicity (n=16), Menière's disease (n=10), infectious inner-ear disorders (n=11), sensorineural hearing-loss (n=11), cerebellar-ataxia-neuropathy-vestibular-areflexia-syndrome (CANVAS, n=5), other causes (n=19) as well as those with unknown origin (n=47)...
August 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Denis S Uffer, Stefan C A Hegemann
OBJECTIVE: To determine whether patients with acute unilateral peripheral vestibulopathy (PVP), often called "vestibular neuritis/neuronitis or neuropathy" (VN) have a vestibular lesion pattern consistent with the distribution of the neurological afferents. BACKGROUND: Much is known about the clinical nature of PVP, however less so about its etiology and pathogenesis. Due to the frequency with which VN is used to describe the syndrome, an inflammation of the vestibular nerve or of one of its branches is often assumed to be the cause of PVP, though there is insufficient data so far to support this assumption...
July 2, 2016: Journal of Vestibular Research: Equilibrium & Orientation
Jinsei Jung, Michelle J Suh, Sung Huhn Kim
OBJECTIVE: We performed the video head impulse test (vHIT) and caloric test in patients with enlarged vestibular aqueducts (EVA). We compared the results with those found in Ménière's disease (MD) and acute vestibular neuritis to clarify the characteristics of vestibular dysfunction in EVA and to suggest reasons for the discrepancy between the vHIT and caloric tests in endolymphatic hydrops. STUDY DESIGN: Retrospective analysis. METHODS: Ten patients with EVA and confirmed biallelic SLC26A4 genetic mutations were enrolled...
July 4, 2016: Laryngoscope
Hamish G MacDougall, Leigh A McGarvie, G Michael Halmagyi, Stephen J Rogers, Leonardo Manzari, Ann M Burgess, Ian S Curthoys, Konrad P Weber
OBJECTIVE: While compensatory saccades indicate vestibular loss in the conventional head impulse test paradigm (HIMP), in which the participant fixates an earth-fixed target, we investigated a complementary suppression head impulse paradigm (SHIMP), in which the participant is fixating a head-fixed target to elicit anticompensatory saccades as a sign of vestibular function. METHODS: HIMP and SHIMP eye movement responses were measured with the horizontal video head impulse test in patients with unilateral vestibular loss, patients with bilateral vestibular loss, and in healthy controls...
July 26, 2016: Neurology
Shwan Mohamed, Imran Khan, Stamatina Iliodromiti, Margaret Gaggini, Georgios Kontorinis
PURPOSE OF THE STUDY: To investigate the relation of Ménière's disease (MD) with medical comorbidity or mental conditions. PROCEDURES: Demographic data, medical and mental comorbidities were retrospectively collected and compared from 3 groups of 30 patients each: a group with patients with definite MD, a second one with patients with vestibulopathies other than MD (non-Ménière's vertigo, NMV) and a third one with patients without any vestibular symptoms (control)...
2016: ORL; Journal for Oto-rhino-laryngology and its related Specialties
Katrin Eysel-Gosepath, Christopher McCrum, Gaspar Epro, Gert-Peter Brüggemann, Kiros Karamanidis
Preserving upright stance requires central integration of the sensory systems and appropriate motor output from the neuromuscular system to keep the centre of pressure (COP) within the base of support. Unilateral peripheral vestibular disorder (UPVD) causes diminished stance stability. The aim of this study was to determine the limits of stability and to examine the contribution of multiple sensory systems to upright standing in UPVD patients and healthy subjects. We hypothesized that closure of the eyes and Achilles tendon vibration during upright stance will augment the postural sway in UPVD patients more than in healthy subjects...
June 2016: Somatosensory & Motor Research
Max Wuehr, Eva Nusser, Julian Decker, Siegbert Krafczyk, Andreas Straube, Thomas Brandt, Klaus Jahn, Roman Schniepp
OBJECTIVE: To examine the effects of imperceptible levels of white noise galvanic vestibular stimulation (nGVS) on dynamic walking stability in patients with bilateral vestibulopathy (BVP). METHODS: Walking performance of 13 patients with confirmed BVP (mean age 50.1 ± 5.5 years) at slow, preferred, and fast speeds was examined during walking with zero-amplitude nGVS (sham trial) and nonzero-amplitude nGVS set to 80% of the individual cutaneous threshold for GVS (nGVS trial)...
June 7, 2016: Neurology
Chun Wai Yip, Miriam Glaser, Claudia Frenzel, Otmar Bayer, Michael Strupp
OBJECTIVES: The primary aim was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the bedside head-impulse test (bHIT) using the video HIT (vHIT) as the gold standard for quantifying the function of the vestibulo-ocular reflex (VOR). Secondary aims were to determine the bHIT inter-rater reliability and sensitivity in detecting unilateral and bilateral vestibulopathy. METHODS: In this prospective study, 500 consecutive outpatients presenting to a tertiary neuro-otology clinic with vertigo or dizziness of various vestibular etiologies who did not have any of the pre-defined exclusion criteria were recruited...
2016: Frontiers in Neurology
Jamie M Bogle, David Barrs, Matthew Wester, Laurie Davis, Michael J Cevette
OBJECTIVE: Labyrinthine concussion due to a postauricular gunshot wound has not been well reported. DESIGN: Retrospective chart review. STUDY SAMPLE: We describe an otherwise healthy 22-year-old male who received a gunshot wound to the left mastoid and subsequently reported hearing loss and rotational vertigo. RESULTS: Audiometric testing demonstrated significant inverted scoop shaped sensorineural hearing loss. Vestibular diagnostic testing indicated a significant uncompensated left peripheral vestibulopathy...
July 2015: International Journal of Audiology
Almir Resende Coelho, Ana Paula do Rego Andre, Júlia Licursi Lambertti Perobelli, Lilian Shizuka Sonobe, Daniela Cristina Carvalho de Abreu
INTRODUCTION: The symptoms associated with chronic peripheral vestibulopathy exert a negative impact on the independence and quality of life of these individuals, and many individuals continue to suffer from these symptoms even after conventional vestibular rehabilitation. OBJECTIVE: To evaluate the acute effect of an anchor system for balance evaluation of patients with chronic dizziness who failed to respond to traditional vestibular rehabilitation. METHODS: Subjects over 50 years of age, presenting with chronic dizziness and postural instability of peripheral vestibular origin, participated in the study...
March 29, 2016: Brazilian Journal of Otorhinolaryngology
Olympia Kremmyda, Katharina Hüfner, Virginia L Flanagin, Derek A Hamilton, Jennifer Linn, Michael Strupp, Klaus Jahn, Thomas Brandt
Bilateral vestibulopathy (BVP) is defined as the impairment or loss of function of either the labyrinths or the eighth nerves. Patients with total BVP due to bilateral vestibular nerve section exhibit difficulties in spatial memory and navigation and show a loss of hippocampal volume. In clinical practice, most patients do not have a complete loss of function but rather an asymmetrical residual functioning of the vestibular system. The purpose of the current study was to investigate navigational ability and hippocampal atrophy in BVP patients with residual vestibular function...
2016: Frontiers in Human Neuroscience
Hanifi Kurtaran, Baran Acar, Emre Ocak, Emre Mirici
INTRODUCTION: A considerable high number of SNHL patients also suffer from dizziness and related vestibular symptoms. OBJECTIVE: To evaluate the association of vestibular dysfunction and sensorineural hearing loss (SNHL) in adult patients. METHODS: Prospective, double-blinded, controlled studies composed by 63 adult patients without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with pure tone audiometry and the vestibular system was tested with vestibular evoked myogenic potential (VEMP)...
February 28, 2016: Brazilian Journal of Otorhinolaryngology
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