Objective:To determine whether cervical ultrasonography,magnetic resonance imaging(MRI),and magnetic resonance angiography(MRA)are useful in the differential diagnosis of etiology and understanding the pathophysiology...Objective:To determine whether cervical ultrasonography,magnetic resonance imaging(MRI),and magnetic resonance angiography(MRA)are useful in the differential diagnosis of etiology and understanding the pathophysiology in cases of apogeotropic direction-changing positional nystagmus(DCPN).Methods:Thirty patients with apogeotropic DCPN were classified into 11 cases of central disease,seven cases of mixed central and peripheral disease,and 12 cases of peripheral disease by differential diagnosis based on various balance function,neuro-otological,and imaging tests.Cervical ultrasonography using the cervical rotation method and MRI and MRA of the head and neck were performed in most patients with apogeotropic DCPN.We reviewed the presence of abnormal imaging findings according to the disease etiology.Results:Of the 30 patients with apogeotropic DCPN,23 showed vascular abnormalities or central lesions on imaging.Vascular lesions were found in six of the 12 patients with peripheral disease.Cervical ultrasonography with cervical rotation detected blood flow disturbance in the vertebral artery in eight patients in whom the disturbance could not be detected by MRI or MRA of the head and neck.Discussion:We hypothesize that the causative disease of apogeotropic DCPN may be strongly associated with circulatory insufficiency of the vertebrobasilar and carotid arteries,and that impaired blood flow in these vessels may affect peripheral vestibular and central function.In patients with apogeotropic DCPN,examinations of vestibular function,central nervous system symptoms,and brain hemodynamics are valuable for differential diagnosis.展开更多
Objective:An acute onset central pathology without any clear neurological symptoms may mimic peripheral vestibular problem in an emergency setting.A 54-year-old man suddenly developed dizziness without any cranial ner...Objective:An acute onset central pathology without any clear neurological symptoms may mimic peripheral vestibular problem in an emergency setting.A 54-year-old man suddenly developed dizziness without any cranial nerve symptoms,paresis,cerebellar signs or sensory disturbances except upbeat positional nystagmus at multiple provoked positions which alerted for a possible acute central pathology.Findings:An instantaneous magnetic resonance imaging and angiography studies further showed obstruction of the left internal carotid artery above the bifurcation.The patient’s subsequent prognosis was consistent with good recovery following anti-coagulant therapy.A follow-up MRI and angiography showed resolution of thrombosis.Conclusion:It should be kept in mind that positional nystagmus is likely to occur in central pathologies.Differentiation between benign paroxysmal positional vertigo and central positioning nystagmus is critical.展开更多
Objective:The goal of this study is to analyze the clinical view of patients with direction-fixed positional nystagmus(DFPN)following head-roll maneuver.Methods:Sixty patients with DFPN were reviewed retrospectively.P...Objective:The goal of this study is to analyze the clinical view of patients with direction-fixed positional nystagmus(DFPN)following head-roll maneuver.Methods:Sixty patients with DFPN were reviewed retrospectively.Patients were categorized into 3 groups according to the direction of nystagmus based on rotation side.Associated problems were documented,and cumulative data were compared between groups.One-way analysis of variance(ANOVA test)was used for statistical analysis(P<0.05).Results:Thirty-three patients(55%)had stronger nystagmus beating towards the direction of head-roll(Group-A).Three patients developed geotropic LC-BPPV.Fourteen patients had inner ear disease.Sixteen patients(27%)had stronger nystagmus beating against the direction of head roll(Group-B).Nine patients had inner ear disease.None of the patients tested with head-shaking had change of direction of nystagmus.Eleven patients(18%)had DFPN with equal velocity during right or left head-roll maneuver(Group-C).Of those,nine patients had inner ear disease.None of the patients had change of direction of nystagmus.Comparison of the incidence of associated problems(migraine,vestibular neuronitis,Meniere’s disease etc.)in each group was not statistically significant(P˃0.05).Conclusion:Patients with DFPN should be followed for a possibility of vestibular pathology since vestibular problem was documented for more than half of the patients in the follow-up.On the other hand,DFPN could be related with a temporary reason(thermal,physical or drug effect etc.)in some patients who do not exhibit any associated disease.Head-shaking testing is recommended to expose the lateral canal BPPV.But the incidence is low.展开更多
BACKGROUND Benign paroxysmal positional vertigo(BPPV)is a form of temporary vertigo induced by moving the head to a specific position.It is a self-limited,peripheral,vestibular disease and can be divided into primary ...BACKGROUND Benign paroxysmal positional vertigo(BPPV)is a form of temporary vertigo induced by moving the head to a specific position.It is a self-limited,peripheral,vestibular disease and can be divided into primary and secondary forms.Congenital nystagmus(CN),an involuntary,rhythmic,binocular-symmetry,conjugated eye movement,is found at birth or within 3 mo of birth.According to the pathogenesis,CN can be divided into sensory-defect nystagmus and motordefect nystagmus.The coexistence of BPPV and CN is rarely seen in the clinic.CASE SUMMARY A 62-year-old woman presented to our clinic complaining of a 15-d history of recurrent positional vertigo.The vertigo lasting less than 1 min occurred when she turned over,sometimes accompanied by nausea and vomiting.Both the patient and her father had CN.Her spontaneous nystagmus was horizontal to right;however,the gaze test revealed variable horizontal nystagmus with the same degree when the eyes moved.The patient’s Dix-Hallpike test was normal,except for persistent nystagmus,and the roll test showed severe variable horizontal nystagmus,which lasted for about 20 s in the same direction as her head movement to the right and left,although the right-side nystagmus was stronger than the left-side.Since these symptoms were accompanied by nausea,she was diagnosed with BPPV with CN and treated by manual reduction.CONCLUSION Though rare,if BPPV with CN is correctly identified and diagnosed,reduction treatment is comparably effective to other vertigo types.展开更多
Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down...Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.展开更多
Background: Acquired See-saw Nystagmus (SSN) is a rare form of nystagmus characterized by elevation and intorsion of one eye with synchronous depression and intorsion of the contralateral eye in the first half cycle, ...Background: Acquired See-saw Nystagmus (SSN) is a rare form of nystagmus characterized by elevation and intorsion of one eye with synchronous depression and intorsion of the contralateral eye in the first half cycle, followed by a reversal in the direction of the movements during the next half cycle. We herein report a case of a 47-year-old woman with a 3-year history of constant diplopia as a consequence of multiple neurosurgical interventions due to hemorrhage from a cavernous angioma located in the subthalamic region. She also had a history of major depressive disorder and ulcerative colitis. The patient underwent a surgical intervention with a 5 mm bilateral recession of the superior and inferior rectus muscles. Five years after surgery, the patient reported less recurrent and prominent episodes of transient horizontal deviation with horizontal diplopia, with a prevalence of well-being and comfort.展开更多
Benign paroxysmal positional vertigo(BPPV)represents the most common form of positional vertigo.It is caused by dislodged otoconia that freely float in the semicircular canals(canalolithiasis)or attach to the cupula(c...Benign paroxysmal positional vertigo(BPPV)represents the most common form of positional vertigo.It is caused by dislodged otoconia that freely float in the semicircular canals(canalolithiasis)or attach to the cupula(cupulolithiasis).A cupulolithiasis-type(or a heavy cupula-type)of BPPV implicating the lateral semicircular canal(LSCC)exhibits persistent ageotropic direction-changing positional nystagmus(DCPN)in a head-roll test.However,in some cases,unlike any type of BPPV,persistent geotropic DCPN cannot be explained by any mechanisms of BPPV,and don’t fit the current classifications.Recently,the notion of light cupula has been introduced to refer to the persistent geotropic DCPN.In this study,we looked at the clinical features of light cuplula and discussed the possible mechanisms and therapeutic strategies of the condition.The notion of light cupula is a helpful addition to the theory of peripheral positional vertigo and nystagmus.展开更多
文摘Objective:To determine whether cervical ultrasonography,magnetic resonance imaging(MRI),and magnetic resonance angiography(MRA)are useful in the differential diagnosis of etiology and understanding the pathophysiology in cases of apogeotropic direction-changing positional nystagmus(DCPN).Methods:Thirty patients with apogeotropic DCPN were classified into 11 cases of central disease,seven cases of mixed central and peripheral disease,and 12 cases of peripheral disease by differential diagnosis based on various balance function,neuro-otological,and imaging tests.Cervical ultrasonography using the cervical rotation method and MRI and MRA of the head and neck were performed in most patients with apogeotropic DCPN.We reviewed the presence of abnormal imaging findings according to the disease etiology.Results:Of the 30 patients with apogeotropic DCPN,23 showed vascular abnormalities or central lesions on imaging.Vascular lesions were found in six of the 12 patients with peripheral disease.Cervical ultrasonography with cervical rotation detected blood flow disturbance in the vertebral artery in eight patients in whom the disturbance could not be detected by MRI or MRA of the head and neck.Discussion:We hypothesize that the causative disease of apogeotropic DCPN may be strongly associated with circulatory insufficiency of the vertebrobasilar and carotid arteries,and that impaired blood flow in these vessels may affect peripheral vestibular and central function.In patients with apogeotropic DCPN,examinations of vestibular function,central nervous system symptoms,and brain hemodynamics are valuable for differential diagnosis.
文摘Objective:An acute onset central pathology without any clear neurological symptoms may mimic peripheral vestibular problem in an emergency setting.A 54-year-old man suddenly developed dizziness without any cranial nerve symptoms,paresis,cerebellar signs or sensory disturbances except upbeat positional nystagmus at multiple provoked positions which alerted for a possible acute central pathology.Findings:An instantaneous magnetic resonance imaging and angiography studies further showed obstruction of the left internal carotid artery above the bifurcation.The patient’s subsequent prognosis was consistent with good recovery following anti-coagulant therapy.A follow-up MRI and angiography showed resolution of thrombosis.Conclusion:It should be kept in mind that positional nystagmus is likely to occur in central pathologies.Differentiation between benign paroxysmal positional vertigo and central positioning nystagmus is critical.
文摘Objective:The goal of this study is to analyze the clinical view of patients with direction-fixed positional nystagmus(DFPN)following head-roll maneuver.Methods:Sixty patients with DFPN were reviewed retrospectively.Patients were categorized into 3 groups according to the direction of nystagmus based on rotation side.Associated problems were documented,and cumulative data were compared between groups.One-way analysis of variance(ANOVA test)was used for statistical analysis(P<0.05).Results:Thirty-three patients(55%)had stronger nystagmus beating towards the direction of head-roll(Group-A).Three patients developed geotropic LC-BPPV.Fourteen patients had inner ear disease.Sixteen patients(27%)had stronger nystagmus beating against the direction of head roll(Group-B).Nine patients had inner ear disease.None of the patients tested with head-shaking had change of direction of nystagmus.Eleven patients(18%)had DFPN with equal velocity during right or left head-roll maneuver(Group-C).Of those,nine patients had inner ear disease.None of the patients had change of direction of nystagmus.Comparison of the incidence of associated problems(migraine,vestibular neuronitis,Meniere’s disease etc.)in each group was not statistically significant(P˃0.05).Conclusion:Patients with DFPN should be followed for a possibility of vestibular pathology since vestibular problem was documented for more than half of the patients in the follow-up.On the other hand,DFPN could be related with a temporary reason(thermal,physical or drug effect etc.)in some patients who do not exhibit any associated disease.Head-shaking testing is recommended to expose the lateral canal BPPV.But the incidence is low.
文摘BACKGROUND Benign paroxysmal positional vertigo(BPPV)is a form of temporary vertigo induced by moving the head to a specific position.It is a self-limited,peripheral,vestibular disease and can be divided into primary and secondary forms.Congenital nystagmus(CN),an involuntary,rhythmic,binocular-symmetry,conjugated eye movement,is found at birth or within 3 mo of birth.According to the pathogenesis,CN can be divided into sensory-defect nystagmus and motordefect nystagmus.The coexistence of BPPV and CN is rarely seen in the clinic.CASE SUMMARY A 62-year-old woman presented to our clinic complaining of a 15-d history of recurrent positional vertigo.The vertigo lasting less than 1 min occurred when she turned over,sometimes accompanied by nausea and vomiting.Both the patient and her father had CN.Her spontaneous nystagmus was horizontal to right;however,the gaze test revealed variable horizontal nystagmus with the same degree when the eyes moved.The patient’s Dix-Hallpike test was normal,except for persistent nystagmus,and the roll test showed severe variable horizontal nystagmus,which lasted for about 20 s in the same direction as her head movement to the right and left,although the right-side nystagmus was stronger than the left-side.Since these symptoms were accompanied by nausea,she was diagnosed with BPPV with CN and treated by manual reduction.CONCLUSION Though rare,if BPPV with CN is correctly identified and diagnosed,reduction treatment is comparably effective to other vertigo types.
基金the National Natural Science Foundation of China(No.81500794,No.81271078 and No.81500791)Scientific Research Project of Hubei Province Health and Family Planning(No.WJ2015MB062).
文摘Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.
文摘Background: Acquired See-saw Nystagmus (SSN) is a rare form of nystagmus characterized by elevation and intorsion of one eye with synchronous depression and intorsion of the contralateral eye in the first half cycle, followed by a reversal in the direction of the movements during the next half cycle. We herein report a case of a 47-year-old woman with a 3-year history of constant diplopia as a consequence of multiple neurosurgical interventions due to hemorrhage from a cavernous angioma located in the subthalamic region. She also had a history of major depressive disorder and ulcerative colitis. The patient underwent a surgical intervention with a 5 mm bilateral recession of the superior and inferior rectus muscles. Five years after surgery, the patient reported less recurrent and prominent episodes of transient horizontal deviation with horizontal diplopia, with a prevalence of well-being and comfort.
基金The study was supported by the National Twelfth-Five Year Research Program of China(No.2012BAI12B02)the National Natural Science Foundation of China(No.81873701).
文摘Benign paroxysmal positional vertigo(BPPV)represents the most common form of positional vertigo.It is caused by dislodged otoconia that freely float in the semicircular canals(canalolithiasis)or attach to the cupula(cupulolithiasis).A cupulolithiasis-type(or a heavy cupula-type)of BPPV implicating the lateral semicircular canal(LSCC)exhibits persistent ageotropic direction-changing positional nystagmus(DCPN)in a head-roll test.However,in some cases,unlike any type of BPPV,persistent geotropic DCPN cannot be explained by any mechanisms of BPPV,and don’t fit the current classifications.Recently,the notion of light cupula has been introduced to refer to the persistent geotropic DCPN.In this study,we looked at the clinical features of light cuplula and discussed the possible mechanisms and therapeutic strategies of the condition.The notion of light cupula is a helpful addition to the theory of peripheral positional vertigo and nystagmus.
