Vestibulospinal testing using cranio-corpo-graphy in patients suffering from acoustic neuroma.
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Biomedical subjects
Publications and source records attributed to C F Claussen.
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By means of a former investigation it has been proved equilibriometrically that the application of 7 X 100 mg minocycline may induce a central equilibrium dysregulation of the brainstem type. It was the purpose of this study to further assure that the minocycline induced brainstem vertigo is due to a destabilization of a supervisory gamma-aminobutyric acid (GABA)ergic loop from the archeocerebellum upon the pontomedullary vestibular regulating pathways. As it is pharmacologically known that pyridoxine is essential for the synthesis of GABA, an inhibitory CNS neurotransmitter, 2 separate double blind trials on 20 healthy young persons each were carried out after the intake of 7 X 100 mg minocycline during 3 days with and without 7 X 40 mg pyridoxine simultaneously. These trials were checked against an additional placebo or initial non drug investigation. In all the 40 test persons it could be proved that the amount of vertigo and nausea symptoms was increased significantly due to the application of minocycline only. However, when combining minocycline with vitamin B 6, the vertigo and nausea symptoms as well as the nystagmus signs from the monaural and the binaural vestibular ocular tests as well as the vestibular spinal signs from the craniocorpography recordings of the stepping and the standing procedures were remarkably reduced. There were no statistical differences between the initial or placebo trials versus the trials with a combination of minocycline with vitamin B 6. The same holds for the vestibular vegetative reactions, measured by the simultaneous electrocardiography during the vestibular tests. All the equilibriometric tests applied showed a significant destabilization under the influence of a pure minocycline loading.(ABSTRACT TRUNCATED AT 250 WORDS)
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An equilibriometric study has been performed on 20 healthy young women before and after the intake of 7 times 100 mg minocycline during 3 days. A systematic neurootological equilibriometry was performed analyzing the vestibular ocular, the vestibular spinal, the retino-ocular and the spontaneous nystagmus pathways. The results demonstrate that the tetracycline minocycline provokes a ponto-medullary liberation of the central vestibular regulating mechanisms. The central vestibular disinhibition could be exhibited by the monaurally elicited vestibular ocular nystagmus as well as by the radar image like cranio-corpography recordings of the head and body movements during a vestibular spinal stepping test. In parallel with these findings the participants of the study increasingly complained about vertigo of the rocking type, instability, malaise and wretching. Thus, the untoward side effects of a tetracycline like minocycline which is a frequent complaint of the patients, appears to be due to a central disinhibition of the vestibular equilibrium regulating mechanisms.
Vertigo or dizziness and nausea are the subjective symptoms characteristic of vertiginous syndromes; nystagmus and oscillations of the head and body are the objective signs. Craniocorpography is a method for recording and measuring these oscillations rapidly and inexpensively. It provides easier diagnosis, follow up and measurement of a double-blind therapeutic effectiveness. In the trial author has demonstrated the beneficial effects of Ginkgo biloba Extract in vertiginous syndromes without obvious anatomical localisation.
Vertigo, giddiness, tinnitus and hearing loss frequently occur in lower brainstem disorders as well as in inner ear diseases. To differentiate the inner ear disorders from central disease we use the impulse-traced craniocorpogram (ITCCG) for the vestibulo-spinal investigation and the acoustically evoked brainstem potentials as an objective indicator of central hearing dysfunction. Craniocorpography is a simple, objective and quantitative whole-body as well as intracorporal recording technique for head and body movements. It can be used as an office procedure, giving objective and quantitative results. It traces the head and shoulder movements with the help of light bulbs. It gives significant results and differentiates between peripheral and central vestibular lesions. The acoustically evoked brainstem potentials are read by a dual channel machine. The same applies to the acoustically evoked cortical potentials. The results are plotted in either case on the electrode-stimulus cross-chart. Thus they can be interpreted at a glance, similarly to the cranio-corpogram.
Among 10 284 data files of neuro-otological patients of our neuro-otological data bank NODEC III, 8,6% pertain to children between 0 and 15 years of age. 350 (3,5%) of these are in the age group of 0-5 years, 261 (2,5%) in the group of 6-10 years and 267 (2,6%) in the group of 11-15 years. Modern inner ear functional diagnostic methods combine computerised neuro-otological audiometric as well as equilibriometric tests. Ranking of diagnostic applicability and efficiency comprises the following 6 steps of neuro-otological equilibriometric and audiometric tests: Child-adapted psychophysical hearing tests, Perrotatory nystagmus tests via electronystagmography, Postrotatory nystagmus tests via electronystagmography, Acoustic brain-stem evoked potentials ( ABEP ) with 2-channel averager, Caloric vestibular test via electronystagmography, Optokinetic nystagmus test via electronystagmography. It has been proved both clinically and statistically that the perrotatory as well as the postrotatory nystagmus recordings are accepted much better by the preschool children than the caloric test. The latter, however, provides us with superior topodiagnostic information. Acoustically evoked potentials usually require to be performed under sedation in preschool children. Automatic nystagmus evaluation via the computer system NYDIAC immediately yields all the important monocular nystagmus parameters and synoptical test charts, i.e. the butterfly calorigram . The computerbased neuro-otological equilibriometric as well as audiometric investigations should be performed by an experienced and specifically trained otolaryngologist. This diagnostic method promotes intense co-operation with colleagues in paediatrics, ophthalmology, neurology and traumatology.
This paper presents a study by means of a modern neurotological technique for investigating the action and the site of action of an antivertiginous drug. The sensory motor tests are able to discriminate the sites of the lesions in the equilibrium regulating system, i.e., peripheral vestibular system, lower brainstem regulating system, upper brainstem nystagmus generating system and supratentorial system. Acoustic brainstem evoked potentials add information. A sample of 40 vertigo and nausea patients was treated by a combined drug, containing cocculus D4 210 mg, conium D3 30 mg, ambra D6 30 mg, mineral oil D8 30 mg (Vertigo-heel). The patients received 3 tablets 3 times per day during 14 days. An initial investigation was performed just before starting the treatment. A second directly followed the therapy. By subjective self-rating 57.5% of the patients reported on an improvement after the intake of Vertigoheel. Statistical evaluations showed that the different vertigo and nausea symptoms as well as the trigger mechanisms of vertigo and nausea (i.e. getting up, turning the head or gazing aside), highly significantly improved due to the therapy. The objective sensory motor tests showed a highly significant improvement in the monaural caloric butterfly chart as well as in the vestibulospinal head and body sway. The site of the action of Vertigoheel is in the brainstem and the Medulla oblongata, especially the middle longitudinal fascicle (MLF). The localisation in this area can be stressed by the investigation with acoustically brainstem evoked potentials (ABEP).(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical olfactometry is described in which patients are exposed to supraliminal stimuli of well-known types of odors. The results are then placed on a graded recognition scale as a polar coordinate system. Each clinical odor tested produces a typical recognition pattern which can easily be interpreted. Typical patterns for different conditions involving olfaction exist, and include euosmia, sensory anosmia, and respiratory anosmia. A simplified U-tube rhinomanometer can also be used, and data graphed on the same chart as for olfactometry. The procedure as described has been successfully tested on several hundred patients and controls.
The initial phase of caloric nystagmus has been investigated. The nystagmussignal does not start in a really discrete manner. It shows a development from eye movements which are no clear cut sawtooth signals to the real nystagmus beats with easily detectable slow and fast phases. 601 ENGs of caloric tests have statistically been evaluated during the first 80 sec from the onset of the irrigation. In 68% of all of the reactions there was an underlying spontaneous nystagmus. A same directional spontaneous nystagmus covers the latency period mostly that much, that the latency period is short or hidden. An opposite directional spontaneous nystagmus leads to a prolongation of the latency period. This definition refers to the real saw tooth nystagmus signals, which are beating in the expected direction. A definition of the latency period after the so called initial nystagmoids is being discussed, too.
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