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PubMed2006

[Neurootological manifestation of migrainous vertigo].

OBJECTIVE: To analyzed the characteristics of migrainous vertigo (MV), a kind of paroxysmal vertigo, in order to demonstrate the extent of damage and dysfunction in MV and to judge whether MV is peripheral or central vertigo. METHODS: Twenty-two cases of acute (5 cases) or subacute (17 cases) MV were examined with oto-neurological tests, spontaneous nystagmus, positional nystagmus and auditory tests. RESULTS: There were 6 males and 16 females. Among those patients, 15 had migraine, 17 motion sickness, 15 family history of migraine or motion sickness, 1 visual aura, 7 motion intolerance (vertigo from head movement and body movement), 4 photophobia, 6 phonophobia and 5 vertigo from insomnia and emotion. There were likely to have vertigo in menstrual period in 2 cases. The duration of vertigo lasted from minutes to days. For pure-tone audiometric, 9 were normal which from mild to moderate hearing loss. Three cases had abnormal high frequency ABR bilaterally and 10 abnormal unilaterally. Subjective visual vertical were normal in all of the cases. Vestibular evoked myogenic potentials were abnormal in 14 cases (13 had low amplitude and 1 had longer latency of P13 wave). Bithermal caloric test was abnormal in 3 cases and 11 had abnormal ocular movement (9 with low gain of optokinetic nystagmus, 1 with overshoot in saccade and 1 with vertical nystagmus after head shaking), in which 10 had abnormal high frequency ABR and 1 was normal. CONCLUSIONS: MV could be peripheral or central vertigo and MV should be included in the differentiation of peripheral and central vertigo.

Adolescent↗
PubMed1985

Characterization of tobacco withdrawal: physiological and subjective effects.

In total, our studies show that changes which occur reliably and consistently in chronic smokers after tobacco deprivation include: decreased heart rate, increased caloric intake/eating, increased number of awakenings during sleep, increased craving for tobacco, and increased confusion, as measured by the POMS. Other changes that were found to occur after tobacco deprivation in some but not all of our studies include decreased orthostatic heart rate, increased irritability, and decreased vigor score on the POMS. Previous investigators have found a consistent effect of tobacco deprivation on heart rate (Gilbert and Pope 1982; Knapp et al. 1963; Parsons and Hamme 1975; Weybrew and Stark 1967; Glauser et al. 1970; Myrsten et al. 1977; Murphee and Schultz 1968). Although decreased blood pressure (Knapp et al. 1963; Murphee and Schultz 1968) and changes in other vital signs such as temperature (Gilbert and Pope 1982; Myrsten et al. 1977; Ague 1974) have been reported, our present studies and studies by others (Weybrew and Stark 1967; Glauser et al. 1970) failed to find a significant deprivation effect on these measures. Perhaps the contradictory findings are a function of the reliability of the measures themselves or of the population tested. Caloric intake has been found to increase in both animals and humans after nicotine or smoking cessation (Gruneberg 1982; Myrsten et al. 1977; Wack and Rodin 1982). These results are consistent with studies which have found that smoking cessation causes an increase in body weight (Wack and Rodin 1982). However, previous studies disagree on how smoking cessation causes weight gain. Our inpatient study is believed to be the first to simultaneously measure changes in caloric intake, fluid retention, and physical activity after tobacco deprivation. In the study, caloric intake increased but fluid retention and physical activity did not change. The increases in weight may not be accounted for solely by increases in caloric intake. There may be other factors such as decreased basal metabolic rate which cause the increase in weight. Other studies have also reported sleep disturbance or insomnia among tobacco-deprived smokers (Larson et al. 1961; Weybrew and Stark 1967). Studies directly monitoring sleep have found a decrease in duration awake (Soldatos et al. 1980), increased REM sleep (Soldatos et al. 1980; Kales et al. 1970; Parsons et al. 1975), and increased Stage IV (greater than 50% delta waves) sleep (Parson et al. 1975; Parsons and Hamme 1975). Thus, objective data indicate that after tobacco deprivation smokers actually sleep longer, which contradicts subjective reports of insomnia.(ABSTRACT TRUNCATED AT 400 WORDS)

Behavior↗
PubMedDate not supplied

[Acute sensorineural hearing loss at the Otorhinolaryngology Department of the General Hospital in Subotica 1991-1996].

INTRODUCTION: Sudden sensorineural hearing loss is an acute hearing loss of a perceptive type, of unknown etiology, in most cases one-sided, or, a every sudden sensorineural deafness that occurs in the period of three days or less. Modern scientific literature points to three possible etiological factors: viral cochleitis, vascular lesion of the labyrinth and unrecognized rupture of the membranous labyrinth. The therapy for this disease is extremely various. There are dozens of reported different (or similar) healing protocols, including vasodilators, Hydroxyethyl starch, low molecular dextran, diuretics, defibrinogenation, fibrmolytic therapy, steroids, prostacyclin, oxygen therapy, hyperbaric oxygen therapy, vitamins, etc. The aim of the study was to recapitulate in brief modern views of etiology and therapy of the sudden sensorineural hearing loss, to analyze cases of this illness within the period of 1991-1996 in our Otorhinolaryngology Department and to compare these data with the same or similar data of other authors. MATERIAL AND METHODS: In this study, medical records of patients admitted in the period of 1991-1996 in the Otorhinolaryngology Department of the Health Center in Subotica with a diagnosis of sudden sensorineural hearing loss were used. There were 53 patients with this diagnosis. All patients were treated in the hospital with infusions of rheoactive drugs. During the diagnostic procedure, all patients underwent a complete clinical otorhinolaryngologic examination, detailed anamnesis was taken, acoustic impedance tests (tympanometry) and tonal liminal audiometry were performed. Routine blood test was made (including complete blood picture, sedimentation rate, blood sugar) and a complete urine examination. Sometimes we demanded x-ray of the temporal bones (Schnller and Stenwers). A short increment sensitivity index (SISI) test and Carhart test were also made, if necessary. Function of the vestibular system was tested in cases when the vestibular symptoms were more strongly expressed. This test was made after passing an acute attack of vertiginous symptoms. Control audiometry was made on the seventh and on the fourteenth day after admission. This therapy consisted of an infusion of physiologic solution (NaCl) 250 or 500 ml twice daily to which 300 mg xanthinol nicotinate ampulla, paracetam 1 g ampulla, dipyridamole 10 mg ampulla and C-vitamin 10% 500 mg ampulla were applied. The number of paracetam and xanthinol nicotinate ampullas was raised on the 14/day, and then it fell to the starting value. The therapy lasted 17 days. Patients were given multivitamine peroral therapy, tranquilizers and diet without coffee, smoking and allergenic food. RESULTS AND DISCUSSION: The study included 53 patients, 27 (50.94%) female and 26 (49.06%) males (Graph 1). Their age (Graph 2) ranged between 16-71 years. The biggest group of patients was between 40-49 (39.62%) years of age. Distribution per year (Graph 3) shows that the incidence of the acute sensorineural hearing loss differs from the findings of other authors, especially in the period of 1991-1994, due to very few cases. Connection of this illness with seasons is shown in Graph 4. We had most cases during summer time (August, 16.98%). There is a mild rise in winter (December, 13.21%). The degree of the hearing loss in decibels is shown in the Graph 5. Most of the patients (75.47%) had mild or severely damaged hearing (40-85 dB). Period of the deafness before patients were admitted to the hospital, is shown in Graph 7. Most of them came in the first seven days after they experienced acute deafness (52.83%). Symptomatology of the persons with acute hearing loss is shown in Table 1. All of them had the feeling of deafness, and 50.94% also had tinnitus. Table 2 shows that only two patients had a pathologic finding (hypo function) on the vestibular caloric test. 57.14% of patients tested by this method showed a normal function of the vestibular apparatus. The recovery of he

Adolescent↗
PubMed1988

A clinical sign of canal paresis.

Unilateral loss of horizontal semicircular canal function, termed canal paresis, is an important finding in dizzy patients. To our knowledge, apart from head-shaking nystagmus, no clinical sign of canal paresis has yet been described and the term derives from the characteristic finding on caloric tests: little or no nystagmus evoked by either hot or cold irrigation of the affected ear. We describe a simple and reliable clinical sign of total unilateral loss of horizontal semicircular canal function: one large or several small oppositely directed, compensatory, refixation saccades elicited by rapid horizontal head rotation toward the lesioned side. Using magnetic search coils to measure head and eye movement, we have validated this sign in 12 patients who had undergone unilateral vestibular neurectomy.

Eye Movements↗
PubMed1996

Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement?

BACKGROUND: Benign paroxysmal positioning vertigo (BPPV) is generally thought to be caused by canalolithiasis in the posterior semicircular canal, an organ that is innervated by the inferior vestibular nerve. We hypothesized that absent vestibular evoked myogenic potentials (VEMPs) would indicate involvement of the inferior vestibular nerve and that posterior semicircular canal-type BPPV could not develop after vestibular neurolabyrinthitis (VNL) in patients with absent VEMPs. OBJECTIVE: To find out if VEMPs could be helpful in evaluating involvement of the inferior vestibular nerve in acute VNL. DESIGN: We reviewed the VEMP findings in 47 patients (34 men and 13 women) with acute VNL, 10 of whom had then developed posterior semicircular canal-type BPPV. RESULTS: While p13-n23, the first positive-negative peak of the VEMP, was ipsilaterally present on stimulation of the unaffected side in all patients, it was absent on the affected side in 16 patients (34%). The absence or presence of p13-n23 was independent of the results of caloric tests, pure tone audiometry, and auditory brain-stem responses. Typical posterior semicircular canal BPPV developed in 10 of the 47 patients after the acute attack of VNL, always on the same side as the neurolabyrinthitis. The p13-n23 potentials were preserved on stimulation of the affected ear in all 10 patients with BPPV. CONCLUSIONS: These results suggest that if VEMPs are absent from an ear that has suffered acute VNL, then posterior semicircular canal BPPV is unlikely to develop as a consequence of the VNL. The reason for this appears to be that the absence of VEMPs is due to involvement of the inferior vestibular nerve or involvement of the structures that it innervates.

Acoustic Stimulation↗
PubMed1997

Skew deviation following vestibular nerve surgery.

Eighteen consecutive patients undergoing vestibular nerve surgery underwent pre- and postoperative examination of ocular motility. Five patients developed a skew deviation following surgery, with the lower eye on the operated side and an incomitant pattern of deviation in all cases. Three patients experienced diplopia lasting from 1 day to 6 months. The magnitude of skew deviation was increased by head tilt away from the operated side in only 1 case. The development of skew deviation was not determined by preoperative ocular alignment or binocular function, or any particular type or pattern of vestibular disease. There was an association with large changes in ocular torsion and subjective visual vertical, which correlated with lesser degrees of canal paresis to preoperative caloric testing on the operated side. No patient developed a head tilt postoperatively. There is a gradation of responses to surgical vestibular deafferentation in humans, skew deviation only occurring in patients suffering marked changes in subjective visual vertical and ocular torsion.

Adult↗
PubMed1975

[The acute vestibular paralysis (author's transl)].

Acute vestibular paralysis may not be considered as a nosologic entity but as a syndrome. Symptomatology (vertigo, spontaneous and provoked vestibular nystagmus, absence of cochlear signs) shows an uniform picture. The results of the caloric test as well as the nystagmic responses induced by galvanic stimulation and the development of central vestibular compensation however indicate that the site of the lesion is not only confined to the labyrinth but may also occur at the level of the peripheral neuron or even the vestibular nuclei. Etiology and pathology are still vague. Our own clinical observations as well as the scarce data in literature about morphological and experimental studies suggest in a way that vascular and infectious disorders are of importance as primary releasing factors. Hypothetically, vestibular loss of function may either be caused by a disturbance of labyrinthine microcirculation, initiated in a great majority of cases by infection, or by a direct lesion of the peripheral neuron as well as the vestibular nuclei. Retrolabyrinthine lesions may be due to menigoencephalitis, caused by a neurotropic virus or other infectious agents such as Toxoplasma gondii. Acute vestibular paralysis should be strictly distinguished from vestibular neuronitis. While vestibular paralysis is a syndrome, vestibular neuronitis must be considered as a nosologic entity, including a lesion of the peripheral neuron as well as evidence of an infectious event.

Adolescent↗
PubMed1975

[Electronystagmographic esaminations of caloric latency (author's transl)].

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.

Adolescent↗
PubMed1978

Which are the parameters of choice from the evaluation of caloric nystagmus?

On hand of caloric tests on 202 healthy subjects, the coefficient of correlation between the currently most frequently used intensity parameters was established separately for each of the four irrigations, i.e. between maximum velocity of the slow phase, maximum amplitude, maximum frequency, total number of beats and duration of reaction. The maximum velocity of the slow phase is so closely correlated to the maximum amplitude, and the maximum frequency is so closely correlated to the total number of beats (r = always greater than 0.75) that it is sufficient to merely determine one of the two well correlated parameters in healthy subjects. However, the parameters maximum velocity of the slow phase and maximum amplitude are less closely correlated to the parameters maximum frequency and total number of beats (r = smaller, in part considerably smaller than 0.75). A better correlation exists between the nystagmus parameters nearly always by warm irrigations, as compared to cold ones. The findings speak for the fact that maximum velocity of the slow phase and maximum amplitude on one hand, and maximum frequency and total number of beats on the other, are an expression of various characteristics of the experimental nystagmus. In a consecutive publication, we are going to report in which way the various nystagmic parameters of patients are being changed by different lesions of the vestibular system.

Adolescent↗
PubMed1976

Clinical study of chronic arachnoiditis in the posterior fossa.

A series of 12 cases of chronic arachnoiditis in the posterior fossa is reported. The diagnosis in six patients was established at suboccipital craniectomy whch brought about marked improvement in symptoms. The other six were diagnosed as having arachnoiditis in the posterior fossa from the facts that improvement in clinical symptoms was achieved by lumbar air insufflation, which has often been said to be effective in arachnoiditis, and no abnormal findings were revealed by pneumoencephalo-roulette tomography. By investigating the clinical features of these cases, we came to the following conclusions: many cases of this disease have had head trauma or chronic inflammatory disease in the past; the symptoms are apt to occur abruptly, and display repeated remission and aggravation; symptoms originating in the cranial nerves are diversified, and are often bilaterial; peripheral vestibular disturbances and retrocochlear hearing losses are observed on neuro-otological examination. In the caloric test especially the patients show canal paresis (CP) on the more impaired side, but none of them appeared to be nonresponsive to the test; lumbar air insufflation is often an effective treatment for this disease; pneumoencephalo-roulette tomography is very useful for diagnosing pathological changes in the posterior fossa.

Adult↗
PubMed1992

Gastrointestinal transit and digestibility of maltitol, sucrose and sorbitol in rats: a multicompartmental model and recovery study.

Using data obtained with a dye marker and the gavage technique, the kinetics of gastrointestinal transit of different loads of sugar substitutes (maltitol, sorbitol) and sugar (sucrose) in the rat were analysed using a linear multicompartmental model over a range from the realistic to the non-physiologic high, of carbohydrate intake levels and using only a few experimental time points. The model gave detailed insight into intestinal propulsion and gastrocecal transit time. Rate constants of transport between the compartments investigated were determined; they showed characteristics which could be related to the substance and the dosage administered. Analyses of the gastrointestinal content and calculations of the intestinal net water movement showed that the digestibility and absorption of the disaccharide sugar alcohol, maltitol, in the small gut depended inversely on the dose ingested. For all substances tested, caloric availability in the small intestine was calculated. At a physiological low level of maltitol intake, the results also indicated an insignificant calorie-saving effect in comparison to sucrose, an effect based mainly on the slow absorption rate of the maltitol cleavage product sorbitol.

Animals↗
PubMed2007

[Intracochlear schwannoma as a cause of a deafness: a case report].

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

Adult↗
PubMed2002

[Medical management of patients with benign paroxysmal positional vertigo].

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder which can be simply diagnosed. The evolution of highly effective positioning maneuvers has made BPPV the most successfully treatable cause of vertigo. We evaluated patients with BPPV with regard to past medical history and disease-related diagnostic and therapeutic procedures. Forty-two patients were recruited from a specialised dizziness clinic, and a further 29 patients were recruited from a neurological practice. The mean duration of the disease was 3.2 years, with an average of 2.4 episodes lasting typically several weeks to months. More than half of the patients felt severely disabled by BPPV. On average, three different medical specialities were consulted. Cerebral imaging (42%), caloric testing (46%), and audiometry (49%) were performed more often than diagnostic positioning (28%). Most patients received ineffective or no therapy, and only 4% were treated with a specific therapeutic positioning maneuver. Benign paroxysmal positional vertigo is a long-lasting and frequently recurrent disease which leads to significant morbidity and medical costs. The recent progress in the diagnosis and therapy of BPPV has not yet been widely established in medical practice in Germany.

Adult↗
PubMed2005

Antiphospholipid antibodies in patients with sensorineural hearing loss.

Sensorineural hearing loss can be associated with autoimmune diseases and the presence of antiphospholipid antibodies. Sixty patients (mean age 47 years, range 18-76 years) with sudden sensorineural hearing loss were studied with audiograms, stapedial thresholds, otoacoustic emissions, positional and caloric testing. The serologic testing included antibodies against phosphatidylserine and beta(2)-glycoprotein. Additionally, a group of 34 patients (mean age 65 years, range 31-81 years) with normal tension glaucoma was examined because in a previous study these patients were reported to have elevated concentrations of antiphospholipid antibodies with a coincidence of progressive sensorineural hearing loss. The baseline for antiphospholipid antibody levels was established in a control group of 40 healthy blood donors. In 12 of the 60 patients with sudden sensorineural hearing loss, levels of antiphospholipid antibodies were elevated. Antiphosphatidylserine IgM antibodies were significantly lower compared to controls and patients with the combination of hearing loss and normal tension glaucoma (Fisher's exact two-sided test, P < 0.01). Our data suggest that antibodies against beta2-glycoprotein seem to coincidence with an acute event, such as sudden sensorineural hearing loss, whereas antibodies against phosphatidylserine IgG are detectable in the prolonged sequel, such as in patients with progressive sensorineural hearing loss and normal tension glaucoma.

Adolescent↗
PubMed2005

Potential usefulness of Tl-201 SPECT for differentiating radionecrosis in an irradiated nasopharyngeal carcinoma patient.

Differentiation between cerebral radionecrosis and intracranial relapse in irradiated nasopharyngeal carcinoma (NPC) patients challenges the clinicians, especially when clinical manifestation and MRI findings are inconclusive. A 63-year-old NPC patient had intermittent dizziness and unsteady gait 3 years after irradiation. An ice water caloric test revealed absent response on the right ear, which was compatible with an enhanced lesion at the right temporal lobe on MRI scan. Furthermore, abnormal focally increased uptake over the anteriomedial aspect of the right temporal lobe was disclosed on 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET), which suggested intracranial relapse. Conversely, serological study for Epstein-Barr viral titer was within normal limits, arguing against either recurrent or metastatic NPC. Hence, thallium (Tl)-201 single photon emission computed tomography (SPECT) was subsequently conducted, which failed to demonstrate abnormal thallium accumulation in the corresponding area. Accordingly, radiation necrosis of the temporal lobe rather than intracranial relapse is considered. The patient was rather well without locoregional recurrence or distant metastasis 2 years after presentation.

Carcinoma↗
PubMed2001

Vestibular schwannoma: negative growth and audiovestibular features.

At the University Medical Center Utrecht, non-operative management was used for 44 patients with a unilateral vestibular schwannoma between 1990 and 1997. During that period, consecutive tumor sizes were determined by magnetic resonance imaging. Three of the 44 patients showed an average decrease in tumor size of 16.7% according to American Academy of Otolaryngology-Head and Neck Surgery standards. This study describes the initial vestibular status and audiometric changes measured over up to 10 years in these three patients. Vestibular function was determined once, by means of the bithermal caloric test, the torsion test, the saccade test, the smooth pursuit test, and the registration of spontaneous nystagmus. The three patients had severe vestibular paresis on the affected side. Pure-tone and speech audiometry were performed at regular intervals. Although the size of their tumors decreased, their hearing gradually deteriorated, just as it does in the majority of patients with a growing or stable vestibular schwannoma. The observations presented here suggest that the development of symptoms in a vestibular schwannoma does not differentiate between patients with a stable, growing or shrinking tumor. The development of symptoms may be the result of the same pathogenetic mechanism.

Adult↗
PubMed2002

Seventh nerve palsies may be the only clinical sign of small pontine infarctions in diabetic and hypertensive patients.

BACKGROUND: Small brainstem infarctions are increasingly recognized as a cause of isolated ocular motor and vestibular nerve palsies in diabetic and/or hypertensive patients. This raises the question whether there are also isolated 7(th) nerve palsies due to pontine infarctions in patients with such risk factors for the development of cerebrovascular diseases. METHODS: Over an 11-year-period, we retrospectively identified 10 diabetic and/or hypertensive patients with isolated 7(th) nerve palsies and electrophysiological abnormalities indicating pontine dysfunction. All patients had examinations of masseter and blink reflexes, brainstem auditory evoked potentials, direct current electro-oculography including bithermal caloric testing, and T1- and T2-weighted MRI (slice thickness: 4-7 mm). RESULTS: Electrophysiological abnormalities on the side of the 7(th) nerve palsy included delayed masseter reflex latencies (4 patients), slowed abduction saccades (4 patients), vestibular paresis (2 patients), and abnormal following eye movements (2 patients). Electrophysiological abnormalities were always improved or normalized at re-examination, which was always associated with clinical improvement. MRI revealed an ipsilateral pontine infarction in 2 patients. Another 2 had bilateral hyperintense intrapontine lesions, and one an ipsilateral cerebellar infarction. CONCLUSIONS: Simultaneous improvement or recovery of abnormal clinical and electrophysiological findings strongly indicated that both were caused by the same actual pontine lesions. A 7(th) nerve palsy may be the only clinical sign of a pontine infarction in diabetic and/or hypertensive patients. Such mechanism may be underestimated if based on MRI only.

Adult↗