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This paper presents an approach to the prediction of peripheral and central vestibular disorders from a mathematical statistical point of view. An analysis was performed by the quantification method for multi-dimensional qualitative data. The data analysed were from 713 patients with a complaint of dizziness or vertigo who were subjected mainly to neurootological tests on 14 items. The categorical discriminant analysis of peripheral and central vestibular disorders revealed a discriminant success rate of 82%. We used the following five tests in discrimination: optokinetic test (OKN), caloric test, eye-tracking test (ETT), hearing test, and standing test. A system for the screening of patients with vertigo was assessed by use of a microcomputer and is in daily use in our department.
Visual suppression of vestibulo-ocular reflexes (induced vestibular nystagmus) differs between normal subjects and patients with various neurological disorders. Abnormalities of VOR suppression were associated consistently with abnormalities of the visual and/or vesitibular oculomotor reflexes and in particular with abnormal smooth pursuit eye movements in the direction of abnormal suppression. Absent VOR suppression in a gaze position of, and in the same direction as, a spontaneous nystagmus was found exclusively in patients with spontaneous nystagmus of central nervous system origin. Conversely, ability to suppress in these circumstances was found only in patients with spontaneous nystagmus of peripheral labyrinthine origin. Suppression of VOR was abnormal ipsilaterally in patients with unilateral cerebral hemisphere lesions and abnormal in both the horizontal and vertical planes in patients with basal ganglia lesions. Failure of VOR suppression in the absence of spontaneous nystagmus indicates a supratentorial lesion.
One hundred twenty-one patients were identified who presented to an emergency room with the complaint of dizziness. Peripheral vestibular disease (24 percent of patients) was the most common cause of dizziness, but the cause remained unknown at follow-up after six months in 37 percent of the patients. The history and physical examination were sufficient for diagnosis in 83 percent of patients in whom a diagnosis could be made. Diagnostic tests, such as complete blood counts (four patients) and chest roentgenograms (four patients), provided crucial information in some cases. At the time of follow-up, 7 percent of patients had suffered either major morbidity or had died as a result of the cause of the index episode of dizziness. Patients with an initial diagnosis of anemia, stroke, or diabetes represented a high-risk (50 percent) group for a poor outcome. However, patients who were aged under 50 years or whose dizziness was due to peripheral vestibular disease, vasovagal or psychogenic cause, drugs, or infection formed a low-risk (2 percent) group.
The purpose of this study is to investigate the diagnostic value of using the damped pendular rotation test (DPRT) (1) with an ocular fixation (ocular fixation test, i.e. OFT), and (2) in the dark with the eyes open, jointly with auditory brain stem response (ABR) audiometry. Impairment of ocular fixation was found in patients with either brain stem lesions, cerebellar lesions, or cerebellopontine angle tumors. A collective evaluation of the findings of OFT with those of ABR audiometry has suggested the possibility of differentiating upper brain stem lesions from lower brain stem lesions, tumors of the IVth ventricle, and cerebellar tumors. However, differentiating IVth ventricle lesions from tumors involving the cerebellar vermis extending into the IVth ventricle by this battery of tests was somewhat limited.
An animal model of experimental perilymphatic fistula (EPLF) was developed in the guinea pig in order to study vestibular pathophysiology. In experimental animals, 4 microL of perilymph was suctioned from one cochlea via the round window membrane. Changes in vestibular function were as follows. 1) During the acute stage (5 hours postoperatively), spontaneous nystagmus directed toward the normal side was noted in 57.4% of the EPLF animals. This lasted less than 24 hours. 2) One week postoperatively, direction-fixed positional nystagmus toward the lesioned ear was present in 22.7% of the EPLF animals, especially when the lesioned ear was positioned inferiorly. 3) With the ice water caloric test, no response was present in 58.1% of the EPLF animals and an irregular response was found in 22.6% of them, 1 week postoperatively. These results tend to indicate that tests of vestibular function may differentiate between patients with Meniere's disease and those with perilymphatic fistula. Histologic findings indicate that a floating labyrinth is the cause of positional nystagmus and caloric irregularity. The absence of caloric responses was associated with collapse of the vestibular labyrinth.
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Intense vertiginous attacks with sudden onset and of several months' duration were observed in a group of patients following viral infection. Neurotological examination revealed different types of signs of involvement of the central vestibular apparatus. All of these patients became dizzier when medicated with vestibular depressor drugs, and could obtain symptomatic relief with corticosteroids. They became asymptomatic after a period of 3-4 months from the onset of the disease, but the signs of central vestibular involvement persisted for 6-12 months.
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