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PubMed1983

The Quix test.

Professor Doctor F.H. Quix, of Utrecht, was a keen student of macular function, who published extensively at the beginning of this century. He described many useful tests for otolithic function, and one in particular has continued to be fairly widely used. The so-called "Quix Test" is performed with the patient standing, feet slightly apart, arms outstretched, index fingers extended, and the examiner assumes a similar mirror-image posture, such that the fingertips almost touch. The patient is then requested to close his eyes, and the index fingers are observed for drift. The lateralizing value of this sign of vestibular disease is discussed.

Humans↗
PubMed2004

Neuroradiological features of vertigo.

The diagnostic pathway in a patient with vertigo starts with the accurate evaluation of medical history followed by a general physical and neurological examination. This step can often lead to the identification of the correct cause of the disease or, at least, to a distinction between peripheral and central vertigo. Neuroradiological investigations have to be considered as elective diagnostic procedures and include: computed tomography (CT), magnetic resonance (MR), MR angiography (MRA), angiography. For the diagnosis of peripheral vertigo, benign paroxysmal positional vertigo, labyrinthitis, Meniere disease, perilymphatic fistula, local trauma, toxic labyrinthitis, acute otitis media and chronic middle ear effusion,the role of imaging techniques is controversial. CT and MR are performed to rule out other pathologies and to confirm the diagnosis. Increased resolution and application of special MR sequences enhancing the intralabyrinthine fluids have enabled more detailed analysis of labyrinthine structures and pathology. Both T2 and T1 contrast sequences are necessary. A high resolution CT study is required when otitis media is suspected and in the follow-up of post-traumatic vertigo. The causes of central vertigo are numerous and include: vertebro-basilar circulation vascular events, multiple sclerosis (MS), migraine-associated vertigo, cerebellar and brainstem tumors, CNS infections. Among them cerebrovascular ischemia and multiple sclerosis are the most frequent. In these situations imaging studies become mandatory. CT can diagnose most cerebellar hemorrhages and some cerebellar and brainstem acute ischemia, enhanced MR has proved to be the most sensitive tool to detect posterior fossa lesion. Diffusion-weighted MR can reveal acute ischemic changes before routine MR. There has been evidence that MR angiography, providing angiogram-like images of the intracranial vessels may sometimes avoid invasive angiography. MRA resolution is not as good as traditional angiography and may also be compromised by movements and other artifacts. Selective angiography of the posterior circulation is often indicated for therapeutic decisions.

Brain↗
PubMed1979

The value and cost analysis of the ENG as of 1978.

The use of ENG in office practice and its use as a helpful, time-saving procedure is discussed. The following practical clinical questions are answered: 1. Is the vestibular mechanism normal or abnormal? 2. Is the vestibular pathology peripheral or central? 3. Is the peripheral disease right or left sided? Cost analysis of ENG in office practice is presented.

Costs and Cost Analysis↗
PubMed1979

Acute cochleovestibular dysfunction.

A case of acute vertigo and sudden deafness with concomitant eye lesions is presented. The possible differential diagnoses are discussed, and the principles of treatment outlined.

Acute Disease↗
PubMed1985

[Otoneurologic symptomatology in mild craniocerebral injuries in the acute period].

Vestibular disorders are observed in all cases of a mild craniocerebral injury and are often the only objective sign of the sustained trauma because loss of consciousness and neurological symptoms may not infrequently be absent. Vestibular disorders are manifested by a small clonic horizontal bilateral multiple nystagmus. The caloric test revealed bilateral elevation of the caloric nystagmus in terms of duration and nature, with a regular alteration of the nystagmic phases. From the 5th to the 10th day after the injury there was an increase in asymmetric caloric nystagmus. Mild craniocerebral injury was characterized by an increase in sensory and vegetative responses after calorization. Spontaneous nystagmus and bilateral hyperreflexia of the caloric nystagmus were most expressed in the first 4 days and an increase in sensory and vegetative reactions within the first 9 days. Two weeks after a mild craniocerebral injury the vestibular disturbances were completely or partially compensated for by all parameters, which was expressed in the disappearance of the spontaneous nystagmus and the predominance of the symmetrically inhibited caloric nystagmus in the absence of sensory-vegetative reactions. In patients with diseases involving the cerebral vessels, compensation of vestibular disorders following a mild injury tends to be slower.

Acute Disease↗
PubMed1990

CT and MR imaging of intralabyrinthine schwannoma: report of two cases and review of the literature.

Two cases of intralabyrinthine schwannoma were studied with computed tomography (CT) and magnetic resonance (MR) imaging. On CT scans, a soft-tissue mass was identified in the round window niche in both cases. Widening of the basilar turn of the cochlea and characteristic erosion of the promontory were noticed in one case. Preoperative MR imaging (performed in only one case) revealed a soft-tissue mass in the labyrnth, extending into the round window niche. Findings at CT and MR imaging are discussed, and a differential diagnosis is given. The literature is reviewed. The authors' findings suggest that CT and MR imaging may prove very valuable in the previously difficult preoperative diagnosis of these tumors. In the setting of progressive sensorineural hearing loss, atypical Meniere disease, or recurrent vertigo, the presence of a mass in the labyrinth or labyrinthine windows- delineated on CT or MR images, despite a normal internal auditory canal, cerebellopontine angle, or brain stem - is highly suggestive of intralabyrinthine schwannoma.

Aged↗
PubMed1996

Treatment of Cochlear-Tinnitus with Dexamethasone Infusion into the Tympanic Cavity.

Intratympanic dexamethasone infusion was performed as a treatment for cochlear-tinnitus and its efficacy was investigated. This is a Steroid Targeting Therapy (STT) for cochlear-tinnitus. The overall effective rate for the 1214 patients with 1466 affected ears was 71%. In this study, cochlear tinnitus was seen frequently in the age group of 50 - 60 years old, a relatively older population. The results of the treatment for tinnitus in different age groups did not show a correlation between age and efficacy rate of treatment. In the investigation of the treatment results with different underlying ear diseases, the efficacy rate was high for tinnitus accompanying chronic otitis media, Ménière's disease, and labyrinth syphilis. The efficacy rate tended to decrease more with longer disease duration. When the mean hearing level and treatment results were evaluated, a high effective rate was found in patients who had mild deafness. The efficacy rate was high in tinnitus of low tone pitch, and low tinnitus with high tone pitch. On the other hand, different degreees of loudness of tinnitus did not correlate with treatment effects. This treatment method is useful as a local therapy for cochlear-tinnitus in an outpatient setting.

Journal Article↗
PubMedDate not supplied

Direction-changing positional nystagmus: incidence and meaning.

Direction-changing positional nystagmus (DCPN) is a nystagmus that changes its direction with different body and head positions. Many authors consider that it indicates the presence of a central nervous system lesion. Of 1,196 patients whose abnormal electronystagmographic (ENG) traces were reviewed, 46 (3.8 per cent) showed DCPN. Of these, ten (22 per cent) had central neurologic diseases, 14 (30 per cent) had peripheral vestibular diseases, and for 22 (48 per cent) there was no definite clinical diagnosis. Nineteen patients (41 per cent) with DCPN had ENG findings suggesting a peripheral vestibular lesion, while only five (11 per cent) had ENG findings suggesting a central vestibular lesion. Four of 44 control subjects exhibited DCPN. Thus, the presence of DCPN does not necessarily indicate disease of the vestibular system and definitely does not localize the site of a lesion in the vestibular pathways, but more often indicates a peripheral vestibular site. As with spontaneous nystagmus, lack of suppression with fixation suggests a central lesion.

Adult↗