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PubMed2004

Torsional vestibulo-ocular reflex during whole-body oscillation in the upright and the supine position: II. Responses in patients after vestibular neuritis.

In a recent study we demonstrated that otolith input modifies the torsional angular vestibulo-ocular reflex (torVOR) of healthy human subjects: Compared to turntable oscillations in supine position, oscillations in upright position increased the gain of torVOR by 0.1 and cancelled the phase lead originating from low-frequency semicircular canal signals. We asked whether these otolith-related changes of torVOR are still present in patients after vestibular neuritis (VN). Eight patients were sinusoidally oscillated about their naso-occipital axis in supine (canal-only stimulation) and upright (canal-and-otolith stimulation) position. Three-dimensional eye movements were recorded with dual search coils. The patients showed similar otolith-related gain and phase changes of the torVOR as healthy subjects: the gain increased by about 0.1 (p < 0.05) and the low-frequency phase lead from semicircular canal signals was abolished. These results indicate that otolith function after VN is still sufficient to interact with semicircular canal signals to optimize torsional gaze stabilization when the head is upright.

Adult↗
PubMed2004

[Inferior vestibular nerve impairment in auditory neuropathy].

OBJECTIVE: To investigate if auditory neuropathy have inferior vestibular nerve (IVN) lesion and to explore the relation between AN and the IVN lesion by vestibular evoked myogenic potentials (VEMPs). METHODS: VEMPs were observed in 13 patients with auditory neuropathy. And the relation among the duration, hearing threshold of lower frequency and speech discrimination score with VEMPs were observed. RESULTS: Fifty-four percent patients in auditory neuropathy had abnormal VEMPs. They took the form of lower amplitude and no response. The statistical analysis showed that the abnormality of VEMPs had no correlation with lower frequency hearing loss, the duration and speech discrimination score. CONCLUSIONS: The IVN dysfunction may coexist with auditory neuropathy, having lesion in the IVN. However, there was no significant relation between the severity of AN and VEMPs, which meant that AN and inferior vestibular neuropathy had their independence to some extent.

Adolescent↗
PubMed2005

Influence of acute unilateral vestibular lesions on the respiratory rhythm after active change of posture in human subjects.

The influence of acute unilateral vestibular lesions on respiratory rhythm after active change of posture, was evaluated by comparing responses from patients with acute vestibular neuritis, with those from normal subjects with minor injuries other than vestibular (e.g. epistaxis, headache) and patients with chronic bilateral vestibular dysfunction. Respiratory movements of the thorax-abdomen were recorded during 5 minutes in supine position, 5 minutes of back-unsupported sitting and 5 minutes of upright stance. Compared to supine position, sitting-up induced different responses in each group (p < 0.05, ANOVA). The healthy subjects showed a consistent decrease in the mean respiratory frequency related to an increase of the expiration time, which was absent in patients with vestibular neuritis. Subjects with minor injuries showed the opposite changes of expiration time and inspiration time with no change of the respiratory frequency and patients with bilateral vestibular dysfunction showed a trend to increase their respiratory frequency. Standing-up did not evoke any further changes in any group. We conclude that the vestibular system modulates the respiratory response to reorientation of the head and trunk to upright position and this influence is reduced during the acute stage of a vestibular lesion.

Acute Disease↗
PubMed2005

Vestibular neuritis: etiopathogenesis.

Vestibular neuritis presents as sudden unilateral vertigo in the absence of hearing loss or neurologic involvement and is thought to be due to neurotropic viruses. Its morbidity is unknown and it affects both sexes equally, with the highest incidence at 40-50 years of age. The etiology of this condition has been ascribed to viral, bacterial and protozoan infections, as well as allergic and auto-immune causes. Inflammation of the vestibular nerve is followed by demyelination and loss of function, which is not always reversible. Higher plasma fibrinogen and CRP levels in the acute phase, longer BERA latency and I-III interval and increased gadolinium uptake in the vestibular nerve and Scarpa's ganglion on enhanced MRI confirm the inflammatory nature of the process. An animal model of vestibular neuritis using retroauricular inoculation of herpes simplex virus in mice, histologic findings in the temporal bone of individuals who had vestibular neuritis, and influenza A virus infection in cultured Schwann's cells suggest viral infection as the main aetiologic cause.

Animals↗
PubMed2005

Treatment and rehabilitation in vestibular neuritis.

During the acute phase, symptomatic treatment is practically the only option, and a wide variety of drugs are available. For years, much has been focused on the possibility of using corticosteroids in the treatment of vestibular neuritis. Clearly, if we suspect an inflammatory cause, a treatment that reduces that inflammatory process would, if not reduce the severity of the attack, at least help recovery. If the different studies on this matter failed to concord in many aspects, they do however agree that the use of corticosteroids in the acute phase entails long term beneficial effects for the recovery of vestibular function and allows for a better vestibular compensation. The second part of the treatment is the rehabilitation. In my experience most of the patients undergo a spontaneous vestibular compensation in a short time. Nevertheless, some exercises of visual fixation while the patient is still bed-ridden, can accelerate the recovery process. Those patients, in whom certain instability persists, who are too anxious after their experience or those who will demand this type of treatment, are candidates to undergo a rehabilitative vestibular program. In this paper I will comment on the instrumental and non-instrumental techniques that I use in my daily practice.

Adrenal Cortex Hormones↗
PubMed2005

Sensitivity and specificity of mastoid vibration test in detection of effects of vestibular neuritis.

Aim of this study was to determine sensitivity and specificity of the mastoid vibration test in patients who had suffered an attack of vestibular neuritis. Results were compared with the caloric test and two bedside tests of vestibular function (head shaking test and head thrust test). Results are reported in 28 patients who had a residual vestibular deficit 6 months after acute neuritis and in 25 healthy subjects. Mastoid vibration nystagmus was evoked in 21 patients but not in controls. In these patients, mastoid vibration test had a sensitivity of 75% and specificity of 100%. Since one patient had inverted mastoid vibration nystagmus, specificity of identification on the pathological side was 95%. Sensitivity of the test increased with increasing severity of the vestibular lesion. Indeed, mastoid vibration nystagmus was induced in 93% of patients with caloric paralysis and in 58% of those with caloric paresis. Nystagmus could usually be modulated or elicited by stimulation of either mastoid. In the few patients in whom mastoid vibration nystagmus was elicited only from one side, or when there was a clear difference in intensity of the nystagmus induced on the two sides, the stimulated side was more often the affected side. Four patients still showed spontaneous nystagmus. The caloric test was abnormal in 26/28 patients (93%) with paralysis in 16 and paresis in 12; 71% of patients had a head shaking induced nystagmus: 64% had an asymmetrical response in head thrust test. In conclusion, mastoid vibration test was overall more sensitive than head thrust test. Mastoid vibration test was slightly less sensitive than head shaking test in patients with severe residual deficit and more sensitive in patients with partial deficit. Mastoid vibration test, a valid, low cost clinical screening test for rapid detection of asymmetrical vestibular function, does not cause patient discomfort. It is suggested that this test be included in the diagnostic workup of all patients with suspected vestibular dysfunction.

Acute Disease↗
PubMed2005

Personal experiences with vestibular evoked myogenic potentials as a modern method of diagnosing vestibular organ lesion and monitoring treatment.

Vestibular evoked myogenic potentials (VEMPs) appear to represent a new and promising technique for the assessment of vestibulospinal reflex function. The primary aims of the study described in this article were (1) to record VEMPs in normal volunteers using available equipment and to establish a range of norms of VEMP parameter values (latency, amplitude); (2) to confirm the saccular origin of VEMPs; (3) to assess the diagnostic significance of VEMPs; and (4) to evaluate the usefulness of VEMPs in monitoring therapeutic results. The study population consisted of 252 patients representing various diagnoses of hearing loss and vestibular organ lesion. Twenty-three patients were treated with an antihomotoxic remedy, and some received placebo. The results of this study demonstrated that VEMPs are helpful in evaluating the physiological and pathological equilibrium system and in monitoring reflex reactions after treatment.

Adolescent↗
PubMed2006

Opsoclonus-myoclonus syndrome: a clinicopathological confrontation.

Opsoclonus-myoclonus syndrome (OMS), a movement disorder characterised by chaotic eye movements and myoclonus, is a rare clinical entity. We present two cases of opsoclonus-myoclonus syndrome of paraneoplastic origin. In the first patient the syndrome was associated with a breast carcinoma and in the second patient with a non small cell lung carcinoma. However none of the commonly associated antibodies were found in these cases. From the neuropathological findings from the first patient we find arguments that support the current hypothesis on the pathophysiology of OMS namely a dysfunction in brainstem and cerebellum. We conclude that in adults with OMS one has to be very suspicious of a possible neoplastic origin of the syndrome. The antibodies associated with some cases of OMS are thought to play a role in the pathophysiology of the syndrome although the exact immunologic mechanism remains unknown. Research into the neuropathological substrate of OMS yields a broad range of abnormalities in brain stem and cerebellum. However none of these findings seem to be pathognomonic. As for the possible therapy of OMS, several immunomodulating strategies can be used with varying success. At present there is no established standard therapy.

Brain↗
PubMed2006

[Childhood peripheral vestibular disorders: a report of three cases].

Vertigo is uncommon in childhood. Its etiology is different from that of adults. Both central and peripheral disorders may give rise to vertigo symptoms in pediatric patients. The evaluation of vertigo in children requires a detailed history taking, clinical examination, audiometric assessment, and vestibular function tests. We present three pediatric patients with vertigo symptoms, together with treatment methods and results of treatment. Their ages ranged from 10 to 14 years. The diagnoses were vestibular neuritis in one patient, and benign paroxismal positional vertigo in two patients. Treatment was comprised of vestibular rehabilitation for vestibular neuritis, and canalith repositioning maneuver for benign paroxismal positional vertigo. All the patients benefited well from the procedures applied.

Adolescent↗
PubMedDate not supplied

[Topographic and cytoarchitectonics analysis of the vestibular complex in rats].

The limits of the vestibular nuclei and accessory groups were analyzed in 7 rats. This information was taken using camera lucida drawings of the vestibular nuclei and their neurons in serial sections. The study of the morphometric parameters of the neurons (area and maximum diameter) were accomplished by means of a program for image analysis. The cells of the superior nucleus had an area and maximum diameter of 302.05 microns2 and 24.05 microns, those of the medial nucleus 222.98 microns2 and 20.49 microns, those of the lateral nucleus 609.94 microns2 and 34.21 microns, and the descending nucleus cells 327.55 microns2 and 25.24 microns. The cellular parameters of the associated groups were also studied and the distribution of them in several intervals was established.

Animals↗
PubMedDate not supplied

[Morphological and biochemical analysis of the organs and tissues of rats following a 30-day exposure to increased gravitational forces of 1.1 and 2.0 G].

During 30 days rats were centrifuged at 1.1 and 2.0 G. On centrifugation day 30 the rats showed body mass losses, decrease of plasma ACTH, activation of the renin-angiotensin-aldosterone system (RAAS) and ultrastructural changes in the mossy fiber terminals in the nodulus cortex which were indicative of the state of excitation (at 1.1 G) or excess excitation (at 2.0 G) in the system of the utriculus receptor cell and vestibular ganglion neuron (RCN). On the 2nd day after centrifugation the ultrastructural changes in the terminals pointed to a lower activity of the RCN system which was below the physiological norm. As compared to centrifugation day 30, the RAAS became more active on the 2nd day of recovery. On the 7th day of recovery (after centrifugation at 1.1 G) the RCN ultrastructure, RAAS and ACTH concentrations returned to the normal. The general trends of the RAAS and RCN changes seen on the 2nd day of recovery and identified by other authors at an acute stage of adaptation to microgravity suggest that the data obtained on the 2nd day of recovery may be used to analyze certain effects which develop during an acute stage of adaptation to microgravity in mammalian organs and systems responsible for the perception of modified gravity and their adaptation to a new level of gravity.

Adaptation, Physiological↗
PubMed1987

Importance of the visual cortex for postural stabilization: inferences from pigeon and frog data.

Optokinetically induced self-motion with its consequences for postural balance is based upon visual-vestibular convergence. It is a matter for speculation which visual pathways--subcortical accessory optic tract and/or cortical striate projection--convey optokinetic information to the central vestibular system. The functional significance of the visual cortex was tested by a behavioral approach in two animals, selected for their different evolutionary stage: frog (midbrain visual center); pigeon (primitive neocortical center). Lateral postural sway during optokinetic stimulation in roll served as a measurement for induced rollvection and apparent body tilt. Roll motion elicits a tonic 'compensatory' postural adjustment towards the direction of pattern motion in pigeon as in man but not in frog. From the lack of this reaction we infer that the frog does not perceive rollvection because it has no visual cortex. This agrees with the absence of visual-vestibular convergence in the frogs vestibular nuclei neurons as well as the absence of a nystagmus velocity storage in the brainstem. The animal experiments fit human data in hemianopic patients who also only experience rollvection when stimulated in the unaffected hemifield.

Animals↗