1/5. multiple system atrophy manifested as dizziness and imbalance: a report of two cases.multiple system atrophy (MSA) is a progressive neurodegenerative disease of undetermined origin that occasionally manifests as dizziness and imbalance. It is not often considered in clinical situations, especially not by neuro-otological consultants. Hence, we report our recent experience with two cases of MSA. One is that of a 62-year-old man with MSA with a predominant cerebellar feature, and the other is that of a 72-year-old man with MSA with a predominant parkinsonian feature. The results of the syncopic study correlated with orthostatic hypotension. The neuro-otological study in both patients revealed an abnormal eye tracking test, abnormal optokinetic nystagmus test and loss of visual suppression in the caloric nystagmus. These indicate that the central vestibular system, e.g., the cerebellum or brain stem, is affected by MSA, contributing to dizziness and imbalance. Therefore, diagnosis of MSA should be kept in mind by neuro-otological consultants when dealing with patients with dizziness and imbalance, especially when this is accompanied by orthostatic hypotension.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
2/5. Migraine-associated dizziness.We reviewed the clinical histories, examinations and results of quantitative vestibular testing in 91 patients with migraine-associated dizziness. nausea and vomiting, hypersensitivity to motion and postural instability accompanied the dizziness. In the majority of patients, the temporal profile of the dizziness was more typical of the headache phase of migraine than of the aura phase. Nineteen patients (20.9%) had unilateral hypoexcitability to caloric stimulation, which represents a modestly increased risk of damage to the peripheral vestibular apparatus. We propose two separate pathophysiologic mechanisms for the production of dizziness with migraine: Short-duration vertiginous attacks lasting minutes to 2 hours and temporally associated with headache are due to the same mechanism as other aura phenomena (spreading wave of depression and/or transient vasospasm). Longer-duration attacks of vertigo and motion sickness lasting days, with or without headache, result from the release of neuroactive peptides into peripheral and central vestibular structures, causing an increased baseline firing of primary afferent neurons and increased sensitivity to motion.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
3/5. Lesion site in idiopathic bilateral vestibulopathy: a galvanic vestibular-evoked myogenic potential study.CONCLUSION: The result suggests that patients with idiopathic bilateral vestibulopathy may have nerve lesions when the inferior nerve system is affected, while the inferior vestibular nerve system may be spared. OBJECTIVE: To clarify the lesion site in idiopathic bilateral vestibulopathy, an acquired bilateral vestibulopathy of unknown cause. MATERIAL AND methods: Two 75-year-old males diagnosed with idiopathic bilateral vestibulopathy were enrolled. Both showed absent or highly decreased responses on the caloric test on both sides. They underwent vestibular-evoked myogenic potential (VEMP) testing by means of acoustical and electrical stimulation. As acoustic stimulation, 95 dB nHL clicks and short tone bursts (500 Hz) were presented, while 3 mA (1 ms) short-duration galvanic stimuli were presented as electrical stimulation. Responses were recorded on the sternocleidomastoid muscles. RESULTS: Both patients showed unilateral absence of VEMPs with both acoustic and short-duration galvanic stimuli.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
4/5. dizziness in childhood.dizziness in childhood is not an infrequent symptom. Accurate history taking and close co-operation between otologist, paediatrician and neurologist are necessary in the approach to the dizzy child. Most cases of childhood dizziness settle in time and investigations should be carefully selected; those with severe and persistent dizziness or ataxia should be thoroughly investigated including: EEG, ENG, calorics and CT scan. The conditions causing dizziness in children are discussed and are illustrated with case histories from our series of 27 children. dizziness of unknown aetiology, serous otitis media and benign paroxysmal vertigo were the most common diagnostic labels applied to our patients. Treatment is rarely necessary but dimenhydrinate or a labyrinthine sedative in those with troublesome vertigo, or the adjustment of the medical regime in those epileptics on phenytoin, may be beneficial. Surgical intervention is only required in those with an operable lesion.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
5/5. An approach to quantify central vestibular compensation.Central vestibular compensation is the ultimate goal for the dizzy patient. Monitoring spontaneous nystagmus and caloric responses are not usually correlated with the patient progress and cannot be objectively documented. On the other hand, Temporal Asymmetry Shift (TAS) is a more accurate and objective measure of central vestibular compensation. Furthermore, its dynamic pattern offers a reliable indicator to differentiate between peripheral and central vestibular dysfunctions.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |