Glucocorticoids stimulate endolymphatic water reabsorption in inner ear through aquaporin 3 regulation.
Today, 9 Ιουνίου 2016, 1 minute ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Nevoux J, Viengchareun S, Lema I, Lecoq AL, Ferrary E, Lombès M
Abstract
Menière's disease, clinically characterized by fluctuating, recurrent, and invalidating vertigo, hearing loss, and tinnitus, is linked to an increase in endolymph volume, the so-called endolymphatic hydrops. Since dysregulation of water transport could account for the generation of this hydrops, we investigated the role of aquaporin 3 (AQP3) in water transport into endolymph, the K-rich, hyperosmotic fluid that bathes the apical ciliated membrane of sensory cells, and we studied the regulatory effect of dexamethasone upon AQP3 expression and water fluxes. The different AQP subtypes were identified in inner ear by RT-PCR. AQP3 was localized in human utricle and mouse inner ear by immunohistochemistry and confocal microscopy. Unidirectional transepithelial water fluxes were studied by means of (3)H2O transport in murine EC5v vestibular cells cultured on filters, treated or not with dexamethasone (10(-7) M). The stimulatory effect of dexamethasone upon AQP3 expression was assessed in EC5v cells and in vivo in mice. AQP3 was unambiguously detected in human utricle and was highly expressed in both endolymph secretory structures of the mouse inner ear, and EC5v cells. We demonstrated that water reabsorption, from the apical (endolymphatic) to the basolateral (perilymphatic) compartments, was stimulated by dexamethasone in EC5v cells. This was accompanied by a glucocorticoid-dependent increase in AQP3 expression at both messenger RNA (mRNA) and protein level, presumably through glucocorticoid receptor-mediated AQP3 transcriptional activation. We show that glucocorticoids enhance AQP3 expression in human inner ear and stimulate endolymphatic water reabsorption. These findings should encourage further clinical trials evaluating glucocorticoids efficacy in Menière's disease.
PMID: 25339224 [PubMed - indexed for MEDLINE]
Prognostic significance of vestibulospinal abnormalities in patients with vestibular migraine.
Today, 9 Ιουνίου 2016, 1 minute ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Jung JH, Yoo MH, Song CI, Lee JR, Park HJ
Abstract
OBJECTIVES: We evaluated vestibular function test results in vestibular migraine (VM) patients, including caloric, vestibular evoked myogenic potential (VEMP), and dynamic posturography measurements and assessed their relationship with treatment responses.
STUDY DESIGN: Retrospective case series review.
SETTING: Tertiary referral center.
METHODS: We investigated a cohort of 80 VM patients who had suffered recurrent vertigo attacks for more than 6 months. A combination of lifestyle modifications and prophylactic medications were used to treat these subjects. The patients were asked to score the treatment success by ranking symptom score from 0% to 100% for the improvement in overall severity of headache and vertigo. Patients were then classified as complete remission, symptomatic improvement 50% or more, or less than 50% improvement after 6 months of treatment. The periods needed for symptomatic improvement in the 50% or more patient group were recorded, and the responsiveness to medications and the vestibular test result metrics were analyzed to identify clinical outcome predictors.
RESULTS: A symptomatic improvement of 50% or more in vertigo and headache was observed in 71% and 75% of the study subjects across mean periods of 2.3 and 2.2 months, respectively. Improvements in vertigo and headache did not coincide in all. Abnormal caloric, VEMP, and vestibular ratio measurements were found in 25%, 29%, and 58%, respectively. Abnormal vestibular ratios on posturography showed a significant correlation with a poor treatment response of vertigo, and a normal VEMP was significantly related to complete remission from headache, although abnormal caloric results showed no significant correlation with treatment responses. A poor response of vertigo symptoms was observed in 6% of patients with a normal vestibular ratio and 48% of patients with abnormal vestibular ratio. Complete remission from headache was observed in 61% of patients with a normal VEMP and 30% in patients with an abnormal VEMP.
CONCLUSION: More than 70% of the patients with VM experienced improvements in both headache and vertigo through a combination of lifestyle changes and prophylactic medications. Abnormal vestibular ratios on posturography and abnormal VEMP responses were frequent findings in VM patients with recurrent attacks for more than 6 months and were indicators of a poor prognosis. The pathophysiology of VM appears to be closely related to vestibular abnormalities, especially in vestibulospinal pathways. Further study with a large population is needed to establish the relationship exactly.
LEVEL OF EVIDENCE: 2b Individual retrospective cohort study.
PMID: 25369908 [PubMed - indexed for MEDLINE]
Grey zones in the diagnosis of adult migraine without aura based on the International Classification of Headache Disorders-III beta: exploring the covariates of possible migraine without aura.
Today, 9 Ιουνίου 2016, 2 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Ozge A, Aydinlar E, Tasdelen B
Abstract
BACKGROUND: Exploring clinical characteristics and migraine covariates may be useful in the diagnosis of migraine without aura.
OBJECTIVE: To evaluate the diagnostic value of the International Classification of Headache Disorders (ICHD)-III beta-based diagnosis of migraine without aura; to explore the covariates of possible migraine without aura using an analysis of grey zones in this area; and, finally, to make suggestions for the final version of the ICHD-III.
METHODS: A total of 1365 patients (mean [± SD] age 38.5±10.4 years, 82.8% female) diagnosed with migraine without aura according to the criteria of the ICHD-III beta were included in the present tertiary care-based retrospective study. Patients meeting all of the criteria of the ICHD-III beta were classified as having full migraine without aura, while those who did not meet one, two or ≥3 of the diagnostic criteria were classified as zones I, II and III, respectively. The diagnostic value of the clinical characteristics and covariates of migraine were determined.
RESULTS: Full migraine without aura was evident in 25.7% of the migraineurs. A higher likelihood of zone I classification was shown for an attack lasting 4 h to 72 h (OR 1.560; P=0.002), with pulsating quality (OR 4.096; P<0.001), concomitant nausea⁄vomiting (OR 2.300; P<0.001) and photophobia⁄phonophobia (OR 4.865; P<0.001). The first-rank determinants for full migraine without aura were sleep irregularities (OR 1.596; P=0.005) and periodic vomiting (OR 1.464; P=0.026). However, even if not mentioned in ICHD-III beta, the authors determined that motion sickness, abdominal pain or infantile colic attacks in childhood, associated dizziness and osmophobia have important diagnostic value.
CONCLUSIONS: In cases that do not fulfill all of the diagnostic criteria although they are largely consistent with the characteristics of migraine in clinical terms, the authors believe that a history of infantile colic; periodic vomiting (but not periodic vomiting syndrome); recurrent abdominal pain; the presence of motion sickness or vertigo, dizziness or osmophobia accompanying the pain; and comorbid atopic disorder are characteristics that should to be discussed and considered as additional diagnostic criteria (covariates) in the preparation of the final version of ICHD-III.
PMID: 25493966 [PubMed - indexed for MEDLINE]
[Vertigo/dizziness and syncope from a neurological perspective].
Today, 9 Ιουνίου 2016, 2 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Machetanz J
Abstract
Vertigo/dizziness and syncope are among the most frequent clinical entities encountered in neurology. In patients with presumed syncope, it is important to distinguish it from neurological and psychiatric diseases causing a transient loss of consciousness due to another etiology. Moreover, central nervous disorders of autonomic blood pressure regulation as well as affections of the peripheral autonomic nerves can be responsible for the onset of real syncope. This is particularly relevant in recurrent syncope. Vertigo occurs in the context of temporary disorders, relatively harmless diseases associated with chronic impairment, as well as in acute life-threatening states. Patient history and clinical examination play an important role in classifying these symptoms. It is of crucial importance in this context, e.g., to establish whether the patient is experiencing an initial manifestation or whether such episodes have been known to occur recurrently over a longer period of time, as well as how long the episodes last. Clinical investigations include a differential examination of the oculomotor system with particular regard to nystagmus. The present article outlines the main underlying neurological diseases associated with syncope and vertigo, their relevant differential diagnoses as well as practical approaches to their treatment.
PMID: 25502655 [PubMed - indexed for MEDLINE]
Effects and tolerability of betahistine in patients with vestibular vertigo: results from the Romanian contingent of the OSVaLD study.
Today, 9 Ιουνίου 2016, 2 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Băjenaru O, Roceanu AM, Albu S, Zainea V, Pascu A, Georgescu MG, Cozma S, Mărceanu L, Mureşanu DF
Abstract
BACKGROUND AND METHODS: An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD). Endpoints were changes in the Dizziness Handicap Index (primary endpoint), Medical Outcome Study Short-Form 36 (SF-36v2(®)), and the Hospital Anxiety and Depression Scale.
RESULTS: During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale). Statistically significant improvements of 12-14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001). Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001) and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001). Betahistine was well tolerated, with only one suspected adverse drug reaction recorded in the Romanian safety population (n=259).
CONCLUSION: Betahistine 48 mg/day was associated with improvements in multiple measures of health-related quality of life and had a good tolerability profile in these Romanian patients with recurrent peripheral vestibular vertigo.
PMID: 25506241 [PubMed]
Patients who experience chronic dizziness
Today, 9 Ιουνίου 2016, 3 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Patients with long-lasting dizziness: a follow-up after neurotological and psychotherapeutic inpatient treatment after a period of at least 1 year.:
Authors: Schaaf H, Hesse G
Abstract
Patients who experience chronic dizziness are considered to be difficult to treat. Persisting symptoms of vertigo can be caused by recurrent organic as well as a variety of psychogenic factors, the latter usually being part of anxiety and depression disorders. Psychotherapeutic interventions can achieve improvements, the effects, however, in general do not persist over a longer time. The purpose of this study is to investigate the long-term effects of a symptom-related indoor treatment including neurotological and psychotherapeutic approaches as well as vestibular and balance rehabilitation. 23 indoor patients 16 male patients and 7 female., mean age 56.6 years (SD 12) with chronic vestibular symptoms (longer than six months), who were treated with neurotological counseling, psychotherapy, vestibular and balance rehabilitation and-if necessary-antidepressant drugs during a lengthy hospital stay [average 40 days (SD 14)], were re-examined. After a time period of at least one year (average 32 months; SD 15) they were asked to answer a questionnaire concerning post-therapeutic status of dizziness, symptoms and coping strategies as well as the Hospital Anxiety and Depression Score (HADS D). 18 of 23 patients (78%) reported a sustained reduction in their vertiginous symptoms. Four patients did not report a persistent improvement and one even got worse. Patients with a chronic form of dizziness can improve through a coordinated neurotologic and psychotherapeutic approach including vestibular and balance rehabilitation.
PMID: 25519474 [PubMed - indexed for MEDLINE]
Preoperative MRI in neurovascular compression syndromes and its role for microsurgical considerations.
Today, 9 Ιουνίου 2016, 3 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Tanrikulu L, Scholz T, Nikoubashman O, Wiesmann M, Clusmann H
Abstract
BACKGROUND: Neurovascular compression (NVC) in the posterior fossa is characterized by complex, three-dimensional (3D) neurovascular relationships at the root entry zones (REZ) and other parts of cranial nerves, resulting in syndromes such as trigeminal neuralgia (TN), hemifacial spasm, vertigo and glossopharyngeal neuralgia. Microvascular decompression (MVD) requires microsurgical experience and 3D orientation within the cisternal spaces to achieve adequate clinical results. The vascular structures in anatomical relation to the trigeminal nerve root at the lateral pontine aspect of the brainstem should be examined and maximally decompressed to minimize the risk of recurrent TN. Indication was traditionally based on clinical decisions, only. New MR techniques have become available, and their chances and potential impact should be evaluated in this study.
METHODS: In our study we examined 7 consecutive patients with TN and one patient with vertigo analyzing the details of NVC with high resolution magnetic resonance (MR) imaging in correlation to the intraoperative findings. All 8 patients underwent 1.5 T MRI with T2 fast spin echo. The MRI data were retrospectively analyzed and compared to the intraoperative findings with the focus on the length of the corresponding cranial nerve and topography of the NVC site, the distance of the location of the NVC from the surface of the brainstem.
RESULTS: The superior cerebellar artery (SCA) was the most common causative vessel in 5 of 8 cases (62.5%), the anterior inferior cerebellar artery (AICA) in 2 of 8 cases (25%) and veins in 1 of 8 cases (12.5%). The cisternal length of the examined trigeminal nerve on the high resolution MR images at the affected side ranged from 8.1mm to 10.8mm and on the unaffected contralateral sides from 9.4mm to 11.4mm. The vestibular nerve in one vertigo patient had an equal cisternal length of 18.0mm on either side, whereas the distance of the neurovascular conflict site was 8.0mm from the surface of the flocculus. The distance of the neurovascular conflict location site to the brainstem ranged from 1.4mm to 8.5mm on the reviewed MR image slices. One patient with vertigo showed an AICA loop in the MR images, which was confirmed intraoperatively. All causative vessels on the trigeminal nerve performed loops from cranially to caudally. All 7 patients (100%) with TN and one vertigo patient were symptom-free since discharge.
CONCLUSION: We show that high resolution MR images provide reliable and detailed information on corresponding intraoperative anatomy. Especially in unusual cases, the application of such MR techniques and preoperative evaluation may contribute to indication, planning, and also for teaching purposes.
PMID: 25524482 [PubMed - indexed for MEDLINE]
Accompanying Symptoms Overlap during Attacks in Menière's Disease and Vestibular Migraine.
Today, 9 Ιουνίου 2016, 3 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Lopez-Escamez JA, Dlugaiczyk J, Jacobs J, Lempert T, Teggi R, von Brevern M, Bisdorff A
Abstract
Menière's disease and vestibular migraine (VM) are the most common causes of spontaneous recurrent vertigo. The current diagnostic criteria for the two disorders are mainly based on patients' symptoms, and no biological marker is available. When applying these criteria, an overlap of the two disorders is occasionally observed in clinical practice. Therefore, the present prospective multicenter study aimed to identify accompanying symptoms that may help to differentiate between MD, VM, and probable vestibular migraine (pVM). Two hundred and sixty-eight patients were included in the study (MD: n = 119, VM: n = 84, pVM: n = 65). Patients with MD suffered mainly from accompanying auditory symptoms (tinnitus, fullness of ear, and hearing loss), while accompanying migraine symptoms (migraine-type headache, photo-/phonophobia, visual aura), anxiety, and palpitations were more common during attacks of VM. However, it has to be noted that a subset of MD patients also experienced (migraine-type) headache during the attacks. On the other hand, some VM/pVM patients reported accompanying auditory symptoms. The female/male ratio was statistically higher in VM/pVM as compared to MD, while the age of onset was significantly lower in the former two. The frequency of migraine-type headache was significantly higher in VM as compared to both pVM and MD. Accompanying headache of any type was observed in declining order in VM, pVM, and MD. In conclusion, the present study confirms a considerable overlap of symptoms in MD, VM, and pVM. In particular, we could not identify any highly specific symptom for one of the three entities. It is rather the combination of symptoms that should guide diagnostic reasoning. The identification of common symptom patterns in VM and MD may help to refine future diagnostic criteria for the two disorders.
PMID: 25566172 [PubMed]
Intravascular large B-cell lymphoma that presented with recurrent multiple cerebral infarctions and followed an indolent course]
Today, 9 Ιουνίου 2016, 4 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
[A case of
Authors: Mitsutake A, Kanemoto T, Suzuki Y, Sakai N, Kuriki K
Abstract
A 66-year-old woman presented with vertigo and deafness. Diffusion-weighted magnetic resonance imaging of the head showed multiple cerebral infarctions involving several blood vessel regions. A diagnosis of cardiogenic embolism was made, and anticoagulation therapy was begun. The woman had no additional symptoms until suddenly developing left hemiparesis one year later. She was again found to have multiple cerebral infarctions. The hemiparesis gradually improved, but ataxic gait and apraxia appeared and progressed over two weeks. Holter ECG, carotid ultrasound, and transthoracic/transesophageal echocardiography revealed no evidence of cardiogenic embolism. However, serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL2R) levels were elevated (LDH, 782 IU/l; sIL2R, 1,396 IU/ml), which suggested malignant lymphoma. Contrast chest/abdominal CT scan and gallium-67 scintigraphy revealed no evident lesions; however, random skin biopsy and open brain biopsy showed that blood vessels were infiltrated by CD20-positive atypical lymphocytes. These findings were consistent with intravascular large B-cell lymphoma. This type of lymphoma is known as a rapidly progressive disease with poor prognosis, but this case followed an indolent course, with a one-year interruption in disease progression.
PMID: 25746073 [PubMed - in process]
Misdiagnosis : Recurrent vertigo, hearing loss of the left ear, and tinnitus.
Today, 9 Ιουνίου 2016, 4 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
[Vestibular schwannoma: a case report of misdiagnosis]
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi.
Authors: You H, Li X, Wang W
Abstract
Vestibular schwannoma is a rare tumor, which is easily misdiagnosed. The authors presented a case of vestibular schwannoma in a 36-year-old woman. The clinical manifestations were recurrent vertigo, hearing loss of the left ear, and tinnitus. The pure tone audiometry threshold of the left ear was 45dBHL with air conduction, and 33 dBHL with bone conduction. A CT scan of the temporal bone region didn't show any abnormal finding. A MRI scan of the head showed nodule abnormal signal in the internal of left vestibular and the narrow of perilymphaticum gap in T2W1 + T2Flair. The initial diagnosis was Meniere's disease. And the post-operation pathologic diagnosis was vestibular schwannoma.
PMID: 25752127 [PubMed - indexed for MEDLINE]
Positive pressure therapy for Ménière's disease or syndrome.
Today, 9 Ιουνίου 2016, 5 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: van Sonsbeek S, Pullens B, van Benthem PP
Abstract
BACKGROUND: Ménière's disease is an incapacitating disease in which recurrent attacks of vertigo are accompanied by hearing loss, tinnitus and/or aural fullness, all of which are discontinuous and variable in intensity. A number of different therapies have been identified for patients with this disease, ranging from dietary measures (e.g. a low-salt diet) and medication (e.g. betahistine (Serc®), diuretics) to extensive surgery (e.g. endolymphatic sac surgery). The Meniett® low-pressure pulse generator (Medtronic ENT, 1999) is a device that is designed to generate a computer-controlled sequence of low-pressure (micro-pressure) pulses, which are thought to be transmitted to the vestibular system of the inner ear. The pressure pulse passes via a tympanostomy tube (grommet) to the middle ear, and hence to the inner ear via the round and/or oval window. The hypothesis is that these low-pressure pulses reduce endolymphatic hydrops.
OBJECTIVES: To assess the effects of positive pressure therapy (e.g. the Meniett device) on the symptoms of Ménière's disease or syndrome.
SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 6 June 2014.
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing positive pressure therapy (using the Meniett or a similar device) with placebo in patients with Ménière's disease. The primary outcome was control of vertigo; secondary outcomes were loss or gain of hearing, severity of tinnitus, perception of aural fullness, functional level, complications or adverse effects, and sick days.
DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, assessed risk of bias and extracted data. We contacted authors for additional data. Where possible, we pooled study results using a fixed-effect, mean difference (MD) meta-analysis and tested for statistical heterogeneity using both the Chi² test and I² statistic. This was only possible for the secondary outcomes loss or gain of hearing and sick days. We presented results using forest plots with 95% confidence intervals (Cl).
MAIN RESULTS: We included five randomised clinical trials with 265 participants. All trials were prospective, double-blind, placebo-controlled randomised controlled trials on the effects of positive pressure therapy on vertigo complaints in Ménière's disease. Overall, the risk of bias varied: three out of five studies were at low risk, one was at unclear risk and one was at high risk of bias. Control of vertigo For the primary outcome, control of vertigo, it was not possible to pool data due to heterogeneity in the measurement of the outcome measures. In most studies, no significant difference was found between the positive pressure therapy group and the placebo group in vertigo scores or vertigo days. Only one study, at low risk of bias, showed a significant difference in one measure of vertigo control in favour of positive pressure therapy. In this study, the mean visual analogue scale (VAS) score for vertigo after eight weeks of treatment was 25.5 in the positive pressure therapy group and 46.6 in the placebo group (mean difference (MD) -21.10, 95% CI -35.47 to -6.73; scale not stated - presumed to be 0 to 100). Secondary outcomes For the secondary outcomes, we carried out two pooled analyses. We found statistically significant results for loss or gain of hearing . Hearing was 7.38 decibels better in the placebo group compared to the positive pressure therapy group (MD) (95% CI 2.51 to 12.25; two studies, 123 participants). The severity of tinnitus and perception of aural fullness were either not measured or inadequate data were provided in the included studies. For the secondary outcome functional level , it was not possible to perform a pooled analysis. One included study showed less functional impairment in the positive pressure group than the placebo group (AAO-HNS criteria, one- to six-point scale: MD -1.10, 95% CI -1.81 to -0.39, 40 participants); another study did not show any significant results. In addition to the predefined secondary outcome measures, we included sick days as an additional outcome measure, as two studies used this outcome measure and it is a complementary measurement of impairment due to Ménière's disease. We did not find a statistically significant difference in sick days. No complications or adverse effects were noted by any study.
AUTHORS' CONCLUSIONS: There is no evidence, from five included studies, to show that positive pressure therapy is effective for the symptoms of Ménière's disease. There is some moderate quality evidence, from two studies, that hearing levels are worse in patients who use this therapy. The positive pressure therapy device itself is minimally invasive. However, in order to use it, a tympanostomy tube (grommet) needs to be inserted, with the associated risks. These include the risks of anaesthesia, the general risks of any surgery and the specific risks of otorrhoea and tympanosclerosis associated with the insertion of a tympanostomy tube. Notwithstanding these comments, no complications or adverse effects were noted in any of the included studies.
PMID: 25756795 [PubMed - indexed for MEDLINE]
Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable Meniere's disease.
Today, 9 Ιουνίου 2016, 5 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Sakagami M, Kitahara T, Ito T, Ota I, Nishimura T, Nishimura A, Otsuka S, Yamanaka T
Abstract
CONCLUSIONS: At the second postoperative year, there were no significant differences between results for vertigo and hearing after endolymphatic sac drainage with steroid instillation surgery (EDSS) and EDSS with posterior tympanotomy with steroids at the round window (EDRW). In particular, as regards hearing recovery to the preoperative level, the periods after EDRW were shorter than those after the second EDSS.
OBJECTIVES: Patients sometimes faces recurrent problems years after EDSS due to endolymphatic sac closure and/or disease progression. In the present study, we examined the effects of EDRW on vertigo and hearing after revision surgery for intractable relapsed Meniere's disease.
METHODS: Sixteen patients with Meniere's disease had revision surgery due to intractable recurrence of disease, and were followed up regularly at least for 2 years. As revision surgery, EDSS was performed repeated in eight cases and EDRW was performed in the other eight. There were no significant differences between the patients' backgrounds in the two groups.
RESULTS: Periods of hearing recovery to the preoperative level were 11.5 ± 4.4 months after the first EDSS, although it took 16.4 ± 2.6 months longer after revision surgery with the second EDSS (p = 0.038 < 0.05: first EDSS vs second EDSS) and was 10.0 ± 3.3 months shorter after revision surgery with EDRW (p = 0.010 < 0.05: second EDSS vs EDRW).
PMID: 25762028 [PubMed - indexed for MEDLINE]
Exercise-induced downbeat nystagmus in a family with a nonsense mutation in CACNA1A.:
Today, 9 Ιουνίου 2016, 5 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
in a Korean family
Authors: Choi JH, Seo JD, Choi YR, Kim MJ, Shin JH, Kim JS, Choi KD
Abstract
Episodic ataxia type 2 (EA2) is characterized by recurrent attacks of vertigo and ataxia lasting hours triggered by emotional stress or exercise. Although interictal horizontal gaze-evoked nystagmus and rebound nystagmus are commonly observed in patients with EA2, the nystagmus has been rarely reported during the vertigo attack. To better describe exercise-induced nystagmus in EA2, four affected members from three generations of a Korean family with EA2 received full neurological and neuro-otological evaluations. Vertigo was provoked in the proband with running for 10 min to record eye movements during the vertigo attack. We performed a polymerase chain reaction-based direct sequence analysis of all coding regions of CACNA1A in all participants. The four affected members had a history of exertional vertigo, imbalance, childhood epilepsy, headache, and paresthesia. The provocation induced severe vertigo and imbalance lasting several hours, and oculography documented pure downbeat nystagmus during the attack. Genetic analyses identified a nonsense mutation in exon 23 which has been registered in dbSNP as a pathogenic allele (c.3832C>T, p.R1278X) in all the affected members. Ictal downbeat nystagmus in the studied family indicates cerebellar dysfunction during the vertigo attack in EA2. In patients with episodic vertigo and ataxia, the observation of exercise-induced nystagmus would provide a clue for EA2.
PMID: 25784583 [PubMed - indexed for MEDLINE]
Light cupula of the horizontal semicircular canal occurring alternately on both sides: a case report.
Today, 9 Ιουνίου 2016, 6 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Shin JE, Kim CH
Abstract
BACKGROUND: The light cupula is a condition wherein the cupula of the semicircular canal has a lower specific gravity than its surrounding endolymph. It is characterized by a persistent geotropic direction-changing positional nystagmus in the supine head-roll test, and the identification of a null plane with slight head-turning to either side.
CASE PRESENTATION: This study describes a case of recurring light cupula that occurred alternately on both sides. At the first episode, a null plane was identified on the right side, which led to the diagnosis of a light cupula on the right side. At the second episode, a null plane was identified on the left side, leading to the diagnosis of a light cupula on the left side.
CONCLUSION: This is the first case report of recurring light cupula alternately involving both sides. Although the pathophysiology is not entirely understood yet, the light cupula should be considered as one of causes of recurrent positional vertigo.
PMID: 25792970 [PubMed]
Canal switch and re-entry phenomenon in benign paroxysmal positional vertigo: difference between immediate and delayed occurrence.
Today, 9 Ιουνίου 2016, 6 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Dispenza F, DE Stefano A, Costantino C, Rando D, Giglione M, Stagno R, Bennici E
Abstract
This prospective study was designed to evaluate the differences between immediate and delayed canal re-entry of otoliths after therapeutic manoeuvres in patients with benign paroxysmal positional vertigo (BPPV). A total of 196 patients with BPPV were visited and 127 matched our inclusion criteria. The mean age was 54.74 years. The horizontal semicircular canal (HSC) was involved in 30 cases and the posterior semicircular canal (PSC) in 97 patients. Patients with hearing loss in the ear affected by BPPV have a more recurrent form, compared to those with normal hearing. An immediate canal re-entry was recorded in 3 patients with HSC BPPV, all with geotropic nystagmus. In 7 patients with PSC BPPV, the immediate canal re-entry was detected and the delayed form was noted in 5 patients. The patients with the delayed canal re-entry underwent more than 2 previous manoeuvres. The canal re-entry was not related to the manoeuvre performed. The timing of the Dix-Hallpike test to verify the resolution of the BPPV had a significant role in immediate canal re-entry. A recurrence in the follow-up at least one month after treatment was recorded in 20 patients and was more frequent in patients that had canal re-entry. The canal re-entry or canal switch is a clinical entity that should be kept in mind of the neurotologist when approaching BPPV patients. It is important to distinguish it from recurrence when delayed and from manoeuvre failure when immediate. The timing of manoeuvre performing, in particular the final verification test after therapeutic sessions, is important to prevent the immediate reflux of particles into canals.
PMID: 26019396 [PubMed - in process]
Audiovestibular impairments associated with intracranial hypotension.
Today, 9 Ιουνίου 2016, 7 minutes ago | noreply@blogger.com (Alexandros G. Sfakianakis)
Authors: Choi JH, Cho KY, Cha SY, Seo JD, Kim MJ, Choi YR, Kim SH, Kim JS, Choi KD
Abstract
OBJECTIVE: To investigate the patterns and mechanisms of audiovestibular impairments associated with intracranial hypotension.
METHODS: We had consecutively recruited 16 patients with intracranial hypotension at the Neurology Center of Pusan National University Hospital for two years. Spontaneous, gaze-evoked, and positional nystagmus were recorded using 3D video-oculography in all patients, and the majority of them also had pure tone audiometry and bithermal caloric tests.
RESULTS: Of the 16 patients, five (31.3%) reported neuro-otological symptoms along with the orthostatic headache while laboratory evaluation demonstrated audiovestibular impairments in ten (62.5%). Oculographic analyses documented spontaneous and/or positional nystagmus in six patients (37.5%) including weak spontaneous vertical nystagmus with positional modulation (n=4) and pure positional nystagmus (n=2). One patient presented with recurrent spontaneous vertigo and tinnitus mimicking Meniere's disease, and showed unidirectional horizontal and torsional nystagmus with normal head impulse tests during the attacks. Bithermal caloric tests were normal in all nine patients tested. Audiometry showed unilateral (n=6) or bilateral (n=1) sensorineural hearing loss in seven (53.8%) of the 13 patients tested.
CONCLUSIONS: Intracranial hypotension frequently induces audiovestibular impairments. In addition to endolymphatic hydrops and irritation of the vestibulocochlear nerve, compression or traction of the brainstem or cerebellum due to loss of CSF buoyancy may be considered as a mechanism of frequent spontaneous or positional vertical nystagmus