Clinical Manifestations of Patients with Migraine-associated Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The clinical association between migraine and vestibular symptoms has been indicated in many studies and it is believed that migraine-associated vertigo is one of the most common causes of spontaneous recurrent vertigo. SUBJECTS AND METHOD: We investigated the nature of vestibular and migrainous symptoms of 26 patients suffering vertigo associated with migraine and their responses to antimigrainous medications. Neurotologic tests such as oculomotor tests, calorictest, and audiometry were performed between attacks. RESULTS: A marked female predominance was found. The duration of rotational (77%) and/or to-and-fro vertigo (23%) lasted from a few seconds to several hours or, less frequently, even days. We found that patients showed vestibular abnormalities in central and peripheral types. In the symptom-free interval, 31% of the patients showed central oculomotor signs such as delayed saccadic latency and horizontal saccadic pursuit. On the other hand, 15% showed unilateral weakness in the caloric test and 15% showed positive results in the head thrust tests. Overall, 85% of patients experienced resolution or significant reduction of their attacks of vertigo with medication. CONCLUSION: Most patients with migraine-associated vertigo showed normal results on the vestibular tests and responded well to preventive medication. Migraine-associated vertigo caused various clinical manifestations and there should be relevant differential diagnosis for epiodic vertigo.

Changes of VEMP Responses by the Strength of SCM Muscles Contraction and Stimulation Intensities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of the strength of SCM muscle contraction and the intensity of the sound stimulation on the VEMP parameters (amplitude, latency and threshold). SUBJECTS AND METHOD: Twenty normal subjects were included. Subjects pushed with their jaw against the hand-held inflated cuff to generate cuff pressures of 20, 40 and 60 mmHg and sequential stimulation intensities were applied. Variances of each parameter were analyzed. RESULTS: There was no significant difference in terms of threshold according to the side and strength of SCM contraction. P1-N1 amplitude demonstrated no significant differences according to the side ; however, the amplitude increased significantly as the cuff pressure and stimulation intensity increased. Interaural amplitude difference ratios showed an increased difference at 20 mmHg when compared to those at 60 mmHg. There was neither a cuff pressure effect, nor stimulation intensity effect when considering the P1 latencies. As for the N1 values, there was no stimulation intensity effect but there was a delayed latency at 20 mmHg when compared to those at 40 or 60 mmHg. Interaural latency difference of N1 latencies did not differ significantly according to the cuff pressure ; however, there was an increased difference at 20 mmHg when compared to those at 40 or 60 mmHg. CONCLUSION: This study shows that VEMP response is influenced by the cuff pressure and stimulation intensity, and we recommend to get each VEMP parameter using this feedback method in the clinical setting.

Cerebello-Pontine Angle Lipoma: Case Report and Review of the Literature

Intracranial lipomas located in the cerebellopontine angle are extremely rare. These tumors are maldevelopmental lesions which can cause slowly progessive neurological symptoms. The clinical management of these tumours differs significantly from other lesions in this region. A 45 year old man presented with a 3-month history of vertigo and tinnitus in the left ear. In T1-weighted magnetic resonance imaging, the lesion was hyperintense and did not enhance after application of gadolinium. The patient was treated with medical therapy with good response. We present a review of the literature, with particular regard to management. Conservative treatment is recommended and limited surgery is usually indicated if the patients suffer from disabling neurological symptoms and signs e.g., vertigo, nausea, trigeminal neuralgia, facial weakness or facial spasm.