Factores asociados a falla terapéutica con maniobras de reposición canalicular en pacientes con diagnóstico de vértigo posicional paroxístico benigno en la Clínica de Otorrinolaringología de Antioquia, Medellín, Colombia / Factors associated with therapeutic failure with canalicular repositioning maneuvers in patients diagnosed with benign paroxysmal positional vertigo at Antioquia Otorhinolaryngology Clinic, Medellin, Colombia"

Introducción: múltiples factores se han relacionado con el desarrollo de la recurrencia del vértigo posicional paroxístico benigno (VPPB). Objetivo: determinar la asociación entre la falla terapéutica de las maniobras de reposición canalicular (MRC) y las variables sociodemográficas y clínicas en los pacientes con diagnóstico de VPPB. Diseño: estudio observacional de cohorte retrospectiva. Materiales y métodos: revisión de historias clínicas de la consulta de vértigo de la Clínica Orlant, Medellín, Colombia. Resultados: se incluyeron 41 pacientes con diagnóstico de VPPB a quienes se les realizó MRC y seguimiento clínico entre 1 y 8 semanas. El 90,2 % eran de sexo femenino, con una mediana de edad de 58 (±183) años; se encontró uso de vestibulosupresores en un 68,3 %, y es la betahistina el más consumido (43,9 %). El 51,2 % de pacientes presentaron falla terapéutica y se identificó una asociación con el número total de MRC realizadas y el uso de vibrador mastoideo (p < 0,001), teniendo en cuenta que los pacientes mejoraron clínicamente al final del seguimiento con una media de 77 % (p < 0,001). No se encontraron asociaciones estadísticamente significativas con el resto de variables. Conclusión: no hubo asociación entre la falla terapéutica y las variables estudiadas, excepto número de MRC, el uso del vibrador mastoideo y la mejoría clínica final, posiblemente porque el vibrador mastoideo se aplica a los pacientes en quienes hay persistencia de síntomas y signos con las maniobras desencadenantes, y por factores fisiopatológicos no esclarecidos; con esto finalmente se logra una mejoría clínica con más de dos MRC

Introduction: Multiple factors have been related to the development of recurrence of benign paroxysmal positional vertigo (BPPV). Objective: To determine the association between therapeutic failure of canalicular repositioning maneuvers (CRM) with sociodemographic and clinical variables in patients with a diagnosis of BPPV. Design: Observational retrospective cohort study. Materials and methods: Review of medical records of the vertigo clinic of the Orlant Clinic, Medellín - Colombia. Results: 41 patients with a diagnosis of BPPV who underwent CRM and clinical follow-up between 1 and 8 weeks were included. 90.2% were female, with a median age of 58 (± 18.3) years, use of vestibulosuppressants was found in 68.3%, betahistine being the most consumed (43.9%). 51.2% of patients presented therapeutic failure, identifying an association with the total number of CRMs performed and the use of a mastoid vibrator with (p < 0.001), taking into account that the patients improved clinically at the end of follow-up with a mean of 77% (p < 0.001). No statistically significant associations were found with the rest of the variables. Conclusion: There was no association between therapeutic failure and the variables studied except number of CRM, use of the mastoid vibrator and final clinical improvement, possibly because the mastoid vibrator is applied to patients in whom there are persistence of symptoms and signs with the triggering maneuvers for unclear pathophysiological factors, finally achieving clinical improvement with more than two CRMs.

Interpretación de resultados de las pruebas oculomotoras, posicionales y calóricas de la videonistagmografía. Revisión documental / Interpretation of the results of the oculomotor, positional and caloric test of the videonistagmography. Documentary review

Introducción: en la actualidad, se reconocen cuadros vestibulares periféricos y centrales que pueden ser diagnosticados mediante la videonistagmografía (VNG). Los avances en la tecnología han provocado en los profesionales una constante actualización en el uso e interpretación de las distintas pruebas que conlleven, en su lectura cruzada, un diagnóstico acertado y a tratamientos de rehabilitación exitosos. El objetivo fue describir las interpretaciones de los resultados de las pruebas oculomotoras, posicionales y calóricas de la VNG para lograr un diagnóstico detallado de las disfunciones vestibulares. Materiales y métodos: revisión documental obtenida de 40 fuentes reportadas en la literatura científica entre 2010 a 2020 tomadas de bases de datos, tesis de grado y libros. Discusión: dentro de la revisión se encontraron tres categorías (pruebas oculomotoras, posicionales y calóricas) y siete subcategorías (nistagmo espontáneo, nistagmo evocado por la mirada, rastreo, sacadas, optocinético, Dix-Hallpike y roll test). Conclusión: los diversos elementos encontrados en la presente revisión son relevantes ya que precisan no solo el tipo de vértigo, sino también su localización topográfica, lo que favorece el proceso de evaluacióndiagnóstico en la población en general.

Introduction: At present, peripheral and central vestibular frames are recognized that can be diagnosed by videonystagmography (VNG). Advances in technology have caused professionals to constantly update the use and interpretation of the different tests that lead, in their cross-reading, to an accurate diagnosis and successful rehabilitation treatments. The objective was to describe the interpretations of the results of the oculomotor, positional and caloric tests of the VNG, for a detailed diagnosis of the vestibular dysfunctions. Materials and method: Documentary review obtained from 40 sources reported in the scientific literature between 2010 and 2020, taken from databases, thesis and books. Discussion: Within the review, three categories were found (oculomotor, positional and caloric tests) and seven subcategories (spontaneous nystagmus, gaze-evoked nystagmus, tracking, saccades, optokinetic, Dix-Hallpike and roll test). Conclusion: The various elements found in this review are relevant in that they specify not only the type of vertigo but also its topographic location, favoring the evaluation-diagnosis process in the general population.

Visual outcomes of audio-luminous biofeedback training for a child with idiopathic nystagmus / Desfechos visuais de treinamento de biofeedback audioluminoso em criança com nistagmo idiopático

ABSTRACT Microperimetry biofeedback training is a vision rehabilitation method that involves the training of attention and oculomotor control, and the rehabilitation of poorly located and non-functional preferred retinal loci. It can significantly improve distance and near visual acuity in age-related macular degeneration. Previous studies have shown that biofeedback training using electrical nystagmography can reduce nystagmus amplitude and increase foveation time. However, these improvements have not been sustained following training sessions. We hereby report a pediatric case of idiopathic nystagmus in an 11-year old patient treated with microperimetric biofeedback to improve visual acuity and fixation stability. The training had a beneficial impact, positively affecting fixation stability as well as distance and near reading vision. Subjectively, improvement in quality of life was also reported. Conversely to previous studies, the positive effects in this case were maintained for as long as twelve months following therapy. To the best of our knowledge, this is the first case with long-term benefits to be reported in the literature.(AU)

RESUMO O treinamento de biofeedback por microperimetria é um método de reabilitação da visão que envolve treinamento de atenção, controle oculomotor e reabilitação do locus preferencial de fixação da retina. Esse treinamento pode melhorar significativamente a acuidade visual para longe e perto na degeneração macular relacionada à idade. Estudos anteriores mostraram que o treinamento de biofeedback usando a nistagmografia elétrica pode reduzir a amplitude do nistagmo e aumentar o período de foveação. Entretanto, os resultados não se mantiveram após o término das sessões. Aqui é relatado um caso de tratamento com biofeedback por microperimetria para melhorar a acuidade visual e a estabilidade de fixação em uma criança de 11 anos de idade. O treinamento teve impacto benéfico e afetou positivamente a estabilidade da fixação e a visão para longe, para perto e de leitura. Subjetivamente, foi relatada melhoria da qualidade de vida. Em contraste com estudos anteriores, os efeitos positivos foram mantidos até 12 meses após a terapia. Até onde sabemos, este é o primeiro caso na literatura que relata benefícios de longo prazo.(AU)

A case of jerky seesaw nystagmus caused by mesencephalic and thalamic infarcts / 中华神经科杂志

Seesaw nystagmus is a rare spontaneous ocular movement,which refers to mixed torsional-vertical nystagmus with conjugate torsional components and the vertical components in the opposite directions.It is divided into the pendular and jerky types,according to the movement features.Seesaw nystagmus has not been reported in China.We herein report a case of jerky seesaw nystagmus caused by mesencephalic and thalamic infarcts,in order to improve awareness about the ocular sign.

Persistent geotropic direction-changing positional nystagmus: an independent disease entity? / 中华耳鼻咽喉头颈外科杂志

Persistent geotropic direction-changing positional nystagmus (DCPN) has been described in recent years as no latency or fatigability but a null plane when head is turned toward the affected side. Different from the canalolithiasis of horizontal semicircular canal, it is similar with cupulolithiasis, but the direction of nystagmus are opposite. Light cupula theory has been used to explain the characteristics of this unique nystagmus. In this paper, the characteristics, possible etiologies, pathogenesis, related diseases, diagnosis, treatment and prognosis of DCPN are reviewed.

Síndrome da deiscência do canal semicircular superior: relato de dois casos / Semicircular superior canal dehiscence: cases reports

RESUMO A Síndrome da Deiscência do Canal Semicircular Superior (SDCSS) é caracterizada pelo desgaste da camada óssea que recobre o canal semicircular superior. São sintomas comuns da SDCSS a presença de vertigem associada à nistagmos induzidos por estímulos sonoros intensos ou por modificações das pressões intracraniana ou da orelha média. O objetivo deste trabalho é descrever os achados audiólogicos e vestibulares de dois pacientes com diagnóstico de Síndrome da Deiscência do Canal Semicircular Superior, com diagnóstico confirmado por meio de tomografia computadorizada. Foram realizadas meatoscopia, anamnese, audiometria tonal e vocal seguida das medidas de imitância acústica, Weber audiométrico, pesquisa do fenômeno de Túlio e manobra de Valsalva, realizados pela mesma pesquisadora em uma única sessão. Foram observados gap aéreo-ósseo, curva timpanométrica tipo A e reflexos acústicos presentes. O gap aéreo-ósseo apresenta-se com maior amplitude nas frequências baixas. As queixas auditivas não foram relatadas pelas pacientes como os primeiros sintomas. O Weber mostrou lateralização, nos dois casos, confirmando a presença de gap. O fenômeno de Túlio apresentou-se positivo para vertigem em ambos os casos. A manobra de Valsalva apresentou alteração em apenas um caso.

ABSTRACT The Superior Semicircular Canal Dehiscence Syndrome (SSCDS) is characterized by bone wear layer overlying the superior semicircular canal. Common symptoms of SSCDS the presence of vertigo associated with nystagmus induced by intense sound stimuli or changes in intracranial pressure or middle ear. The aim of this study is to describe the audiological and vestibular findings of two patients diagnosed with Superior Semicircular Canal Deiscence Syndrome, with confirmed diagnosis by computed tomography. Meatoscopy, anamnesis, pure tone audiometry and vocal followed by the acoustic impedance measurements, audiometric Weber, research Tulio phenomenon and Valsalva maneuver, performed by the same researcher in one session were held. Air-bone gap were observed, type A tympanometric curve and acoustic reflex. The air-bone gap is presented with greater amplitude at low frequencies. Hearing complaints were not reported by patients as the first symptoms. Weber showed lateralization in both cases, confirming the presence of gap. The Thulium phenomenon is positive for vertigo in both cases. The Valsalva maneuver showed a change in only one case.

Clinical manifestation and gene analyses of 15 patients with intellectual disability or developmental delay complicated with congenital nystagmus / 中华儿科杂志

Objective@#To analyze the clinical and genetic features of 15 cases with intellectual disability or developmental delay (ID/DD) complicated with congenital nystagmus.@*Method@#The clinical characteristics and the results of laboratory tests, images and genetics of 15 patients with ID/DD complicated with congenital nystagmus, confirmed by gene diagnosis in the Department of Neurology, Children's Hospital Affiliated to Capital Institute of Pediatrics from March 2015 to October 2016, were retrospectively analyzed. The physiological function of 13 disease genes and the molecular signaling pathways were also comparatively studied.@*Result@#The patients included 11 males and four females, with an age of 2 months-15 years (median age 27 months). The result of multiplex ligation-dependent probe amplification was positive in two patients only with hypomyelination on head MRI. Positive results were found in 13 patients with or without abnormal head MRI or other deformities using targeted capture technology and next generation sequencing. Two patients were diagnosed with Pelizaeus-Merzbacher disease, two had hypomyelination with an atrophy of the basal ganglia and cerebellum and two had oculocutaneous albinism. Pelizaeus-Merzbacher-like disease was found in one case, cerebro-oculo-facio-skeletal syndrome in one case, Rubinstein-Taybi syndrome in one case, mental retardation type 5 in one case, methylmalonic aciduria combined with hyperhomocysteinemia in 1 case, ataxia telangiectasia in one case, hypomyelinating leukodystrophy type 8 in one case, Marinesco-Sjögren syndrome in one case and CHARGE syndrome in one case. A total of 12 novo mutations were reported in this study.@*Conclusion@#The causes of children with ID/DD complicated with congenital nystagmusis are complex. Comprehensive clinical and auxiliary examinations should be performed to improve the accuracy of the diagnosis. Reasonable application of different genetic testing methods can significantly improve the diagnostic accuracy of molecular genetic etiology in children with ID/DD.

The exploration on optimization of two alternatives between roll test and Dix-Hallpike test in benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the objective characteristics of roll test and Dix-Hallpike test in benign paroxysmal positional vertigo(BPPV)patients, discussing the premier solution of positional test.@*Methods@#A total of 230 patients with BPPV, whereas 170 posterior semicircular canal canalithiasis (PSC-Can) BPPV and 60 horizontal semicircular canal canalithiasis (HSC-Can) BPPV were involved respectively. The induced nystagmus in roll test and Dix-Hallpike test was recorded by video nystagmuo graph (VNG), and the direction, intensity and time characteristics of nystagmus were compared in various BPPV.SPSS19.0 software was used for statistical analysis.@*Results@#Vertically upward nystagmus was induced by hanging in 170 PSC-Can Dix-Hallpike test, and the nystagmus reversed and turned weaker when the subjects came to sit. The intensity of nystagmus at turning to lesion side by hanging and sitting were (30.3±14.1)°/s and (12.6±7.5)°/s respectively, the difference was statistically significant (t=20.153, P<0.05). However, no nystagmus was induced in PSC-Can roll test. Horizontal nystagmus in the same direction with turning was induced in 60 HSC-Can roll test. The intensity of nystagmus at turning to lesion side and normal side was (42.0±18.0)°/s and (20.3±8.7)°/s respectively, the difference was statistically significant (t=12.731, P<0.05). Furthermore, horizontal nystagmus in the same direction with turning was induced in 57 HSC-Can Dix-Hallpike. The coherence was 95% with the results of roll test.@*Conclusions@#Dix-Hallpike test can not only be used to diagnose PSC-Can, but also induce nystagmus in HSC-Can effectively. Whereas the roll test only show significance in diagnosing HSC-Can. To avoid uncomfortable stimulation to patients as much as possible, we suggest to use Dix-Hallpike test at first, and to judge whether using roll test based on the result of the horizontal nystagmus.

Light cupulopathy: persistent direction changing positional nystagmus with a null plane / 中华耳鼻咽喉头颈外科杂志

Objective@#The purpose of this study was to report two cases of light cupulopathy, and describe the characteristics of these cases and analysis the possible physiopathological mechanisms.@*Methods@#The histories, clinical features, characteristics of nystagmus, and vestibular function, as well as audiologic results of the two patients with light cupula were analyzed.@*Results@#The two patients showed persistent geotropic direction changing positional nystagmus(DCPN)in the supine head roll tests. The null plane was present when the head was turn slightly towards affected side. Canalith repositioning maneuver was not effective. A mild sensorineural hearing loss was found on the involved ear in one patient but not in the other. The vestibular functions of two patients were abnormal.@*Conclusions@#The characteristics of nystagmus with light cupulopathy are persistent geotropic DCPN with a null plane. The clinical features are similar with the horizontal semicircular canal canalolithasis. Canalith repositioning maneuver is not recommended for its ineffectiveness.

The clinical features and efficacy of patients with geotropic direction-changing positional nystagmus / 中华耳鼻咽喉头颈外科杂志

Objective@#The purpose of this study was to observe the clinical characteristics of two types of geotropic direction-changing positional nystagmus, the transient(nystagmus time <1 min) and the persistent(nystagmus time > 1 min), and to evaluate the efficacy of the barbecue roll maneuver.@*Methods@#A total of 105 cases diagnosed by supine roll test were studied, which including 35 males and 70 females and the average age was (56.9±14.6)years. There were 70 transient geotropic DCPN and 35 persistent geotropic DCPN. The clinical characteristics and the immediate and one-week efficacy of the barbecue roll maneuver were discussed.@*Results@#The nystagmus disappeared at the null-point position and the nystagmus in supine position were opposite to the bowing (90° nose-down) position in persistent geotropic DCPN cases. While to the transient geotropic DCPN cases, there were no NP and no nystagmus in prone position. The ratio of the first onset of the two groups was 28.6% (persistent) and 72.9% (transient) respectively, and the difference was statistically significant (P<0.05). The immediate and one-week efficacy after barbecue roll maneuver were 91.4% and 80.0% in transient geotropic DCPN cases, and 0% and 42.9% in persistent geotropic DCPN cases, which were statistically significant different(P<0.05).@*Conclusions@#The light cupula hypothesis can mainly explain the clinical features of persistent geotropic DCPN cases; the barbecue roll maneuver is invalid to persistent geotropic DCPN cases which can be self-healing.

Phase portrait analysis of eye movement waveforms in congenital nystagmus eyes / 中华实验眼科杂志

Background The characteristics of eye movement waveforms in congenital nystagmus eyes is so complicated that the time-series waveform can hardly demonstrate the oscillational kinetic property of the eye movement of nystagmus,which is not convenient for the clinical diagnosis and evaluation.The eye movement system is a nonlinear feedback control system,and phase portrait analysis is a useful method in describing the characteristics of movement in a nonlinear system.Objective This study was to establish the phase portrait analysis method of the eye movement waveforms in congenital nystagmus eyes and provide a new technique for the clinical diagnosis and evaluation of congenital nystagmus.Methods A prospective series-case observational study was performed.This study complied with the Declaration of Helsinki and was approved by Ethic Commission of Tianjin Eye Hospital.Written informed consent was obtained from each patient before examination.Twenty-five patients with congenital nystagmus were enrolled and received examination of video-oculography (VOG) in Tianjin Eye Hospital from April 2012 to February 2013,including 12 patients with congenital motor nystagmus (CMN) and 13 patients with latent nystagmus (LN).The VOG data were format-converted and processed by a Matlab routine.VOG-based phase portraits of eye movement cycles were drawn and related parameters were measured from the phase portraits for further analysis and comparison.Main measurement indexes were cycle position shift (CPS),slow phase peak velocity (SPV),standardized slow-phase peak (SSPV),fast phase peak velocity (FPV) and standardized fast-phase peak velocity (SFPV).Two principal types of waveforms,increasing-velocity type and decreasing-velocity type were compared.Results The phase portraits of the waveforms of congenital nystagmus were cycles of reciprocating trajectories.The slow phases were in dense ribbon region,and the fast phases were in sparse annular region,and all the trajectories travelled in clockwise.The CPS,SPV and FPV of increasing-velocity type were (4.646 ± 1.565),(223.821 ± 114.049),(767.481 ±263.560) ° per second,respectively.The CPS,SPV and FPV of decreasing-velocity type were (9.373 ±4.189),(357.531 ± 154.300) and (1 148.706 ±541.362) ° per second,respectively.The SPVs and FPVs of both increasing-velocity type and decreasing-velocity type showed strong correlation with CPS,respectively (the increasing-velocity type:rSPV-CPS =0.685,P=0.000;rFPV-CPS =0.680,P=0.000;the decreasing-velocity type rSPV-CPS =0.783,P =0.000;rFPV-CPS =0.803,P =0.000).FPVs were significantly larger than SPVs in both types of waveforms (t =6.558,P =0.000;t =5.068,P =0.000).The SSPV of increasing-velocity type was (48.062 ± 15.365) ° per second,which was slightly larger than (41.099± 17.027) ° per second of decreasing-velocity type,with no significant difference between them (t=1.070,P=0.296).The SFPV of increasing-velocity type was (171.186±47.825)° per second,which was larger than (125.317-±38.266)° per second of decreasing-velocity type,showing a significant difference between them (t =2.658,P =0.014).Conclusions Phase portraits can visualize the cyclically dynamic features of congenital nystagmus in a direct way.It facilitates the measurement of eye movement amplitude,speed and other parameters.The phase portrait analysis method provides a novel useful tool in the clinical diagnosis and treatment efficacy evaluation of congenital nystagmus.

Relationship between nystagmus and effectiveness in Semont maneuver for patients with benign paroxysmal positional vertigo / 中华全科医师杂志

Semont maneuver was performed in 97 patients with benign paroxysmal positional vertigo involving the posterior semicircular canal.Among 97 patients the Semont maneuver was successful in 69 cases and failed in 28 cases.There were three nystagmus patterns during the third position of the Semont maneuver:orthotropic nystagmus (n=45), no nystagmus (n=42) and reversed nystagmus (n=10);and the effective rates in three groups were 93%, 64% and 0%, respectively (P0.05) .

A Case of Creutzfeldt-Jakob Disease Presenting Mainly with Abnormal Eye Movements / 대한평형의학회지

Creutzfeldt-Jakob disease (CJD) is a human prion disease with rapidly progressive neurodegeneration. The major clinical manifestations of CJD include mental deterioration, myoclonus, cerebellar dysfunction, and neuro-ophthalmic symptoms and signs. However, abnormal eye movements as an early sign of CJD are rare. We report a 49-year-old man with periodic alternating nystagmus in early disease course.

"Cherry red spot" in a patient with Tay-Sachs disease: case report / "Mácula em cereja" em paciente com doença de Tay-Sachs: relato de caso

Tay-Sachs disease is an autosomal recessive disorder of sphingolipid metabolism, caused by enzime hexosaminidase A deficiency that leads to an accumulation of GM2 in neurocytes which results in progressive loss of neurological function. The accumulation of lipid in retinal ganglion cells that leads to a chalk-white appearance of the fundus called "cherry red spot" is the hallmark of Tay-Sachs disease. It is also seen in others neurometabolic diseases as well as in central retinal artery occlusion. This case reports a child with Tay-Sachs disease in a family with four previous similar deaths without diagnostic.

Tay-Sachs é uma doença autossômica recessiva, caracterizada pela deficiência da enzima hexosaminidase A levando ao acúmulo de esfingolipídios (GM2) em células neuronais que resulta em uma perda progressiva da função neurológica. O acúmulo de lipídios em células ganglionais da retina leva a uma aparência de mácula em cereja, característica do fundo de olho de pessoas acometidas. "Mácula em cereja" também pode ser vista em outras doenças neurometabólicas e em oclusão da artéria central da retina. Este trabalho relata o caso de um paciente com doença de Tay-Sachs em uma família com história de quatro óbitos por causas semelhantes sem diagnóstico.

The Role of Frequency Complementarities of Vestibular Tests in the Evaluation of Vestibular Function / 天津医药

Objective: To analyze the role of frequency complemcntarities of vestibular tests including caloric test (CT),head shaking test(HST),and vibration test(VT) in the evaluation of vestibular function. Methods: Five hundreds and eightyfour patients with unilateral peripheral lesions were tested with CT, HST and VT in order to compare the frequency characteristic of abnormal vestibular function. Results: Of the 584 patients, 189 (32.36%), 283 (48.46%) and 368 (63.01%)cases showed vibration-induced nystagmus (VIN), head shaking nystagnms (HSN) and abnormal unilateral weakness (UW)respectively. There were 22 isolated VIN, 52 HSN and 145 cases of abnormal UW respectively. One hundred and fifty-nine (27.23%) cases had combination damage of two frequency bands, 101 (17.29%) had vestibular damage at all frequency bands,479 (82.02%) had abnormal results in any of the three tests, and 105 (17.98%) had no abnormality in all those three tests.Through consistency test, CT and HST (Kappa=0.106, P＜ 0.05), CT and VT(Kappa=0.068, P＜ 0.05), VT and HST (Kappa=0.321, P＜0.05) showed low consistency among them. VIN and HSN were more hkely to be evoked with the increasing of the UW (X'2VIN=22.686,X2HSN=23.023, P＜ 0.05). Conclusion: The vestibular damage in the patients with vertigo could reflect at isolated low, middle, high frequency or multi frequency bands. Thus, CT, HST and VT all make significant contributions to multiple-frequency analysis of vestibular function and show a well complementarities. So they can be used in evaluating the overall function of the vestibular and indicating a serious vestibular lesion if the damage affected multi frequency bands.

Periodic Alternating Nystagmus in Vestibulocochlear Disorder / 대한평형의학회지

Periodic alternating nystagmus (PAN) is characterized by horizontal nystagmus that reverses direction periodically. PAN can occur in both congenital and acquired conditions. We report a 58-year old man with peripheral vertigo and hearing impairment showing PAN in darkness.

A Case of Lateral Medullary Syndrome with Ipsilesional Nystagmus due to Intramedullary Hemorrhage / 대한평형의학회지

We report a rare case of primary dorsal medullary hemorrhage showing lateral medullary syndrome with ipsilesional nystagmus. A 41-year woman, presented with the first degree horizontal vestibular nystagmus and ocular tilt reaction to the left in lateral medullary hemorrhagic lesion. Primary medullary hemorrhage is rare and details of the abnormal eye movement in the lesion have never been described well. While most of the reported vestibular nystagmus in the lateral medullary infarction was contralesional., the nystagmus in this case was ipsilesional. This ipsilesional beating of the nystagmus might be explained that either destruction of the rostral part of vestibular nuclei or irritative effect of blood to vestibular nuclei is responsible. In addition, ocular tilt reaction (OTR) can be more important in deciding the side of the lesion in medullary hemorrhage

The effect of Brandt-Daroff exercises on positional vertigo with atypical positioning nystagmus / 中国耳鼻咽喉头颈外科

OBJECTIVE Identify the effect of Brandt-Daroff exercises for positional vertigo with atypical positioning nystagmus.METHODS 11 cases of positional vertigo during 2006～2007 with atypical positioning nystagmus when carrying Dix-Hallpike and roll test,the nystagmus had the follwing characters:poly-positions,atypical direction,long lasting(more than 3 mins),no fatigue.After ruling out centrul neural system disorders,the patients were instructed to do Brandt-Daroff exercises 2-3 times/day,and 6-10 times every time.RESULTS After doing the exercises for 3-4 days,the vertigo of all the 11 cases were all relieved.After 1-2 weeks,10 cases were cured,syptom of the other 1 was relieved significantly,and the nystagmus was alleviated.CONCLUSION Cases with atypical positioning nystagmus may present a different kind of BPPV related with the otolith and vestibular nerve disease.Brandt-Daroff exercises was a good method for the atypical positioning nystagmus cases.

Clinical Characteristics of Benign Paroxysmal Positional Vertigo in Korea: A Multicenter Study

Benign paroxysmal positional vertigo (BPPV) is characterized by episodic vertigo and nystagmus provoked by head motions. To study the characteristics of BPPV in a large group of patients in Korea, we retrospectively analyzed clinical features of 1,692 patients (women: 1,146, 67.7%; men: 54.6, 32.3%; mean age: 54.8+/-14.0 yr), who had been diagnosed as BPPV by trained neuro-otologists Dizziness Clinics. The diagnosis of BPPV was based on typical nystagmus elicited by positioning maneuvers. Posterior semicircular canal was involved in 60.9% of the patients, horizontal canal in 31.9%, anterior canal in 2.2%, and mixed canals in 5.0%. The horizontal canal type of BPPV (HC-BPPV) comprised 49.5% of geotropic and 50.5% of apogeotropic types. We could observe significant negative correlation between the proportion of HC-BPPV of each clinic and the mean time interval between the symptom onset and the first visit to the clinics (r=-0.841, p<0.05). Most patients were successfully treated with canalith repositioning maneuvers (86.9%). The high incidence of HC-BPPV in this study may be explained by relatively shorter time interval between the symptom onset and visit to the Dizziness Clinics in Korea, compared with previous studies in other countries.

Preoperative clinical features and surgical results of congenital cataract / 北京大学学报(医学版)

Objective: To evaluate the relationship between preoperative nystagmus and visual outcome of congenital cataract surgery. Methods: Retrospective review of 81 patients (84 eyes) who underwent surgery for cataract was conducted,in which 7 cases of unilateral cataract and 3 of bilateral cataract were associated with preoperative nystagmus. All patients lacked other structural ocular defects or neurologic abnormalities and were old enough to cooperate with recognition visual acuity testing. Outcome parameters studied were best-corrected postoperative visual acuity of the eyes. Results: Best corrected postoperative visual acuity of the nystagmus eyes was 0.05 or worse in 3(23%,3/13), between 0.05 and 0.3 in 9(69%,9/13),and 0.3 or better in 1(8%,1/13).Best corrected visual acuity of the eyes without nystagmus was 0.05 or worse in 6(8%),between 0.05 and 0.3 in 24(34%),and 0.3 or better in 41 ((58%).) There was a statistical significance of preoperative visual acuity compared to postoperative visual acuity in cataract with(P=0.04) or without nystagmus. The great statistical significance was shown in the improvement of visual acuity between the patients with nystagmus and without nystagmus. Conclusion: Preoperative nystagmus in children with cataract does not preclude visual improvement, but may predict a poorer visual acuity outcome after cataract surgery. In these patients a decision must be made as to whether or not surgical intervention for the cataract would be worthwhile at this stage.