Clinical Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Acute Unilateral Vestibulopathy

Background@#and PurposeThe neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been identified as useful biomarkers for assessing the inflammatory response and for predicting the prognosis of various diseases. This study aimed to determine the clinical significance and effects on prognostic prediction of NLR and PLR in acute unilateral vestibulopathy (AUV). @*Methods@#We retrospectively recruited 128 patients who were diagnosed with AUV from July 2016 to April 2021, and compared NLR and PLR values between these patients with AUV and age- and sex-matched healthy subjects. We also analyzed the correlations of various clinical parameters with NLR and PLR. @*Results@#NLR and PLR in the AUV group were 3.41±2.80 (mean±standard deviation) and 128.86±67.06, respectively, with only NLR being significantly higher than that in the control group (1.55±0.60, p<0.001). The gain asymmetry of the horizontal vestibulo-ocular reflex (VOR) was slightly larger in patients with high NLR (n=52) than in those with normal NLR (n=76) (41.9%±20.2% vs. 33.6%±17.4%, p=0.048). However, the hospitalization period, preceding infection, canal paresis, and absolute horizontal VOR gain did not differ between patients with high and normal NLR and PLR values. The correlation analyses also revealed that none of the clinical parameters were significantly correlated with NLR or PLR. At 3-month follow-up examinations, NLR and PLR did not differ significantly between patients with and without function recovery of the horizontal VOR. @*Conclusions@#This study found a high NLR in AUV, suggesting an acute inflammatory status in the vestibular organ. However, the usefulness of NLR and PLR as prognostic markers remains unclear.

Diabetes and COVID-19 Vaccination / 임상당뇨병

Diabetes is one of the major comorbidities associated with increased risk of mortality and severe clinical outcomes in coronavirus disease 19 (COVID-19) patients. Thus, timely and appropriate vaccination is the most effective strategy for mitigating the risk of COVID-19 infection in people with diabetes. Recent studies have shown that immune response after vaccination is significant in both diabetes and non-diabetes groups, but slightly lower in patients with diabetes. Inadequate glucose control might impair the immune response. Blood glucose monitoring is required more often than usual for several days after vaccination. If a patient’s blood glucose is not controlled adequately, appropriate management should be provided.

Persistent Nystagmus in Chronic Phase of Lateral Medullary Infarction

Background@#and PurposeWe aimed to determine the patterns and mechanisms of persistent nystagmus (PN) lasting >1 year in lateral medullary infarction (LMI). @*Methods@#We recruited 13 patients with PN due to LMI and another 13 with transient nystagmus (TN) (<1 year) as control. All patients underwent oculography, rotatory chair test, caloric test, bedside head impulse test, dizziness handicap inventory (DHI), and brain MRI. @*Results@#All patients had spontaneous, contralesional, horizontal-torsional nystagmus during the acute phase. Although two patients exhibited consistent contralesional torsional nystagmus, most patients (11/13, 85%) with PN evolved from the initial contralesional to ipsilesional nystagmus. During horizontal gaze, the patterns of ipsilesional PN were diverse; torsional (n=5), torsional-downbeat (n=2), horizontal (n=2), and horizontal nystagmus while looking at the lesion side, and torsional nystagmus while looking at the opposite side (n=2). During rotatory chair test, the gains of the vestibulo-ocular reflex in the PN group were lower than those in the TN group to the lesion side at 0.02 and 0.64 Hz. The caudal and ventrolateral parts of the vestibular nuclei were mostly involved in patients with PN. The DHI score did not differ between the groups. @*Conclusions@#PN patterns frequently change in LMI. Resultant vestibular asymmetry after vestibular afferents or cerebellar inhibitory pathway damage and/or inappropriate vestibular compensation may be responsible for PN in LMI. Impairment of the horizontal or vertical neural integrators may be another cause. The presence of PN does not necessarily indicate more severe dizziness in LMI.

Customized Vestibular Rehabilitation in the Patients with Bilateral Vestibulopathy: A Pilot Study in One Referred Center / 대한평형의학회지

OBJECTIVES: Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulopathy, we analyzed the questionnaires and functional status before and after treatment. METHODS: Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck's depression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular rehabilitation. RESULTS: The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment. CONCLUSIONS: Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual peculiarities is the most important for vestibular rehabilitation.

Vertical Diplopia as a Major Manifestation of Acute Peripheral Vestibulopathy

No abstract available.

Orbital Lymphoma Presenting with Inferior Rectus Palsy

No abstract available.

Spectral Analysis of Polysomnography in Narcolepsy

OBJECTIVE: This study was conducted to identify differences between people with narcolepsy and the normal control of delta and theta activity using electroencephalogram (EEG) spectrum analysis of nocturnal polysomnography (PSG). METHODS: Seven narcolepsy patients and seven age-sex matched normal controls underwent PSG and multiple sleep latency tests. Participants' non-rapid eye movement (NREM) sleep EEGs in PSG was analyzed using a Fast Fourier Transform technique. RESULTS: While NREM delta activity of people with narcolepsy declined during the first three periods of NREM, there was no change during the 4th period of NREM. The increase in NREM theta activity also lasted until the 3rd period of NREM but did not occur during the 4th period of NREM. In comparing sleep parameters, REM sleep latency in the narcolepsy group was significantly shorter than in controls. CONCLUSION: These results suggest that people with narcolepsy are likely to have a delta and theta activity-related sleep disturbance mechanism in NREM sleep.

Opsoclonus-Myoclonus Syndrome Associated with Scrub Typhus / 대한평형의학회지

Scrub typhus is an infective acute febrile disorder caused by the intracellular parasite Orientia tsutsugamushi. Neurological manifestations of scrub typhus are meningoencephalitis, cerebellitis, transverse myelitis, papilledema, and cranial nerve palsy. However, opsoclonus-myoclonus syndrome associated with scrub typhus has been rarely reported. A 59-year-old man developed vertigo, nausea, vomiting, and imbalance following scrub typhus infection for eight days. Examination showed eschar at the axilla, decreased mentality, and opsoclonus-myoclonus syndrome. Video-oculography disclosed opsoclonus with an amplitude of 15°–20° and a frequency of 6–8 Hz. The serum antibody titers to Orientia tsutsugamushi were 1:5,120, and cerebrospinal fluid analysis revealed pleocytosis. Brain magnetic resonance imaging was normal. Neurological symptoms and signs completely improved by systemic steroid and antibiotics treatment. Various mechanisms including direct disseminating inflammation or indirect immune modulation may give rise to neurological complications following scrub typhus.

Episodic Ataxias: Clinical and Genetic Features

Episodic ataxia (EA) is a clinically heterogeneous group of disorders that are characterized by recurrent spells of truncal ataxia and incoordination lasting minutes to hours. Most have an autosomal dominant inheritance pattern. To date, 8 subtypes have been defined according to clinical and genetic characteristics, and five genes are known to be linked to EAs. Both EA1 and EA2, which are caused by mutations in KCNA1 and CACNA1A, account for the majority of EA, but many patients with no identified mutations still exhibit EA-like clinical features. Furthermore, genetically confirmed EAs have mostly been identified in Caucasian families. In this article, we review the current knowledge on the clinical and genetic characteristics of EAs. Additionally, we summarize the phenotypic features of the genetically confirmed EA2 families in Korea.

Ocular Flutter associated with Merkel Cell Carcinoma

Ocular flutter is a relatively rare eye movement disorder that refers to occasional bursts of involuntary horizontal oscillation around the point of fixation, characterized by rapid, repetitive, horizontal, symmetrical and sinusoidal oscillation without inter- saccadic interval. It is known to be associated with disorders of the cerebellum and brainstem resulting from various pathological conditions, but it's anatomical and pathophysiological basis remains unclear. Here, we present the case of a patient who had severe ocular flutter associated with Merkel cell carcinoma.

Multiple Cerebral Infarction in Cogan's Syndrome / 대한평형의학회지

Cogan's syndrome is a rare chronic inflammatory disease Characterized by non-syphilitic keratitis and vestibuloauditory dysfunction. Although the precise pathogenesis of Cogan's syndrome is unknown, it is thought to develop from vasculitis involving multiple organ system. It can be accompanied with various systemic diseases including arthritis, lymphadenopathy, splenomegaly, and aortitis with insufficiency. We report a case of typical Cogan's syndrome with multiple cerebral infarctions.

Saccadic Palsy after Cardiac Surgery: Serial Neuroimaging Findings during a 6-Year Follow-Up

BACKGROUND: Patients who develop horizontal and vertical saccadic palsy after cardiac surgery have rarely been described. Although most such patients exhibit distinct neurological deficits, their brain MRI findings are almost normal. In addition, functional neuroimaging of such patients has never been reported. CASE REPORT: A 43-year-old woman with dysarthria, dysphagia, and horizontal and vertical saccadic palsy after cardiac surgery was followed up for about 6 years; serial brain MRIs has been performed during this period, including susceptibility-weighted imaging (SWI) and [18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). Multiple microbleeds in the cerebral cortex, cerebellum, and brainstem, and glucose hypometabolism in the brainstem, cerebellum, and multiple cortical areas. CONCLUSIONS: To the best of our knowledge, this is the first reported case of saccadic palsy after cardiac surgery with serial SWI and [18F]-FDG-PET performed to explore the possible cerebral lesions.

Isolated Body Lateropulsion as a Presenting Symptom of Lateral Medullary Infarction / 대한평형의학회지

Body lateropulsion is a common manifestation of lateral medullary infarction (LMI), and usually associated with vertigo, limb ataxia, sensory disturbance, and Horner's syndrome. However, isolated body lateropulsion as a presenting symptom of LMI is rare, and the responsible lesion for lateropulsion remains uncertain. We report a 71-year-old woman who showed isolated body lateropulsion as a presenting symptom of LMI. Ipsilateral body lateropulsion in our patient may be ascribed to the involvement of the ascending dorsal spinocerebellar tract rather than the descending lateral vestibulospinal tract, which runs more ventromedially.

Recurrent Vertigo in Vestibular Schwannoma Responsive to Oxcarbazepine / 대한평형의학회지

Vestibular schwannoma (VS) are benign neoplasms that arise from Schwann cells of the eighth cranial nerve. Although progressive unilateral hearing loss with dizziness or disequilibrium provides a high suspicion index of VS, vertigo is the symptom causing the most pronounced negative effect on quality of life in patients with VS. We report a 55-year-old woman with recurrent paroxysmal vertigo and hyperventilation-induced nystagmus due to VS, which improved by oxcarbazepine treatment. We suggest that episodic vertigo in VS may be ascribed to the ectopic paroxysmal neuronal discharge from the partially demyelinated vestibular nerve due to tumor compression.

Cerebellar Control of Saccades / 대한임상신경생리학회지

Saccades are rapid eye movements that shift the line of sight between successive points of fixation. The cerebellum calibrates saccadic amplitude (dorsal vermis and fastigial nucleus) and the saccadic pulse-step match (flocculus) for optimal visuo-ocular motor behavior. Based on electrophysiology and the pharmacological inactivation studies, early activity in one fastigial nucleus could be important for accelerating the eyes at the beginning of a saccade, and the later activity in the other fastigial nucleus could be critical for stopping the eye on target, which is controlled by inhibitory projection from the dorsal vermis. The cerebellum could monitor a corollary discharge of the saccadic command and terminate the eye movement when it is calculated to be on target. The fastigial nucleus and dorsal vermis also participate in the adaptive control of saccadic accuracy.

Moyamoya Disease Associated with Optic Disc Coloboma

Moyamoya disease is a cerebrovascular disorder characterized by progressive stenosis of the distal internal carotid arteries, and in rare cases can occur in association with optic disc coloboma. We describe a 31-year-old man with transient left-sided weakness caused by steno-occlusion of the bilateral internal carotid arteries. A fundoscopic examination revealed a coloboma involving the optic disc of the right eye. Clinicians should be aware of the possibility of moyamoya disease in patients with optic disc coloboma, even when other classic symptoms of this disease are absent.

Analysis of gene expression during mineralization of cultured human periodontal ligament cells

PURPOSE: Under different culture conditions, periodontal ligament (PDL) stem cells are capable of differentiating into cementoblast-like cells, adipocytes, and collagen-forming cells. Several previous studies reported that because of the stem cells in the PDL, the PDL have a regenerative capacity which, when appropriately triggered, participates in restoring connective tissues and mineralized tissues. Therefore, this study analyzed the genes involved in mineralization during differentiation of human PDL (hPDL) cells, and searched for candidate genes possibly associated with the mineralization of hPDL cells. METHODS: To analyze the gene expression pattern of hPDL cells during differentiation, the hPDL cells were cultured in two conditions, with or without osteogenic cocktails (beta-glycerophosphate, ascorbic acid and dexamethasone), and a DNA microarray analysis of the cells cultured on days 7 and 14 was performed. Reverse transcription-polymerase chain reaction was performed to validate the DNA microarray data. RESULTS: The up-regulated genes on day 7 by hPDL cells cultured in osteogenic medium were thought to be associated with calcium/iron/metal ion binding or homeostasis (PDE1A, HFE and PCDH9) and cell viability (PCDH9), and the down-regulated genes were thought to be associated with proliferation (PHGDH and PSAT1). Also, the up-regulated genes on day 14 by hPDL cells cultured in osteogenic medium were thought to be associated with apoptosis, angiogenesis (ANGPTL4 and FOXO1A), and adipogenesis (ANGPTL4 and SEC14L2), and the down-regulated genes were thought to be associated with cell migration (SLC16A4). CONCLUSIONS: This study suggests that when appropriately triggered, the stem cells in the hPDL differentiate into osteoblasts/cementoblasts, and the genes related to calcium binding (PDE1A and PCDH9), which were strongly expressed at the stage of matrix maturation, may be associated with differentiation of the hPDL cells into osteoblasts/cementoblasts.

Analysis of gene expression during mineralization of cultured human periodontal ligament cells

PURPOSE: Under different culture conditions, periodontal ligament (PDL) stem cells are capable of differentiating into cementoblast-like cells, adipocytes, and collagen-forming cells. Several previous studies reported that because of the stem cells in the PDL, the PDL have a regenerative capacity which, when appropriately triggered, participates in restoring connective tissues and mineralized tissues. Therefore, this study analyzed the genes involved in mineralization during differentiation of human PDL (hPDL) cells, and searched for candidate genes possibly associated with the mineralization of hPDL cells. METHODS: To analyze the gene expression pattern of hPDL cells during differentiation, the hPDL cells were cultured in two conditions, with or without osteogenic cocktails (beta-glycerophosphate, ascorbic acid and dexamethasone), and a DNA microarray analysis of the cells cultured on days 7 and 14 was performed. Reverse transcription-polymerase chain reaction was performed to validate the DNA microarray data. RESULTS: The up-regulated genes on day 7 by hPDL cells cultured in osteogenic medium were thought to be associated with calcium/iron/metal ion binding or homeostasis (PDE1A, HFE and PCDH9) and cell viability (PCDH9), and the down-regulated genes were thought to be associated with proliferation (PHGDH and PSAT1). Also, the up-regulated genes on day 14 by hPDL cells cultured in osteogenic medium were thought to be associated with apoptosis, angiogenesis (ANGPTL4 and FOXO1A), and adipogenesis (ANGPTL4 and SEC14L2), and the down-regulated genes were thought to be associated with cell migration (SLC16A4). CONCLUSIONS: This study suggests that when appropriately triggered, the stem cells in the hPDL differentiate into osteoblasts/cementoblasts, and the genes related to calcium binding (PDE1A and PCDH9), which were strongly expressed at the stage of matrix maturation, may be associated with differentiation of the hPDL cells into osteoblasts/cementoblasts.

A Case of Catatonia and Neuroleptic Malignant Syndrome Probably Associated with Antipsychotic in Korea

Several studies have reported on catatonia caused by the use of antipsychotic drugs and on the association between catatonia and neuroleptic malignant syndrome (NMS), but none has reported such a case in Korea. Here, we report the case of a 20-year-old woman whose catatonia and NMS appeared associated with the administration of an atypical antipsychotic drug. We discuss the association between NMS and catatonia due to neuroleptic use.

The Clinical Characteristics and Endovascular Management Outcomes of Dural Carotid Cavernous Fistulas

PURPOSE: To describe the clinical characteristics and endovascular management outcomes of Dural carotid cavernous sinus fistula (Dural CCF). METHODS: Ocular symptoms, signs, and complications of 15 eyes from 14 patients confirmed with Dural CCF by angiography were examined. The medical records of patients who underwent endovascular management were analyzed retrospectively. RESULTS: The mean age of the patients was 50.6 +/- 14.2 years; 4 were men and 10 were women. The eye consisted of 7 right eyes and 8 left eyes. Two eyes were of hypertension patients. The chief clinical symptoms on the first visit were diplopia, injection, ocular pain, proptosis, ptosis, and tinnitus. On cerebral angiography, Barrow Type D was the most common consisting of 12 cases (80%). Endovascular embolization was performed in 13 eyes and the average number of times received was 1. Signs and symptoms improved over a mean of 4.5 months of clinical follow-up in 12 eyes. There were no ocular complications related to endovascular embolization. CONCLUSIONS: Dural CCF should be suspected in a middle-aged woman with injection or diplopia. Endovascular embolization is considered minimally invasive and highly successful for the treatment of Dural CCF.