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Kraus M, Hassannia F, Dabiri S, Vergara Olmos G, Rutka JA. Central Vestibular Dysfunction in Head Injury. J Otolaryngol Head Neck Surg 2024; 53:19160216241250354. [PMID: 38888938 PMCID: PMC11155370 DOI: 10.1177/19160216241250354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/27/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES This study aims to provide an overview of dizziness post head injury in those with prominent features for central vestibular dysfunction (CVD) in comparison to those with a post-traumatic peripheral vestibular etiology. STUDY DESIGN Retrospective. SETTING University Health Network (UHN) Workplace Safety and Insurance Board (WSIB) database from 1988 to 2018 were evaluated for post-traumatic dizziness. METHODS The UHN WSIB neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for head-injured workers presenting with features for CVD associated with trauma. All patients had a detailed neurotological history and examination, audiovestibular testing that included video nystagmography (VNG) and cervical vestibular-evoked myogenic potentials (cVEMPs). Imaging studies including routine brain and high-resolution temporal bone computed tomography (CT) scans and/or intracranial magnetic resonance imaging (MRI) were available for the majority of injured workers. RESULTS Among 4291 head-injured workers with dizziness, 23 were diagnosed with features/findings denoting CVD. Complaints of imbalance were significantly more common in those with CVD compared to vertigo and headache in those with peripheral vestibular dysfunction. Atypical positional nystagmus, oculomotor abnormalities and facial paralysis were more common in those with CVD. CONCLUSION Symptomatic post-traumatic central vestibular injury is uncommon. It occurred primarily following high-impact trauma and was reflective for a more severe head injury where shearing effects on the brain often resulted in diffuse axonal injury. Complaints of persistent imbalance and ataxia were more common than complaints of vertigo. Eye movement abnormalities were highly indicative for central nervous system injury even in those with minimal change on CT/MRI.
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Affiliation(s)
- Mordechai Kraus
- Department of Otolaryngology—Head and Neck Surgery, Soroka Medical School, Ben Gurion University of the Negev, Beer Sheva, Southern Israel
| | - Fatemeh Hassannia
- Division of Otology/Neurotology, Department of Otolaryngology—Head and Neck Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sasan Dabiri
- Division of Otology/Neurotology, Department of Otolaryngology—Head and Neck Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Gabriela Vergara Olmos
- Division of Otology/Neurotology, Department of Otolaryngology—Head and Neck Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - John Alexander Rutka
- Division of Otology/Neurotology, Department of Otolaryngology—Head and Neck Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Bal N, Şengül Y, Behmen MB, Powell A, Louis ED. Vestibular reflexes in essential tremor: abnormalities of ocular and cervical vestibular-evoked myogenic potentials are associated with the cerebellum and brainstem involvement. J Neural Transm (Vienna) 2023; 130:1553-1559. [PMID: 37199795 DOI: 10.1007/s00702-023-02652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
This study utilized cervical vestibular-evoked myogenic potentials tests (cVEMP) and ocular vestibular-evoked myogenic potentials tests (oVEMP) to investigate the vestibulocollic and vestibuloocular reflex arcs and to evaluate cerebellar and brainstem involvement) in essential tremor (ET). Eighteen cases with ET and 16 age- and gender-matched healthy control subjects (HCS) were included in the present study. Otoscopic and neurologic examinations were performed on all participants, and both cervical and ocular VEMP tests were performed. Pathological cVEMP results were increased in the ET group (64.7%) compared to the HCS (41,2%; p > 0.05). The latencies of P1 and N1 waves were shorter in the ET group than in HCS (p = 0.01 and p = 0.001). Pathological oVEMP responses were significantly higher in the ET group (72.2%) compared to the HCS (37.5%; p = 0.01). There was no statistically significant difference in oVEMP N1-P1 latencies between groups (p > 0.05). Because the ET group had high pathological responses to the oVEMP, but not the cVEMP, the upper brainstem pathways may be more affected by ET.
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Affiliation(s)
- Nilüfer Bal
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.
- Subdepartment of Audiology, Department of Otolarygology, Faculty of Medicine, Subdepartment of Audiology, Marmara University, Istanbul, Turkey.
| | - Yıldızhan Şengül
- Department of Neurology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Meliha Başöz Behmen
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Allison Powell
- Department of Neurology, University Texas Southwestern Med. Center, Dallas, Texas, USA
| | - Elan D Louis
- Department of Neurology, University Texas Southwestern Med. Center, Dallas, Texas, USA
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Kim HJ, Lee JO, Kim JS. Otoconial Degeneration After Transient Ischemia Induced by Four-Vessel Occlusion in Rats. J Clin Neurol 2023; 19:478-482. [PMID: 36700479 PMCID: PMC10471547 DOI: 10.3988/jcn.2022.0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Ischemia of the inner ear may damage the otoconia. However, no study has explored any changes in the configuration of otoconia after transient ischemia of the labyrinth. METHODS Nineteen 7-week-old Sprague-Dawley rats were randomly assigned to either the sham (n=5) or the experimental group (n=14). The rats in the experimental group were subjected to global ischemia for 20 minutes using a four-vessel occlusion model, and were sacrificed seven days after the procedure. The rats in the sham group were sacrificed without any procedure. The otolithic organs (utricle and saccule) were dissected out for scanning electron microscope. RESULTS The otolithic organs in the sham group showed their normal gross configuration with a dense clumping of otoconia with a normal hexagonal morphology and a smooth surface. The otolithic organs in the experimental group also maintained a grossly normal configuration, but each otoconia showed irregular surfaces with numerous cracks or furrows, especially in the periphery of the otoconial bed. CONCLUSIONS The current study showed that otoconial degeneration may occur even after transient ischemia of the labyrinth. This finding supports an association between cerebral ischemia and benign paroxysmal positional vertigo.
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Affiliation(s)
- Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Ok Lee
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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Klunk D, Woost TB, Fricke C, Classen J, Weise D. Differentiating neurodegenerative parkinsonian syndromes using vestibular evoked myogenic potentials and balance assessment. Clin Neurophysiol 2021; 132:2808-2819. [PMID: 34628341 DOI: 10.1016/j.clinph.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/15/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vestibular evoked myogenic potentials (VEMP) were investigated to differentiate between parkinsonian syndromes. We correlated balance and VEMP parameters to investigate the VEMP brainstem circuits as possible origin for postural instability. METHODS We assessed clinical status, ocular and cervical VEMP (oVEMP, cVEMP) and conducted a balance assessment (posturography, Activities-specific Balance Confidence Scale, Berg Balance Scale, modified Barthel Index) in 76 subjects: 30 with Parkinson's disease (PD), 16 with atypical parkinsonism (AP) and 30 healthy controls. VEMP were elicited by using a mini-shaker on the forehead. RESULTS Patients with PD had a prolonged oVEMP n10 in comparison to controls and prolonged p15 compared to controls and AP. Patients with AP showed reduced oVEMP amplitudes compared to PD and controls. CVEMP did not differ between groups. Postural impairment was higher in AP compared to controls and PD, particularly in the rating scales. No correlations between VEMP and posturography were found. A support vector machine classifier was able to automatically classify controls and patient subgroups with moderate to good accuracy based on oVEMP latencies and balance questionnaires. CONCLUSIONS Both oVEMP and posturography, but not cVEMP, may be differentially affected in PD and AP. We did not find evidence that impairment of the cVEMP or oVEMP pathways is directly related to postural impairment. SIGNIFICANCE OVEMP and balance assessment could be implemented in the differential diagnostic work-up of parkinsonian syndromes.
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Affiliation(s)
- Dietrich Klunk
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Neurology, Altenburger Land Hospital, Am Waldessaum 10, 04600 Altenburg, Germany
| | - Timo B Woost
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Christopher Fricke
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - David Weise
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Neurology, Asklepios Fachklinikum Stadtroda, Bahnhofstraße 1A, 07646 Stadtroda, Germany.
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Scarpa A, Gioacchini FM, Cassandro E, Tulli M, Ralli M, Re M, Cassandro C. Clinical application of cVEMPs and oVEMPs in patients affected by Ménière's disease, vestibular neuritis and benign paroxysmal positional vertigo: a systematic review. ACTA ACUST UNITED AC 2020; 39:298-307. [PMID: 31708577 PMCID: PMC6843588 DOI: 10.14639/0392-100x-2104] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
Affiliation(s)
- A Scarpa
- Department of Medicine and Surgery, University of Salerno, Italy
| | - F M Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - E Cassandro
- Department of Medicine and Surgery, University of Salerno, Italy
| | - M Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - M Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - M Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - C Cassandro
- Surgical Sciences Department, University of Turin, Italy
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BENITO OREJAS JI. Utilidad clínica de los potenciales evocados miogénicos vestibulares (VEMPs). REVISTA ORL 2016. [DOI: 10.14201/orl201674.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Weber KP, Rosengren SM. Clinical utility of ocular vestibular-evoked myogenic potentials (oVEMPs). Curr Neurol Neurosci Rep 2015; 15:22. [PMID: 25773001 DOI: 10.1007/s11910-015-0548-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the last years, vestibular-evoked myogenic potentials (VEMPs) have been established as clinical tests of otolith function. Complementary to the cervical VEMPs, which assess mainly saccular function, ocular VEMPs (oVEMPs) test predominantly utricular otolith function. oVEMPs are elicited either with air-conducted (AC) sound or bone-conducted (BC) skull vibration and are recorded from beneath the eyes during up-gaze. They assess the vestibulo-ocular reflex and are a crossed excitatory response originating from the inferior oblique eye muscle. Enlarged oVEMPs have proven to be sensitive for screening of superior canal dehiscence, while absent oVEMPs indicate a loss of superior vestibular nerve otolith function, often seen in vestibular neuritis (VN) or vestibular Schwannoma.
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Affiliation(s)
- Konrad P Weber
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland,
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Ribeiro RS, Pereira MM, Pedroso JL, Braga-Neto P, Barsottini OGP, Manzano GM. Cervical and ocular vestibular evoked potentials in Machado–Joseph disease: Functional involvement of otolith pathways. J Neurol Sci 2015; 358:294-8. [DOI: 10.1016/j.jns.2015.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/21/2015] [Accepted: 09/03/2015] [Indexed: 12/29/2022]
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Vestibular-evoked myogenic potentials in central vestibular disorders. J Neurol 2015; 263:210-220. [DOI: 10.1007/s00415-015-7860-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 12/20/2022]
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Venhovens J, Meulstee J, Verhagen WIM. Vestibular evoked myogenic potentials (VEMPs) in central neurological disorders. Clin Neurophysiol 2015; 127:40-49. [PMID: 25649969 DOI: 10.1016/j.clinph.2014.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
Several types of acoustic stimulation (i.e. tone bursts or clicks), bone-conducted vibration, forehead taps, and galvanic stimulation elicit myogenic potentials. These can be recorded in cervical and ocular muscles, the so called vestibular evoked myogenic potentials (VEMPs). The cervical VEMP (cVEMP) resembles the vestibulo-collic reflex and the responses can be recorded from the ipsilateral sternocleidomastoid muscle. The ocular VEMP resembles the vestibulo-ocular reflex and can be recorded from extra-ocular muscles by a surface electrode beneath the contralateral infraorbital margin. Initially, the literature concerning VEMPs was limited to peripheral vestibular disorders, however, the field of VEMP testing is rapidly expanding, with an increasing focus on central neurological disorders. The current literature concerning VEMP abnormalities in central neurological disorders is critically reviewed, especially regarding the methodological aspects in relation to quality as well as the clinical interpretation of the VEMP results. Suggestions for further research are proposed as well as some clinically useful indications.
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Affiliation(s)
- J Venhovens
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands.
| | - J Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
| | - W I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
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Magnano I, Pes GM, Pilurzi G, Cabboi MP, Ginatempo F, Giaconi E, Tolu E, Achene A, Salis A, Rothwell JC, Conti M, Deriu F. Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations. Clin Neurophysiol 2014; 125:2286-2296. [DOI: 10.1016/j.clinph.2014.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/24/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
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Weng YC, Young YH. Mapping affected territory of anterior/posterior inferior cerebellar artery infarction using a vestibular test battery. Acta Otolaryngol 2014; 134:268-74. [PMID: 24460135 DOI: 10.3109/00016489.2013.851797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Although the affected territory in the posterior/anterior inferior cerebellar artery (PICA/AICA) infarction could not be meticulously demonstrated by magnetic resonance imaging (MRI), it could be picked up by the results of a vestibular test battery comprising caloric, ocular vestibular evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests. OBJECTIVES This study applied audiometry and caloric, oVEMP, and cVEMP tests to map affected territory in patients with PICA/AICA infarction. METHODS Fourteen patients, including 11 with PICA infarction and 3 with AICA infarction, were enrolled in this study during the last 8 years. Each patient underwent audiometry, caloric test, oVEMP test, and cVEMP test. RESULTS In the PICA group, 8 (36%) of 22 ears had a mean hearing level >25 dB. All six ears (100%) in the AICA group had abnormal hearing, and thus both groups revealed a significant difference. Conversely, significant differences were not observed in the vestibular test battery between the PICA and AICA groups. MRI demonstrated infarction at the brainstem for six patients, while one patient also had cerebellar involvement, indicated by loss of visual suppression on caloric nystagmus. Six patients showed infarction at the cerebellum, and four of them had brainstem affliction based on abnormal oVEMP/cVEMP test results.
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Affiliation(s)
- Yu-Cheng Weng
- Department of Otolaryngology, En Chu Kong Hospital , New Taipei City
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Choi SY, Lee SH, Kim HJ, Kim JS. Impaired Modulation of the Otolithic Function in Acute Unilateral Cerebellar Infarction. THE CEREBELLUM 2014; 13:362-71. [DOI: 10.1007/s12311-013-0544-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Yeh KA, Young YH. Mapping affected sites of cavernous malformation in the posterior cranial fossa. Clin Otolaryngol 2013; 38:536-40. [DOI: 10.1111/coa.12173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- K.-A. Yeh
- Department of Otolaryngology; National Taiwan University Hospital Yun-Lin Branch; Dou-Liou Taiwan
| | - Y.-H. Young
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
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Inner ear deficits after chronic otitis media. Eur Arch Otorhinolaryngol 2013; 271:2165-70. [PMID: 24061573 DOI: 10.1007/s00405-013-2714-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
Investigation of the causes of vestibular symptoms in patients with chronic otitis media (COM) faces frustration, mainly because the bithermal caloric test using tap water is generally contraindicated in perforated ears. This study utilized audiometry, ocular vestibular-evoked myogenic potential (oVEMP) test, and cervical VEMP (cVEMP) test to evaluate inner ear deficits after COM. A total of 85 COM patients (117 ears) underwent otoscopy, image study, audiometry, oVEMP test, and cVEMP test. Mean bone-conducted (BC) hearing threshold ≤25 dB was observed in 74 ears, 26-40 dB in 30 ears, and >40 dB in 13 ears. Restated, abnormal BC hearing threshold was identified in 43 ears (37 %). Percentages of abnormal cVEMP test, oVEMP test, and BC hearing threshold in 117 COM ears were 65, 62, and 37 %, respectively, exhibiting a significantly declining sequence in inner ear function. Furthermore, cVEMP/oVEMP test results were significantly correlated with BC hearing threshold, whereas no correlation existed between the cVEMP and oVEMP test results. In conclusion, the sequence of inner ear deficits after COM runs from the saccule/utricle to the cochlea and semicircular canals. Restated, in addition to BC hearing test, the cVEMP/oVEMP test may serve as a supplementary tool for early detection of inner ear involvement in COM patients.
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Su CH, Young YH. Clinical significance of pathological eye movements in diagnosing posterior fossa stroke. Acta Otolaryngol 2013; 133:916-23. [PMID: 23944944 DOI: 10.3109/00016489.2013.783716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Close observation of pathological eye movements such as disconjugate eye movements, multi-directional gaze nystagmus, and persistent unilateral gaze nystagmus may facilitate the effort of clinicians to arrange magnetic resonance imaging (MRI) study, because physical examinations may overlook the posterior fossa lesions. OBJECTIVE This paper reviews our experience of patients with posterior fossa stroke via observation of pathological eye movements over the past 10 years. METHODS Seventy patients with posterior fossa stroke manifested as acute vertiginous attack were admitted. All patients underwent examination of eye movements, MRI, and a battery of audiovestibular function tests. RESULTS Of the 70 patients, 22 (31%) demonstrated pathological eye movements including persistent (>24 h) unilateral gaze nystagmus in 12 patients, and multi-directional gaze nystagmus in 10 patients. Conjugate eyes movements were identified in 18 patients, and disconjugate eye movements were shown in 4 patients including medial longitudinal fasciculus syndrome in 1, paramedian pontine reticular formation syndrome in 1, and one and a half syndrome in 2. The vestibular test battery revealed abnormal responses for >85% of the patients in each test. MRI demonstrated infarction or hemorrhage involving the brainstem in 12 patients, cerebellum in 8 patients, and both in 2 patients.
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Affiliation(s)
- Chia-Hung Su
- Department of Otolaryngology, Catholic Cardinal Tien Hospital, Fu-Jen Catholic University , Taipei
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Abstract
PURPOSE OF REVIEW The aim of this study is to review the recent findings on the prevalence, clinical features, and diagnosis of vertigo from brainstem and cerebellar strokes. RECENT FINDINGS Patients with isolated vertigo are at higher risk for stroke than the general population. Strokes involving the brainstem and cerebellum may manifest as acute vestibular syndrome, and acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Appropriate bedside evaluation is superior to MRI for detecting central vestibular syndromes. Recording of vestibular-evoked myogenic potentials is useful for evaluation of the central otolithic pathways in brainstem and cerebellar strokes. SUMMARY Accurate identification of isolated vascular vertigo is very important since misdiagnosis of acute stroke may result in significant morbidity and mortality, whereas overdiagnosis of vascular vertigo would lead to unnecessary costly work-ups and medication.
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Sinha SK, Bohra V, Sanju HK. Comparison of Cervical and Ocular Vestibular Evoked Myogenic Potentials in Dancers and Non-Dancers. Audiol Res 2013; 3:e6. [PMID: 26557344 PMCID: PMC4627122 DOI: 10.4081/audiores.2013.e6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 11/23/2022] Open
Abstract
The objective of the study was to assess the sacculocollic and otolith ocular pathway function using cervical vestibular evoked myogenic potentials (cVEMP) and ocular vestibular myogenic potentials (oVEMP) in dancers and non dancers. Total 16 subjects participated in the study. Out of 16 participants, 8 were trained in Indian classical form of dance (dancers) and other 8 participants who were not trained in any dance form (non dancers). cVEMP and oVEMP responses were recorded for all the subjects. Non Parametric Mann-Whitney U test revealed no significant difference between dancers and non dancers for the latency and amplitude parameter for cVEMP and oVEMP, i.e. P13, N23 latency and P13-N23 complex amplitude and N10, P14 latency, N10-P14 complex amplitude respectively. The vestibular system comprises of several structures. It is possible that the dance style practiced by the dancer’s group assessed in this study does not contribute towards improving the plasticity of the sacculocollic and otolith-ocular pathways. It can be concluded that not all forms of dance training brings about a change in the plasticity of the sacculocollic and otolithocular pathways.
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Affiliation(s)
- Sujeet Kumar Sinha
- Department of Audiology, All India Institute of Speech and Hearing , India
| | - Vaishnavi Bohra
- Department of Audiology, All India Institute of Speech and Hearing , India
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Tseng CC, Young YH. Sequence of vestibular deficits in patients with noise-induced hearing loss. Eur Arch Otorhinolaryngol 2012; 270:2021-6. [PMID: 23143507 DOI: 10.1007/s00405-012-2270-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 11/02/2012] [Indexed: 11/28/2022]
Abstract
This study utilized audiometry, and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP) and caloric tests to investigate the sequence of vestibular deficits in patients with noise-induced hearing loss (NIHL). Thirty patients with NIHL underwent an inner ear test battery. Another 30 normal controls with age- and sex-matched were included for comparison. The abnormal percentages of the audiometry, and cVEMP, oVEMP and caloric tests were 100, 70, 57 and 33 % in NIHL patients, which showed significant differences from 13, 13, 7 and 3 % in normal controls, respectively. A significantly decreasing trend among the four tests, with the sequence of damage from the cochlea, followed by the saccule, utricle, and semicircular canals was noted in NIHL patients, but not in normal controls. In conclusion, the decreasing order of abnormal percentages in the function of the cochlea, saccule, utricle and semicircular canals after chronic noise exposure further supports that the pars inferior (cochlea and saccule) is more vulnerable to noise exposure than the pars superior (utricle and semicircular canals).
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Affiliation(s)
- Chia-Chen Tseng
- Department of Otolaryngology, National Taiwan University Hospital, 1, Chang-Te St., Taipei, Taiwan
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Characteristics and clinical applications of ocular vestibular evoked myogenic potentials. Hear Res 2012; 294:55-63. [PMID: 23123220 DOI: 10.1016/j.heares.2012.10.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/17/2012] [Accepted: 10/21/2012] [Indexed: 01/08/2023]
Abstract
Recently, ocular vestibular evoked myogenic potentials (oVEMPs) have been described and added to the neuro-otologic test battery as a new measure for the vestibulo-ocular reflex. oVEMPs represent extraocular muscle activity in response to otolith stimulation e.g. by air-conducted sound or bone-conducted vibration. In response to vestibular stimulation, electromyographic activity of the extraocular muscles can be recorded by means of surface electrodes placed beneath the contralateral eye. oVEMPs are likely to reflect predominantly utricular function, while the widely established cervical vestibular evoked myogenic potentials (cVEMPs) assess saccular function. Thus, measuring oVEMPs and cVEMPs in addition to caloric and head impulse testing provides further evaluation of the vestibular system and enables quick and cost-effective assessment of otolith function. This review summarizes the neurophysiological properties of oVEMPs, gives recommendations for recording conditions and discusses oVEMP alterations in various disorders of the vestibular system. With increasing insight into oVEMP characteristics in vestibular disorders, e.g. Menière's disease and superior semicircular canal dehiscence syndrome, oVEMPs are becoming a promising new diagnostic tool for evaluating utricular function.
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Ocular and cervical vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 2012; 123:1872-9. [DOI: 10.1016/j.clinph.2012.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 11/24/2022]
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