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Kim SH, Kim H, Lee SU, Park E, Cho BH, Cho KH, Kim GJ, Yu S, Kim JS. Bilaterally positive head-impulse tests can differentiate AICA infarction from labyrinthitis. Front Neurol 2024; 15:1448989. [PMID: 39268064 PMCID: PMC11390645 DOI: 10.3389/fneur.2024.1448989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Video head-impulse tests (video-HITs) often fail to detect anterior inferior cerebellar artery (AICA) infarction due to peripheral and central vestibular system involvement. Anecdotal studies suggest that video-HITs may reveal bilateral impairment in AICA infarction. However, the diagnostic utility of video-HITs has not been established, particularly when compared to labyrinthitis, which accounts for the majority of acute audiovestibular syndrome (AAVS) cases. Methods We reviewed the medical records of consecutive patients presenting with new-onset acute hearing loss and spontaneous vertigo (i.e., AAVS) between March 2018 and July 2023 at a tertiary hospital in South Korea. Video-HIT patterns were categorized as follows: (1) ipsilaterally positive, (2) contralaterally positive, (3) bilaterally normal, and (4) bilaterally positive. Results Twenty-eight patients with AICA infarction (mean age ± standard deviation = 67 ± 15 years; 14 men) and 51 with labyrinthitis (63 ± 17 years, 26 men) were included in the analyses. Among the 28 patients with AICA infarction, 15 presented with AAVS in isolation, without other co-morbid neurologic deficits (15/28, 54%). The vestibulo-ocular reflex (VOR) gains of ipsilesional horizontal canals (HCs) ranged from 0.21 to 1.22 (median = 0.81, interquartile range [IQR] = 0.50-0.89). However, those for contralateral HC gain ranged from 0.57 to 1.19 (median = 0.89 [IQR = 0.73-0.97]). Collectively, HITs were bilaterally positive in 13 patients (including 12 patients with bilaterally positive HITs for the horizontal canal), normal in eight, ipsilesionally positive in six, and contralesionally positive in one patient with AICA infarction. The VOR gains were typically decreased ipsilaterally in 28 (28/51, 55%), normal in 17 (17/51, 33%), and decreased bilaterally in six patients with labyrinthitis (6/51, 12%). Logistic regression analysis revealed that bilaterally positive HITs (p = 0.004) and multiple vascular risk factors (p = 0.043) were more frequently associated with AICA infarction than labyrinthitis. Discussion Among patients presenting with AAVS, bilaterally positive HITs can be indicative of AICA infarction in patients with multiple vascular risk factors.
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Affiliation(s)
- Sung-Hwan Kim
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Hanseob Kim
- Department of Computer Science and Engineering, Korea University, Seoul, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, Republic of Korea
| | - Euyhyun Park
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bang-Hoon Cho
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Gerard J Kim
- Department of Computer Science and Engineering, Korea University, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cornforth E, Schmahmann JD. Physical Therapy and Aminopyridine for Downbeat Nystagmus Syndrome: A Case Report. J Neurol Phys Ther 2024:01253086-990000000-00067. [PMID: 38898545 DOI: 10.1097/npt.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND PURPOSE Individuals with downbeat nystagmus (DBN) syndrome present with DBN, dizziness, blurred vision, and unsteady gait. Pharmacological intervention with 4-aminopyridine (4-AP) may be effective in improving oculomotor function, but there is minimal evidence to date that it improves gait. This suggests the possible benefit of combining pharmacotherapy with physical therapy to maximize outcomes. This case report documents improvements in gait and balance after physical therapy and aminopyridine (AP) in an individual with DBN syndrome. CASE DESCRIPTION The patient was a 70-year-old man with a 4-year history of worsening dizziness and imbalance, diagnosed with DBN syndrome. He demonstrated impaired oculomotor function, dizziness, and imbalance, which resulted in falls and limited community ambulation. INTERVENTION The patient completed a customized, tapered course of physical therapy over 6 months. Outcome measures included the 10-meter walk test, the Timed Up and Go (TUG), the Dynamic Gait Index (DGI), and the modified clinical test of sensory integration and balance. OUTCOMES Improvements exceeding minimal detectable change were demonstrated on the TUG and the DGI. Gait speed on the 10-meter walk test did not change significantly, but the patient was able to use a cane to ambulate in the community and reported no further falls. DISCUSSION Controlled studies are needed to explore the potential for AP to augment physical therapy in people with DBN syndrome. Physical therapists are encouraged to communicate with referring medical providers about the use of AP as pharmacotherapy along with physical therapy for individuals with DBN syndrome.
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Affiliation(s)
- Elizabeth Cornforth
- Author Affiliations: MGH Institute of Health Professions, Boston, MA and Department of Physical Therapy, Spaulding Rehabilitation Hospital, Boston, MA (E.C.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Boston, MA (J.D.S.)
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Marcelli V, Giannoni B, Volpe G, Faralli M, Fetoni AR, Pettorossi VE. Downbeat nystagmus: a clinical and pathophysiological review. Front Neurol 2024; 15:1394859. [PMID: 38854962 PMCID: PMC11157062 DOI: 10.3389/fneur.2024.1394859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Downbeat nystagmus (DBN) is a neuro-otological finding frequently encountered by clinicians dealing with patients with vertigo. Since DBN is a finding that should be understood because of central vestibular dysfunction, it is necessary to know how to frame it promptly to suggest the correct diagnostic-therapeutic pathway to the patient. As knowledge of its pathophysiology has progressed, the importance of this clinical sign has been increasingly understood. At the same time, clinical diagnostic knowledge has increased, and it has been recognized that this sign may occur sporadically or in association with others within defined clinical syndromes. Thus, in many cases, different therapeutic solutions have become possible. In our work, we have attempted to systematize current knowledge about the origin of this finding, the clinical presentation and current treatment options, to provide an overview that can be used at different levels, from the general practitioner to the specialist neurologist or neurotologist.
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Affiliation(s)
- Vincenzo Marcelli
- Audiology and Vestibology Unit, Department of ENT, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
- Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples ‘’Federico II’’, Napoli, Italy
| | - Beatrice Giannoni
- Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Florence, Italy
| | - Giampiero Volpe
- Department of Neurology, Ospedale San Luca di Vallo della Lucania, ASL Salerno, Salerno, Italy
| | - Mario Faralli
- Department of ENT, University of Perugia, Perugia, Italy
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples ‘’Federico II’’, Napoli, Italy
| | - Vito E. Pettorossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Comacchio F, Magnavita P, Bellemo B. Paroxysmal Positional Nystagmus in Acoustic Neuroma Patients. Audiol Res 2023; 13:304-313. [PMID: 37102776 PMCID: PMC10136250 DOI: 10.3390/audiolres13020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023] Open
Abstract
The association between acoustic neuroma and positional vertigo with paroxysmal positional nystagmus is relatively rare, but, when present, it certainly represents a challenge for the otoneurologist. There are few reports in the literature on this particular issue, and some questions are still unanswered, particularly regarding the characteristics of positional nystagmus that may distinguish between a true benign paroxysmal vertigo and a positional nystagmus associated with the tumor. We present the videonystagmographic patterns of seven patients with acoustic tumor who had paroxysmal positional nystagmus and analyzed its features. A concomitant true benign paroxysmal positional vertigo may be present during the follow-up of a non-treated patient, as the paroxysmal positional vertigo may be the first symptom of the tumor, and it may show characteristics that are very similar to a posterior semicircular canal canalolithiasis or a horizontal canal "heavy or light cupula". The possible mechanisms are discussed.
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Affiliation(s)
- Francesco Comacchio
- Otolaryngology Unit and Vertigo Regional Specialized Center, Sant'Antonio Hospital, Via J. Facciolati 71, 35127 Padova, Italy
- Department of Surgery, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
| | - Paola Magnavita
- Otolaryngology Unit and Vertigo Regional Specialized Center, Sant'Antonio Hospital, Via J. Facciolati 71, 35127 Padova, Italy
- Department of Surgery, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
| | - Barbara Bellemo
- Otolaryngology Unit and Vertigo Regional Specialized Center, Sant'Antonio Hospital, Via J. Facciolati 71, 35127 Padova, Italy
- Department of Surgery, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
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Naito R, Watanabe Y, Naito A, Sugasawa K, Nakata Y, Kamiyama T, Okiyama R, Yokochi F, Isozaki E, Yamasoba T, Takahashi K. Visual fixation suppression of caloric nystagmus in progressive supranuclear palsy - A comparison with Parkinson's disease. J Vestib Res 2023; 33:385-401. [PMID: 37599554 DOI: 10.3233/ves-210147] [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] [Indexed: 08/22/2023]
Abstract
BACKGROUND Impairment of visual fixation suppression (VS) in progressive supranuclear palsy (PSP) is not well documented. OBJECTIVE To evaluate the usefulness of impaired VS of caloric nystagmus as an index for differential diagnosis between PSP and Parkinson's disease (PD), which is often difficult, especially in the early stage. METHODS Subjects comprised 26 PSP patients and 26 PD patients clinically diagnosed at Tokyo Metropolitan Neurological Hospital. We retrospectively investigated VS of caloric nystagmus, horizontal pursuit, saccades, and horizontal optokinetic nystagmus recorded on direct-current-electronystagmography, and neuroradiological findings. RESULTS The median of the average VS% was 0% and 50.0% in PSP and PD patients, respectively. In PSP, VS was impaired even in the early stage of disease. We found a significant correlation between VS and velocity of saccades or maximum slow phase velocity of optokinetic nystagmus only in PSP patients. PSP patients with atrophy of the subthalamic nucleus or with decreased blood flow in the frontal lobe showed significantly more severe impairment of VS. CONCLUSIONS VS may be a useful biomarker to differentiate patients with PSP from those with PD. Cerebellar networks that connect with the cerebral cortex and basal ganglia may contribute to impaired VS of caloric nystagmus in PSP.
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Affiliation(s)
- Rie Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yuki Watanabe
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Akira Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicines, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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Lee SU, Kim HJ, Choi JY, Choi JH, Zee DS, Kim JS. Nystagmus only with fixation in the light: a rare central sign due to cerebellar malfunction. J Neurol 2022; 269:3879-3890. [PMID: 35396603 DOI: 10.1007/s00415-022-11108-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
Fixation nystagmus refers to the nystagmus that appears or markedly increases with fixation. While relatively common in infantile (congenital) nystagmus, acquired fixation nystagmus is unusual and has been ascribed to lesions involving the cerebellar nuclei or the fibers projecting from the cerebellum to the brainstem. We aimed to report the clinical features of patients with acquired fixation nystagmus and discuss possible mechanisms using a model simulation and diagnostic significance. We describe four patients with acquired fixation nystagmus that appears or markedly increases with visual fixation. All patients had lesions involving the cerebellum or dorsal medulla. All patients showed direction-changing gaze-evoked nystagmus, impaired smooth pursuit, and decreased vestibular responses on head-impulse tests. The clinical implication of fixation nystagmus is that it may occur in central lesions that impair both smooth pursuit and the vestibulo-ocular reflex (VOR) but without creating a spontaneous nystagmus in the dark. We develop a mathematical model that hypothesizes that fixation nystagmus reflects a central tone imbalance due to abnormal function in cerebellar circuits that normally optimize the interaction between visual following (pursuit) and VOR during attempted fixation. Patients with fixation nystagmus have central lesions involving the cerebellar circuits that are involved in visual-vestibular interactions and normally eliminate biases that cause a spontaneous nystagmus.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Gyeonggi-do, Seongnam-si, 13620, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - David S Zee
- Departments of Neurology, Ophthalmology, Otolaryngology-Head and Neck Surgery, and Neuroscience, Division of Neuro-Visual and Vestibular Disorders, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ji-Soo Kim
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea. .,Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Atypical Positional Vertigo: Definition, Causes, and Mechanisms. Audiol Res 2022; 12:152-161. [PMID: 35314613 PMCID: PMC8938844 DOI: 10.3390/audiolres12020018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/05/2023] Open
Abstract
Paroxysmal positional vertigo is a frequent cause for consultation. When approaching these patients, we try to differentiate central from peripheral causes, but sometimes we find manifestations that generate diagnostic doubts. In this review, we address atypical paroxysmal positional vertigo, reviewing the literature on the subject and giving a provisional definition of atypical positional vertigo as well as outlining its causes and pathophysiological mechanisms.
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Mantokoudis G, Wyss T, Zamaro E, Korda A, Wagner F, Sauter TC, Kerkeni H, Kalla R, Morrison M, Caversaccio MD. Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients: A Diagnostic Accuracy Study. Neurology 2021; 97:e42-e51. [PMID: 33986142 PMCID: PMC8312858 DOI: 10.1212/wnl.0000000000012176] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Failure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem; however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown. METHODS Patients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the emergency department between 2015 and 2020. All patients received neuroimaging, which served as a reference standard. We recorded fixation suppression with video-oculography (VOG) for forward, right, and left gaze. The ocular fixation index (OFI) and the spontaneous nystagmus slow velocity reduction was calculated. RESULTS We screened 1,646 patients reporting dizziness in the emergency department and tested for spontaneous nystagmus in 148 patients with AVS. We analyzed 56 patients with a diagnosed acute unilateral vestibulopathy (vestibular neuritis) and 28 patients with a confirmed stroke. There was a complete nystagmus fixation suppression in 49.5% of patients with AVS, in 40% of patients with vestibular neuritis, and in 62.5% of patients with vestibular strokes. OFI scores had no predictive value for detecting strokes; however, a nystagmus reduction of less than 2 °/s showed a high accuracy of 76.9% (confidence interval 0.59-0.89) with a sensitivity of 62.2% and specificity of 84.8% in detecting strokes. CONCLUSIONS The presence of fixation suppression does not rule out a central lesion. The magnitude of suppression was lower compared to patients with vestibular neuritis. The nystagmus suppression test predicts vestibular strokes accurately provided that eye movements are recorded with VOG. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with an AVS, decreased fixation suppression recorded with VOG occurred more often in stroke (76.9%) than in vestibular neuritis (37.8%).
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Affiliation(s)
- Georgios Mantokoudis
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland.
| | - Thomas Wyss
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Ewa Zamaro
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Athanasia Korda
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Franca Wagner
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Thomas C Sauter
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Hassen Kerkeni
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Roger Kalla
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Miranda Morrison
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Marco Domenico Caversaccio
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
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Maruta J. The Scientific Contributions of Bernard Cohen (1929-2019). Front Neurol 2021; 11:624243. [PMID: 33510708 PMCID: PMC7835511 DOI: 10.3389/fneur.2020.624243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Abstract
Throughout Bernard Cohen's active career at Mount Sinai that lasted over a half century, he was involved in research on vestibular control of the oculomotor, body postural, and autonomic systems in animals and humans, contributing to our understanding of such maladies as motion sickness, mal de débarquement syndrome, and orthostatic syncope. This review is an attempt to trace and connect Cohen's varied research interests and his approaches to them. His influence was vast. His scientific contributions will continue to drive research directions for many years to come.
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Affiliation(s)
- Jun Maruta
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Izawa Y, Suzuki H. Suppressive control of optokinetic and vestibular nystagmus by the primate frontal eye field. J Neurophysiol 2020; 124:691-702. [DOI: 10.1152/jn.00015.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, electrical stimulation in the frontal eye field (FEF) suppressed the quick and slow phases of optokinetic and vestibular nystagmus at an intensity subthreshold for eliciting saccades. Furthermore, the activity of fixation neurons in the FEF was related to the suppression of optokinetic and vestibular nystagmus by visual fixation. This suggests that a common neuronal assembly in the FEF may contribute to the suppressive control of different functional classes of eye movements.
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Affiliation(s)
- Yoshiko Izawa
- Department of Systems Neurophysiology, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Hisao Suzuki
- Department of Systems Neurophysiology, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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Lee H, Kim HA. Anatomical structure responsible for direction changing bilateral gaze-evoked nystagmus in patients with unilateral cerebellar infarction. Medicine (Baltimore) 2020; 99:e19866. [PMID: 32332650 PMCID: PMC7440085 DOI: 10.1097/md.0000000000019866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The direction-changing bilateral gaze-evoked nystagmus (GEN) (BGEN) is a more specific sign for a gaze-holding deficit than unilateral GEN (UGEN) in a central lesion. We sought to clarify which cerebellar structure is responsible for the generation of BGEN compared with UGEN.We studied 47 cases of UGEN or BGEN associated with isolated unilateral cerebellar infarction in the territories of the cerebellar arteries diagnosed by brain magnetic resonance image (MRI) from June 2007 to April 2014. To identify the structures involved in the generation of BGEN, the overlapped lesions of the BGEN group were subtracted from those of UGEN group and vice versa.About half of the patients (25/47, 53%) showed BGEN and others showed UGEN. There was no difference in the interval from symptom onset to examination between 2 groups (1.3 days vs 2.5 days, P = .24). Thirty-five patients (35/47, 75%) with GEN also showed spontaneous nystagmus. Lesion subtraction analyses revealed that both of the patients with BGEN and UGEN had damage around the vermal pyramid, the uvula and the tonsil, parts of the biventer lobule, and the inferior semilunar lobule.Midline and lower cerebellar structures are related to both BGEN and UGEN in patients with unilateral cerebellar infarction. Regardless of unilateral or bilateral, GEN may represent damage of the gaze-holding neural integrator control system in human.
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Affiliation(s)
- Hyung Lee
- Department of Neurology
- Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyun Ah Kim
- Department of Neurology
- Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
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Holland PJ, Sibindi TM, Ginzburg M, Das S, Arkesteijn K, Frens MA, Donchin O. A Neuroanatomically Grounded Optimal Control Model of the Compensatory Eye Movement System in Mice. Front Syst Neurosci 2020; 14:13. [PMID: 32269516 PMCID: PMC7109542 DOI: 10.3389/fnsys.2020.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/28/2020] [Indexed: 11/13/2022] Open
Abstract
We present a working model of the compensatory eye movement system in mice. We challenge the model with a data set of eye movements in mice (n =34) recorded in 4 different sinusoidal stimulus conditions with 36 different combinations of frequency (0.1-3.2 Hz) and amplitude (0.5-8°) in each condition. The conditions included vestibular stimulation in the dark (vestibular-ocular reflex, VOR), optokinetic stimulation (optokinetic reflex, OKR), and two combined visual/vestibular conditions (the visual-vestibular ocular reflex, vVOR, and visual suppression of the VOR, sVOR). The model successfully reproduced the eye movements in all conditions, except for minor failures to predict phase when gain was very low. Most importantly, it could explain the interaction of VOR and OKR when the two reflexes are activated simultaneously during vVOR stimulation. In addition to our own data, we also reproduced the behavior of the compensatory eye movement system found in the existing literature. These include its response to sum-of-sines stimuli, its response after lesions of the nucleus prepositus hypoglossi or the flocculus, characteristics of VOR adaptation, and characteristics of drift in the dark. Our model is based on ideas of state prediction and forward modeling that have been widely used in the study of motor control. However, it represents one of the first quantitative efforts to simulate the full range of behaviors of a specific system. The model has two separate processing loops, one for vestibular stimulation and one for visual stimulation. Importantly, state prediction in the visual processing loop depends on a forward model of residual retinal slip after vestibular processing. In addition, we hypothesize that adaptation in the system is primarily adaptation of this model. In other words, VOR adaptation happens primarily in the OKR loop.
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Affiliation(s)
- Peter J. Holland
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Department of Biomedical Engineering, Zlotowski Centre for Neuroscience, Ben Gurion University, Beer-Sheva, Israel
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Tafadzwa M. Sibindi
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Department of Biomedical Engineering, Zlotowski Centre for Neuroscience, Ben Gurion University, Beer-Sheva, Israel
- Singapore Institute for Neurotechnology, Singapore, Singapore
| | - Marik Ginzburg
- Department of Biomedical Engineering, Zlotowski Centre for Neuroscience, Ben Gurion University, Beer-Sheva, Israel
| | - Suman Das
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Department of Biomedical Engineering, Zlotowski Centre for Neuroscience, Ben Gurion University, Beer-Sheva, Israel
| | - Kiki Arkesteijn
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Opher Donchin
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Department of Biomedical Engineering, Zlotowski Centre for Neuroscience, Ben Gurion University, Beer-Sheva, Israel
- ABC Centre for Robotics, Ben Gurion University, Beer-Sheva, Israel
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13
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Abstract
The cerebellum works as a network hub for optimizing eye movements through its mutual connections with the brainstem and beyond. Here, we review three key areas in the cerebellum that are related to the control of eye movements: (1) the flocculus/paraflocculus (tonsil) complex, primarily for high-frequency, transient vestibular responses, and also for smooth pursuit maintenance and steady gaze holding; (2) the nodulus/ventral uvula, primarily for low-frequency, sustained vestibular responses; and (3) the dorsal vermis/posterior fastigial nucleus, primarily for the accuracy of saccades. Although there is no absolute compartmentalization of function within the three major ocular motor areas in the cerebellum, the structural-functional approach provides a framework for assessing ocular motor performance in patients with disease that involves the cerebellum or the brainstem.
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14
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Sugawara T, Sakai H, Hirata Y. Vestibulo-ocular reflex characteristics during unidirectional translational whole-body vibration without head restriction. ERGONOMICS 2020; 63:91-100. [PMID: 31707951 DOI: 10.1080/00140139.2019.1683616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
The vestibulo-ocular reflex (VOR) plays a crucial role in ocular stability. However, VOR characteristics under realistic whole-body vibration conditions, particularly without head restriction, remain unclear. The aim of this study was to characterise the VOR over a wide range of whole-body vibration frequencies (0.7-10 Hz), such as occur when driving a car. Eye and head movements were measured in response to unidirectional translational whole-body vibration that resembled actual vehicle vibrations. The VOR was then modelled by regressing eye velocity data on multiple head movement components. Results showed that the VOR was explained by angular velocity, linear acceleration, and linear jerk components of the head movements. Because the VOR in response to head linear-jerk components disrupted ocular stability in the current experimental setup, our results suggest that degraded vision in whole-body vibratory environments might be partially attributable to jerky head movements. Practitioner summary: The vestibulo-ocular reflex (VOR) during unidirectional translational whole-body vibration without head restriction was modelled using multiple head movement components, with the aim of characterising the VOR. Results showed that the VOR was explained by angular velocity, linear acceleration, and linear jerk components of head movements.
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Affiliation(s)
- Tomoko Sugawara
- Strategic Research Division, Toyota Central R&D Labs., Inc, Nagakute, Japan
| | - Hiroyuki Sakai
- Strategic Research Division, Toyota Central R&D Labs., Inc, Nagakute, Japan
| | - Yutaka Hirata
- Department of Robotic Science and Technology, Chubu University College of Engineering, Kasugai, Japan
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15
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Chang TP, Winnick AA, Hsu YC, Sung PY, Schubert MC. The bucket test differentiates patients with MRI confirmed brainstem/cerebellar lesions from patients having migraine and dizziness alone. BMC Neurol 2019; 19:219. [PMID: 31481007 PMCID: PMC6720090 DOI: 10.1186/s12883-019-1442-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8 ± 4.1° and 0.7 ± 1.0°, respectively. The abnormal rate of SVV deviations (> 2.3°) in CVD was significantly higher than VM (p < 0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 74.1%, specificity 91.7%, positive likelihood ratio (LR+) 8.9, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (92.6%) and specificity (88.9%) were optimized (LR+ (8.3), LR- (0.08)). Conclusion The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus. Electronic supplementary material The online version of this article (10.1186/s12883-019-1442-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology/Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan.,Department of Neurology, Tzu Chi University, Hualien, Taiwan
| | - Ariel A Winnick
- Soroka University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yung-Chu Hsu
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Pi-Yu Sung
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 21205, USA. .,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21205, USA.
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16
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Shaikh AG, Zee DS. Eye Movement Research in the Twenty-First Century-a Window to the Brain, Mind, and More. THE CEREBELLUM 2019; 17:252-258. [PMID: 29260439 DOI: 10.1007/s12311-017-0910-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study of eye movements not only addresses debilitating neuro-ophthalmological problems but has become an essential tool of basic neuroscience research. Eye movements are a classic way to evaluate brain function-traditionally in disorders affecting the brainstem and cerebellum. Abnormalities of eye movements have localizing value and help narrow the differential diagnosis of complex neurological problems. More recently, using sophisticated behavioral paradigms, measurement of eye movements has also been applied to disorders of the thalamus, basal ganglia, and cerebral cortex. Moreover, in contemporary neuroscience, eye movements play a key role in understanding cognition, behavior, and disorders of the mind. Examples include applications to higher-level decision-making processes as in neuroeconomics and psychiatric and cognitive disorders such as schizophrenia and autism. Eye movements have become valued as objective biomarkers to monitor the natural progression of disease and the effects of therapies. As specific genetic defects are identified for many neurological disorders, ocular motor function often becomes the cornerstone of phenotypic classification and differential diagnosis. Here, we introduce other important applications of eye movement research, including understanding movement disorders affecting the head and limbs. We also emphasize the need to develop standardized test batteries for eye movements of all types including the vestibulo-ocular responses. The evaluation and treatment of patients with cerebellar ataxia are particularly amenable to such an approach.
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Affiliation(s)
- Aasef G Shaikh
- Neurological Institute, University Hospitals Health System, Cleveland, OH, USA. .,Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
| | - David S Zee
- Department of Neuroscience, The Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD, USA.,Department of Ophthalmology, The Johns Hopkins University, Baltimore, MD, USA
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17
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Cohen HS. A review on screening tests for vestibular disorders. J Neurophysiol 2019; 122:81-92. [PMID: 30995137 PMCID: PMC6689777 DOI: 10.1152/jn.00819.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/08/2023] Open
Abstract
Although many studies have reported on tests of the vestibular system a valid and reliable, evidence-based screening battery for easy clinical use remains elusive. Many screening tests attempt to assess the vestibulo-ocular reflex. Therefore, head shaking, the Dix-Hallpike maneuver, the supine roll test, and head impulse tests are discussed. Other tests address the spatial orientation functions of the vestibular system, such as the Bucket Test and the Fukuda Stepping test. Still, other tests are based on the known correlates with balance skills, both static and dynamic, such as tandem walking and the modern variation of the Romberg test, the modified Clinical Test of Sensory Interaction and Balance. This review provides a critical overview of the literature on some of these tests and their value for clinical use and in epidemiological studies.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine , Houston, Texas
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18
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Yacovino DA, Akly MP, Luis L, Zee DS. The Floccular Syndrome: Dynamic Changes in Eye Movements and Vestibulo-ocular Reflex in Isolated Infarction of the Cerebellar Flocculus. THE CEREBELLUM 2019; 17:122-131. [PMID: 28844105 DOI: 10.1007/s12311-017-0878-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The cerebellar flocculus is a critical structure involved in the control of eye movements. Both static and dynamic abnormalities of the vestibulo-ocular reflex (VOR) have been described in animals with experimental lesions of the flocculus/paraflocculus complex. In humans, lesions restricted to the flocculus are rare so they can become an exceptional model to contrast with the clinical features in experimental animals or in patients with more generalized cerebellar diseases. Here, we examined a 67-year-old patient with an acute vestibular syndrome due to an isolated infarct of the right flocculus. We evaluated him multiple times over 6 months-to follow the changes in eye movements and vestibular function-with caloric testing, video-oculography and head-impulse testing, and the anatomical changes on imaging. Acutely, he had an ipsilateral-beating spontaneous nystagmus, bilateral gaze-evoked nystagmus, borderline impaired smooth pursuit, and a complete contraversive ocular tilt reaction. The VOR gain was reduced for head impulses directed contralateral to the lesion, and there was also an ipsilesional caloric weakness. All abnormalities progressively improved at follow-up visits but with a considerable reduction in volume of the affected flocculus on imaging. The vestibular and ocular motor findings, qualitatively similar to a previously reported patient, further clarify the "acute floccular syndrome" in humans. We also add new information about the pattern of recovery from such a lesion with corresponding changes in the size of the affected flocculus on imaging.
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Affiliation(s)
- Dario Andres Yacovino
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina.
- Memory and Balance Clinic, Buenos Aires, Argentina.
| | - Manuel Perez Akly
- Department of Neuroradiology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
- Department of Radiology, Italian Hospital, Buenos Aires, Argentina
| | - Leonel Luis
- Department of Otolaryngology, Hospital Santa Maria, CHLN, Lisbon, Portugal
| | - David S Zee
- Departments of Neurology, Otolaryngology-Head and Neck Surgery, Ophthalmology and Neuroscience, Johns Hopkins Hospital, Baltimore, MD, USA
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19
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Yang TH, Chen HL, Young YH. Pathological eye movements influence on the recordings of ocular vestibular-evoked myogenic potential. Acta Otolaryngol 2017; 137:807-813. [PMID: 28323487 DOI: 10.1080/00016489.2017.1286037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study investigated the influence of pathological eye movements on the recordings of ocular vestibulo-evoked myogenic potential (oVEMP). METHODS Ten patients with pathological eye movements of non-vestibular origin (nine congenital nystagmus and one opsoclonus) who had negative MRI result were assigned to Group A. Another 20 vestibular neuritis (VN) patients with spontaneous nystagmus were assigned to Group B. Both groups underwent audiometry, and caloric, oVEMP and cervical VEMP (cVEMP) tests. RESULTS In Group A, the caloric, oVEMP and cVEMP tests showed 40%, 55% and 50% abnormalities, respectively. In Group B (VN), caloric, oVEMP and cVEMP tests revealed 100%, 80% and 45% abnormalities on the lesion ears, and 0%, 40% and 0% abnormalities on the healthy (opposite) ears, respectively. The 40% oVEMP abnormality on the healthy ears may be due to recording failure from the presence of spontaneous nystagmus, since five of five VN patients showed normal oVEMPs on the healthy ears, one year after presentation. CONCLUSIONS Presence of pathological eye movements may affect the recordings of oVEMP. Thus, the oVEMP test is recommended to perform after acute vertiginous episode to exclude the influence of pathological eye movements on the oVEMP recordings.
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Affiliation(s)
- Ting-Hua Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Lin Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ho Young
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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20
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Adaptive Acceleration of Visually Evoked Smooth Eye Movements in Mice. J Neurosci 2017; 36:6836-49. [PMID: 27335412 DOI: 10.1523/jneurosci.0067-16.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/17/2016] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED The optokinetic response (OKR) consists of smooth eye movements following global motion of the visual surround, which suppress image slip on the retina for visual acuity. The effective performance of the OKR is limited to rather slow and low-frequency visual stimuli, although it can be adaptably improved by cerebellum-dependent mechanisms. To better understand circuit mechanisms constraining OKR performance, we monitored how distinct kinematic features of the OKR change over the course of OKR adaptation, and found that eye acceleration at stimulus onset primarily limited OKR performance but could be dramatically potentiated by visual experience. Eye acceleration in the temporal-to-nasal direction depended more on the ipsilateral floccular complex of the cerebellum than did that in the nasal-to-temporal direction. Gaze-holding following the OKR was also modified in parallel with eye-acceleration potentiation. Optogenetic manipulation revealed that synchronous excitation and inhibition of floccular complex Purkinje cells could effectively accelerate eye movements in the nasotemporal and temporonasal directions, respectively. These results collectively delineate multiple motor pathways subserving distinct aspects of the OKR in mice and constrain hypotheses regarding cellular mechanisms of the cerebellum-dependent tuning of movement acceleration. SIGNIFICANCE STATEMENT Although visually evoked smooth eye movements, known as the optokinetic response (OKR), have been studied in various species for decades, circuit mechanisms of oculomotor control and adaptation remain elusive. In the present study, we assessed kinematics of the mouse OKR through the course of adaptation training. Our analyses revealed that eye acceleration at visual-stimulus onset primarily limited working velocity and frequency range of the OKR, yet could be dramatically potentiated during OKR adaptation. Potentiation of eye acceleration exhibited different properties between the nasotemporal and temporonasal OKRs, indicating distinct visuomotor circuits underlying the two. Lesions and optogenetic manipulation of the cerebellum provide constraints on neural circuits mediating visually driven eye acceleration and its adaptation.
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21
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Cho BH, Kim SH, Kim SS, Choi YJ, Lee SH. Central positional nystagmus associated with cerebellar tumors: Clinical and topographical analysis. J Neurol Sci 2017; 373:147-151. [DOI: 10.1016/j.jns.2016.12.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
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23
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Kim HA, Yi HA, Lee H. Failure of Fixation Suppression of Spontaneous Nystagmus in Cerebellar Infarction: Frequency, Pattern, and a Possible Structure. THE CEREBELLUM 2016; 15:182-9. [PMID: 26082303 DOI: 10.1007/s12311-015-0688-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To investigate the frequency and pattern of failure of the fixation suppression (FFS) of spontaneous nystagmus (SN) in unilateral cerebellar infarction, and to identify the structure responsible for FFS, 29 patients with acute, mainly unilateral, isolated cerebellar infarction who had SN with a predominantly horizontal component were enrolled in this study. The ocular fixation index (OFI) was defined as the mean slow phase velocity (SPV) of the horizontal component of SN with fixation divided by the mean SPV of the horizontal component of SN without fixation. The OFI from age- and sex-matched patients with vestibular neuritis was calculated and used as the control data. The FFS of SN was only found in less than half (41 %, 12/29) of the patients. Approximately 65 % (n = 7) of the patients with isolated anterior inferior cerebellar artery territory cerebellar infarction showed FFS, whereas only a quarter (n = 3) of the patients with isolated posterior inferior cerebellar artery (PICA) territory cerebellar infarction showed FFS. The proportion of gaze-evoked nystagmus (6/12 [50 %] vs. 2/17 [12 %], p = 0.04) and deficient gain of ipsilesional pursuit (10/12 [83 %] vs. 6/17 [35 %], p = 0.05) was more frequent in the FFS group than in the group without FFS. Lesion subtraction analysis in isolated PICA territory cerebellar infarction revealed that the nodulus was commonly damaged in patients with FFS, compared to that of patients without FFS. Our study shows that FFS of SN due to acute cerebellar infarction is less common than previously thought and the nodulus may be an important structure for the suppression of SN in humans.
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Affiliation(s)
- Hyun-Ah Kim
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea
- Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyon-Ah Yi
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea
- Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyung Lee
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea.
- Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea.
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24
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Modulation of central nystagmus by vision, proprioception, and efference copy signals: a systematic evaluation. J Neurol 2016; 263:735-42. [DOI: 10.1007/s00415-016-8032-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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25
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Gonshor A, Jones GM. Extreme vestibulo-ocular adaptation induced by prolonged optical reversal of vision. J Physiol 2015; 256:381-414. [PMID: 16992508 PMCID: PMC1309313 DOI: 10.1113/jphysiol.1976.sp011330] [Citation(s) in RCA: 304] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1. These experiments investigated plastic changes in the vestibulo-ocular reflex (VOR) of human subjects consequent to long-term optical reversal of vision during free head movement. Horizontal vision-reversal was produced by head-mounted dove prisms. Four normal adults were continuously exposed to these conditions during 2, 6, 7 and 27 days respectively.2. A sinusoidal rotational stimulus, previously shown to be nonhabituating (1/6 Hz; 60 degrees /sec amplitude), was used to test the VOR in the dark at frequent intervals both during the period of vision-reversal and an equal period after return to normal vision. D.c. electro-oculography (EOG) was used to record eye movement, taking care to avoid changes of EOG gain due to light/dark adaptation of the retina.3. All subjects showed substantial reduction of VOR gain (eye velocity/head velocity) during the first 2 days of vision-reversal. The 6-, 7- and 27-day subjects showed further reduction of gain which reached a low plateau at about 25% the normal value by the end of one week. At this time the attenuation of some EOG records was so marked as to defy extraction of a meaningful sinusoidal signal.4. After removal of the prisms VOR gain recovered along a time course which approximated that of the original adaptive attenuation.5. In the 27-day experiment large changes of phase developed in the VOR during the second week of vision-reversal. These changes generally progressed in a lagging sense, to reach 130 degrees phase lag relative to normal by the beginning of the third week. Accompanying this was a considerable restoration of gain from 25 to 50% the normal value. These adapted conditions, which approximate functional reversal of the reflex, were then maintained steady, even overnight, until return to normal vision on the 28th day.6. Thereafter, whereas VOR phase returned to near-normal in 2 hr, restoration of gain occupied a further 2-3 weeks.7. There was a highly systematic relation between instantaneous gain and phase, even during periods of widely fluctuating change associated with transition from one steady state to another. During such transition there was a tendency for directional preponderance to occur in the VOR.8. All the observed changes were highly specific to the plane of vision-reversal, no VOR changes being observed in the sagittal plane.9. VOR changes were adaptive, in the sense that they were always goal-directed towards the requirements of retinal image stabilization during head movement. They were plastic to the extent that there was extensive and retained remodelling of the reflex towards this goal.10. It is inferred that all the observed changes in gain and phase are compatible with a simple neural network employing known vestibulo-ocular projections via brainstem and cerebellar pathways, providing that the reversed visual tracking task can produce plastic modulation of efficacy in the cerebellar pathway and that this pathway exhibits a dynamic characteristic producing moderate phase lead in a sinusoidal signal at 1/6 Hz.
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Affiliation(s)
- A Gonshor
- DRB Aviation Medical Research Unit, Department of Physiology, McGill University, Montréal, Québec, Canada
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An SY, Kim BJ, Suh MW, Rhee CK, Jung JY. Clinical roles of fixation suppression failure in dizzy patients in the ENT clinic. Acta Otolaryngol 2014; 134:1134-9. [PMID: 25315913 DOI: 10.3109/00016489.2014.936623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Conclusion: Any test for visual fixation suppression by itself is insufficient for screening central pathology and should be interpreted in conjunction with other neurotologic findings. OBJECTIVES We evaluated the correlation of visual fixation suppression (VFS) under three different test conditions (spontaneous nystagmus, caloric stimulation, and slow harmonic acceleration, SHA), as well as the diagnostic accuracy of each test for predicting central pathology, in dizzy patients. METHODS We retrospectively reviewed cases in a tertiary referral center; 504 consecutive dizzy patients who visited the ENT clinic were enrolled. The fixation index (FI, slow component velocity during fixation/slow component velocity before fixation × 100%) for the caloric test and spontaneous nystagmus was calculated and failure was indicated when the FI was greater than 60%. VFS during the SHA test at a frequency of 0.04 Hz was also performed and gain more than 0.2 was considered as failure of VFS. RESULTS The incidence of VFS failure was 5.4% in the caloric test, 3.4% in spontaneous nystagmus, and 2.3% in the SHA test, respectively. Significant correlation was found only between the caloric test and the SHA test (r = 0.341, p < 0.001). The sensitivity of VFS in different tests did not exceed 35%. The specificity of VFS was highest (96.4%) in the 0.04 Hz SHA test, and exceeded 80% in the other tests.
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Affiliation(s)
- Se-Young An
- Department of ORL-HNS, College of Medicine, Dankook University , Cheonan
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Periodic alternating nystagmus caused by a medullary lesion in acute disseminated encephalomyelitis. Otol Neurotol 2014; 35:861-5. [PMID: 24608378 DOI: 10.1097/mao.0000000000000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To document a patient with periodic alternating nystagmus (PAN) caused by acute disseminated encephalomyelitis (ADEM) and suggest a mechanism to explain her PAN. PATIENT A 34-year-old woman with PAN caused by ADEM. INTERVENTION Diagnostic. RESULTS The patient complained of severe disequilibrium from the disease onset. Four years after onset, when she visited us, the patient exhibited prominent PAN consisting of alternating rightward and leftward components, which cycled about every 90 seconds and were accompanied by a 5-second translating phase with downbeating nystagmus. Eye movement analysis that separated the horizontal and vertical components revealed the presence of downbeating movements throughout all phases of the PAN. ENG recordings revealed slightly saccadic pursuit, slightly impaired optokinetic eye movement and an absence of visual suppression of the caloric response. MRI recorded at the onset of the disease revealed lesions in the medulla, the spinal cord at the C2 level, and the frontal horn of the left lateral ventricle, but not the cerebellum. CONCLUSION We attribute this patient's PAN to impairment of the nucleus prepositus hypoglossi in the medulla, which plays a role in the velocity storage system. In addition, cerebellar dysfunction is indicated by the occurrence of PAN while fixating.
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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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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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Eye position dependency of nystagmus during constant vestibular stimulation. Exp Brain Res 2013; 226:175-82. [DOI: 10.1007/s00221-013-3423-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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Park HK, Kim JS, Strupp M, Zee DS. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 2013; 260:1576-82. [PMID: 23370610 DOI: 10.1007/s00415-013-6837-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 01/02/2013] [Accepted: 01/07/2013] [Indexed: 12/19/2022]
Abstract
Isolated floccular infarction is extremely rare, and impairments of the vestibulo-ocular reflex (VOR) have not been explored in humans with isolated floccular lesions. The purpose of this study was to examine and report selective impairment of VOR in response to high acceleration using head impulse in a patient with isolated floccular infarction. The patient underwent bedside and laboratory evaluation of vestibular function, which included video-oculography, ocular torsion and the subjective visual vertical, cervical and ocular vestibular-evoked myogenic potentials, bithermal caloric irrigation, rotatory chair test, and the head impulse test (HIT) using search coils. A 70-year-old woman with a unilateral floccular infarction presented with an acute vestibular syndrome with spontaneous nystagmus beating to the lesion side, impaired ipsilesional pursuit, contraversive ocular torsion and tilt of the subjective visual vertical. With rotatory chair testing at low frequencies, horizontal VOR gains were increased. However, VOR gains were decreased with the higher-frequency, higher-speed HIT. While HIT is often normal in patients with central vestibular disorders, decreased HIT responses do not exclude an isolated cerebellar lesion as a cause of the acute vestibular syndrome.
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Affiliation(s)
- Hong-Kyun Park
- Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea
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Kishi M, Sakakibara R, Yoshida T, Yamamoto M, Suzuki M, Kataoka M, Tsuyusaki Y, Tateno A, Tateno F. Visual Suppression is Impaired in Spinocerebellar Ataxia Type 6 but Preserved in Benign Paroxysmal Positional Vertigo. Diagnostics (Basel) 2012; 2:52-6. [PMID: 26859398 PMCID: PMC4665556 DOI: 10.3390/diagnostics2040052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/25/2012] [Accepted: 10/08/2012] [Indexed: 11/22/2022] Open
Abstract
Positional vertigo is a common neurologic emergency and mostly the etiology is peripheral. However, central diseases may mimic peripheral positional vertigo at their initial presentation. We here describe the results of a visual suppression test in six patients with spinocerebellar ataxia type 6 (SCA6), a central positional vertigo, and nine patients with benign paroxysmal positional vertigo (BPPV), the major peripheral positional vertigo. As a result, the visual suppression value of both diseases differed significantly; e.g., 22.5% in SCA6 and 64.3% in BPPV (p < 0.001). There was a positive correlation between the visual suppression value and disease duration, cerebellar atrophy, and CAG repeat length of SCA6 but they were not statistically significant. In conclusion, the present study showed for the first time that visual suppression is impaired in SCA6, a central positional vertigo, but preserved in BPPV, the major peripheral positional vertigo, by directly comparing both groups. The abnormality in the SCA6 group presumably reflects dysfunction in the central visual fixation pathway at the cerebellar flocculus and nodulus. This simple test might aid differential diagnosis of peripheral and central positional vertigo at the earlier stage of disease.
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Affiliation(s)
- Masahiko Kishi
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Tomoe Yoshida
- Department of Otolaryngology, Sakura Medical Center, Toho University, Sakura 285-0841, Japan.
| | - Masahiko Yamamoto
- Department of Otolaryngology, Sakura Medical Center, Toho University, Sakura 285-0841, Japan.
| | - Mitsuya Suzuki
- Department of Otolaryngology, Sakura Medical Center, Toho University, Sakura 285-0841, Japan.
| | - Manabu Kataoka
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura 285-8741, Japan.
| | - Yohei Tsuyusaki
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Akihiko Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
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Suppression of spontaneous nystagmus during different visual fixation conditions. Eur Arch Otorhinolaryngol 2011; 269:1759-62. [PMID: 22057154 DOI: 10.1007/s00405-011-1824-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/25/2011] [Indexed: 10/15/2022]
Abstract
Analysis of spontaneous nystagmus is important in the evaluation of dizzy patients. The aim was to measure how different visual conditions affect the properties of nystagmus using three-dimensional video-oculography (VOG). We compared prevalence, frequency and slow phase velocity (SPV) of the spontaneous nystagmus with gaze fixation allowed, with Frenzel's glasses, and in total darkness. Twenty-five patients (35 measurements) with the peripheral vestibular pathologies were included. The prevalence of nystagmus with the gaze fixation was 40%, and it increased significantly to 66% with Frenzel's glasses and regular room lights on (p < 0.01). The prevalence increased significantly to 83% when the regular room lights were switched off (p = 0.014), and further to 100% in total darkness (p = 0.025). The mean SPV of nystagmus with visual fixation allowed was 1.0°/s. It increased to 2.4°/s with Frenzel's glasses and room lights on, and additionally to 3.1°/s, when the regular room lights were switched off. The mean SPV in total darkness was 6.9°/s. The difference was highly significant between all test conditions (p < 0.01). The frequency of nystagmus was 0.7 beats/s with gaze fixation, 0.8 beats/s in both the test conditions with Frenzel's glasses on, and 1.2 beats/s in total darkness. The frequency in total darkness was significantly higher (p < 0.05) than with Frenzel's glasses, and more so than with visual fixation (p = 0.003). The VOG in total darkness is superior in detecting nystagmus, since Frenzel's glasses allow visual suppression to happen, and this effect is reinforced with gaze fixation allowed. Strict control of visual surroundings is essential in interpreting peripheral nystagmus.
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Abstract
An intact cerebellum is a prerequisite for optimal ocular motor performance. The cerebellum fine-tunes each of the subtypes of eye movements so they work together to bring and maintain images of objects of interest on the fovea. Here we review the major aspects of the contribution of the cerebellum to ocular motor control. The approach will be based on structural–functional correlation, combining the effects of lesions and the results from physiologic studies, with the emphasis on the cerebellar regions known to be most closely related to ocular motor function: (1) the flocculus/paraflocculus for high-frequency (brief) vestibular responses, sustained pursuit eye movements, and gaze holding, (2) the nodulus/ventral uvula for low-frequency (sustained) vestibular responses, and (3) the dorsal oculomotor vermis and its target in the posterior portion of the fastigial nucleus (the fastigial oculomotor region) for saccades and pursuit initiation.
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Affiliation(s)
- Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine Baltimore, MD, USA
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Strupp M, Brandt T. Current treatment of vestibular, ocular motor disorders and nystagmus. Ther Adv Neurol Disord 2011; 2:223-39. [PMID: 21179531 DOI: 10.1177/1756285609103120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Vertigo and dizziness are among the most common complaints with a lifetime prevalence of about 30%. The various forms of vestibular disorders can be treated with pharmacological therapy, physical therapy, psychotherapeutic measures or, rarely, surgery. In this review, the current pharmacological treatment options for peripheral and central vestibular, cerebellar and ocular motor disorders will be described. They are as follows for peripheral vestibular disorders. In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease a recent study showed long-term high-dose treatment with betahistine has a significant effect on the frequency of the attacks. The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA 2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. However, many other eye movement disorders such as ocular flutter opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat. Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA 2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Menière's disease, bilateral vestibular failure, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.
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Affiliation(s)
- Michael Strupp
- Professor of Neurology and Clinical Neurophysiology, University of Munich, Klinikum Grosshadern, Munich, Germany
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Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol 2011; 258:1207-22. [PMID: 21461686 PMCID: PMC3132281 DOI: 10.1007/s00415-011-5999-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 01/28/2023]
Abstract
We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.
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Affiliation(s)
- Michael Strupp
- Department of Neurology, University of Munich, Munich, Germany
| | - Matthew J. Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA USA
| | - Aasef G. Shaikh
- Neurology Service, Veterans Affairs Medical Center and Case Medical Center, Cleveland, OH USA
| | - Thomas Brandt
- Department of Neurology, University of Munich, Munich, Germany
| | - David S. Zee
- Department of Neurology, John Hopkins Medical Center, Baltimore, MD USA
| | - R. John Leigh
- Neurology Service, Veterans Affairs Medical Center and Case Medical Center, Cleveland, OH USA
- Department of Neurology, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106-5040 USA
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VGCC antibody-positive paraneoplastic cerebellar degeneration presenting with positioning vertigo. Neurol Sci 2011; 32:1209-12. [PMID: 21678073 DOI: 10.1007/s10072-011-0648-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 05/30/2011] [Indexed: 02/06/2023]
Abstract
A 70-year-old woman developed paraneoplastic cerebellar degeneration (PCD) due to P/Q-type and N-type voltage-gated calcium channel antibodies and small cell lung cancer, the main clinical manifestations of which were severe positioning vertigo and vomiting. Loss of the visual suppression of caloric nystagmus, spontaneous downbeat nystagmus, periodic alternating nystagmus, and positioning vertigo in our patient most probably corresponds to the cerebellar flocculus/paraflocculus lesion caused by PCD.
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Taki M, Nin F, Hasegawa T, Sakaguchi H, Suzuki T, Hisa Y, Azuma Y, Nakagawa M. A case report of HTLV-I associated myelopathy presenting with cerebellar ataxia and nystagmus. Auris Nasus Larynx 2011; 38:411-4. [DOI: 10.1016/j.anl.2010.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 07/03/2010] [Accepted: 08/31/2010] [Indexed: 11/24/2022]
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Higashi-Shingai K, Imai T, Takeda N, Uno A, Nishiike S, Horii A, Kitahara T, Fuse Y, Hashimoto M, Senba O, Suzuki T, Fujita T, Otsuki H, Inohara H. 3D analysis of spontaneous upbeat nystagmus in a patient with astrocytoma in cerebellum. Auris Nasus Larynx 2011; 39:216-9. [PMID: 21602005 DOI: 10.1016/j.anl.2011.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 02/25/2011] [Accepted: 03/08/2011] [Indexed: 11/17/2022]
Abstract
AIMS We report the case of a 58-year-old female patient who consulted our Department complaining of positional vertigo and showing spontaneous upbeat nystagmus (UBN) in darkness. METHOD We analyzed her UBN three-dimensionally. The MRI scan revealed the astrocytoma in the left cerebellum involving the cerebellar vermis. RESULT Three-dimensional analysis showed a spontaneous UBN rotating around the intra-aural axis in the pitch plane. CONCLUSION Since the cerebellar vermis is known to plays an inhibitory role on the central vertical vestibule-ocular reflex (VOR), the present results suggest that the spontaneous UBN in darkness observed in this patient was induced by an imbalance of central vertical VOR tone.
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Affiliation(s)
- Kayoko Higashi-Shingai
- Depatrment of Otorhinolaryngology--Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suitashi, Osaka, Japan
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Su CH, Young YH. Differentiating cerebellar and brainstem lesions with ocular vestibular-evoked myogenic potential test. Eur Arch Otorhinolaryngol 2010; 268:923-30. [PMID: 21170655 DOI: 10.1007/s00405-010-1463-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/07/2010] [Indexed: 11/29/2022]
Abstract
This study applied both ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests in patients with cerebellar disorders to determine whether VEMP test can differentiate between cerebellar and brainstem lesions. A total of 12 patients with cerebellar disorder, including extended cerebellar lesion (involving the brainstem) in 8 and localized cerebellar lesion (excluding the brainstem) in 4, were enrolled in this study. All patients underwent caloric, visual suppression, and oVEMP and cVEMP tests via bone-conducted vibration stimuli. The abnormal rates for the caloric, visual suppression, and oVEMP and cVEMP tests were 62, 83, 88 and 75% in patients with extended cerebellar lesion and 0, 25, 0 and 0% in those with localized cerebellar lesion, respectively. The rate of abnormal oVEMP results significantly differed between the two groups, but caloric, visual suppression and cVEMP test results did not differ. In another ten healthy subjects, characteristic parameters of oVEMPs obtained under light and dark conditions did not significantly differ. In conclusion, ocular VEMP test can differentiate between cerebellar and brainstem lesions. Abnormal oVEMPs in patients with cerebellar disorder may indicate adjacent brainstem involvement.
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Affiliation(s)
- Chia-Hung Su
- Department of Otolaryngology, Catholic Cardinal Tien Hospital, Fu-Jen Catholic University, Taipei, Taiwan
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Anzai M, Kitazawa H, Nagao S. Effects of reversible pharmacological shutdown of cerebellar flocculus on the memory of long-term horizontal vestibulo-ocular reflex adaptation in monkeys. Neurosci Res 2010; 68:191-8. [PMID: 20674618 DOI: 10.1016/j.neures.2010.07.2038] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/05/2010] [Accepted: 07/18/2010] [Indexed: 11/26/2022]
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Frens MA, Donchin O. Forward models and state estimation in compensatory eye movements. Front Cell Neurosci 2009; 3:13. [PMID: 19956563 PMCID: PMC2786296 DOI: 10.3389/neuro.03.013.2009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 11/06/2009] [Indexed: 11/13/2022] Open
Abstract
The compensatory eye movement (CEM) system maintains a stable retinal image, integrating information from different sensory modalities to compensate for head movements. Inspired by recent models of the physiology of limb movements, we suggest that CEM can be modeled as a control system with three essential building blocks: a forward model that predicts the effects of motor commands; a state estimator that integrates sensory feedback into this prediction; and, a feedback controller that translates a state estimate into motor commands. We propose a specific mapping of nuclei within the CEM system onto these control functions. Specifically, we suggest that the Flocculus is responsible for generating the forward model prediction and that the Vestibular Nuclei integrate sensory feedback to generate an estimate of current state. Finally, the brainstem motor nuclei – in the case of horizontal compensation this means the Abducens Nucleus and the Nucleus Prepositus Hypoglossi – implement a feedback controller, translating state into motor commands. While these efforts to understand the physiological control system as a feedback control system are in their infancy, there is the intriguing possibility that CEM and targeted voluntary movements use the same cerebellar circuitry in fundamentally different ways.
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Affiliation(s)
- Maarten A Frens
- Department of Neuroscience, Erasmus Medical Center Rotterdam, The Netherlands
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Lisberger SG. Internal models of eye movement in the floccular complex of the monkey cerebellum. Neuroscience 2009; 162:763-76. [PMID: 19336251 PMCID: PMC2740815 DOI: 10.1016/j.neuroscience.2009.03.059] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 03/21/2009] [Accepted: 03/24/2009] [Indexed: 11/25/2022]
Abstract
Internal models are a key feature of most modern theories of motor control. Yet, it has been challenging to localize internal models in the brain, or to demonstrate that they are more than a metaphor. In the present review, I consider a large body of data on the cerebellar floccular complex, asking whether floccular output has features that would be expected of the output from internal models. I argue that the simple spike firing rates of a single group of floccular Purkinje cells could reflect the output of three different internal models. (1) An eye velocity positive feedback pathway through the floccular complex provides neural inertia for smooth pursuit eye movements, and appears to operate as a model of the inertia of real-world objects. (2) The floccular complex processes and combines input signals so that the dynamics of its average simple spike output are appropriate for the dynamics of the downstream brainstem circuits and eyeball. If we consider the brainstem circuits and eyeball as a more broadly conceived "oculomotor plant," then the output from the floccular complex could be the manifestation of an inverse model of "plant" dynamics. (3) Floccular output reflects an internal model of the physics of the orbit where head and eye motion sum to produce gaze motion. The effects of learning on floccular output suggest that it is modeling the interaction of the visually-guided and vestibular-driven components of eye and gaze motion. Perhaps the insights from studying oculomotor control provide groundwork to guide the analysis of internal models for a wide variety of cerebellar behaviors.
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Affiliation(s)
- S G Lisberger
- Howard Hughes Medical Institute, Department of Physiology, W. M. Keck Foundation Center for Integrative Neuroscience, University of California, Box 0444, 513 Parnassus Avenue, Room HSE-802, San Francisco, CA 94143-0444, USA.
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Yakushin SB, Tarasenko Y, Raphan T, Suzuki JI, Della Santina CC, Minor LB, Cohen B. Modification of the cervico-ocular reflex by canal plugging. Ann N Y Acad Sci 2009; 1164:60-7. [PMID: 19645881 DOI: 10.1111/j.1749-6632.2009.03775.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The cervico-ocular reflex (COR) has a low gain in normal animals. In this study, we determined whether COR gain increases were specific to the low/midband frequency range, which is the range over which the angular vestibulo-ocular reflex (aVOR) is compromised by plugging. The gain and phase of the yaw and pitch COR and aVOR were compared in normal monkeys and those with all six semicircular canals or only the lateral canal plugged. During experiments animals sat with the body fixed to a chair and the head fixed in space. The body was oscillated about body-yaw and body-pitch axes over a frequency range of 0.05-6 Hz, with amplitude <10 degrees. For normal animals, both yaw and pitch eye velocities were compensatory to the relative velocity of the head with respect to the body. The gains were 0.1-0.2 at frequencies below 1 Hz and decreased to zero as stimulus frequency increased above 1 Hz. Canal-plugged animals had COR gains close to 1.0 at low frequencies, decreasing to approximately 0.6 at 0.5 Hz and to 0.2 for stimulus frequencies above 3 Hz. The phase of eye velocity was 180 degrees relative to head-re-body velocity at frequencies below 0.5 Hz and shifted toward 270 degrees as frequencies were increased to 4 Hz. This study demonstrates that adaptation of COR gain is tuned to a frequency range at which the aVOR is compromised by the canal plugging.
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Affiliation(s)
- Sergei B Yakushin
- Departments of Neurology, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Herishanu YO. Abnormal cancellation of the vestibulo-ocular reflex (VOR) after mild head and/or neck trauma. Neuroophthalmology 2009. [DOI: 10.3109/01658109209058144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Barr CC, Schultheis LW, Robinson DA. Voluntary, Non-Visual Control of The Human Vestibulo-Ocular Reflex. Acta Otolaryngol 2009. [DOI: 10.3109/00016487609119974] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Inui, Yoshiyuki Kitaoku, Keiji Yone H. MR-angiographic Findings of Patients with Central Vestibular Disorders. Acta Otolaryngol 2009. [DOI: 10.1080/00016489850183755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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