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Lee SU, Kim HJ, Choi JY, Choi KD, Kim JS. Expanding Clinical Spectrum of Anti-GQ1b Antibody Syndrome: A Review. JAMA Neurol 2024:2818518. [PMID: 38739407 DOI: 10.1001/jamaneurol.2024.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Importance The discovery of the anti-GQ1b antibody has expanded the nosology of classic Miller Fisher syndrome to include Bickerstaff brainstem encephalitis, Guillain-Barré syndrome with ophthalmoplegia, and acute ophthalmoplegia without ataxia, which have been brought under the umbrella term anti-GQ1b antibody syndrome. It seems timely to define the phenotypes of anti-GQ1b antibody syndrome for the proper diagnosis of this syndrome with diverse clinical presentations. This review summarizes these syndromes and introduces recently identified subtypes. Observations Although ophthalmoplegia is a hallmark of anti-GQ1b antibody syndrome, recent studies have identified this antibody in patients with acute vestibular syndrome, optic neuropathy with disc swelling, and acute sensory ataxic neuropathy of atypical presentation. Ophthalmoplegia associated with anti-GQ1b antibody positivity is complete in more than half of the patients but may be monocular or comitant. The prognosis is mostly favorable; however, approximately 14% of patients experience relapse. Conclusions and Relevance Anti-GQ1b antibody syndrome may present diverse neurological manifestations, including ophthalmoplegia, ataxia, areflexia, central or peripheral vestibulopathy, and optic neuropathy. Understanding the wide clinical spectrum may aid in the differentiation and management of immune-mediated neuropathies with multiple presentations.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Deparment of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Deparment of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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Lee SM, Choi SY, Choi JH, Oh EH, Yoo D, Lee SU, Kim HJ, Choi JY, Kim JS, Choi KD. Ocular motor and vestibular dysfunction in central nervous system lymphoma. Eur J Neurol 2024; 31:e16242. [PMID: 38344918 DOI: 10.1111/ene.16242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Diagnosis of lymphoma involving the central nervous system (CNS) is challenging. This study aimed to explore the abnormal vestibular and ocular motor findings in CNS lymphoma. METHODS A retrospective search of the medical records identified 30 patients with CNS lymphoma presenting ocular motor and vestibular abnormalities from four neurology clinics of university hospitals in South Korea (22 men, age range 14-81 years, mean 60.6 ± 15.2). The demographic and clinical features and the results of laboratory, radiological and pathological evaluation were analyzed. RESULTS Patients presented with diplopia (13/30, 43%), vestibular symptoms (15/30, 50%) or both (2/30, 7%). In 15 patients with diplopia, abnormal ocular motor findings included ocular motor nerve palsy (n = 10, 67%), internuclear ophthalmoplegia (n = 2, 13%), external ophthalmoplegia (n = 2, 13%) and exophoria (n = 1, 7%). The vestibular abnormalities were isolated in 14 (82%) of 17 patients with vestibular symptoms and included combined unilateral peripheral and central vestibulopathy in three from lesions involving the vestibular nuclei. CNS lymphoma involved the brainstem (53%), cerebellum (33%), leptomeninges (30%), deep gray nuclei (23%) or cranial nerves (17%). Two patients showed the "double-panda" sign by involving the midbrain. CONCLUSIONS This study expands the clinical and radiological spectra of CNS lymphoma. Neuro-ophthalmological and neuro-otological evaluation may guide the early diagnosis of CNS lymphoma.
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Affiliation(s)
- Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
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Hong JP, Baik K, Park E, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. The vestibulospinal dysfunction has little impact on falls in patients with mild Parkinson's disease. Parkinsonism Relat Disord 2024; 122:106081. [PMID: 38461689 DOI: 10.1016/j.parkreldis.2024.106081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
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Yoon HJ, Lee SU, Park E, Choi JY, Kim JS. Ocular Flutter Evoked by Vestibular Stimulation. Cerebellum 2024; 23:872-874. [PMID: 37458900 DOI: 10.1007/s12311-023-01588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 03/20/2024]
Affiliation(s)
- Ho-Jin Yoon
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Euyhyun Park
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Lee SU, Park E, Kim HJ, Choi JY, Kim JS. Evolution of Vestibular Findings During and Between the Attacks of Meniere Disease: Update. Neurol Clin Pract 2024; 14:e200235. [PMID: 38223349 PMCID: PMC10783974 DOI: 10.1212/cpj.0000000000200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 01/16/2024]
Abstract
Purpose of Review The diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the evolution of vestibular function and their underlying physiology during and between the attacks of MD and thus aims to help identify this common disorder with many faces according to the phase. Recent Findings During the attacks, the direction of spontaneous nystagmus changes over time, beating initially toward the affected ear (irritative nystagmus), then toward the healthy ear (paretic nystagmus), and finally back toward the affected ear again (recovery nystagmus). Apart from these direction changes, atypical forms of spontaneous nystagmus, such as downbeat, discordant horizontal-torsional, and aperiodic alternating nystagmus, can be observed. Head impulse tests (HITs) are mostly normal during the irritative/recovery phases, but positive in more than half of patients during the paretic phase. By contrast, caloric tests are usually abnormal irrespective of the phases, although paradoxical caloric hyper-responsiveness can be observed in 18% of patients during the irritative/recovery phases. Thus, dissociation in the findings of caloric tests-HITs can be observed during and between the attacks. Horizontal head shaking tends to augment spontaneous nystagmus during each phase, while skull vibration mostly induces nystagmus beating toward the healthy ear irrespective of the phases. During the attacks, ocular vestibular-evoked myogenic potentials (VEMPs) may be enhanced, whereas cervical VEMPs are usually decreased during stimulation of the involved ear. Summary Recognizing these evolutions of vestibular findings during and between the attacks of MD would provide insights into its pathophysiology and aid in treatments and diagnosis.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Euyhyun Park
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kim HJ, Lee SU, Lee ES, Choi JY, Kim JS. Recurrence and long-term outcomes of Tolosa-Hunt syndrome. J Neurol 2024; 271:935-943. [PMID: 37853245 DOI: 10.1007/s00415-023-12044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND PURPOSE Tolosa-Hunt Syndrome (THS) is a rare disorder, and detailed clinical information and treatment outcomes have yet to be fully elucidated. This study aims to investigate the clinical features and factors associated with the treatment outcomes of THS, as defined by the established diagnostic criteria. METHODS This study retrospectively recruited 91 patients with a diagnosis of THS from 2003 to 2020. We analyzed the clinical features and outcomes, the initial treatment response, recurrences, and the final treatment response. RESULTS Isolated ocular motor nerve palsy was the most common (82.4%) finding of ophthalmoplegia, involving the oculomotor nerve in more than half of the cases (52.0%). The MRI lesions were mostly observed in the cavernous sinus (94.5%) with an extracavernous extension in about one-third of them. Five patients showed only extracavernous lesions. A total of 25 (27.5%) patients experienced recurrence. Recurrence occurred during steroid tapering as part of the initial treatment in seven, while in 18 patients, it happened after the successful termination of the initial treatment. However, all patients achieved complete remission at the final. Age was associated with a decrease in initial symptom duration (HR = 1.023, CI = 1.004-1.044) as well as an increase in recurrence-free duration (HR = 0.944, CI = 0.911-0.978). High-dose corticosteroid treatment was associated with a decrease in initial symptom duration (HR = 1.642, CI = 1.001-2.695) and total treatment duration (HR = 2.203 CI = 1.302-3.730). CONCLUSIONS THS can recur frequently especially in younger but have a favorable prognosis. High-dose corticosteroids can be an effective initial treatment and reduce the total treatment duration.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sun-Uk Lee
- Neurotology Laboratory, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yoon HJ, Lee JH, Lee JH, Park E, Lee SU, Kim BJ, Kim JS. Effects of pupil size in video head-impulse tests. J Neurol 2024; 271:819-825. [PMID: 37805976 DOI: 10.1007/s00415-023-12026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
The results of video head impulse tests (video-HITs) may be confounded by data artifacts of various origins, including pupil size and eyelid obstruction of the pupil. This study aimed to determine the effect of these factors on the results of video-HITs. We simulated ptosis by adopting pharmacological dilatation of the pupil in 21 healthy participants (11 women; age 24-58 years). Each participant underwent video-HITs before and after pupillary dilatation using 0.5% tropicamide. We assessed the changes in the vestibulo-ocular reflex (VOR) gain, corrective saccade amplitude, and frequency of eyelid flicks. After pupillary dilatation, the VOR gain decreased for both right (RAC; 1.12 [Formula: see text] 0.12 vs. 1.01 [Formula: see text] 0.16, p = 0.011) and left anterior canals (LACs; 1.15 [Formula: see text] 0.13 vs. 0.96 [Formula: see text] 0.14, p < 0.001), and right posterior canal (RPC, 1.10 [Formula: see text] 0.13 vs. 0.98 [Formula: see text] 0.09, p = 0.001). The corrective saccade amplitudes also decreased significantly for all four vertical canals. The frequency of eyelid flicks, however, did not change. The changes of VOR gain were positively correlated with the lid excursion in RPC (r = 0.629, p = 0.002) and LPC (r = 0.549, p = 0.010). Our study indicates that eyelid position and pupil size should be considered when interpreting the results of video-HITs, especially for the vertical canals. Pupils should be shrunk in a very well-lit room, and artifacts should be prevented by taping or lifting the eyelids as required during video-HITs.
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Affiliation(s)
- Ho-Jin Yoon
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jeong-Heon Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Joo-Hyeong Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Euyhyun Park
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Hong JP, Kwon H, Park E, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. The semicircular canal function is preserved with little impact on falls in patients with mild Parkinson's disease. Parkinsonism Relat Disord 2024; 118:105933. [PMID: 38007917 DOI: 10.1016/j.parkreldis.2023.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Postural instability is a cardinal symptom of Parkinson's disease (PD), which suggests the vestibular system may be affected in PD. This study aimed to determine whether vestibular dysfunction is associated with the risk of falls in PD. METHODS We prospectively recruited patients with de-novo PD at a tertiary medical center between December 2019 and March 2023. During initial assessment, each patient was queried about falls within the preceding year. All patients underwent evaluation of video head-impulse tests (video-HITs), motion analysis, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MOCA). We determined whether head impulse gain of the vestibulo-ocular reflex (VOR) was associated with clinical severity of PD or risk of falls. RESULTS Overall, 133 patients (mean age ± SD = 68 ± 10, 59 men) were recruited. The median Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III) was 23 (interquartile range = 16-31), and 81 patients (61 %) scored 2 or less on the Hoehn and Yahr scale. Fallers were older (p = 0.001), had longer disease duration (p = 0.001), slower gait velocity (p = 0.009), higher MDS-UPDRS-III (p < 0.001) and H&Y scale (p < 0.001), lower MMSE (p = 0.018) and MOCA scores (p = 0.001) than non-fallers. Multiple logistic regression showed that MDS-UPDRS-III had a positive association with falling (p = 0.004). Falling was not associated with VOR gain (p = 0.405). The VOR gain for each semicircular canal showed no correlation with the MDS-UPDRS-III or disease duration. CONCLUSIONS The semicircular canal function, as determined by video-HITs, is relatively spared and has little effect on the risk of falls in patients with mild-to-moderate PD.
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Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
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Yoon H, Kwon H, Lee SU, Park E, Lee CN, Kim BJ, Kim JS, Park KW. Scale for Ocular Motor Disorders in Ataxia (SODA) in Patients with Multiple System Atrophy. Cerebellum 2023:10.1007/s12311-023-01653-y. [PMID: 38117451 DOI: 10.1007/s12311-023-01653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
A clinical scale fully dedicated to evaluating ocular motor abnormalities is required for now. We investigated the utility of a recently developed Scale for Ocular motor Disorders in Ataxia (SODA) in patients with multiple system atrophy (MSA). We prospectively assessed SODA in consecutive patients with MSA between August 2021 and August 2023 at the Korea University Medical Center. The results of the clinical exam-based SODA were compared with those measured using video-oculography (VOG-guided SODA). We also compared the findings with other established clinical scales targeting patients with MSA, including the Unified Multiple System Atrophy Rating Scale (UMSARS) I-II, Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (UPDRS-III), Scale for Assessment of Rating of Ataxia (SARA), Composite Autonomic Symptom Score-31 (COMPASS-31), and Composite Autonomic Severity Score (CASS). Twenty patients were enrolled in our study (17 with cerebellar-type MSA and three with Parkinson-type MSA). Scores ranged from 1 to 14 (median [interquartile range (IQR)] = 8 [5-10]). Among the subscales, saccades had a median score of 2.5 (IQR = 1-3), followed by ocular pursuit (1 [0-1]), nystagmus (1 [0-2]), saccadic intrusions (1 [0-1]), vestibulo-ocular reflex (VOR) (0.5 [0-1]), ocular alignment (0 [0-1]), and VOR cancellation (1 [0-1]). The clinical-exam-based SODA (p = 0.020) and VOG-guided SODA (p = 0.034) positively correlated with disease duration. No correlation was found between clinical exam-based SODA and other scales. Skew deviation, gaze-evoked nystagmus, VOR cancellation, and smooth pursuit had the highest precision among the items. Ocular misalignment and spontaneous and positional nystagmus were frequently false positive and were poorly detected with clinical exam-based SODA. Six patients with repeated evaluation exhibited higher scores, along with deterioration documented on other clinical scales. The SODA can reliably predict neurodegeneration as an additional clinical surrogate in MSA.
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Affiliation(s)
- Hojin Yoon
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Euyhyun Park
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
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Yoon HJ, Lee JH, Lee SU, Kim JS. Bilateral Superior Ophthalmic Vein Thrombosis as the Sole Manifestation of Protein S Deficiency. J Neuroophthalmol 2023:00041327-990000000-00536. [PMID: 38117562 DOI: 10.1097/wno.0000000000002060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Ho-Jin Yoon
- Department of Neurology (H-JY, J-HL, S-UL), Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-Ophthalmology Laboratory (S-UL), Korea University Anam Hospital, Seoul, South Korea; Department of Neurology (J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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11
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Lee HJ, Lee SU, Park E, Kim JS. Cavernous malformation in the fourth ventricle: trivial findings but grave prognosis. Acta Neurol Belg 2023:10.1007/s13760-023-02464-y. [PMID: 38117457 DOI: 10.1007/s13760-023-02464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Hyo-Jeong Lee
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, South Korea.
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Euyhyun Park
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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12
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Yoon HJ, Lee JH, Lee SU, Kim JS. Metronidazole-induced cerebellar dysfunction preferentially involving the saccadic system. J Neurol 2023; 270:6166-6169. [PMID: 37688634 DOI: 10.1007/s00415-023-11972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Ho-Jin Yoon
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, South Korea
| | - Joo-Hyeong Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, South Korea
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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13
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Kim SH, Lee JH, Baek SH, Lee SU, Yu S, Kim JS. Triquarter Visual Field Defect Due to Internal Carotid Artery Giant Aneurysm. J Neuroophthalmol 2023; 43:e280-e282. [PMID: 36166775 DOI: 10.1097/wno.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Seong-Hwan Kim
- Department of Neurology (S-HK, J-HL, S-HB, S-UL, SY), Korea University Medical Center, Seoul, Republic of Korea; Department of Neurology (S-UL, J-SK), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology (SY), Korea University College of Medicine, Seoul, Republic of Korea; and Department of Neurology (J-SK), Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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14
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Kim KT, Park E, Lee SU, Kim B, Kim BJ, Kim JS. Clinical Features and Neurotologic Findings in Patients With Acute Unilateral Peripheral Vestibulopathy Associated With Antiganglioside Antibody. Neurology 2023; 101:e1913-e1921. [PMID: 37748887 PMCID: PMC10663017 DOI: 10.1212/wnl.0000000000207814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Anecdotal studies have reported the presence of antiganglioside antibodies in acute unilateral peripheral vestibulopathy (AUPV). This study aimed to determine the prevalence, clinical characteristics, and neurotologic findings of AUPV associated with antiganglioside antibodies. METHODS Serum antigangliosides were measured in consecutive patients with AUPV according to the Bárány Society criteria during the acute and recovery phases in a referral-based university hospital in South Korea from September 2019 to January 2023. Clinical characteristics and neurotologic findings were compared between those with and without antiganglioside antibodies. The results of video-oculography, video head impulse and bithermal caloric tests, and other neurotologic evaluations including ocular and cervical vestibular-evoked myogenic potentials and subjective visual vertical were compared between the 2. MRIs dedicated to the inner ear were also conducted when considered necessary. RESULTS One hundred five patients (mean age ± SD = 60 ± 13 years, 57 male) were included for analyses. During the acute phase, 12 patients (12/105, 11%) were tested positive for serum antiganglioside antibodies, including anti-GQ1b immunoglobulin (Ig) G (n = 5) or IgM (n = 4), anti-GM1 IgM (n = 3), and anti-GD1a IgG (n = 1, including 1 patient with a positive anti-GQ1b antibody). Patients with antiganglioside antibodies showed lesser intensity of spontaneous nystagmus (median [interquartile range] = 1.8 [1.2-2.1] vs 3.4 [1.5-9.5], p = 0.003) and a lesser degree of canal paresis (30 [17-47] vs 58 [34-79], p = 0.028) and gain asymmetry of the vestibulo-ocular reflex for the horizontal semicircular canal during head impulse tests (0.07 [-0.04 to 0.61] vs 0.36 [0.18-0.47], p = 0.032) than those without antibodies. Negative conversion of antibodies and vestibular recovery were observed in most patients (6/8, 75%). Among 30 patients with AUPV with 4-hour delayed 3D fluid-attenuated inversion recovery dedicated to the inner ear, gadolinium enhancement was observed in 18 (18/30, 60%), either in the vestibule (n = 9), semicircular canal (n = 6), or vestibular nerve (n = 5). The positivity rates based on specific antibodies could not be determined due to limited sample sizes. DISCUSSION The association between antiganglioside antibodies and AUPV suggests an immune-mediated mechanism in acute vestibular failure and extends the clinical spectrum of antiganglioside antibody syndrome.
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Affiliation(s)
- Keun-Tae Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Euyhyun Park
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Sun-Uk Lee
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea.
| | - Byungjun Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Byung-Jo Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
| | - Ji-Soo Kim
- From the Department of Neurology (K.-T.K., B.-J.K.), Korea University Medical Center; Department of Otorhinolaryngology-Head and Neck Surgery (E.P.), Korea University College of Medicine; Korea University Medical Center (S.-U.L.); Department of Radiology (B.K.), Korea University Anam Hospital; BK21 FOUR Program in Learning Health Systems (B.-J.K.), Korea University; Dizziness Center (J.-S.K.), Clinical Neuroscience Center, Seoul National University Bundang Hospital; and Department of Neurology (J.-S.K.), Seoul National University College of Medicine, South Korea
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15
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Affiliation(s)
- Young-Bin Park
- Department of Neurology (Y-BP, S-HB, S-UL, SY), Korea University Medical Center, Seoul, Republic of Korea; Department of Neurology (S-UL, J-SK), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology (SY), Korea University College of Medicine, Seoul, Republic of Korea; and Dizziness Center (J-SK), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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16
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Kim KT, Lee SU, Kim JB, Choi JY, Kim BJ, Kim JS. Augmented ocular vestibular-evoked myogenic potentials in postural orthostatic tachycardia syndrome. Clin Auton Res 2023; 33:479-489. [PMID: 37115468 DOI: 10.1007/s10286-023-00943-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/08/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To delineate the association between otolith function and changes in mean orthostatic blood pressure (BP) and heart rate (HR) in patients with postural orthostatic tachycardia syndrome (POTS). METHODS Forty-nine patients with POTS were prospectively recruited. We analyzed the results of ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPs), as well as head-up tilt table tests using a Finometer. The oVEMP and cVEMP responses were obtained using tapping stimuli and 110 dB tone-burst sounds, respectively. We measured maximal changes in 5-s averaged systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) within 15 s and during 10 min after tilting. We compared the results with those of 20 age- and sex-matched healthy participants. RESULTS The n1-p1 amplitude of oVEMPs was larger in patients with POTS than in healthy participants (p = 0.001), whereas the n1 latency (p = 0.280) and interaural difference (p = 0.199) did not differ between the two. The n1-p1 amplitude was a positive predictor for POTS (odds ratio 1.07, 95% confidence interval 1.01-1.13, p = 0.025). Body weight (p = 0.007) and n1-p1 amplitude of oVEMP (p = 0.019) were positive predictors for ΔSBP15s in POTS, whereas aging was a negative predictor (p = 0.005). These findings were not observed in healthy participants. CONCLUSIONS Augmented utricular inputs may be associated with a relative predominance of sympathetic over vagal control of BP and HR, especially for an early response during orthostasis in patients with POTS. Overt sympathoexcitation due to exaggerated utricular input and lack of readaptation may be associated with the pathomechanism of POTS.
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Affiliation(s)
- Keun-Tae Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Jung-Bin Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kim SH, Lee SU, Cho BH, Cho KH, Yu S, Kim BJ, Kim JS. Analyses of Head-Impulse Tests in Patients With Posterior Circulation Stroke and Vestibular Neuritis. Neurology 2023:WNL.0000000000207299. [PMID: 37076307 DOI: 10.1212/wnl.0000000000207299] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/02/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The interpretation of video head-impulse tests (video-HITs) can often be complicated, limiting their clinical utility in acute vestibular syndrome. We aimed to determine video-HIT findings in patients with posterior circulation strokes (PCS) and vestibular neuritis (VN). METHODS We retrospectively analyzed the results of video-HITs in 59 patients with PCS. Irrespective of the actual lesion revealed later on MRIs, ipsilateral and contralateral sides were assigned according to the direction of slow-phase of spontaneous nystagmus (SN). Then, the patterns of video-HIT findings were classified according to the vestibulo-ocular reflex (VOR) gain for the horizontal canals; 1) ipsilaterally positive, 2) contralaterally positive, 3) bilaterally normal, and 4) bilaterally positive. The abnormal responses were further defined into 5) wrong-way saccades, 6) perverted, and 7) early acceleration followed by premature deceleration. We also analyzed the asymmetry of the corrective saccadic amplitude between the sides, calculated from the sum of cumulative saccadic amplitudes on both sides. The results were compared with video-HIT results from 71 patients with VN. RESULTS Video-HITs were normal in 32 (54%), ipsilaterally positive in 11 (19%), bilaterally positive in 10 (17%), and contralaterally positive in six (10%) patients with PCS. Wrong-way saccades were more frequently observed in VN than PCS [31/71 (44%) vs. 5/59 (9%), p < 0.001]. Saccadic amplitude asymmetry was greater in VN than PCS [median = 100% (IQR = 82-144, 95% CI = 109-160) vs. 0% (-29-34, -10-22, p < 0.001)]. When differentiating VN from PCS, the sensitivity was 81.7%, and specificity was 91.5% at the cut-off value of 71% for saccadic amplitude asymmetry with an area under the curve (AUC) of 0.91 (95% CI = 0.86-0.97). The AUC for saccadic amplitude asymmetry was larger than that for the ipsilateral VOR gain (p = 0.041) and other parameters. DISCUSSION Patients with PCS may show various head-impulse responses that deviate from the findings expected in VN, which include normal, contralaterally positive, and negative saccadic amplitude asymmetry (i.e. a greater cumulative saccadic amplitude contralaterally). A thorough analysis of corrective saccades in video-HITs can improve the differentiation of PCS from VN even before MRIs.
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Affiliation(s)
- Sung-Hwan Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Bang-Hoon Cho
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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18
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Lee SU, Kim JS, Yoo D, Kim A, Kim HJ, Choi JY, Park JY, Jeong SH, Kim JM, Park KW. Ocular Motor Findings Aid in Differentiation of Spinocerebellar Ataxia Type 17 from Huntington's Disease. Cerebellum 2023; 22:1-13. [PMID: 34993890 DOI: 10.1007/s12311-021-01356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 02/01/2023]
Abstract
Differentiation of spinocerebellar ataxia type 17 (SCA17) from Huntington's disease (HD) is often challenging since they share the clinical features of chorea, parkinsonism, and dystonia. The ocular motor findings remain to be elucidated in SCA17, and may help differentiating SCA17 from HD. We retrospectively compared the ocular motor findings of 11 patients with SCA17 with those of 10 patients with HD. In SCA17, abnormal ocular motor findings included impaired smooth pursuit (9/11, 82%), dysmetric saccades (9/11, 82%), central positional nystagmus (CPN, 7/11, 64%), abnormal head-impulse tests (4/11, 36%), and horizontal gaze-evoked nystagmus (GEN, 3/11, 27%). Among these, CPN was more frequently observed in SCA17 than in HD (7/11 (64%) vs. 0/10 (0%), p = 0.004) while saccadic slowing was more frequently observed in HD than in SCA17 (8/10 (80%) vs. 2/11 (18%), p = 0.009). Of six patients with follow-up evaluation, five later developed bilateral saccadic hypermetria (n = 4), GEN (n = 1), CPN (n = 1), bilaterally abnormal smooth pursuit (n = 1), and hyperactive head-impulse responses (n = 1) along with a clinical decline. Ocular motor abnormalities can be utilized as a diagnostic marker for differentiation of SCA17 from HD as well as a surrogate marker for clinical decline in SCA17.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea. .,Clinical Neuroscience Center, Dizziness Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Dallah Yoo
- Department of Neurology, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Movement Disorder Center, Department of Neurology, Kyung Hee University Hospital, Gangdong-gu, Republic of Korea
| | - Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Clinical Neuroscience Center, Dizziness Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Yun Park
- Deparment of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Clinical Neuroscience Center, Dizziness Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
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Hong JP, Lee SU, Yu S, Kim JS. Pseudo-pupil sparing oculomotor nerve palsy in cavernous-carotid fistula. J Neurol 2023; 270:552-554. [PMID: 35976435 DOI: 10.1007/s00415-022-11332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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20
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Lee SU, Baek SH, Kim HJ, Choi JY, Kim BJ, Kim JS. Acute comitant strabismus in anti-GQ1b antibody syndrome. J Neurol 2023; 270:486-492. [PMID: 36175671 DOI: 10.1007/s00415-022-11394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
Ophthalmoplegia is the diagnostic hallmark of anti-GQ1b antibody syndrome. This study aimed to define the patterns of acute comitant strabismus in patients with anti-GQ1b antibody syndromes. We retrospectively analyzed the ocular motor findings in 84 patients with anti-GQ1b antibody-associated ophthalmoplegia during the acute phases. Of the 84 patients, 11 (13%) showed acute comitant strabismus. Compared to those without, patients with acute comitant strabismus frequently showed abnormal ocular motor findings that included gaze-evoked (n = 8), spontaneous (n = 4) and positional nystagmus (n = 4), saccadic hypermetria (n = 3), head-shaking nystagmus (n = 2), pulse-step mismatch (n = 1), and impaired visual cancellation of the vestibulo-ocular reflex (n = 1, p < 0.001). On the contrary, iridoplegia (p = 0.029) and ptosis (p = 0.001) were more commonly observed in patients with paralytic (incomitant) strabismus than in those with acute comitant strabismus. Comitant strabismus can manifest during the acute phase of anti-GQ1b antibody syndromes in association with other central ocular motor abnormalities. These findings implicate that the cerebellum and/or brainstem can be the primary target of the anti-GQ1b antibodies.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea. .,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.
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21
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Kong J, Lee SU, Yu S, Kim JS. Isolated Bilateral Superior Cerebellar Peduncular Lesion Presenting Square-Wave Jerks and Ataxia. J Clin Neurol 2023; 19:93-95. [PMID: 36606652 PMCID: PMC9833876 DOI: 10.3988/jcn.2023.19.1.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jooheon Kong
- Department of Neurology, Korea University Medical Center, Seoul, Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, Seoul, Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
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22
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Lee SU, Kim JS. Commentary: Is There an “Acquired Idiopathic Head-Shaking Nystagmus?”: A Discussion of Mechanisms and Clinical Implications Based on a Case Report. Front Neurol 2022; 13:955081. [PMID: 35812107 PMCID: PMC9256932 DOI: 10.3389/fneur.2022.955081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- *Correspondence: Ji-Soo Kim
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23
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Lee SU, Kim HJ, Choi JY, Choi JH, Zee DS, Kim JS. Correction to: Nystagmus only with fixation in the light: a rare central sign due to cerebellar malfunction. J Neurol 2022; 269:3891. [PMID: 35482081 DOI: 10.1007/s00415-022-11157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Song M, Baek SH, Lee SU, Yu S, Kim JS. Vogt-Koyanagi-Harada disease – A diagnostic pitfall for neurologists. eNeurologicalSci 2022; 26:100390. [PMID: 35257031 PMCID: PMC8897202 DOI: 10.1016/j.ensci.2021.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/29/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022] Open
Abstract
VKH is an idiopathic autoimmune disease presenting with uveomeningeal syndrome. Granulomatous uveitis and serious retinal detachments are the most common findings of VKH. VKH can masquerade as IIH by presenting with severe headache and optic disc edema. The characteristic retinal finding of VKH can be easily missed by direct funduscopy.
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26
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Kim KT, Baek SH, Lee SU, Kim JB, Kim JS. Clinical Reasoning: A 48-Year-Old Woman Presenting With Vertigo, Ptosis and Red Eyes. Neurology 2022; 98:678-683. [PMID: 35228336 DOI: 10.1212/wnl.0000000000200141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe acute vestibular syndrome in a 48-year-old woman with breast cancer who was finally found to have anti-Ma2-associated encephalitis. Even though the initial diagnosis was vestibular neuritis elsewhere, progression of symptoms and additional findings of bilateral ptosis and circumlimbal injections, vertical saccadic slowing, and impaired convergence led to a suspicion of a rostral midbrain lesion and final diagnosis. The patient's symptoms and ocular motor signs improved markedly after administration of intravenous methylprednisolone and oral tacrolimus. Our patient again stresses the importance of scrutinized ocular motor evaluation for detection of central lesions even in patients with the clinical features of unilateral peripheral vestibulopathy.
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Affiliation(s)
- Keun-Tae Kim
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Bin Kim
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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27
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Lee SU, Na S, Yu S, Lee TK, Lee ES. Erratum: Mouth-Opening-Induced Vertigo and Downbeat Nystagmus. J Clin Neurol 2022; 18:256. [PMID: 35274849 PMCID: PMC8926768 DOI: 10.3988/jcn.2022.18.2.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Seunghee Na
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Tae-Kyeong Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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28
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Lee SU, Kim T, Lee ES. Acute Bilateral Vestibulopathy Associated With COVID-19. J Clin Neurol 2022; 18:247-249. [PMID: 35274845 PMCID: PMC8926779 DOI: 10.3988/jcn.2022.18.2.247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Tark Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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29
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Kim JG, Kim SH, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. Head-impulse tests aid in differentiation of multiple system atrophy from Parkinson's disease. J Neurol 2021; 269:2972-2979. [PMID: 34767067 DOI: 10.1007/s00415-021-10885-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
The integrity of the vestibulo-ocular reflex (VOR) remains to be delineated in patients with parkinsonism. We aimed to define the findings of the VOR using head-impulse tests (HITs) and their differential diagnostic value in patients with Parkinson's disease (PD) and multiple system atrophy (MSA). From December 2019 to January 2021, 30 patients with PD and 23 patients with MSA (17 with cerebellar-type MSA and 6 with parkinsonian-type MSA) had a video-oculographic recording of HITs at two university hospitals in South Korea. Reversed (p = 0.034) and perverted (p = 0.015) catch-up saccades were more frequently observed in MSA than in PD during HITs. The gain difference between the ACs and the PCs were larger in MSA than in PD (p = 0.031), and positively correlated with the disease duration in patients with MSA (Spearman's coefficient = 0.512, p = 0.012). Multivariate logistic regression analysis showed that reversed (p = 0.044) and perverted (p = 0.039) catch-up saccades were more frequently associated with MSA than with PD during HITs. In conclusion, HITs aid in differentiation of MSA from PD, and may serve as a surrogate marker for the clinical decline.
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Affiliation(s)
- Jae-Gyum Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sung-Hwan Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea. .,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.,BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
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30
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Kim KT, Baek SH, Lee SU, Kim JB, Kim JS. Primary ventriculitis presenting with isolated vestibular syndrome. J Neurol 2021; 268:4891-4893. [PMID: 34165629 DOI: 10.1007/s00415-021-10681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Keun-Tae Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea. .,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jung Bin Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea.,Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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31
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Affiliation(s)
- Hyun-Wook Nam
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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32
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Nah S, Choi S, Lee SU, Kim GW, Lee YH, Han S. Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning: A prospective observational study. Medicine (Baltimore) 2021; 100:e26032. [PMID: 34011113 PMCID: PMC8137110 DOI: 10.1097/md.0000000000026032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/03/2021] [Indexed: 01/05/2023] Open
Abstract
Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the "smoker's paradox" whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001-1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778-0.956; P = .005), and pack-years (OR 0.947; CI 0.903-0.993; P = .023) were statistically significant for DNS development.These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.
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Affiliation(s)
- Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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33
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Lee SU, Kim HJ, Choi JY, Koo JW, Kim JS. Evolution of caloric responses during and between the attacks of Meniere's disease. J Neurol 2021; 268:2913-2921. [PMID: 33611629 DOI: 10.1007/s00415-021-10470-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/21/2022]
Abstract
Caloric tests are useful for disease surveillance of Meniere's disease (MD), although the interpretation of caloric tests remains controversial during the attacks of MD. Therefore, we aimed to characterize the findings of caloric tests during the attacks of MD. We analyzed the results of bithermal caloric tests during and between the attacks in 43 patients with unilateral definite MD. Evaluation was performed during the irritative/recovery phase in 22 and during the paretic phase in 26 patients. During the irritative/recovery phase, less than half of patients (10/22, 45%) showed a caloric asymmetry of more than 25%, lesser responses in the affected ear in six and in the healthy ear in the other four. In contrast, patients usually showed a caloric asymmetry of more than 25% during the paretic phase (19/26, 73%) with a decreased response almost always in the affected ear (18/19, 95%). Between the attacks, caloric asymmetry was found in less than half of the patients (20/43, 47%) with a decreased response almost always in the affected ear (19/20, 95%) when observed. The caloric asymmetry was less during the irritative/recovery phases than between the attacks (p = 0.007). In contrast, the caloric asymmetry was larger during the paretic phase than between the attacks (p = 0.041). The caloric asymmetry decreased during the irritative/recovery phases with an estimated mean difference of 34% (adjusted 95% CI 16-53%, p < 0.001) and 23% (adjusted 95% CI 8-38%, p = 0.002) compared to the paretic and interictal phases. Caloric responses fluctuate during and between the attacks of MD depending on the electrophysiologic status of the vestibular afferents. The results of caloric tests in MD, thus should be interpreted with consideration of each phase when the evaluation was done.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Ja-Won Koo
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea. .,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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34
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Nam HW, Lee SU. Author's Response: Intralbryinthine Schwannoma of the Intravestibular Subtype: A Difficult Diagnosis. Ear Nose Throat J 2020; 100:77. [PMID: 33337253 DOI: 10.1177/0145561320978171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hyun-Wook Nam
- Department of Neurology, 218725Korea University Medical Center, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, 218725Korea University Medical Center, Seoul, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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35
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Han S, Choi S, Nah S, Lee SU, Cho YS, Kim GW, Lee YH. Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A prospective observational study. Neurotoxicology 2020; 82:63-68. [PMID: 33232744 DOI: 10.1016/j.neuro.2020.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A major challenge for physicians is to identify patients with acute carbon monoxide (CO) poisoning who are likely to develop delayed neuropsychiatric sequelae (DNS). DNS is defined as neuropsychological sequelae that develops after 2-40 days of lucid interval after CO intoxication. Currently, there is no consensus on factors that predict the prognosis of CO poisoning. Thus, the purpose of this study was to identify factors predicting the development of DNS using a Cox regression model. METHODS This prospective observational study included 310 CO-poisoned patients admitted to an emergency department in South Korea from July 2017 to February 2020. Demographic, clinical, and laboratory data were analyzed. Kaplan-Meier curves were constructed to estimate the cumulative incidence of DNS. A multivariate Cox regression model was used to identify the main predictors of the development of DNS. RESULTS The incidence of DNS was 18.8 %, and the median onset time was 23.7 days (interquartile range, 14-30 days). The Kaplan-Meier survival curve showed that a serum creatine kinase (CK) level > 175.5 U/L and initial Glasgow Coma Scale (GCS) score ≤ 9 were associated with a higher cumulative incidence of DNS (log-rank test; p < 0.01 and p = 0.02, respectively). Cox regression analysis showed that a serum CK level > 175.5 U/L (hazard ratio [HR]: 2.862, 95 % confidence interval [CI]: 1.491-5.496; p < 0.01) and an initial GCS ≤ 9 (HR: 2.081, 95 % CI: 1.048-4.131; p = 0.04) were significant prognostic factors. CONCLUSION In acute CO poisoning, an initial GCS score ≤ 9 and serum CK level > 175.5 U/L are significant predictors of DNS development.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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36
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Lee SU, Kim HJ, Choi JY, Kim JS. Ictal downbeat nystagmus in Ménière disease: A cross-sectional study. Neurology 2020; 95:e2409-e2417. [PMID: 32817190 DOI: 10.1212/wnl.0000000000010653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/21/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the mechanism of ictal downbeat nystagmus in Ménière disease (MD), we compared the head impulse gain of the vestibulo-ocular reflex (VOR) for each semicircular canal between patients with (n = 7) and without (n = 70) downbeat nystagmus during attacks of MD. METHODS We retrospectively analyzed the results of video-oculography, video head-impulse tests, and cervical vestibular-evoked myogenic potentials (VEMPs) in 77 patients with definite MD who were evaluated during an attack. RESULTS Pure or predominant downbeat nystagmus was observed in 7 patients (9%) with unilateral MD during the attacks. All 7 patients showed spontaneous downbeat nystagmus without visual fixation with a slow phase velocity ranging from 1.5 to 11.2°/s (median 5.4, interquartile range 3.7-8.5). All showed a transient decrease of the head impulse VOR gains for the posterior canals (PCs) in both ears (n = 4) or in the affected ear (n = 3). Cervical VEMPs were decreased in the affected (n = 2) or both ears (n = 2) when evaluated during the attacks. Downbeat nystagmus disappeared along with normalization of the VOR gains for PCs after the attacks in all patients. During the attacks, the head impulse VOR gains for the PC on the affected side were lower in the patients with ictal downbeat nystagmus than in those without (Mann-Whitney U test, p < 0.001), while the gains for other semicircular canals did not differ between the groups. CONCLUSION Downbeat nystagmus may be observed during attacks of MD due to an asymmetry in the vertical VOR or saccular dysfunction. MD should be considered in recurrent audiovestibulopathy and ictal downbeat nystagmus.
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Affiliation(s)
- Sun-Uk Lee
- From the Department of Neurology (S.-U.L.), Korea University Medical Center; Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine; and Research Administration Team (H.-J.K.) and Dizziness Center (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- From the Department of Neurology (S.-U.L.), Korea University Medical Center; Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine; and Research Administration Team (H.-J.K.) and Dizziness Center (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- From the Department of Neurology (S.-U.L.), Korea University Medical Center; Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine; and Research Administration Team (H.-J.K.) and Dizziness Center (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- From the Department of Neurology (S.-U.L.), Korea University Medical Center; Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine; and Research Administration Team (H.-J.K.) and Dizziness Center (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam, South Korea.
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Jeong SH, Lee SU, Kim JS. Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis. J Neurol 2020; 269:619-626. [DOI: 10.1007/s00415-020-09952-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
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Kim JG, Lee SU, Lee CN, Yu SW, Park KW, Kim JS. Bilateral vestibulopathy as an early manifestation of systemic lupus erythematosus. J Neurol 2020; 267:1855-1858. [DOI: 10.1007/s00415-020-09876-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
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Lee SU, Lee J, Kim HJ, Choi JY, Oh HJ, Kim JS. Vestibular Hyperreflexia and Opsoclonus in Acute Hepatitis A Virus Infection. Cerebellum 2020; 18:1151-1153. [PMID: 31154623 DOI: 10.1007/s12311-019-01043-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Juyoung Lee
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea. .,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Hui Jong Oh
- The MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, Daegu, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
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Lee SU, Kim HJ, Choi JY, Song JJ, Choi BS, Kim JS. Teaching Video NeuroImages: Intralabyrinthine schwannoma masquerading as Ménière disease. Neurology 2020; 94:e1227-e1228. [PMID: 32132176 DOI: 10.1212/wnl.0000000000009095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sun-Uk Lee
- From the Department of Neurology (S.-U.L.), Korea University Medical Center, Seoul; and Research Administration Team (H.-J.K.), Dizziness Center, Clinical Neuroscience Center (J.-Y.C., J.-S.K.), and Departments of Neurology (J.-Y.C., J.-S.K.), Otolaryngology-Head and Neck Surgery (J.-J.S.), and Radiology (B.-S.C.), Seoul National University Bundang Hospital, and Department of Neurology, Seoul National University College of Medicine (S.-U.L., J.-Y.C., J.-S.K.), Seongnam, South Korea
| | - Hyo-Jung Kim
- From the Department of Neurology (S.-U.L.), Korea University Medical Center, Seoul; and Research Administration Team (H.-J.K.), Dizziness Center, Clinical Neuroscience Center (J.-Y.C., J.-S.K.), and Departments of Neurology (J.-Y.C., J.-S.K.), Otolaryngology-Head and Neck Surgery (J.-J.S.), and Radiology (B.-S.C.), Seoul National University Bundang Hospital, and Department of Neurology, Seoul National University College of Medicine (S.-U.L., J.-Y.C., J.-S.K.), Seongnam, South Korea.
| | - Jeong-Yoon Choi
- From the Department of Neurology (S.-U.L.), Korea University Medical Center, Seoul; and Research Administration Team (H.-J.K.), Dizziness Center, Clinical Neuroscience Center (J.-Y.C., J.-S.K.), and Departments of Neurology (J.-Y.C., J.-S.K.), Otolaryngology-Head and Neck Surgery (J.-J.S.), and Radiology (B.-S.C.), Seoul National University Bundang Hospital, and Department of Neurology, Seoul National University College of Medicine (S.-U.L., J.-Y.C., J.-S.K.), Seongnam, South Korea
| | - Jae-Jin Song
- From the Department of Neurology (S.-U.L.), Korea University Medical Center, Seoul; and Research Administration Team (H.-J.K.), Dizziness Center, Clinical Neuroscience Center (J.-Y.C., J.-S.K.), and Departments of Neurology (J.-Y.C., J.-S.K.), Otolaryngology-Head and Neck Surgery (J.-J.S.), and Radiology (B.-S.C.), Seoul National University Bundang Hospital, and Department of Neurology, Seoul National University College of Medicine (S.-U.L., J.-Y.C., J.-S.K.), Seongnam, South Korea
| | - Byung-Se Choi
- From the Department of Neurology (S.-U.L.), Korea University Medical Center, Seoul; and Research Administration Team (H.-J.K.), Dizziness Center, Clinical Neuroscience Center (J.-Y.C., J.-S.K.), and Departments of Neurology (J.-Y.C., J.-S.K.), Otolaryngology-Head and Neck Surgery (J.-J.S.), and Radiology (B.-S.C.), Seoul National University Bundang Hospital, and Department of Neurology, Seoul National University College of Medicine (S.-U.L., J.-Y.C., J.-S.K.), Seongnam, South Korea
| | - Ji-Soo Kim
- From the Department of Neurology (S.-U.L.), Korea University Medical Center, Seoul; and Research Administration Team (H.-J.K.), Dizziness Center, Clinical Neuroscience Center (J.-Y.C., J.-S.K.), and Departments of Neurology (J.-Y.C., J.-S.K.), Otolaryngology-Head and Neck Surgery (J.-J.S.), and Radiology (B.-S.C.), Seoul National University Bundang Hospital, and Department of Neurology, Seoul National University College of Medicine (S.-U.L., J.-Y.C., J.-S.K.), Seongnam, South Korea.
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Lee SU, Kim JS, Kim HJ, Choi JY, Park JY, Kim JM, Yang X. Evolution of the vestibular function during head impulses in spinocerebellar ataxia type 6. J Neurol 2020; 267:1672-1678. [DOI: 10.1007/s00415-020-09756-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/19/2022]
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Abstract
AbstractBilateral vestibular dysfunction (BVD) refers to hypofunction of the vestibular nerves or labyrinths on both sides. Patients with BVD present with dizziness, oscillopsia, and unsteadiness, mostly during locomotion, which worsen in darkness or on uneven ground. Although aminoglycoside ototoxicity, Meniere's disease, infection, and genetic disorders frequently cause BVD, the etiology remains undetermined in up to 50% of the patients. The diagnosis of BVD requires both symptoms and documentation of deficient vestibulo-ocular reflex function using head-impulse, bithermal caloric, and rotatory chair tests. Since various neurologic and systemic disorders may present with BVD, clinicians should be cautious not to overlook the symptoms and signs of central nervous system and systemic involvements. Vestibular rehabilitation, application of vibrotactile and auditory feedbacks, and vestibular prosthesis can aid the patients with BVD along with the correction of the underlying causes.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
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Lee SU, Kim HJ, Oh SW, Song EY, Choi JY, Kim JS. Pearls & Oy-sters: Windmill nystagmus in paraneoplastic cerebellar degeneration. Neurology 2019; 91:e1831-e1833. [PMID: 30397048 DOI: 10.1212/wnl.0000000000006477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sun-Uk Lee
- From the Departments of Neurology (S.-U.L., J.-Y.C., J.-S.K.) and Laboratory Medicine (E.Y.S.), Seoul National University College of Medicine; Dizziness Center, Clinical Neuroscience Center, and Department of Neurology (S.-U.L., H.-J.K., S.-W.O., J.-Y.C., J.-S.K.), and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Laboratory Medicine (E.Y.S.), Seoul National University Hospital, South Korea
| | - Hyo-Jung Kim
- From the Departments of Neurology (S.-U.L., J.-Y.C., J.-S.K.) and Laboratory Medicine (E.Y.S.), Seoul National University College of Medicine; Dizziness Center, Clinical Neuroscience Center, and Department of Neurology (S.-U.L., H.-J.K., S.-W.O., J.-Y.C., J.-S.K.), and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Laboratory Medicine (E.Y.S.), Seoul National University Hospital, South Korea
| | - Sea-Won Oh
- From the Departments of Neurology (S.-U.L., J.-Y.C., J.-S.K.) and Laboratory Medicine (E.Y.S.), Seoul National University College of Medicine; Dizziness Center, Clinical Neuroscience Center, and Department of Neurology (S.-U.L., H.-J.K., S.-W.O., J.-Y.C., J.-S.K.), and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Laboratory Medicine (E.Y.S.), Seoul National University Hospital, South Korea
| | - Eun Young Song
- From the Departments of Neurology (S.-U.L., J.-Y.C., J.-S.K.) and Laboratory Medicine (E.Y.S.), Seoul National University College of Medicine; Dizziness Center, Clinical Neuroscience Center, and Department of Neurology (S.-U.L., H.-J.K., S.-W.O., J.-Y.C., J.-S.K.), and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Laboratory Medicine (E.Y.S.), Seoul National University Hospital, South Korea
| | - Jeong-Yoon Choi
- From the Departments of Neurology (S.-U.L., J.-Y.C., J.-S.K.) and Laboratory Medicine (E.Y.S.), Seoul National University College of Medicine; Dizziness Center, Clinical Neuroscience Center, and Department of Neurology (S.-U.L., H.-J.K., S.-W.O., J.-Y.C., J.-S.K.), and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Laboratory Medicine (E.Y.S.), Seoul National University Hospital, South Korea
| | - Ji-Soo Kim
- From the Departments of Neurology (S.-U.L., J.-Y.C., J.-S.K.) and Laboratory Medicine (E.Y.S.), Seoul National University College of Medicine; Dizziness Center, Clinical Neuroscience Center, and Department of Neurology (S.-U.L., H.-J.K., S.-W.O., J.-Y.C., J.-S.K.), and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Laboratory Medicine (E.Y.S.), Seoul National University Hospital, South Korea.
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Lee SU, Kim HJ, Choi JY, Kim JK, Kim JS. Acute vestibular syndrome associated with anti-GQ1b antibody. Neurology 2019; 93:e1085-e1092. [PMID: 31399495 DOI: 10.1212/wnl.0000000000008107] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/18/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To delineate the clinical features and ocular motor findings in acute vestibular syndrome (AVS) associated with anti-GQ1b antibodies. METHODS We reviewed 90 patients with positive serum anti-GQ1b antibody in association with various neurological syndromes at Seoul National University Bundang Hospital from 2004 to 2018. The diagnoses included typical Miller Fisher syndrome (n = 31), acute ophthalmoplegia without ataxia (n = 27), Guillain-Barre syndrome with ophthalmoplegia (n = 18), AVS (n = 11), and Bickerstaff brainstem encephalitis (n = 3). Of them, the 11 patients with AVS formed the basis of this study. We also conducted a systematic review on AVS reported in association with anti-GQ1b antibody. RESULTS Patients with AVS showed various ocular motor findings that included head-shaking nystagmus (n = 6), spontaneous nystagmus (n = 5), gaze-evoked nystagmus (n = 5), central positional nystagmus (n = 3), canal paresis (n = 2), and abnormal head-impulse tests (n = 1) without any internal or external ophthalmoplegia. Compared to those with other subtypes, patients with AVS mostly showed normal deep tendon reflexes (8 of 11 [73%], p = 0.002) and normal results on nerve conduction studies (4 of 4 [100%], p = 0.010). The clinical and laboratory findings resolved or improved markedly in all patients within 6 months of symptom onset. Systematic review further identified 7 patients with AVS and positive serum anti-GQ1b antibody who showed various ocular motor findings, including gaze-evoked nystagmus, saccadic dysmetria, central positional nystagmus, and ocular flutter or opsoclonus. CONCLUSION Anti-GQ1b antibody may cause acute vestibulopathy by involving either the central or peripheral vestibular structures. AVS may constitute a subtype of anti-GQ1b antibody syndrome.
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Affiliation(s)
- Sun-Uk Lee
- From the Department of Neurology (S.-U.K.), Korea University Medical Center, Seoul; Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University College of Medicine; Research Administration Team (H.-J.K.), Dizziness Center (J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Neurology (J.K.K.), Dong-A University College of Medicine, Busan, South Korea
| | - Hyo-Jung Kim
- From the Department of Neurology (S.-U.K.), Korea University Medical Center, Seoul; Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University College of Medicine; Research Administration Team (H.-J.K.), Dizziness Center (J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Neurology (J.K.K.), Dong-A University College of Medicine, Busan, South Korea
| | - Jeong-Yoon Choi
- From the Department of Neurology (S.-U.K.), Korea University Medical Center, Seoul; Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University College of Medicine; Research Administration Team (H.-J.K.), Dizziness Center (J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Neurology (J.K.K.), Dong-A University College of Medicine, Busan, South Korea
| | - Jong Kuk Kim
- From the Department of Neurology (S.-U.K.), Korea University Medical Center, Seoul; Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University College of Medicine; Research Administration Team (H.-J.K.), Dizziness Center (J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Neurology (J.K.K.), Dong-A University College of Medicine, Busan, South Korea
| | - Ji-Soo Kim
- From the Department of Neurology (S.-U.K.), Korea University Medical Center, Seoul; Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University College of Medicine; Research Administration Team (H.-J.K.), Dizziness Center (J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Department of Neurology (J.-Y.C., J.-S.K.), Seoul National University Bundang Hospital, Seongnam; and Department of Neurology (J.K.K.), Dong-A University College of Medicine, Busan, South Korea.
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Lee SU, Bae YJ, Kim HJ, Choi JY, Song JJ, Choi BY, Choi BS, Koo JW, Kim JS. Intralabyrinthine Schwannoma: Distinct Features for Differential Diagnosis. Front Neurol 2019; 10:750. [PMID: 31396141 PMCID: PMC6664015 DOI: 10.3389/fneur.2019.00750] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to delineate the clinical and laboratory features suggestive of intralabyrinthine schwannoma (ILS). Methods: We compared the clinical features of 16 patients with ILS, who had been diagnosed at the Seoul National University Bundang Hospital from 2003 to 2018, with those of 18 patients with symptomatic unilateral intracanalicular schwannoma and randomly selected 20 patients with definite or probable unilateral Meniere's disease (MD). Results: Patients with ILS presented with either recurrent spontaneous dizziness/vertigo combined with auditory symptoms (n = 8), isolated auditory symptoms without dizziness/vertigo (n = 7), or recurrent spontaneous dizziness/vertigo without auditory symptoms (n = 1). Most patients reported no improvement (n = 11) or worsening (n = 1) of the symptoms despite medical treatments including intratympanic (n = 5) or intravenous steroids (n = 2). Conventional brain MRIs failed to detect ILS in about a half of the patients (7/16, 44%). However, ILS showed a filling defect on 3-dimensional (3D) heavily T2-weighted MRIs (n = 12), and nodular enhancement on 3D contrast-enhanced T1 (n = 15) or FLAIR MRIs (n = 13) targeted for the inner ear. Compared to MD or intracanalicular schwannoma, ILS showed mostly abnormal head-impulse tests (HITs, p = 0.001). In contrast, the incidence of canal paresis did not differ among the groups (p = 0.513). Conclusion: ILS may mimic MD by presenting recurrent dizziness/vertigo and auditory symptoms. ILS should be suspected in patients with recurrent audiovestibulopathy especially when (1) the duration of the dizziness is not typical for MD, (2) the patients do not respond to medical treatments, or (3) HITs are abnormal.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jae-Jin Song
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung Yoon Choi
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung-Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ja-Won Koo
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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Jung I, Ahn SH, Lee J, Lee SU, Oh HJ, Kim HJ, Choi JY, Kim JS. Age-related deterioration of saccule-related neural function is associated with decreased estimated glomerular filtration rate and increased free thyroxine. Clin Neurophysiol 2019; 130:795-801. [DOI: 10.1016/j.clinph.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/31/2018] [Accepted: 02/03/2019] [Indexed: 01/30/2023]
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Lee SU, Kim HJ, Choi JH, Choi JY, Kim JS. Comparison of Ocular Motor Findings Between Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis Involving the Brainstem and Cerebellum. Cerebellum 2019; 18:511-518. [DOI: 10.1007/s12311-019-01018-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lee SU, Kim HJ, Koo JW, Choi JY, Kim JS. Vertigo Induced During Coitus. Front Neurol 2019; 9:1187. [PMID: 30687228 PMCID: PMC6336730 DOI: 10.3389/fneur.2018.01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/24/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to describe the clinical features of vertigo developed during sexual intercourse. Methods: We retrospectively reviewed the clinical and laboratory findings of seven patients who reported recurrent vertigo during sexual intercourse. Results: All the patients reported spinning sensation for a few minutes to 1 h, which developed during the coitus. Most patients (6/7, 86%) reported associated auditory symptoms including tinnitus (n = 4), ear fullness (n = 2), autophony (n = 1), hearing impairment (n = 1), or hyperacusis (n = 1). Four patients reported the vertigo to occur exclusively during sexual intercourse or masturbation while the other three patients also experienced vertigo during other physical activities. Underlying disorders included Meniere's disease (n = 3), superior canal dehiscence (n = 1), and high jugular bulb anomaly (n = 1) while the remaining two patients had no identifiable causes. Conclusions: Various disorders may cause coital vertigo probably due to disruption of the mechanism that normally refrains the increased intracranial pressure from being directly transferred to the peripheral vestibular organs.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ja-Won Koo
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
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Lee SU, Kim HJ, Choi JY, Kim JS. Anti-ganglioside antibody-associated acute unilateral peripheral vestibulopathy. J Neurol 2018; 266:250-252. [PMID: 30421339 DOI: 10.1007/s00415-018-9109-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82, Seongnam, Gyeongggi-do, 13620, Republic of Korea
| | - Hyo-Jung Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82, Seongnam, Gyeongggi-do, 13620, Republic of Korea.,Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82, Seongnam, Gyeongggi-do, 13620, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82, Seongnam, Gyeongggi-do, 13620, Republic of Korea.
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