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Dontham A, Anil AK, Akhtar N, Deepak KK. A novel methodology to demonstrate vestibulo-ocular reflex using caloric stimulation in undergraduate physiology laboratory. Adv Physiol Educ 2024; 48:211-214. [PMID: 38234296 DOI: 10.1152/advan.00065.2022] [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] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
The study aims to develop a novel methodology to demonstrate the vestibulo-ocular reflex (VOR) and nystagmus by caloric stimulation in an undergraduate medical physiology laboratory. The experimental setup involved two sets of electrodes: one set positioned laterally to both eyes, and another set positioned vertically over either the right or left eye. The caloric method is used to stimulate ears, which involves irrigation of warm (44°C) and cold (30°C) water into the ears while maintaining a temperature difference of approximately ±7°C from the body temperature. The changes in chorioretinal potential were calibrated to angular displacement by a two-point calibration method, and angular velocity was derived after taking the first-time derivative. The results obtained from the digital data acquisition system were compared to the traditional instrument used in our Otorhinolaryngology Department [Interacoustics Videonystagmography (VNG) System for hospitals, medical grade] for the normal subject's data. No significant differences in angular velocity were noted (P > 0.05). The cold stimuli elicit a more pronounced VOR compared to the warm stimuli. It has been consistently observed that the onset of nystagmus occurs approximately 20 s after irrigation, reaching its peak intensity between 45 and 90 s, and gradually diminishing until it ceases after approximately 200 s. Our developed methodology enables the recording and quantification of nystagmus using easily accessible equipment. This study serves the goal of visualizing the physiological process of VOR and thereby fulfills the goal of an effective teaching tool for demonstrating to undergraduate medical students.NEW & NOTEWORTHY We developed a novel methodology to demonstrate and visualize the most common and important physiological phenomenon like the vestibulo-ocular reflex as a teaching module for undergraduate students.
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Affiliation(s)
- Aditya Dontham
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhijith K Anil
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nasreen Akhtar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Xing J, Yang P, Yun Y, Cheng Z, Han P, Zhang T, Li B, Chang H. [Discussion and analysis the value of supine median³ nystagmus in the diagnosis and treatment of HC-BPPV]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:432-435;441. [PMID: 38686483 DOI: 10.13201/j.issn.2096-7993.2024.05.016] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 05/02/2024]
Abstract
Objective:To explore the clinical value of supine median³ nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo(HC-BPPV). Methods:A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2020 to March 2021 were selected. Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis. The nystagmus parameters of patients left and right supine position and supine median³ position were recorded in detail by RART. According to the direction of supine median³ nystagmus, patients were divided into three groups: group A(nystagmus to weak side), group B(nystagmus to strong side), group C(negative nystagmus). The canalith repositioning manoeuvres(CRM) was carried out by utility of an automatic vestibular function diagnosis and therapy system(SRM-IV). The cure rate of CRM in three groups of HC-BPPV patients was compared, Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV. Results:The cure rates of group A, group B and group C were 81.58%, 16.13% and 56.25%, respectively. The difference among the three groups was statistically significant. Then a pairwise comparison of group A, B and C, the difference was statistically significant(χ²A-B=40.294,P<0.001,χ²B-C=14.528, P<0.001,χ²A-C=11.606, P=0.001); the results of multivariate logistic regression analysis showed that the direction of supine median³ nystagmus and BMI were the influencing factors of CRM for HC-BPPV. Conclusion:The direction, intensity and duration of supine median³ nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV.
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Affiliation(s)
- Juanli Xing
- Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'anJiaotong University School of Medicine,Xi'an,710061,China
| | - Pan Yang
- Department of Neurology,Jingyang County Hospital
| | - Yanning Yun
- Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'anJiaotong University School of Medicine,Xi'an,710061,China
| | - Zijun Cheng
- Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'anJiaotong University School of Medicine,Xi'an,710061,China
| | - Peng Han
- Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'anJiaotong University School of Medicine,Xi'an,710061,China
| | - Ting Zhang
- Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'anJiaotong University School of Medicine,Xi'an,710061,China
| | - Baiya Li
- Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'anJiaotong University School of Medicine,Xi'an,710061,China
| | - Huimin Chang
- Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Xi'an Medical University
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Keller Sarmiento IJ, Bustos BI, Blackburn J, Hac NEF, Ruzhnikov M, Monroe M, Levy RJ, Kinsley L, Li M, Silani V, Lubbe SJ, Krainc D, Mencacci NE. De novo FRMD5 Missense Variants in Patients with Childhood-Onset Ataxia, Prominent Nystagmus, and Seizures. Mov Disord 2024. [PMID: 38576116 DOI: 10.1002/mds.29791] [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: 11/05/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND FRMD5 variants were recently identified in patients with developmental delay, ataxia, and eye movement abnormalities. OBJECTIVES We describe 2 patients presenting with childhood-onset ataxia, nystagmus, and seizures carrying pathogenic de novo FRMD5 variants. Weighted gene co-expression network analysis (WGCNA) was performed to gain insights into the function of FRMD5 in the brain. METHODS Trio-based whole-exome sequencing was performed in both patients, and CoExp web tool was used to conduct WGCNA. RESULTS Both patients presented with developmental delay, childhood-onset ataxia, nystagmus, and seizures. Previously unreported findings were diffuse choreoathetosis and dystonia of the hands (patient 1) and areas of abnormal magnetic resonance imaging signal in the white matter (patient 2). WGCNA showed that FRMD5 belongs to gene networks involved in neurodevelopment and oligodendrocyte function. CONCLUSIONS We expanded the phenotype of FRMD5-related disease and shed light on its role in brain function and development. We recommend including FRMD5 in the genetic workup of childhood-onset ataxia and nystagmus. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ignacio J Keller Sarmiento
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bernabe I Bustos
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joanna Blackburn
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicholas E F Hac
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maura Ruzhnikov
- Neurology and Neurological Sciences, Division of Child Neurology, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Matthea Monroe
- Department of Genetics, Stanford University, Stanford, California, USA
| | - Rebecca J Levy
- Neurology and Neurological Sciences, Division of Child Neurology, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Lisa Kinsley
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Megan Li
- Invitae Corporation, San Francisco, California, USA
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Steven J Lubbe
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dimitri Krainc
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Niccolò E Mencacci
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for Neurogenetics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Tu Z, Degg C, Bach M, McLean R, Sheth V, Thomas MG, Yang S, Gottlob I, Proudlock FA. ERG Responses in Albinism, Idiopathic Infantile Nystagmus, and Controls. Invest Ophthalmol Vis Sci 2024; 65:11. [PMID: 38573619 PMCID: PMC10996992 DOI: 10.1167/iovs.65.4.11] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose Our primary aim was to compare adult full-field ERG (ffERG) responses in albinism, idiopathic infantile nystagmus (IIN), and controls. A secondary aim was to investigate the effect of within-subject changes in nystagmus eye movements on ffERG responses. Methods Dilated Ganzfeld flash ffERG responses were recorded using DTL electrodes under conditions of dark (standard and dim flash) and light adaptation in 68 participants with albinism, 43 with IIN, and 24 controls. For the primary aim, the effect of group and age on ffERG responses was investigated. For the secondary aim, null region characteristics were determined using eye movements recorded prior to ffERG recordings. ffERG responses were recorded near and away from the null regions of 18 participants also measuring the success rate of recordings. Results For the primary aim, age-adjusted photopic a- and b-wave amplitudes were consistently smaller in IIN compared with controls (P < 0.0001), with responses in both groups decreasing with age. In contrast, photopic a-wave amplitudes increased with age in albinism (P = 0.0035). For the secondary aim, more intense nystagmus significantly reduced the success rate of measurable responses. Within-subject changes in nystagmus intensity generated small, borderline significant differences in photopic b-wave peak times and a-and b-wave amplitudes under scotopic conditions with standard flash. Conclusions Age-adjusted photopic ffERG responses are significantly reduced in IIN adding to the growing body of evidence of retinal abnormalities in IIN. Differences between photopic responses in albinism and controls depend on age. Success at obtaining ffERG responses could be improved by recording responses at the null region.
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Affiliation(s)
- Zhanhan Tu
- University of Leicester Ulverscroft Eye Unit, School of Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Christopher Degg
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Michael Bach
- Eye Center, Freiburg University, Killianstraße 5, Freiburg, Germany
| | - Rebecca McLean
- University of Leicester Ulverscroft Eye Unit, School of Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Viral Sheth
- University of Leicester Ulverscroft Eye Unit, School of Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Mervyn G. Thomas
- University of Leicester Ulverscroft Eye Unit, School of Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Shangqing Yang
- Gonville and Caius College, University of Cambridge, Cambridge, United Kingdom
| | - Irene Gottlob
- University of Leicester Ulverscroft Eye Unit, School of Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
- Cooper University Hospital, Camden, United States
| | - Frank A. Proudlock
- University of Leicester Ulverscroft Eye Unit, School of Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
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An JB, Kim J, Park SH, Yoon J, Choo OS, Park SK, Chang J. Pediatric Benign Paroxysmal Positional Vertigo: Degree of Nystagmus and Concurrent Dizziness Differs from Adult BPPV. J Clin Med 2024; 13:1997. [PMID: 38610761 PMCID: PMC11012783 DOI: 10.3390/jcm13071997] [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: 03/03/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief, intense episodes of vertigo triggered by abrupt changes in head position. It is generally accepted as being most common in adults, while it is regarded as rare in children. It is necessary to compare the disease between pediatric and adult patients for a better understanding of the disease's characteristics and its natural history. This study aimed to identify the clinical characteristics of BPPV in children and compare them with those of adult BPPV patients. Methods: All children ≤ 18 years old who were diagnosed with BPPV were selected by searching the electronic database of our hospital. Clinical features were identified by medical record review. For adult patients, we collected data from patients > 19 years of age. Results: A total of 30 pediatric (13.65 ± 4.15 years old) and 264 adult patients (60.86 ± 13.74 years old) were included in the study. Among pediatric patients, the lateral canals were involved in 80% and the posterior canals in 16.67%. In adult patients, the lateral and posterior canals were involved similarly (p = 0.007). The degree of nystagmus in pediatric patients was 6.82 ± 12.09, while in adults it was 15.58 ± 20.90 (p < 0.001). The concurrent dizziness disorder was higher in the pediatric group and recurrence was higher in the adult group. In the regression analysis, it was found that adult patients had a stronger nystagmus with a value of 6.206 deg/sec, and the risk of concurrent dizziness disorder was found to be 5.413 times higher in the pediatric group (p < 0.05). Conclusions: BPPV occurs in pediatric patients with lower prevalence, but it cannot be overlooked. In the pediatric group, a relatively high proportion of patients demonstrated lateral canal involvement, weaker nystagmus, and additional dizziness disorder.
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Affiliation(s)
- Jun Beom An
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Jisu Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Seok Hyun Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Joonsung Yoon
- Hallym Medical School, Hallym University College of Medicine, Chuncheon Campus, Chuncheon 24252, Republic of Korea
| | - Oak Sung Choo
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Su-Kyoung Park
- PSK99-Ear Nose and Throat Clinic, Seoul 07442, Republic of Korea
| | - Jiwon Chang
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Duvieusart B, Leung TS, Koohi N, Kaski D. Digital biomarkers from gaze tests for classification of central and peripheral lesions in acute vestibular syndrome. Front Neurol 2024; 15:1354041. [PMID: 38595848 PMCID: PMC11003708 DOI: 10.3389/fneur.2024.1354041] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Acute vestibular syndrome (AVS) is characterised by a sudden vertigo, gait instability, nausea and nystagmus. Accurate and rapid triage of patients with AVS to differentiate central (potentially sinister) from peripheral (usually benign) root causes is a challenge faced across emergency medicine settings. While there exist bedside exams which can reliably differentiate serious cases, they are underused due to clinicians' general unfamiliarity and low confidence interpreting results. Nystagmus is a fundamental part of AVS and can facilitate triaging, but identification of relevant characteristics requires expertise. This work presents two quantitative digital biomarkers from nystagmus analysis, which capture diagnostically-relevant information. The directionality biomarker evaluates changes in direction to differentiate spontaneous and gaze-evoked (direction-changing) nystagmus, while the intensity differential biomarker describes changes in intensity across eccentric gaze tests. In order to evaluate biomarkers, 24 sets of three gaze tests (left, right, and primary) are analysed. Both novel biomarkers were found to perform well, particularly directionality which was a perfect classifier. Generally, the biomarkers matched or eclipsed the performance of quantitative nystagmus features found in the literature. They also surpassed the performance of a support vector machine classifier trained on the same dataset, which achieved an accuracy of 75%. In conclusion, these biomarkers simplify the diagnostic process for non-specialist clinicians, bridging the gap between emergency care and specialist evaluation, ultimately benefiting patients with AVS.
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Affiliation(s)
- Benjamin Duvieusart
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Terence S. Leung
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Nehzat Koohi
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Diego Kaski
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
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Yetiser S, Ince D. Bilateral simultaneous presentation of posterior canal benign paroxysmal positional vertigo. J Laryngol Otol 2024; 138:284-288. [PMID: 37350236 DOI: 10.1017/s0022215123001111] [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] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To outline the clinical picture of bilateral posterior canal benign paroxysmal positional vertigo. METHODS A total of 573 patients with posterior canal benign paroxysmal positional vertigo were classified as having unilateral, or true or pseudo bilateral, posterior canal benign paroxysmal positional vertigo, and were treated with the Epley manoeuvre. Statistical significance was set at p < 0.05. RESULTS Of the patients, 483 had unilateral and 90 (15.7 per cent) had bilateral presentation. Of the latter, 72 patients had pseudo bilateral posterior canal benign paroxysmal positional vertigo. Comparisons of site of involvement, male to female ratio and the incidence of associated problems in unilateral, and true and pseudo bilateral posterior canal benign paroxysmal positional vertigo did not reveal any statistically significant differences (p = 0.828, p = 0.200, p = 0.142). Comparisons of the number of manoeuvres required to provide symptom relief and the rate of recurrence were significant (p < 0.05). CONCLUSION Identification of true and pseudo bilateral posterior canal benign paroxysmal positional vertigo is important given the differences in aetiology and treatment outcome. Treatment of patients with true bilateral posterior canal benign paroxysmal positional vertigo requires several therapeutic manoeuvre attempts, and patients should be warned about recurrence.
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Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology and Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Vestibular Laboratory, Department of Otorhinolaryngology and Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
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Sasaki R, Hara M, Yasuda N, Osugi N, Nakagawa I. Antiseizure Medication-Induced Nystagmus During Eye Closure Identified by Electroencephalography. Cureus 2024; 16:e56884. [PMID: 38659559 PMCID: PMC11041858 DOI: 10.7759/cureus.56884] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Nystagmus is a well-known side effect of antiseizure medicines (ASMs), but it is often underestimated and overlooked. Here, we describe a case in which nystagmus during eye closure was identified early using routine electroencephalography (EEG). A 34-year-old man developed focal epilepsy after head trauma at the age of 25 years. The patient was treated with carbamazepine but liver dysfunction was observed; therefore, treatment was attempted with lacosamide (LCM) and lamotrigine. With an increase in the LCM dose, steep potential changes suggestive of horizontal nystagmus were observed in the electrooculogram, F7, and F8 on EEG, and the patient complained of eye shaking during eye closure. These symptoms and EEG findings improved with LCM dose reduction. If the presence of nystagmus is identified on EEG coincidentally and a patient's subjective symptoms with ASM are confirmed, it is advisable to taper and/or discontinue the causative agent.
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Affiliation(s)
- Ryota Sasaki
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Mirei Hara
- Department of Clinical Laboratory, National Hospital Organization Nara Medical Center, Nara, JPN
| | - Nagisa Yasuda
- Department of Clinical Laboratory, National Hospital Organization Nara Medical Center, Nara, JPN
| | - Nahomi Osugi
- Department of Clinical Laboratory, National Hospital Organization Nara Medical Center, Nara, JPN
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
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Cho C, Park S, Ma S, Lee HJ, Lim EC, Hong SK. Feasibility of video-based real-time nystagmus tracking: a lightweight deep learning model approach using ocular object segmentation. Front Neurol 2024; 15:1342108. [PMID: 38450068 PMCID: PMC10915048 DOI: 10.3389/fneur.2024.1342108] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Background Eye movement tests remain significantly underutilized in emergency departments and primary healthcare units, despite their superior diagnostic sensitivity compared to neuroimaging modalities for the differential diagnosis of acute vertigo. This underutilization may be attributed to a potential lack of awareness regarding these tests and the absence of appropriate tools for detecting nystagmus. This study aimed to develop a nystagmus measurement algorithm using a lightweight deep-learning model that recognizes the ocular regions. Method The deep learning model was used to segment the eye regions, detect blinking, and determine the pupil center. The model was trained using images extracted from video clips of a clinical battery of eye movement tests and synthesized images reproducing real eye movement scenarios using virtual reality. Each eye image was annotated with segmentation masks of the sclera, iris, and pupil, with gaze vectors of the pupil center for eye tracking. We conducted a comprehensive evaluation of model performance and its execution speeds in comparison to various alternative models using metrics that are suitable for the tasks. Results The mean Intersection over Union values of the segmentation model ranged from 0.90 to 0.97 for different classes (sclera, iris, and pupil) across types of images (synthetic vs. real-world images). Additionally, the mean absolute error for eye tracking was 0.595 for real-world data and the F1 score for blink detection was ≥ 0.95, which indicates our model is performing at a very high level of accuracy. Execution speed was also the most rapid for ocular object segmentation under the same hardware condition as compared to alternative models. The prediction for horizontal and vertical nystagmus in real eye movement video revealed high accuracy with a strong correlation between the observed and predicted values (r = 0.9949 for horizontal and r = 0.9950 for vertical; both p < 0.05). Conclusion The potential of our model, which can automatically segment ocular regions and track nystagmus in real time from eye movement videos, holds significant promise for emergency settings or remote intervention within the field of neurotology.
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Affiliation(s)
- Changje Cho
- Hallym University Medical Center, DIDIM Research Institute, Chuncheon, Republic of Korea
| | - Sejik Park
- Hallym University Medical Center, DIDIM Research Institute, Chuncheon, Republic of Korea
| | - Sunmi Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hyo-Jeong Lee
- Hallym University Medical Center, DIDIM Research Institute, Chuncheon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Eun-Cheon Lim
- Hallym University Medical Center, DIDIM Research Institute, Chuncheon, Republic of Korea
| | - Sung Kwang Hong
- Hallym University Medical Center, DIDIM Research Institute, Chuncheon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Zhang J, Zhang S, Li Y, Xiao L, Yu S, Wu X, Shen S, Xu H. Investigation on biomechanical responses in bilateral semicircular canals and nystagmus in vestibulo-ocular reflex experiments under different forward-leaning angles. Front Bioeng Biotechnol 2024; 12:1322008. [PMID: 38384434 PMCID: PMC10879882 DOI: 10.3389/fbioe.2024.1322008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Different head positions affect the responses of the vestibular semicircular canals (SCCs) to angular movement. Specific head positions can relieve vestibular disorders caused by excessive stimulating SCCs. In this study, we quantitatively explored responses of human SCCs using numerical simulations of fluid-structure interaction and vestibulo-ocular reflex (VOR) experiments under different forward-leaning angles of the head, including 0°, 10°, 20°, 30°, 40°, 50°, and 60°. It was found that the horizontal nystagmus slow-phase velocity and corresponding biomechanical responses of the cupula in horizontal SCC increased with the forward-leaning angles of the head, reached a maximum when the head was tilted 30° forward, and then gradually decreased. However, no obvious vertical or torsional nystagmus was observed in the VOR experiments. In the numerical model of bilateral SCCs, the biomechanical responses of the cupula in the left anterior SCC and the right anterior SCC showed the same trends; they decreased with the forward-leaning angles, reached a minimum at a 40° forward tilt of the head, and then gradually increased. Similarly, the biomechanical responses of the cupula in the left posterior SCC and in the right posterior SCC followed a same trend, decreasing with the forward-leaning angles, reaching a minimum at a 30° forward tilt of the head, and then gradually increasing. Additionally, the biomechanical responses of the cupula in both the anterior and posterior SCCs consistently remained lower than those observed in the horizontal SCCs across all measured head positions. The occurrence of these numerical results was attributed to the consistent maintenance of mutual symmetry in the bilateral SCCs with respect to the mid-sagittal plane containing the axis of rotation. This symmetry affected the distribution of endolymph pressure, resulting in biomechanical responses of the cupula in each pair of symmetrical SCCs exhibiting same tendencies under different forward-leaning angles of the head. These results provided a reliable numerical basis for future research to relieve vestibular diseases induced by spatial orientation of SCCs.
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Affiliation(s)
- Jing Zhang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Shili Zhang
- Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yue Li
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Lijie Xiao
- Department of Neurology, General Hospital of Xuzhou Mining Group, Xuzhou, China
| | - Shen Yu
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian, China
| | - Xiang Wu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Shuang Shen
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
| | - Hang Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
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Alarfaj G, Alhashim H, Alotaibi HM, Almubarak M, Alhamad J. Apparently X-linked Foveal Hypoplasia of Two Brothers: A Report of a Rare Case. Cureus 2024; 16:e53891. [PMID: 38465154 PMCID: PMC10924645 DOI: 10.7759/cureus.53891] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Foveal hypoplasia is a retinal disorder characterized by the anatomic absence of the foveal pit. It might be isolated or associated with poor vision and several conditions such as albinism, aniridia, microphthalmos, congenital nystagmus, or other diseases. Genetic and non-genetic causes can play a role in foveal pit development. However, the exact mechanism that causes foveal pit absence has not been determined. This study reports a five-year-old boy who presented to the eye clinic with bilateral poor vision since birth. Optical coherence tomography (OCT) was performed and confirmed the absence of the foveal pit in both eyes. Diagnosis of foveal hypoplasia was made. The parents reported a positive family history of similar conditions, specifically, a paternal grandfather, a male paternal cousin, and a brother. To the best of our knowledge, this is the first reported case of foveal hypoplasia, with a positive family history in the male gender specifically. Thus, inheritance is presumed to be X-linked recessive. We acknowledge that further investigation by genetic testing would offer further insight into this case.
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Affiliation(s)
- Ghufran Alarfaj
- Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, SAU
| | - Hassan Alhashim
- Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Mahdi Almubarak
- Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, SAU
| | - Jinan Alhamad
- Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, SAU
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12
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Sheth V, McLean RJ, Tu Z, Ather S, Gottlob I, Proudlock FA. Visual Field Deficits in Albinism in Comparison to Idiopathic Infantile Nystagmus. Invest Ophthalmol Vis Sci 2024; 65:13. [PMID: 38319668 PMCID: PMC10854418 DOI: 10.1167/iovs.65.2.13] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose This is the first systematic comparison of visual field (VF) deficits in people with albinism (PwA) and idiopathic infantile nystagmus (PwIIN) using static perimetry. We also compare best-corrected visual acuity (BCVA) and optical coherence tomography measures of the fovea, parafovea, and circumpapillary retinal nerve fiber layer in PwA. Methods VF testing was performed on 62 PwA and 36 PwIIN using a Humphrey Field Analyzer (SITA FAST 24-2). Mean detection thresholds for each eye were calculated, along with quadrants and central measures. Retinal layers were manually segmented in the macular region. Results Mean detection thresholds were significantly lower than normative values for PwA (-3.10 ± 1.67 dB, P << 0.0001) and PwIIN (-1.70 ± 1.54 dB, P < 0.0001). Mean detection thresholds were significantly lower in PwA compared to PwIIN (P < 0.0001) and significantly worse for left compared to right eyes in PwA (P = 0.0002) but not in PwIIN (P = 0.37). In PwA, the superior nasal VF was significantly worse than other quadrants (P < 0.05). PwIIN appeared to show a mild relative arcuate scotoma. In PwA, central detection thresholds were correlated with foveal changes in the inner and outer retina. VF was strongly correlated to BCVA in both groups. Conclusions Clear peripheral and central VF deficits exist in PwA and PwIIN, and static VF results need to be interpreted with caution clinically. Since PwA exhibit considerably lower detection thresholds compared to PwIIN, VF defects are unlikely to be due to nystagmus in PwA. In addition to horizontal VF asymmetry, PwA exhibit both vertical and interocular asymmetries, which needs further exploration.
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Affiliation(s)
- Viral Sheth
- Health Sciences School, University of Sheffield, Sheffield, Yorkshire, United Kingdom
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Rebecca J. McLean
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Zhanhan Tu
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Sarim Ather
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxfordshire, United Kingdom
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
- Department of Neurology, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, United States
| | - Frank A. Proudlock
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
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Bastani PB, Rieiro H, Badihian S, Otero‐Millan J, Farrell N, Parker M, Newman‐Toker D, Zhu Y, Saber Tehrani A. Quantifying Induced Nystagmus Using a Smartphone Eye Tracking Application (EyePhone). J Am Heart Assoc 2024; 13:e030927. [PMID: 38226513 PMCID: PMC10926800 DOI: 10.1161/jaha.123.030927] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND There are ≈5 million annual dizziness visits to US emergency departments, of which vestibular strokes account for over 250 000. The head impulse, nystagmus, and test of skew eye examination can accurately distinguish vestibular strokes from peripheral dizziness. However, the eye-movement signs are subtle, and lack of familiarity and difficulty with recognition of abnormal eye movements are significant barriers to widespread emergency department use. To break this barrier, we sought to assess the accuracy of EyePhone, our smartphone eye-tracking application, for quantifying nystagmus. METHODS AND RESULTS We prospectively enrolled healthy volunteers and recorded the velocity of induced nystagmus using a smartphone eye-tracking application (EyePhone) and then compared the results with video oculography (VOG). Following a calibration protocol, the participants viewed optokinetic stimuli with incremental velocities (2-12 degrees/s) in 4 directions. We extracted slow phase velocities from EyePhone data in each direction and compared them with the corresponding slow phase velocities obtained by the VOG. Furthermore, we calculated the area under the receiver operating characteristic curve for nystagmus detection by EyePhone. We enrolled 10 volunteers (90% men) with an average age of 30.2±6 years. EyePhone-recorded slow phase velocities highly correlated with the VOG recordings (r=0.98 for horizontal and r=0.94 for vertical). The calibration significantly increased the slope of linear regression for horizontal and vertical slow phase velocities. Evaluating the EyePhone's performance using VOG data with a 2 degrees/s threshold showed an area under the receiver operating characteristic curve of 0.87 for horizontal and vertical nystagmus detection. CONCLUSIONS We demonstrated that EyePhone could accurately detect and quantify optokinetic nystagmus, similar to the VOG goggles.
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Affiliation(s)
- Pouya B. Bastani
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute Center for Diagnostic ExcellenceBaltimoreMDUSA
| | - Hector Rieiro
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute Center for Diagnostic ExcellenceBaltimoreMDUSA
| | - Shervin Badihian
- Armstrong Institute Center for Diagnostic ExcellenceBaltimoreMDUSA
- Neurological Institute, Cleveland ClinicClevelandOHUSA
| | - Jorge Otero‐Millan
- Herbert Wertheim School of Optometry and Vision ScienceUniversity of CaliforniaBerkeleyCAUSA
| | - Nathan Farrell
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute Center for Diagnostic ExcellenceBaltimoreMDUSA
| | - Max Parker
- Department of Neurology, NYU Langone HealthNew YorkNYUSA
| | - David Newman‐Toker
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute Center for Diagnostic ExcellenceBaltimoreMDUSA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Yuxin Zhu
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute Center for Diagnostic ExcellenceBaltimoreMDUSA
- Department of BiostatisticsJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | - Ali Saber Tehrani
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
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14
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Huang X, Zhang X, Deng Q, Li S, Liu Q, Wen C, Wang W, Chen T. Three-dimensional characteristics of nystagmus induced by low frequency in semicircular canals of healthy young people. Front Neurosci 2024; 17:1321906. [PMID: 38239831 PMCID: PMC10794563 DOI: 10.3389/fnins.2023.1321906] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
Objective The study aimed to analyze the three-dimensional characteristics of nystagmus induced by different semicircular canal combinations in healthy young people, and to determine the reference range of nystagmus slow phase velocity (SPV) and its asymmetry. Materials and methods Fifty-two healthy volunteers (26 males and 26 females, aged 17-42 years, average 23.52 ± 6.59), were recruited to perform the manual triaxial rotation testing with a 3D-Videonystagmography (3D-VNG) device (VertiGoggles (ZT-VNG-II), Shanghai ZEHNIT Medical Technology Co., Ltd., Shanghai, China) using a 0.3 Hz prompt beat and a 90° amplitude, respectively. The induced nystagmus around the Z-, X-, and Y-axes were recorded in the yaw, pitch, and roll planes. The directions and slow phase velocities of the horizontal, vertical, and torsional components of the induced nystagmus under different semicircular canal combinations (the left lateral and right lateral semicircular canal combination, bilateral anterior semicircular canals, bilateral posterior semicircular canals combination, and the anterior and posterior semicircular canals combination of each ear), as well as their asymmetry, were taken as the observation indexes to analyze the characteristics of the nystagmus vectors of different combinations. Results Fifty-two healthy volunteers had no spontaneous nystagmus. The characteristic nystagmus was induced by the same head movement direction in all three axial rotation tests. The SPVs of the left and right nystagmus were 44.45 ± 15.75°/s and 43.79 ± 5.42°/s, respectively, when the subjects' heads were turned left or right around the Z-axis (yaw). The SPVs of vertically upward and downward nystagmus were 31.67 ± 9.46°/s and 30.01 ± 9.20°/s, respectively, when the subjects' heads were pitched around the X-axis (pitch). The SPVs of torsional nystagmus, with the upper poles of the eyes twisting slowly to the right and left ears (from the participant's perspective), were 28.99 ± 9.20°/s and 28.35 ± 8.17°/s, respectively, when the subjects' heads were turned left or right around the Y-axis (roll). There was no significant difference in the SPVs of nystagmus induced by the same rotation axis in two opposite directions (p > 0.05). The reference ranges for the slow phase velocities (SPVs) of nystagmus induced by the triaxial rotation testing were as follows: For the Z-axis (yaw), the SPVs were 13.58-75.32°/s for leftward head rotation and 13.56-74.02°/s for rightward head rotation. For the X-axis (pitch), the SPVs were 13.13-50.21°/s for upward head nystagmus and 11.98-48.04°/s for downward head nystagmus. For the Y-axis (roll), the SPVs were 10.97-47.02°/s for the left-sided head rotation and 12.34-44.35°/s for the right-sided head rotation. Conclusion This study clarified the three-dimensional characteristics of nystagmus induced by different semicircular canal combinations in healthy young people. It also established a preliminary reference range of SPVs and SPV asymmetry of nystagmus induced by the vertical semicircular canal. It can further provide a basis for the mechanism of semicircular canal-induced nystagmus and the traceability of nystagmus in patients with otogenic vertigo. It is shown that the portable 3D-VNG eye mask can be used for the manual triaxial rotation testing to achieve the evaluation of the low-frequency angular vestibulo-ocular reflex (aVOR) function of the vertical semicircular canal, which is convenient, efficient, and practical.
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Affiliation(s)
- Xiaobang Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Xueqing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Qiaomei Deng
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Shanshan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Qiang Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Chao Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Wei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Taisheng Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
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15
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Johnson LL, Abrahante JE, McLoon LK. Nystagmus in the B6(CG)Tyr(c-2J)/J Albino Mouse: A Functional and RNA-Seq Analysis. Invest Ophthalmol Vis Sci 2024; 65:26. [PMID: 38206276 PMCID: PMC10787582 DOI: 10.1167/iovs.65.1.26] [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: 07/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Infantile nystagmus syndrome (INS) is a gaze-holding disorder characterized by conjugate, uncontrolled eye oscillations that can result in significant visual acuity loss. INS is often associated with albinism, but the mechanism is unclear. Albino mice have nystagmus; however, a pigmented mouse with a tyr mutation making it phenotypically albino, the B6(CG)-Tyr(c-2J)/J (B6 albino), had not been tested. We tested optokinetic response (OKR) in B6 albino and control mice. RNA-Seq was performed on extraocular muscles (EOM), tibialis anterior (TA) muscle, abducens (CN6), and oculomotor (CN3) neurons to uncover molecular differences that may contribute to nystagmus. Methods OKR was measured using an ISCAN system. RNA was isolated from four tissues to identify differentially expressed genes and validated with qPCR and immunohistochemistry. Ingenuity pathway analyses identified top biological pathways. Results All B6 albino mice tested had nystagmus. Differential RNA expression analysis showed 383 genes differentially expressed in EOM, 70 in CN3, 20 in CN6, and 639 in the TA. Two genes were differentially expressed in all four tissues: wdfy1 and nnt. Differences were validated by qPCR and immunostaining. Conclusions The tyr mutation in B6 albino mice, genotypically pigmented and phenotypically albino, is sufficient to result in spontaneous nystagmus. The two genes with decreased expression in the B6 albino tissues examined, wdfy1 and nnt, have been implicated in mitochondrial dysfunction and stem cell maintenance in other systems. Their function in extraocular muscle is unknown. These studies suggest that this mouse model of nystagmus may allow molecular identification of candidate nystagmus-related genes.
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Affiliation(s)
- Laura L. Johnson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, United States
- Graduate Program in Cellular, Molecular, Developmental Biology and Genetics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Juan E. Abrahante
- University of Minnesota Informatics Institute, University of Minnesota, Minneapolis, Minnesota, United States
| | - Linda K. McLoon
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, United States
- Graduate Program in Cellular, Molecular, Developmental Biology and Genetics, University of Minnesota, Minneapolis, Minnesota, United States
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Daryabari SH, Mosavi SA, Sharoubandi SH, Zarei H. Internuclear ophthalmoplegia following radial artery cardiac catheterization approach: An unusual presentation. Saudi J Ophthalmol 2024; 38:64-66. [PMID: 38628413 PMCID: PMC11017003 DOI: 10.4103/sjopt.sjopt_2_23] [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: 01/02/2023] [Revised: 02/11/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2024] Open
Abstract
Internuclear ophthalmoplegia (INO) may happen following percutaneous coronary intervention and angiography. However, no reports of INO during radial artery angioplasty were reported yet. We report a rare case in a 47-year-old man presenting with diplopia after radial artery angioplasty. Although the symptoms were resolved after 60 days, diagnosing this obstacle is necessary to reduce the patient and physician's anxiety.
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Affiliation(s)
- Seyed H. Daryabari
- Chemical Injuries Research Center, Systems Biology and Poisonings Institutes, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed A. Mosavi
- Bina Eye Hospital Research Center, Tehran, Iran
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyed H. Sharoubandi
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hooman Zarei
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- Department of Anatomy, Student Research Committee, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Akbari MR, Khorrami-Nejad M, Shakor YA, Dehghanian Nasrabadi F, Kangari H, Dalvand H. The Frequency and Manifestations of Ocular Causes of Abnormal Head Posture. J Binocul Vis Ocul Motil 2024; 74:9-16. [PMID: 37983128] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
PURPOSE To determine the frequency and manifestations of different ocular causes of abnormal head posture (AHP). METHOD This prospective, consecutive case series study was performed on 149 patients with ocular AHP at Farabi hospital, Iran, from February 2020 to June 2021. All patients underwent routine ophthalmic examinations. The manifestation of AHP was determined by direct observation from three viewing angles, while the patient read the smallest line on the vision chart that they could see. In front, above, and lateral gazes, observations were performed to find head tilt, head turn, and chin abnormal position, respectively. A picture with habitual AHP was taken from all patients. The amount of head tilt was measured by calculating the angle between the line that connects the lips center to the center of the eyebrows and the vertical line using the Corel Draw X7 computer software. RESULTS The mean age of 149 patients with ocular AHP [101 (67.8%) males and 48 (32.2%) females] was 16.2 ± 12.2 (range, 2-57) years. The most common ocular sources of AHP were found to be superior oblique palsy (SOP) in 66 (44.3%) patients, 54 (36.2%) cases with Duane's retraction syndrome (DRS), and 12 (8.1%) patients with nystagmus. Other frequent causes of ocular AHP were dissociated vertical deviation (DVD) in 5 (3.4%), A and V pattern strabismus in 3 (2.0%), and 2 cases (1.3%) in each of Brown syndrome, inferior rectus (IR) palsy, and congenital fibrosis of the extraocular muscles (CFEOM). The most common manifestations of AHP in all cases were "pure head turn" (48.3%), followed by "pure head tilt" (24.8%), "simultaneous head tilt and head turn" (20.8%), and "chin up" (6.0%). The mean head tilt among all patients with head tilt was 10.4° ± 8.9° (range, 5.0°-31.7°). CONCLUSION The most frequent ocular sources of AHP were SOP, DRS, and nystagmus, followed by DVD, A and V pattern strabismus, IR palsy, CFEOM, and Brown syndrome. In addition, pure head turn and pure head tilt were the most common manifestations of ocular AHP but were not always seen in the same direction or combination as previously reported with these etiologies.
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Affiliation(s)
- Mohammad Reza Akbari
- Translational research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
| | - Masoud Khorrami-Nejad
- Translational research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran
| | - Yasr Adil Shakor
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran
| | - Farzaneh Dehghanian Nasrabadi
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Haleh Kangari
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran
| | - Hamid Dalvand
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran
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18
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Nikles F, Kerkeni H, Zamaro E, Korda A, Wagner F, Sauter TC, Kalla R, Morrison M, Mantokoudis G. Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity. Eur J Neurol 2024; 31:e16066. [PMID: 37738525 DOI: 10.1111/ene.16066] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross-sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes. METHODS As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms. RESULTS Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory. CONCLUSIONS A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
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Affiliation(s)
- Florence Nikles
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Chen X, Mao J, Ye H, Fan L, Tong Q, Zhang H, Wu C, Yang X. The effectiveness of the modified Epley maneuver for the treatment of posterior semicircular canal benign paroxysmal positional vertigo. Front Neurol 2023; 14:1328896. [PMID: 38187143 PMCID: PMC10771316 DOI: 10.3389/fneur.2023.1328896] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To compare the repositioning effect of the modified Epley maneuver and the traditional Epley maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV). Methods Sixty-five patients with unilateral PC-BPPV were randomly divided into two groups. The control group received the traditional Epley maneuver, while the experimental group received the modified Epley maneuver, which prolonged the time in the healthy side lying position and the final bowing position. The number of successful repositions after one, two, and three attempts and the total number of successful repositions were recorded and compared between the two groups. A BPPV virtual simulation model was used to analyze the mechanism of the modified Epley maneuver. Results The first repositioning success rate of the experimental group was significantly higher than that of the control group (85% vs. 63%, p = 0.040). The experimental group achieved 100% repositioning success rate after two attempts, while the control group needed three attempts to reach 86% repositioning success rate. Four cases in the control group experienced canal switching during the repositioning process, while none in the experimental group did. The BPPV virtual simulation model showed that the modified Epley maneuver could facilitate the passage of otoliths through the posterior arm of the posterior semicircular canal, especially through the location of obstruction. Conclusion The modified Epley maneuver is more effective than the traditional Epley maneuver in improving the single repositioning success rate and reducing the canal switching rate for PC-BPPV. This study provides a new option for the treatment of BPPV.
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Affiliation(s)
- Xiaosu Chen
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Jiesheng Mao
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Hua Ye
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Luping Fan
- Rehabilitation Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Qiaowen Tong
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Hehui Zhang
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Chengcheng Wu
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
| | - Xiaokai Yang
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China
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20
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Chen CC, Bery AK, Chang TP. Weak nystagmus in the dark persists for months after acute unilateral vestibular loss. Front Neurol 2023; 14:1327735. [PMID: 38162452 PMCID: PMC10754966 DOI: 10.3389/fneur.2023.1327735] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background Weak nystagmus with fixation removed can be seen both in normal individuals and in recovery from a unilateral vestibular insult, thus its clinical significance is unclear in patients with dizziness. We thus sought to compare features of nystagmus at various stages following unilateral vestibular loss (UVL). Methods We enrolled thirty consecutive patients after acute UVL with impaired vestibulo-ocular reflex (VOR) gain. The patients were allocated into three groups according to time from onset of symptoms: acute (1-7 days), subacute (8-30 days), and chronic (>30 days). Patients underwent video-oculography (with and without fixation) and video head impulse testing (vHIT) to determine VOR gain. We examined the relationships amongst SPV, VOR gain, and time from symptom onset across groups. Results There were 11, 10, and 9 patients in the acute, subacute, and chronic stages of UVL, respectively. With visual fixation, only 8 patients (26.7%) demonstrated nystagmus, all from the acute group. With fixation removed, 26 patients (86.7%) exhibited spontaneous nystagmus, including 90.9%, 90%, and 77.8% of the patients from the acute, subacute, and chronic groups, respectively. Horizontal nystagmus was paralytic (i.e., fast phase contralesional) in 25 (96.7%) cases. Horizontal SPV was negatively correlated with logarithm of time from onset to examination (r = -0.48, p = 0.007) and weakly negatively correlated with ipsilesional VOR gain (r = -0.325, p = 0.08). Conclusion In the subacute or chronic stages of UVL, paralytic nystagmus with fixation removed persisted at a low intensity. Therefore, weak nystagmus in the dark may have diagnostic value in chronic dizziness.
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Affiliation(s)
- Chih-Chung Chen
- Dizziness and Balance Disorder Center, Taipei Medical University–Shuang Ho Hospital, New Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Anand K. Bery
- Division of Neuro-Visual and Vestibular Disorders, Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Tzu-Pu Chang
- Department of Neurology/Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
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21
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Kaur P, Kaur A, Sinha A, Khaliq W, Dumic I, Singh A. Amiodarone-Induced Nystagmus and Ataxia: Case Report and Systematic Review of Case Reports. J Clin Pharmacol 2023; 63:1324-1329. [PMID: 37571970 DOI: 10.1002/jcph.2330] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
Amiodarone is an antiarrhythmic drug with a significant adverse effect profile, including neurotoxicity. While ataxia, neuropathy, and tremors are more commonly seen forms of amiodarone neurotoxicity, very few cases of nystagmus are reported. We report the case of an 86-year-old man who presented with abrupt-onset ataxia, dizziness, and inability to ambulate, 10 days after initiating amiodarone for atrial fibrillation. His examination revealed gaze-evoked nystagmus along with features of cerebellar dysfunction. After excluding other etiologies, amiodarone was stopped. His nystagmus resolved, and his ataxia improved within 48 h of stopping amiodarone. Due to the rarity of this drug-induced adverse effect, we performed a systematic review of available case reports in the literature (PubMed and Scopus) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and presented our findings. Nystagmus is a rarely reported adverse effect of amiodarone, which can occur within days to months of starting the medication. Treatment includes stopping the drug and monitoring for resolution of nystagmus.
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Affiliation(s)
| | - Ashampreet Kaur
- Sri Guru Ramdas Institute of Medical Sciences & Research, Amritsar, India
| | | | - Waseem Khaliq
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Mayo Clinic Health System, Eau Claire, WI, USA
| | - Amteshwar Singh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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22
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Talsma HE, Kruijt CC, de Wit GC, Zwerver SHL, van Genderen MM. Nystagmus Characteristics in Albinism: Unveiling the Link to Foveal Hypoplasia and Visual Acuity. Invest Ophthalmol Vis Sci 2023; 64:30. [PMID: 38133506 PMCID: PMC10746925 DOI: 10.1167/iovs.64.15.30] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose The purpose of this study was to describe the association among nystagmus characteristics, foveal hypoplasia, and visual acuity in patients with albinism. Methods We studied nystagmus recordings of 50 patients with albinism. The nystagmus waveform was decomposed into two types: dominantly pendular and dominantly jerk. We correlated the nystagmus type, amplitude, frequency, and percentage of low velocity (PLOV) to Snellen visual acuity and foveal hypoplasia grades. Results The grade of foveal hypoplasia and visual acuity showed a strong correlation (r = 0.87, P < 0.0001). Nystagmus type and PLOV had the strongest significant (P < 0.0001) correlation with visual acuity (r = 0.70 and r = -0.56, respectively) and with foveal hypoplasia (r = 0.76 and r = -0.60, respectively). Patients with pendular nystagmus type had the lowest PLOV, and the highest grade of foveal hypoplasia (P < 0.0001). Severe foveal hypoplasia (grade 4), was almost invariably associated with pendular nystagmus (86%). Conclusions Foveal hypoplasia grade 4 is associated with pendular nystagmus, lower PLOV, and worse visual acuity. Based on these results, nystagmus recordings at a young age may contribute to predicting visual outcomes.
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Affiliation(s)
- Herman E. Talsma
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands
| | - Charlotte C. Kruijt
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard C. de Wit
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands
| | - Stefan H. L. Zwerver
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Maria M. van Genderen
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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Pogson JM, Shemesh A, Roberts DC, Zee DS, Otero-Milan J, Ward BK. Longer duration entry mitigates nystagmus and vertigo in 7-Tesla MRI. Front Neurol 2023; 14:1255105. [PMID: 38046576 PMCID: PMC10690370 DOI: 10.3389/fneur.2023.1255105] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Patients and technologists commonly describe vertigo, dizziness, and imbalance near high-field magnets, e.g., 7-Tesla (T) magnetic resonance imaging (MRI) scanners. We sought a simple way to alleviate vertigo and dizziness in high-field MRI scanners by applying the understanding of the mechanisms behind magnetic vestibular stimulation and the innate characteristics of vestibular adaptation. Methods We first created a three-dimensional (3D) control systems model of the direct and indirect vestibulo-ocular reflex (VOR) pathways, including adaptation mechanisms. The goal was to develop a paradigm for human participants undergoing a 7T MRI scan to optimize the speed and acceleration of entry into and exit from the MRI bore to minimize unwanted vertigo. We then applied this paradigm from the model by recording 3D binocular eye movements (horizontal, vertical, and torsion) and the subjective experience of eight normal individuals within a 7T MRI. The independent variables were the duration of entry into and exit from the MRI bore, the time inside the MRI bore, and the magnetic field strength; the dependent variables were nystagmus slow-phase eye velocity (SPV) and the sensation of vertigo. Results In the model, when the participant was exposed to a linearly increasing magnetic field strength, the per-peak (after entry into the MRI bore) and post-peak (after exiting the MRI bore) responses of nystagmus SPV were reduced with increasing duration of entry and exit, respectively. There was a greater effect on the per-peak response. The entry/exit duration and peak response were inversely related, and the nystagmus was decreased the most with the 5-min duration paradigm (the longest duration modeled). The experimental nystagmus pattern of the eight normal participants matched the model, with increasing entry duration having the strongest effect on the per-peak response of nystagmus SPV. Similarly, all participants described less vertigo with the longer duration entries. Conclusion Increasing the duration of entry into and exit out of a 7T MRI scanner reduced or eliminated vertigo symptoms and reduced nystagmus peak SPV. Model simulations suggest that central processes of vestibular adaptation account for these effects. Therefore, 2-min entry and 20-s exit durations are a practical solution to mitigate vertigo and other discomforting symptoms associated with undergoing 7T MRI scans. In principle, these findings also apply to different magnet strengths.
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Affiliation(s)
- Jacob M. Pogson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ari Shemesh
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, Berkeley, CA, United States
| | - Dale C. Roberts
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neuroscience, The Johns Hopkins University, Baltimore, MD, United States
| | - David S. Zee
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neuroscience, The Johns Hopkins University, Baltimore, MD, United States
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, United States
| | - Jorge Otero-Milan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, Berkeley, CA, United States
| | - Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Crincoli E, Leoni C, Viscogliosi G, Onesimo R, Mattei R, Tartaglia M, Catania F, Rizzo S, Zampino G, Salerni A. Systematic ophthalmologic evaluation in cardio-facio-cutaneous syndrome: A genotype-endophenotype correlation. Am J Med Genet A 2023; 191:2783-2792. [PMID: 37697822 DOI: 10.1002/ajmg.a.63395] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
Abstract
Cardio-facio-cutaneous syndrome (CFCS) is a rare genetic disorder belonging to the RASopathies, a group of developmental syndromes caused by upregulated RAS/MAPK signaling. Pathogenic variants affecting four genes, KRAS, BRAF, MAP2K1 and MAP2K2, encoding core signal transducers of the pathway, underlie the condition. Major clinical features include a distinctive facies, ectodermal and cardiac anomalies, reduced postnatal growth, intellectual disability, and musculoskeletal abnormalities. Similar to other RASopathies, reports of visual impairment, high refractive error, optic nerve pallor, and other ocular abnormalities have been anecdotally reported in the literature. The aim of our study is to report the prevalence of ophthalmologic abnormalities in a large monocentric cohort of individuals affected by CFCS and explore the occurrence of genotype-endophenotype correlations in this series of patients. We observed that BRAF mutations are associated to a higher prevalence of anisometropia >3D (11.8% vs. 0%) and high astigmatism (29.4% vs. 0%; both p < 0.001) while patients with mutations in other genes had a significantly higher prevalence of myopia >6 D (60% vs. 5.9%; p = 0.012). Pale optic disc was associated with higher prevalence of inferior oblique muscle (IO) overaction (33.3% vs. 0%) and lower prevalence of ptosis (0% vs. 11.8%; both p < 0.001). Combined exotropia, IO overaction and nystagmus were frequent in patients with pale optic nerve. Our findings might suggest the need for earlier ophthalmologic referral for CFCS patients due to high risk of amblyopia, especially those expressing BRAF mutations.
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Affiliation(s)
- Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberta Mattei
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Fiammetta Catania
- Department of Ophthalmology, Hopital Fondation Adolphe De Rothschild, Paris, France
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- "Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze", Pisa, Italy
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annabella Salerni
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
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Al-Nosairy KO, Quanz EV, Eick CM, Hoffmann MB, Kornmeier J. Altered Perception of the Bistable Motion Quartet in Albinism. Invest Ophthalmol Vis Sci 2023; 64:39. [PMID: 38015177 PMCID: PMC10691394 DOI: 10.1167/iovs.64.14.39] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose Perception of the motion quartet (MQ) alternates between horizontal and vertical motion, with a bias toward vertical motion. This vertical bias has been explained by the dominance of intrahemispheric processing. In albinism, each hemisphere receives input from both visual hemifields owing to enhanced crossing of the optic nerves at the optic chiasm. This might affect the perception of the ambiguous MQ and particularly the vertical bias. Methods The effect of optic nerve misrouting in persons with albinism and nystagmus (PWA, n = 14) on motion perception for MQ was compared with healthy controls (HC; n = 11) and with persons with nystagmus in the absence of optic nerve misrouting (PWN; n = 12). We varied the ratio of horizontal and vertical distances of MQ dots (aspect ratio [AR]) between 0.75 and 1.25 and compared the percentages of horizontal and vertical motion percepts as a function of AR between groups. Results For HC, the probability of vertical motion perception increased as a sigmoid function with increasing AR exhibiting the expected vertical percept bias (mean, 58%; median, 54%; vertical motion percepts). PWA showed a surprisingly strong horizontal bias independent of the AR with a mean of 11% (median, 10%) vertical motion percepts. The PWN was in between PWA and HC, with a mean of 34% (median, 47%) vertical perception. Nystagmus alone is unlikely to explain this pattern of results because PWA and PWN had comparable fixation stabilities. Conclusions The strong horizontal bias observed in PWA and PWN might partly result from the horizontal nystagmus. The even stronger horizontal bias in PWA indicates that the intrahemispherical corepresentation of both visual hemifields may play an additional role. The altered perception of the MQ in PWA opens opportunities to (i) understand the interplay of stability and plasticity in altered visual pathway conditions and (ii) identify visual pathway abnormalities with a perception-based test using the MQ.
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Affiliation(s)
| | - Elisabeth V. Quanz
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
| | - Charlotta M. Eick
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
| | - Michael B. Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
| | - Jürgen Kornmeier
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Marcelli V, Marcelli E. Magnetic field, nystagmus and serendipity. Acta Otorhinolaryngol Ital 2023; 43:360-361. [PMID: 37519140 PMCID: PMC10551731 DOI: 10.14639/0392-100x-n2485] [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] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/21/2023] [Indexed: 08/01/2023]
Affiliation(s)
| | - Edoardo Marcelli
- University of Salerno, Faculty of Medicine and Surgery, Salerno, Italy
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Khan AO. Full-field electroretinography - when do we need it? Saudi J Ophthalmol 2023; 37:263-268. [PMID: 38155681 PMCID: PMC10752284 DOI: 10.4103/sjopt.sjopt_126_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/30/2023] [Accepted: 08/15/2023] [Indexed: 12/30/2023] Open
Abstract
Multimodal imaging and genetic testing allow sophisticated assessment of suspected inherited retinal disease. Given the availability of such technology, some question whether the full-field electrogram (ffERG) is needed anymore. In fact, a ffERG remains essential for certain clinical scenarios. The goal of this case-based review is to provide a clear understanding of what clinical situations warrant a ffERG. All practicing ophthalmologists should be familiar with this information.
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Affiliation(s)
- Arif O. Khan
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Aslaksen AK, Vikesdal GH, Voie MT, Rowlands M, Skranes J, Haugen OH. Visual function in Norwegian children aged 5-13 years with prenatal exposure to opioid maintenance therapy: A case-control study. Acta Ophthalmol 2023. [PMID: 37702266 DOI: 10.1111/aos.15764] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To assess various aspects of visual function in school children prenatally exposed to opioid maintenance therapy (OMT) and to explore possible outcome differences between prenatal methadone and buprenorphine exposure. METHODS In a cross-sectional case-control study, 63 children aged 5-13 years with prenatal OMT exposure were compared with 63 age- and gender-matched, non-exposed controls regarding important visual parameters, such as visual acuity, orthoptic status, refractive state, colour vision, and visual field. RESULTS The OMT-exposed children had significantly poorer visual acuity, both for the best eye, the worst eye and binocularly. Two children had mild visual impairment. Manifest strabismus was more frequent in the OMT group, 30%, vs. 4.8% in the control group. The most frequent types of strabismus were accommodative esotropia and intermittent exotropia. Manifest nystagmus was present in 10 (16%) of the exposed children compared to one among the non-exposed children. The accommodative amplitude was decreased in the OMT group compared to the controls. After adjusting for polydrug exposure and SGA (small-for-gestational-age), the between-group differences in visual acuity, strabismus, and nystagmus remained. The methadone-exposed children had poorer visual acuity, increased frequency of strabismus and a higher percentage of nystagmus, hypermetropia and astigmatism compared to the buprenorphine-exposed children. CONCLUSIONS School-age children exposed to methadone or buprenorphine in utero had a higher prevalence of strabismus and nystagmus, and a lower visual acuity and accommodation amplitude. Buprenorphine exposure was associated with more favourable results than methadone exposure on most visual outcome measures and should be the preferred substance in OMT.
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Affiliation(s)
- Anne Kathinka Aslaksen
- Department of Paediatrics, Sørlandet Hospital, Arendal, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Gro Horgen Vikesdal
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | | | - Megan Rowlands
- Department of Ophthalmology, Sørlandet Hospital, Arendal, Norway
| | - Jon Skranes
- Department of Paediatrics, Sørlandet Hospital, Arendal, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav H Haugen
- Department of Clinical Medicine K1, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
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Demir İ, Uğur Cengiz D, Çalışkan Demir A, Can Çolak S, Demirel Birişik S, Özel Özcan Ö. Vestibular Evaluation of Children Diagnosed with Specific Learning Disorder. Alpha Psychiatry 2023; 24:211-216. [PMID: 38105778 PMCID: PMC10724714 DOI: 10.5152/alphapsychiatry.2023.221097] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/29/2023] [Indexed: 12/19/2023]
Abstract
Objective The aim of this study was to determine the vestibular function of children diagnosed with specific learning disorders (SLD). Methods This study was conducted with 30 children diagnosed with SLD and 30 healthy children matched for age and sex, and vestibular tests were applied. Results Optokinetic and head shake test values in videonystagmography subtests were found to be pathological in the study group, and the lateral asymmetry value in video head impulse test (v-HIT) was found to be significantly higher in the study group. Also, a significant difference was found in the N1 latency, P1-N1 interlatency, P1-N1 amplitude values in the cervical vestibular evoked myogenic potential test, and asymmetry values in the ocular vestibular evoked myogenic potential test. Conclusion The current study showed that vestibular functions may differ from normal in SLD patients and that vestibular dysfunction may play a role in symptoms such as postural instability, balance, and gross and fine motor disorders that are frequently observed in these children.
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Affiliation(s)
- İsmail Demir
- Department of Otorhinolaryngology, Inonu University, Turgut Özal Medical Center, Malatya, Turkey
| | - Deniz Uğur Cengiz
- Department of Audiology, Inonu University, Faculty of Health Sciences, Malatya, Turkey
| | - Arzu Çalışkan Demir
- Department of Child and Adolescent Mental Health and Diseases, Inonu University, Turgut Özal Medical Center, Malatya, Turkey
| | - Sanem Can Çolak
- Department of Audiology, Inonu University, Faculty of Health Sciences, Malatya, Turkey
| | | | - Özlem Özel Özcan
- Department of Child and Adolescent Mental Health and Diseases, Inonu University, Turgut Özal Medical Center, Malatya, Turkey
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Kavalaraki A, Paraskevopoulos K, Kavalaraki M, Karakosta C, Liaskou M. Foveal Hypoplasia in a Child With Tyrosinase-Positive Albinism. Cureus 2023; 15:e44558. [PMID: 37790023 PMCID: PMC10544804 DOI: 10.7759/cureus.44558] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
The purpose of this article is to report a case of bilateral foveal hypoplasia in an eight-year-old girl who presented to the ophthalmology department due to poor vision in both eyes. Clinical examination revealed bilateral nystagmus, decreased vision, as well as iris transillumination. Dilated fundus examination indicated the absence of light reflex around the foveal area and optical coherence tomography (OCT) imaging exhibited the absence of the fovea centralis depression. These findings, in addition to the patient's light-colored hair and skin complexion, raised suspicion for albinism. The patient was referred for genetic testing and the results confirmed the diagnosis of tyrosinase-positive oculocutaneous albinism (OCA2).
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Affiliation(s)
| | | | | | | | - Maria Liaskou
- Ophthalmology, Penteli General Children's Hospital, Athens, GRC
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31
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Lovato A, Disco C, Frosolini A, Monzani D, Perini F. Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine. Medicina (Kaunas) 2023; 59:1560. [PMID: 37763679 PMCID: PMC10534399 DOI: 10.3390/medicina59091560] [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] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Background. Monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP) or its receptor represented the first targeted and specialized approach to migraine prophylaxis. Nevertheless, they have been rarely considered in the treatment of vestibular migraine (VM). Our aim was to evaluate the effectiveness of anti-CGRP mAbs in VM patients who did not respond to conventional migraine treatments. Methods. Consecutive VM patients treated with erenumab were considered. As a comparison, we considered the same VM patients during conventional migraine treatments (i.e., propranolol, flunarizine, or valproic acid), which were tried before mAbs therapy. Videonystagmography, the Italian version of the Dizziness Handicap Inventory (DHI) questionnaire, and migraine days over the last 3 months were evaluated in all patients before and after treatments. Results. In the present retrospective study, we included 21 female and 2 male VM patients, mean age 45.2 years. All patients underwent contrast-enhanced magnetic resonance imaging that ruled out other causes of vertigo. The DHI questionnaire significantly improved after mAb therapy (p < 0.0001). Mean migraine days over the last 3 months were significantly reduced after treatment (p = 0.001). Videonystagmography was altered in 11 (48%) patients prior to monoclonal antibodies. We found vertical positional nystagmus in 9 patients and horizontal positional nystagmus in 2 patients. After the treatment, we found vertical positional nystagmus only in 1 patient (p = 0.002). When patients were treated with conventional therapies, there was no significant reduction in DHI, and instrumental vestibular examinations remained altered. Conclusions. VM patients using anti-CGRP mAbs experienced a reduction in the dizziness-derived handicap, as reported in the DHI questionnaire. Furthermore, these treatments were significantly associated with a normalization of vestibular instrumental analysis. These findings were not seen with conventional treatments. Treatment with anti-CGRP mAbs may be effective in VM patients who did not respond to conventional migraine treatments. These findings should be tested in large, randomized clinical trials.
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Affiliation(s)
- Andrea Lovato
- Otorhinolaryngology Unit, Department of Surgical Specialties, Vicenza Civil Hospital, 36100 Vicenza, Italy
- Otorhinolaryngology Unit, Department of Surgical Specialties, San Gaetano Clinic, 36016 Thiene, Italy
| | - Caterina Disco
- Neurology Unit, Department of Neuroscience, Vicenza Civil Hospital, 36100 Vicenza, Italy
| | - Andrea Frosolini
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Daniele Monzani
- Otorhinolaryngology Unit, Department of Surgical Specialties, University of Verona, 37100 Verona, Italy
| | - Francesco Perini
- Neurology Unit, Department of Neuroscience, Vicenza Civil Hospital, 36100 Vicenza, Italy
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Waissbluth S, Sepúlveda V, Leung JS, Oyarzún J. Vestibular and Oculomotor Findings in Vestibular Migraine Patients. Audiol Res 2023; 13:615-626. [PMID: 37622929 PMCID: PMC10452030 DOI: 10.3390/audiolres13040053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. METHODS A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. RESULTS Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. CONCLUSIONS Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus.
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Affiliation(s)
- Sofia Waissbluth
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile
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Chan HW, Van den Broeck F, Cools A, Walraedt S, Joniau I, Verdin H, Balikova I, Van Nuffel S, Delbeke P, De Baere E, Leroy BP, Nerinckx F. Paediatric cataract surgery with 27G vitrectomy instrumentation: the Ghent University Hospital Experience. Front Med (Lausanne) 2023; 10:1197984. [PMID: 37601772 PMCID: PMC10435324 DOI: 10.3389/fmed.2023.1197984] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To describe a cohort of paediatric patients who underwent unilateral or bilateral lens extractions at Ghent University hospital using the Dutch Ophthalmic Research Center (D.O.R.C.) ultra-short 27G vitrectomy system. Methods Retrospective analysis of the medical and surgical records of all children that underwent lens extraction between September 2016 and September 2020 using the D.O.R.C. ultra-short 27G vitrectomy system. Results Seventy-two eyes of 52 patients were included. The most important aetiologies in this study were of secondary (25.5%), developmental (13.7%), or genetic (13.7%) nature. No definitive cause could be established in more than a quarter of cases (27.5%) despite extensive work-up, them being deemed idiopathic. The remainder of cases (19.6%) was not assigned a final aetiologic designation at the time of the study due to contradicting or missing diagnostic data. This study could not identify any cataract cases related to infection or trauma. Surgical complications rate was 61.1% of which posterior capsule opacification was the most frequent with a rate of 25%. A significant short-term postoperative best-corrected visual acuity gain (≤ -0.2 LogMAR) was observed in 60.5% of eyes for which usable acuity data were available (n = 38). Conclusion Many different instruments and techniques have been described and used in the context of paediatric lens extractions, each with its advantages and disadvantages. This study illustrates that an ultra-short 27G vitrectomy system can be used to perform paediatric lens extractions with good surgical outcomes. Further studies and comparative trials are needed to ascertain this further.
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Affiliation(s)
- Hwei Wuen Chan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Department of Ophthalmology, National University Singapore, Singapore, Singapore
| | - Filip Van den Broeck
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Axelle Cools
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Sophie Walraedt
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Inge Joniau
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Irina Balikova
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Bart P. Leroy
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Fanny Nerinckx
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
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Montijn JS, Riguccini V, Levelt CN, Heimel JA. Impaired Direction Selectivity in the Nucleus of the Optic Tract of Albino Mice. Invest Ophthalmol Vis Sci 2023; 64:9. [PMID: 37548962 PMCID: PMC10411648 DOI: 10.1167/iovs.64.11.9] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Human albinos have a low visual acuity. This is partially due to the presence of spontaneous erroneous eye movements called pendular nystagmus. This nystagmus is present in other albino vertebrates and has been hypothesized to be caused by aberrant wiring of retinal ganglion axons to the nucleus of the optic tract (NOT), a part of the accessory optic system involved in the optokinetic response to visual motion. The NOT in pigmented rodents is preferentially responsive to ipsiversive motion (i.e., motion in the contralateral visual field in the temporonasal direction). We compared the response to visual motion in the NOT of albino and pigmented mice to understand if motion coding and preference are impaired in the NOT of albino mice. Methods We recorded neuronal spiking activity with Neuropixels probes in the visual cortex and NOT in C57BL/6JRj mice (pigmented) and DBA/1JRj mice with oculocutaneous albinism (albino). Results We found that in pigmented mice, NOT is retinotopically organized, and neurons are direction tuned, whereas in albino mice, neuronal tuning is severely impaired. Neurons in the NOT of albino mice do not have a preference for ipsiversive movement. In contrast, neuronal tuning in visual cortex was preserved in albino mice and did not differ significantly from the tuning in pigmented mice. Conclusions We propose that excessive interhemispheric crossing of retinal projections in albinos may cause the disrupted left/right direction encoding we found in NOT. This, in turn, impairs the normal horizontal optokinetic reflex and leads to pendular albino nystagmus.
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Affiliation(s)
- Jorrit S. Montijn
- Department of Circuits, Structure & Function, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Valentina Riguccini
- Department of Molecular Visual Plasticity, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
| | - Christiaan N. Levelt
- Department of Molecular Visual Plasticity, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
- Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - J. Alexander Heimel
- Department of Circuits, Structure & Function, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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Wüthrich M, Wang Z, Martinez CM, Carmona S, Mantokoudis G, Tarnutzer AA. Systematic review and meta-analysis of the diagnostic accuracy of spontaneous nystagmus patterns in acute vestibular syndrome. Front Neurol 2023; 14:1208902. [PMID: 37396773 PMCID: PMC10312004 DOI: 10.3389/fneur.2023.1208902] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives For the assessment of patients presenting with acute prolonged vertigo meeting diagnostic criteria for acute vestibular syndrome (AVS), bedside oculomotor examinations are essential to distinguish peripheral from central causes. Here we assessed patterns of spontaneous nystagmus (SN) observed in AVS and its diagnostic accuracy at the bedside. Methods MEDLINE and Embase were searched for studies (1980-2022) reporting on the bedside diagnostic accuracy of SN-patterns in AVS patients. Two independent reviewers determined inclusion. We identified 4,186 unique citations, examined 219 full manuscripts, and analyzed 39 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted and SN beating-direction patterns were correlated with lesion locations and lateralization. Results Included studies reported on 1,599 patients, with ischemic strokes (n = 747) and acute unilateral vestibulopathy (n = 743) being most frequent. While a horizontal or horizontal-torsional SN was significantly more often found in peripheral AVS (pAVS) than in central AVS (cAVS) patients (672/709 [94.8%] vs. 294/677 [43.4%], p < 0.001), torsional and/or vertical SN-patterns were more prevalent in cAVS than in pAVS (15.1 vs. 2.6%, p < 0.001). For an (isolated) vertical/vertical-torsional SN or an isolated torsional SN specificity (97.7% [95% CI = 95.1-100.0%]) for a central origin etiology was high, whereas sensitivity (19.1% [10.5-27.7%]) was low. Absence of any horizontal SN was more frequently observed in cAVS than in pAVS (55.2 vs. 7.0%, p < 0.001). Ipsilesional and contralesional beating directions of horizontal SN in cAVS were found at similar frequency (28.0 vs. 21.7%, p = 0.052), whereas for pAVS a contralesional SN was significantly more frequent (95.2 vs. 2.5%, p < 0.001). For PICA strokes presenting with horizontal SN, beating direction was ipsilesional more often than contralesional (23.9 vs. 6.4%, p = 0.006), while the opposite was observed for AICA strokes (2.2 vs. 63.0%, p < 0.001). Conclusions (Isolated) vertical and/or torsional SN is found in a minority (15.1%) of cAVS patients only. When present, it is highly predictive for a central cause. A combined torsional-downbeating SN-pattern may be observed in pAVS also in cases with isolated lesions of the inferior branch of the vestibular nerve. Furthermore, in cAVS patients the SN beating direction itself does not allow a prediction on the lesion side.
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Affiliation(s)
| | - Zheyu Wang
- Division of Quantitative Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Sergio Carmona
- Fundación San Lucas para la Neurosciencia, Rosario, Argentina
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Andrea Tarnutzer
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Neurology, Cantonal Hospital of Baden, Baden, Switzerland
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Dumas G, Curthoys IS, Castellucci A, Dumas L, Perrin P, Schmerber S. A bone-conducted Tullio phenomenon-A bridge to understand skull vibration induced nystagmus in superior canal dehiscence. Front Neurol 2023; 14:1183040. [PMID: 37360355 PMCID: PMC10288865 DOI: 10.3389/fneur.2023.1183040] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Nystagmus produced in response to air-conducted sound (ACS) stimulation-the Tullio phenomenon-is well known in patients with a semicircular canal (SCC) dehiscence (SCD). Here we consider the evidence that bone-conducted vibration (BCV) is also an effective stimulus for generating the Tullio phenomenon. We relate the clinical evidence based on clinical data extracted from literature to the recent evidence about the physical mechanism by which BCV may cause this nystagmus and the neural evidence confirming the likely mechanism. The hypothetical physical mechanism by which BCV activates SCC afferent neurons in SCD patients is that traveling waves are generated in the endolymph, initiated at the site of the dehiscence. We contend that the nystagmus and symptoms observed after cranial BCV in SCD patients is a variant of Skull Vibration Induced Nystagmus (SVIN) used to identify unilateral vestibular loss (uVL) with the major difference being that in uVL the nystagmus beats away from the affected ear whereas in Tullio to BCV the nystagmus beats usually toward the affected ear with the SCD. We suggest that the cause of this difference is a cycle-by-cycle activation of SCC afferents from the remaining ear, which are not canceled centrally by simultaneous afferent input from the opposite ear, because of its reduced or absent function in uVL. In the Tullio phenomenon, this cycle-by-cycle neural activation is complemented by fluid streaming and thus cupula deflection caused by the repeated compression of each cycle of the stimuli. In this way, the Tullio phenomenon to BCV is a version of skull vibration-induced nystagmus.
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Affiliation(s)
- Georges Dumas
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, AUSL–IRCCS di reggio Emilia, Reggio Emilia, Italy
| | - Laurent Dumas
- Laboratoire Radiopharmaceutiques Biocliniques (LRB), INSERM U1039, Faculté de Médecine La Tronche, Université Grenoble Alpes, Grenoble, France
| | - Philippe Perrin
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France
- Department of Paediatric Oto-Rhino-Laryngology, University Hospital of Nancy, Vandovuvre-lés-Nancy, France
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France
- Brain Tech Laboratory, INSERM UMR 2015, Grenoble, France
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Curthoys IS, Smith CM, Burgess AM, Dlugaiczyk J. A Review of Neural Data and Modelling to Explain How a Semicircular Canal Dehiscence (SCD) Causes Enhanced VEMPs, Skull Vibration Induced Nystagmus (SVIN), and the Tullio Phenomenon. Audiol Res 2023; 13:418-430. [PMID: 37366683 DOI: 10.3390/audiolres13030037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/02/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Angular acceleration stimulation of a semicircular canal causes an increased firing rate in primary canal afferent neurons that result in nystagmus in healthy adult animals. However, increased firing rate in canal afferent neurons can also be caused by sound or vibration in patients after a semicircular canal dehiscence, and so these unusual stimuli will also cause nystagmus. The recent data and model by Iversen and Rabbitt show that sound or vibration may increase firing rate either by neural activation locked to the individual cycles of the stimulus or by slow changes in firing rate due to fluid pumping ("acoustic streaming"), which causes cupula deflection. Both mechanisms will act to increase the primary afferent firing rate and so trigger nystagmus. The primary afferent data in guinea pigs indicate that in some situations, these two mechanisms may oppose each other. This review has shown how these three clinical phenomena-skull vibration-induced nystagmus, enhanced vestibular evoked myogenic potentials, and the Tullio phenomenon-have a common tie: they are caused by the new response of semicircular canal afferent neurons to sound and vibration after a semicircular canal dehiscence.
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Affiliation(s)
- Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Christopher M Smith
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, Annenberg Building, Room 12-90, 1468 Madison Ave., New York, NY 10029, USA
| | - Ann M Burgess
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery & Interdisciplinary Center of Vertigo, Balance and Ocular Motor Disorders, University Hospital Zurich (USZ), University of Zurich (UZH), CH-8091 Zürich, Switzerland
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Patel DJ, Chaudhari K, Shrivastava D, Dave A, Shinde A, Gowda H. Unveiling the Unprecedented: An Astonishing Rarity of Metoclopramide Hydrochloride-Triggered Nystagmus in a Pregnant Woman. Cureus 2023; 15:e40842. [PMID: 37489191 PMCID: PMC10363280 DOI: 10.7759/cureus.40842] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Metoclopramide hydrochloride is a widely used medication for the treatment of gastrointestinal disorders such as nausea, vomiting, and gastroparesis. However, it has been associated with extrapyramidal side effects (EPS) such as tardive dyskinesia, nystagmus, and other locomotive disorders on rare occasions. These reactions are commonly seen in children and females, particularly in young people. In this article, we report a rare case of a 15-week pregnant woman who was prescribed metoclopramide hydrochloride in view of nausea and vomiting, which was later diagnosed as vomiting in pregnancy not relieved with first-line medications, and has later developed drug-induced nystagmus, highlighting its unpredictable nature and shortcomings of management in the pregnant woman. This article will draw the attention of obstetricians and gynecologists to wisely prescribe metoclopramide hydrochloride for treating nausea and vomiting in pregnant women.
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Affiliation(s)
- Dharmesh J Patel
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepti Shrivastava
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Apoorva Dave
- Department of Obstretics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akruti Shinde
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshith Gowda
- Department of Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Paulhus K, Glasscock E. Novel Genetic Variants Expand the Functional, Molecular, and Pathological Diversity of KCNA1 Channelopathy. Int J Mol Sci 2023; 24:8826. [PMID: 37240170 PMCID: PMC10219020 DOI: 10.3390/ijms24108826] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The KCNA1 gene encodes Kv1.1 voltage-gated potassium channel α subunits, which are crucial for maintaining healthy neuronal firing and preventing hyperexcitability. Mutations in the KCNA1 gene can cause several neurological diseases and symptoms, such as episodic ataxia type 1 (EA1) and epilepsy, which may occur alone or in combination, making it challenging to establish simple genotype-phenotype correlations. Previous analyses of human KCNA1 variants have shown that epilepsy-linked mutations tend to cluster in regions critical for the channel's pore, whereas EA1-associated mutations are evenly distributed across the length of the protein. In this review, we examine 17 recently discovered pathogenic or likely pathogenic KCNA1 variants to gain new insights into the molecular genetic basis of KCNA1 channelopathy. We provide the first systematic breakdown of disease rates for KCNA1 variants in different protein domains, uncovering potential location biases that influence genotype-phenotype correlations. Our examination of the new mutations strengthens the proposed link between the pore region and epilepsy and reveals new connections between epilepsy-related variants, genetic modifiers, and respiratory dysfunction. Additionally, the new variants include the first two gain-of-function mutations ever discovered for KCNA1, the first frameshift mutation, and the first mutations located in the cytoplasmic N-terminal domain, broadening the functional and molecular scope of KCNA1 channelopathy. Moreover, the recently identified variants highlight emerging links between KCNA1 and musculoskeletal abnormalities and nystagmus, conditions not typically associated with KCNA1. These findings improve our understanding of KCNA1 channelopathy and promise to enhance personalized diagnosis and treatment for individuals with KCNA1-linked disorders.
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Affiliation(s)
| | - Edward Glasscock
- Department of Biological Sciences, Southern Methodist University, Dallas, TX 75275, USA;
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Ciacca G, Di Giovanni A, Califano L, Pettorossi VE, Ricci G, Pelliccia C, Faralli M. Skull-vibration-induced nystagmus test in patients who are candidates for intratympanic gentamicin injection. Acta Otorhinolaryngol Ital 2023; 43:140-148. [PMID: 37099438 PMCID: PMC10132480 DOI: 10.14639/0392-100x-n2152] [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] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/15/2022] [Indexed: 04/27/2023]
Abstract
Objective This study aims to evaluate the utility of the skull-vibration-induced nystagmus test (SVINT) in the selection of patients with Ménière's disease (MD) for intratympanic injection of gentamicin. To date the indications for this treatment have been based only on subjective elements. Methods A retrospective study was performed in 20 patients diagnosed with unilateral MD. SVINT were performed monthly and the evoked responses were evaluated. After 6 months, the results from patients who were candidates for gentamicin treatment (G group) were compared with those who did not need it (nG group). Correlation with Dizziness Handicap Inventory (DHI) score was evaluated. Results 120 tests were performed. Positive SVINTs were identified in 52 cases (43.3%) and included excitatory nystagmus in 18 (34.7%), inhibitory nystagmus in 28 (53.8%), and atypical pattern in 6 cases (11.5%). A significant increase excitatory nystagmus was recorded in group G (p = 0.00001). Moreover, there was a significant increase in the DHI score in group G compared with the nG group (p < 0.0001) and in patients with evoked excitatory nystagmus. Conclusions The finding of excitatory nystagmus during SVINTs performed on several occasions in the follow-up prior to intratympanic injection of gentamicin strengthens this therapeutic choice.
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Affiliation(s)
- Giacomo Ciacca
- Department of Medicine and Surgery, Otorhinolaryngology Section, University of Perugia, Perugia, Italy
| | - Alfredo Di Giovanni
- Department of Medicine and Surgery, Otorhinolaryngology Section, University of Perugia, Perugia, Italy
| | - Luigi Califano
- Department of Audiology and Phoniatrics, San Pio Hospital, Benevento, Italy
| | - Vito Enrico Pettorossi
- Department of Medicine and Surgery, Human Physiology and Biochemistry Section, University of Perugia, Perugia, Italy
| | - Giampietro Ricci
- Department of Medicine and Surgery, Otorhinolaryngology Section, University of Perugia, Perugia, Italy
| | - Chiara Pelliccia
- Department of Medicine and Surgery, Human Physiology and Biochemistry Section, University of Perugia, Perugia, Italy
| | - Mario Faralli
- Department of Medicine and Surgery, Otorhinolaryngology Section, University of Perugia, Perugia, Italy
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Parekh B, Beil A, Blevins B, Jacobson A, Williams P, Innis JW, Barone Pritchard A, Prasov L. Design and Outcomes of a Novel Multidisciplinary Ophthalmic Genetics Clinic. Genes (Basel) 2023; 14:726. [PMID: 36980998 PMCID: PMC10048684 DOI: 10.3390/genes14030726] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
The Multidisciplinary Ophthalmic Genetics Clinic (MOGC) at the University of Michigan Kellogg Eye Center aims to provide medical and ophthalmic genetics care to patients with inherited ocular conditions. We have developed a clinical and referral workflow where each patient undergoes coordinated evaluation by our multidisciplinary team followed by discussions on diagnosis, prognosis, and genetic testing. Testing approaches are specific to each patient and can be targeted (single-gene, gene panel), broad (chromosomal microarray, whole-exome sequencing), or a combination. We hypothesize that this clinic model improves patient outcomes and quality of care. A retrospective chart review of patients in the MOGC from July 2020 to October 2022 revealed that the most common referral diagnoses were congenital cataracts, optic neuropathy, and microphthalmia, with 52% syndromic cases. Within this patient cohort, we saw a 76% uptake for genetic testing, among which 33% received a diagnostic test result. Our results support a tailored approach to genetic testing for specific conditions. Through case examples, we highlight the power and impact of our clinic. By integrating ophthalmic care with medical genetics and counseling, the MOGC has not only helped solve individual patient diagnostic challenges but has aided the greater population in novel genetic discoveries and research towards targeted therapeutics.
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Affiliation(s)
- Bela Parekh
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
| | - Adelyn Beil
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bridget Blevins
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
| | - Adam Jacobson
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
| | - Pamela Williams
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
| | - Jeffrey W. Innis
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Lev Prasov
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
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Majander A, Sankila EM, Falck A, Vasara LK, Seitsonen S, Kulmala M, Haavisto AK, Avela K, Turunen JA. Natural history and biomarkers of retinal dystrophy caused by the biallelic TULP1 variant c.148delG. Acta Ophthalmol 2023; 101:215-221. [PMID: 36128853 DOI: 10.1111/aos.15252] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/19/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To report clinical features and potential disease markers of inherited retinal dystrophy (IRD) caused by the biallelic c.148delG variant in the tubby-like protein 1 (TULP1) gene. METHODS A retrospective observational study of 16 IRD patients carrying a homozygous pathogenic TULP1 c.148delG variant. Clinical data including fundus spectral-domain optical coherence tomography (SD-OCT) were assessed. A meta-analysis of visual acuity of previously reported other pathogenic TULP1 variants was performed for reference. RESULTS The biallelic TULP1 variant c.148delG was associated with infantile and early childhood onset IRD. Retinal ophthalmoscopy was primarily normal converting to peripheral pigmentary retinopathy and maculopathy characterized by progressive extra-foveal loss of the ellipsoid zone (EZ), the outer plexiform layer (OPL), and the outer nuclear layer (ONL) bands in the SD-OCT images. The horizontal width of the foveal EZ showed significant regression with the best-corrected visual acuity (BCVA) of the eye (p < 0.0001, R2 = 0.541, F = 26.0), the age of the patient (p < 0.0001, R2 = 0.433, F = 16.8), and mild correlation with the foveal OPL-ONL thickness (p = 0.014, R2 = 0.245, F = 7.2). Modelling of the BCVA data suggested a mean annual loss of logMAR 0.027. The level of visual loss was similar to that previously reported in patients carrying other truncating TULP1 variants. CONCLUSIONS This study describes the progression of TULP1 IRD suggesting a potential time window for therapeutic interventions. The width of the foveal EZ and the thickness of the foveal OPL-ONL layers could serve as biomarkers of the disease stage.
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Affiliation(s)
- Anna Majander
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eeva-Marja Sankila
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aura Falck
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Laura Kristiina Vasara
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Seitsonen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Kulmala
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Kaisa Haavisto
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Avela
- Department of Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joni A Turunen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
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Carmona S, Martínez C, Zalazar G, Koohi N, Kaski D. Acute truncal ataxia without nystagmus in patients with acute vertigo. Eur J Neurol 2023; 30:1785-1790. [PMID: 36752029 DOI: 10.1111/ene.15729] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Differentiating between peripheral and central aetiologies can be challenging in patients with acute vertigo, given substantial symptom overlap. A detailed clinical history and focused physical eye movement examination such as the HINTS eye examination appear to be the most reliable approach to identify acute cerebellar/brainstem stroke, outperforming even acute brain imaging. We have observed, however, that isolated vertigo of central cause may be accompanied by acute truncal ataxia, in the absence of nystagmus. METHODS We explored the frequency of ataxia without concurrent nystagmus in a cross section of patients with acute vertigo who presented to the emergency department at two centres in Argentina (Group A) and the UK (Group B). Patients underwent detailed clinical neuro-otological assessments (Groups A and B), which included instrumented head impulse testing and oculography (Group B). RESULTS A total of 71 patients in Group A and 24 patients in Group B were included in this study. We found acute truncal ataxia-without nystagmus-in 15% (n = 14) of our overall cohort. Lesions involved stroke syndromes affecting the posterior inferior cerebellar artery, anterior inferior cerebellar artery, and superior cerebellar artery, thalamic stroke, cerebral hemisphere stroke, multiple sclerosis, and a cerebellar tumour. Additional oculomotor deficits did not reliably identify a central cause in these individuals, even with oculography. CONCLUSIONS We have identified a significant subpopulation of patients with acute vertigo in whom the current standard approaches such as the HINTS examination that focus on oculomotor assessment may not be applicable, highlighting the need for a formal assessment of gait in this setting.
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Affiliation(s)
- Sergio Carmona
- Fundación San Lucas para la Neurociencia, Rosario, Argentina
| | | | - Guillermo Zalazar
- Hospital de San Luis, Fundación San Lucas para la Neurociencia, Rosario, Argentina
| | - Nehzat Koohi
- Institute of Neurology, University College London, London, UK.,Ear Institute, University College London, London, UK
| | - Diego Kaski
- Institute of Neurology, University College London, London, UK
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Muacevic A, Adler JR, Tyagi AK, Varshney S, Kumar A, Jat B, Prasath R, Yadav MC. Cross-Sectional Analysis of Videonystagmography (VNG) Findings in Balance Disorders. Cureus 2023; 15:e34795. [PMID: 36777971 PMCID: PMC9910122 DOI: 10.7759/cureus.34795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To understand the videonystagmography (VNG) findings in various balance disorders in 67 patients who presented to the outpatient department of an otorhinolaryngology clinic. MATERIALS AND METHODS This cross-sectional study was conducted in the outpatient department of the otorhinolaryngology clinic of a tertiary care center. A total of 67 patients between the age group of 18 and 70 years with balance disorders were included in the study. VNG findings in different balance disorders were observed and analyzed. RESULTS A total of 67 patients were enrolled in the study. Findings like caloric inversion and optokinetic nystagmus do not always indicate a central balance disorder due to technical errors and other limitations during the test. However, abnormal saccades seem to be a more relevant finding in central disorders. Rare variants of benign paroxysmal positional vertigo (BPPV) like multiple canal BPPV were also diagnosed using VNG. CONCLUSION VNG has come out as a very useful test in our study aiding in 75% of diagnoses. The overall benefits of VNG in balance disorders are immense and necessitate their inclusion in every vertigo clinic.
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Wang H, Shi T, Shang Y, Chen X, Xu J, Geng Y. Case report: Spiller syndrome initially mimicking vestibular neuritis. Front Neurol 2023; 13:1072220. [PMID: 36698901 PMCID: PMC9868901 DOI: 10.3389/fneur.2022.1072220] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Spiller syndrome is a rare subtype of medial medullary infarction (MMI). Herein, we report on a patient with progressing stroke who presented with the initial features of acute peripheral vestibulopathy and MMI (Spiller syndrome), as confirmed by magnetic resonance imaging (MRI). A 42-year-old man experienced acute persistent vertigo with nausea, vomiting, and severe gait instability for 6 h before presenting to the emergency department. He exhibited spontaneous right-beating horizontal-torsional nystagmus that intensified on rightward gaze. The patient fell to the left side during the Romberg test. Cranial computed tomography (CT) performed immediately upon admission did not provide evidence for ischemia or hemorrhage of the brainstem and cerebellum; however, the symptoms underwent exacerbation 4 h after admission, manifesting as left-sided limb weakness and dysarthria, without dysphagia. Furthermore, bedside examination revealed difficulty in extending the tongue to the right, positive left Babinski's sign, and abnormal vibration and position sense in the paralyzed limb. Head impulse test recording revealed a normal gain in the vestibulo-ocular reflex, and numerous consistent covert corrective saccades were captured upon turning the head to the left side. Cranial MRI depicted an acute infarct confined to the right side of the medial medulla, which met the diagnostic criteria for Spiller syndrome. Our study underscores the importance of considering the possibility of a nucleus prepositus hypoglossi lesion even if the signs and symptoms support the diagnosis of peripheral lesions in patients with acute vestibular syndrome exhibiting vascular risk factors.
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Affiliation(s)
- Huiyuan Wang
- Department of Clinical Medicine, Bengbu Medical College, Bengbu, China.,Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Tianming Shi
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yafei Shang
- Department of Clinical Medicine, Bengbu Medical College, Bengbu, China.,Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xinyi Chen
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jie Xu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yu Geng
- Department of Clinical Medicine, Bengbu Medical College, Bengbu, China.,Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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Han Y, Bai Y, Liu Q, Zhao Y, Chen T, Wang W, Ni G. Assessing vestibular function using electroencephalogram rhythms evoked during the caloric test. Front Neurol 2023; 14:1126214. [PMID: 36908620 PMCID: PMC9996014 DOI: 10.3389/fneur.2023.1126214] [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: 12/17/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The vestibular system is responsible for motion perception and balance preservation in the body. The vestibular function examination is useful for determining the cause of associated symptoms, diagnosis, and therapy of the patients. The associated cerebral cortex processes and integrates information and is the ultimate perceptual site for vestibular-related symptoms. In recent clinical examinations, less consideration has been given to the cortex associated with the vestibular system. As a result, it is crucial to increase focus on the expression of the cortical level while evaluating vestibular function. From the viewpoint of neuroelectrophysiology, electroencephalograms (EEG) can enhance the assessments of vestibular function at the cortex level. Methods This study recorded nystagmus and EEG data throughout the caloric test. Four phases were considered according to the vestibular activation status: before activation, activation, fixation suppression, and recovery. In different phases, the distribution and changes of the relative power of the EEG rhythms (delta, theta, alpha, and beta) were analyzed, and the correlation between EEG characteristics and nystagmus was also investigated. Results The results showed that, when the vestibule was activated, the alpha power of the occipital region increased, and the beta power of the central and top regions and the occipital region on the left decreased. The changes in the alpha and beta rhythms significantly correlate with nystagmus values in left warm stimulation. Discussion Our findings offer a fresh perspective on cortical electrophysiology for the assessment of vestibular function by demonstrating that the relative power change in EEG rhythms can be used to assess vestibular function.
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Affiliation(s)
- Yutong Han
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
| | - Yanru Bai
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
| | - Qiang Liu
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
| | - Yuncheng Zhao
- Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China.,Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Taisheng Chen
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
| | - Wei Wang
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China.,Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
| | - Guangjian Ni
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neuroengineering, Tianjin, China
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Martinkovič L. The patient with acute vertigo - the role of clinical examination and imaging. Vnitr Lek 2023; 69:20-24. [PMID: 37827819 DOI: 10.36290/vnl.2023.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Vertigo/dizziness or balance disorders are among the most common patients complaints in emergency clinics. Up to 25% of them are potentially life-threatening, especially cardiovascular or cerebrovascular events. The combination of a careful history taking (triggers, duration of difficulties, associated symptoms) and the performance of a basic vestibular examination (nystagmus, oculomotor, head impulse test, positional maneuvers, standing and walking examination) leads to a reliable differentiation of central and peripheral vestibular etiology. Standardized diagnostic algorithms (HINTS, HINTS+, STANDING) are used to identify high-risk patients requiring urgent care. Imaging methods must be interpreted with caution to their low sensitivity in acute phase (sensitivity of non-contrast brain CT for ischemia in the posterior cranial fossa is only 16%, MRI of the brain is false negative in up to 20% of cases in stroke patients in the first 48 hours).
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Kim YH. Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver. Medicine (Baltimore) 2022; 101:e32407. [PMID: 36596008 PMCID: PMC9803510 DOI: 10.1097/md.0000000000032407] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Patients with benign paroxysmal positional vertigo (BPPV) occasionally experience severe dizziness, could not maintain the sitting posture, and then fall onto or off the examination table when they return to the sitting position, which is the last step of the barbecue maneuver and Epley maneuver (EM); down-beating nystagmus is also observed. This study aims to investigate the clinical characteristics and significance of these findings. We retrospectively reviewed video data showing nystagmus and medical records of adult patients diagnosed with canalolithiasis of the horizontal canal and the posterior canal (PC) BPPV who underwent barbecue maneuver and EM, respectively, in outpatient clinics from April 2014 to March 2019. This study included 112 patients (28 horizontal canal BPPV and 94 PC BPPV cases). Among the 122 BPPV cases, only 14 (14.9%) were analyzed, due to their occurrence during EM. Down-beating nystagmus appeared at 3.6 seconds on average after returning to the sitting position, and the patients fell onto or off the examination table at 4.4 seconds on average after the onset of the nystagmus. The average duration of the down-beating nystagmus was 20.3 seconds. In all 14 cases, no nystagmus was induced by the Dix-Hallpike test performed again after EM, confirming that the treatment was successful. During the EM, down-beating nystagmus and falling onto or off the examination table occurred in approximately 15% of cases. As the risk of falls increases, the patient should be secured immediately after EM. Moreover, it can be inferred that the findings occur when otoconia in the PC enter the utricle, suggesting a successful treatment.
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Affiliation(s)
- Yee-Hyuk Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
- * Correspondence: Yee-Hyuk Kim, Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, South Korea (e-mail: )
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Strupp M, Straka H, Oh SY. Editorial: Insights in neuro-otology: 2021 and 2022. Front Neurol 2022; 13:1104573. [PMID: 36570457 PMCID: PMC9774463 DOI: 10.3389/fneur.2022.1104573] [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] [Received: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany,*Correspondence: Michael Strupp
| | - Hans Straka
- Faculty of Biology, Ludwig-Maximilians-University, Planegg, Germany
| | - Sun-Young Oh
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
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Vanni S, Nazerian P, Pecci R, Pepe G, Pavellini A, Casula C, de Curtis E, Ronchetti M, Vannucchi P, Bartolucci M, Vanni S, Casula C, Soldati V, Matteucci ML, Gargano U, Mirenda F, Nazerian P, Ottaviani M, Rocchetti M, Caviglioli C, Pavellini A, Vannucchi P, Pecci R, Pepe G, de Curtis E, Baldini A, Magazzini S, Sampieri A, Bartolucci M. Timing for nystagmus evaluation by STANDING or HINTS in patients with vertigo/dizziness in the emergency department. Acad Emerg Med 2022; 30:592-594. [PMID: 36448574 DOI: 10.1111/acem.14635] [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] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Azienda USL Toscana Centro, Empoli, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rudi Pecci
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Pepe
- Department of Emergency Medicine, Azienda USL Nord-Ovest, Viareggio, Italy
| | - Andrea Pavellini
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Claudia Casula
- Department of Emergency Medicine, Azienda USL Toscana Centro, Empoli, Italy
| | - Ersilia de Curtis
- Department of Emergency Medicine, Azienda USL Toscana Centro, Prato, Italy
| | - Mattia Ronchetti
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paolo Vannucchi
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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