Clinical and Electroencephalographical Study on Central Dysrhythmic Vertigo or Dizzy State due to Dysfunction of the Regulation Centers of the Brain Stem

Abstract

The author, at the beginning, illustrated diseases of regulating mechanism of the brainstem: epilepsy of brainstem origin, diencephalosis, mesencephalosis and medioencephalosis, discussing his own data and those of other researchers. Correlation between clinical characteristics and EEG was stressed, and certain. EEG abnormalities: paroxysmal bilateral slow dysrhythmia or paroxysmal bilateral spike and wave complex and 6-14 c/s positive spike pattern, were regarded as the most available indicator of diseases of regulating mechanism of the brainstem. Dysrhythmic vertigo: one of epilepsy of brainstem origin, was dealed in this paper, and the author tried to describe an outline of this disease.
Out of 234 patients with main complaints of recurrent attacks of dizzy state consulted in our clinic in the previous two years, 79 cases: 38 of dysrhythmic vertigo, 15 of epilepsy (grand mal and petit mal) and 26 of Menier's syndrome served this study because of their established symptomatology. Dizzy state of the former two is considered to be of central origin and that of the latter as a symptom of peripheral Cotogenic and vestibular) origin. Investigations were carried out to find out symptomatological and clinical differences between these three diseases.
Age of the onset: 11-55 with the average of 28.9 in dysrhythmic vertigo, 5-32 with the average of 17.3 in epilepsy and 12-55 with the average of 30.3 in Menier's syndrome, showed younger age of the onset of the patients' dizzy state in epilepsy. Features of dizzy state were examined and three categories were settled: vertigo, dizziness and black-out. Frequencies of these three in each of the diseases: 9 vertigo, 26 dizziness and 21 black-out in dysrhythmic vertigo (38 cases), none of vertigo, 9 dizziness and 8 black-out in epilepsy (15 cases) and 16 vertigo, 19 dizziness and 8 black-out in Menier's syndrome (26 cases), showed that vertigo was most correlative to Menier's syndrome while black-out was relatively rare in this syndrome, and that in epilepsy vertigo was neglected. Duration of attacks of dizzy state: a moment to several seconds in 17 cases and several minutes in 3 of dysrhythmic vertigo, a moment to several seconds in 5 and several minutes in 2 of epilepsy, and a moment to several seconds in 3, several minutes in 5, several hours in 5 and several days in 1 of Menier's syndrome, suggested that duration of attacks was much shorter in dysrhythmic vertigo and epilepsy than in Menier's syndrome. Some symptoms and signs were detected at the intervals between the attacks otogenic ones such as deafness, tinnitus, feeling of ear-stenosis and otalgia, ophthalmologic ones such as nystagmus, blurred vision, dimness of vision, double vision, flimmerscotoma, blind spot and photophobia, and those which might be originated from vestibular insufficiency such as arm deviation, positive stepping test, deviated gait and Romberg or Mann phenomena. Distributions of these three kinds of symptoms and signs were compared in the three diseases, showing no significant difference, but Menier's syndrome only had a considerable density in the symptoms and signs of otogenic nature, no matter whether the patients' dizzy state was vertigo, dizziness or black-out. Recurrent or habitual headache at the intervals of the attacks of dizzy state was registered in 61% of the cases of dysrhythmic vertigo, 27% of those of epilepsy and 38% of those of Menier's syndrome, and dysrhythmic vertigo was considered to be most correlative with recurrent headache (dysrhythmic headache).