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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1986 Volume 79 Issue Supplement2 Pages
28
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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1986 Volume 79 Issue Supplement2 Pages
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Jiro HOZAWA, Fumiaki FUJIWARA, Toshio KAMIMURA, Keiichi IKENO
1986 Volume 79 Issue Supplement2 Pages
37-45
Published: January 25, 1986
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The abnormal responses in 185 cases of aural vertigo examined by the computerized trapezoid rotation test (Contraves), were classified into the following 3 types:
1) Labyrinthine preponderance ipsilateralis (LPi) in 66 cases of acute labyrinthosis of the impaired side due to acute labyrinthitis, Meniere's disease, (pre-attack), sudden deafness (recovery stage), etc.
2) Labyrinthine preponderance contralateralis (LPc) in 70 cases of chronic labyrinthosis of the impaired side due to labyrinthine trauma, chronic labyrinthitis, Meniere's disease (post-attack), etc.
3) Vestibular recruitment (Rec) in 49 cases of fixed labyrinthosis of the impaired side due to labyrinthine trauma, sudden deafness (fixed stage), etc.
“Labyrinthine preponderance” was thought to be a very important indicator for follow-up treatment-course of aural vertigo.
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Isao KATO, Ryoji KANAYAMA, Tadashi NAKAMURA, Tomohiko HASEGAWA, Takao ...
1986 Volume 79 Issue Supplement2 Pages
46-56
Published: January 25, 1986
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Optokinetic nystagmus (OKN) is often included in a battery of tests to assess central nervous system disorders. Patients with discrete lesions in either the brainstem or the cerebellum showed OKN when the velocity of stimulation was less than 60°/s. The question arises as to whether the range of OKN stimulation we have applied so far (1.2°/s
2 to 120°/s) is necessary. Therefore, we tried to modify and simplify the OKN test, to steps of constant stimulus velocities at 30°/s, 50°/s, 70°/s and 90°/s and compared the results with those of the OKN tests used previously. The following conclusion can be drawn:
1) The gain of OKN induced by step inputs, with slow phase velocity as a measure, was higher than that of OKN during linear acceleration at each stimulus velocity.
2) Other parameters, such as amplitude and fast phase velocity of OKN showed the same tendency as slow phase velocity.
3) OKN induced by step inputs of constant velocities is a simple and useful test of the function of the oculomotor system.
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-Characteristics of Normal Subjects and Patients with Central Nervous System Dysfunction-
Natsue SHIMIZU, Yaeko NAGATSUKA, Shin AKIBA
1986 Volume 79 Issue Supplement2 Pages
57-67
Published: January 25, 1986
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The sinusoidal chair rotation test was evaluated in 12 normal subjects. Amplitudes of 30°, 45° and 60°, and frequencies of 0.125Hz, 0.25Hz and 0.5Hz were used. The ocular responses were compared during stepwise increases and decreases in amplitude and frequency of chair rotation. Then 21 patients with cerebellar lesions, 27 patients with both cerebellar and extracerebellar lesions, 12 patients with parkinsonism and 18 control subejects with a history of vertigo or dizziness but no objective neurological signs were tested with sinusoidal chair rotation at an amplitude of 30° and frequencies of 0.5Hz, 0.25Hz and 0.125Hz. The vestibulo-ocular reflex (VOR) gain, cancellation gain, phase shift and visual suppression of caloric nystagmus were determined.
The VOR gain tended to decrease when the chair rotation was increased stepwise. The cancellation gain and phase shift were not influenced by the stepwise increase or decrease in amplitude and frequency of chair rotation.
The VOR gain of patients with cerebellar lesions was significantly increased, but the VOR gain of parkinsonism was not. The cancellation gain of patients with cerebellar lesions was significantly decreased and that of patients with both cerebellar and extracerebellar lesions was decreased even further. The cancellation gain of parkinsonism was also significantly decreased. Visual suppression of caloric nystagmus correlated well with the cencellation gain in patients with cerebellar lesions.
We conclude that sinusoidal chair rotation at an amplitude of 30° or 45° and a frequency of 0.5Hz, 0.25Hz and 0.125Hz in this order can be recommended for the evaluation of the VOR gain and cancellation gain, which provide valuable information in central nervous system disorders.
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Tetsuo ISHII, Naomi TSUJITA, Masahiro TAKAHASHI, Ikuyo AKIYAMA
1986 Volume 79 Issue Supplement2 Pages
68-77
Published: January 25, 1986
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To standardize a cold caloric test, we examined 10 normal persons with a simple cold caloric test (20°C water irrigation for 10 seconds with a 5ml syringe and stimulation for 20 seconds) and 54 normal persons with a cold test with a Nelaton catheter.
The simple cold test was then used repeatedly in 90 patients: 17 with accoustic neuroma, 13 with syphilitic labyrinthitis and 64 treated with streptomycin-sulphate.
1. The simple cold test showed a stronger response and better reproducibility than the Nelaton catheter methods.
2. With reliable thermal stimulation, the response to 20°C stimulation was defined as normal when the maximum eye velocity was not less than 20°/sec and the response difference between the two ears was less than 20°/sec. Pathological responses were classified as moderate CP, severe CP and complete CP.
3. Half of the patients examined repeatedly showed pathological responses (49.1% of 180 ears). Of the patients without spontaneous nystagmus 71.9% showed the same results on the second examination, while 63.3% of those who showed spontaneous nystagmus on the first examination and no nystagmus on the second examination.
4. All the affected ears of patients with accoustic neuroma showed pathological responses. The intact ears also showed pathological results in 5 patients, but 2 ears recovered postoperatively.
5. In patients with syphilitic labyrinthitis, 80.8% of the examined ears showed pathological responses. Streptomycin-treated patients showed a gradual decline of the response, but the lower limit of 1 SD was in the normal range.
6. These results indicate that the simple cold test possesses reliable thermal stimulation and good reproducibility. It can be used to diagnose right and left ear lesions separately, and to detect mild and progressive bilateral lesions.
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Yutaka YOSHIMOTO, Jun-Ichi SUZUKI
1986 Volume 79 Issue Supplement2 Pages
78-83
Published: January 25, 1986
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When patients have intense vertigo, it is necessary to perform tests at the bedside in the hospital or at home. The tests should include nystagmus test, simple eye movement tests by gross inspection using a finger and a tape measure (e.g., eye tracking test, optokinetic nystagmus test) and neurological tests.
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Takashi FUTAKI
1986 Volume 79 Issue Supplement2 Pages
84-94
Published: January 25, 1986
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In 48 patients with Meniere's disease, caloric testing was done with 2ml of ice water and 50ml of hot water at 44°C for 20 sec. The simplified method measures the duration of caloric response. With electro nystagmography the maximum velocity of the slow component can be determined.
A statistical comparison showed that the latter test is significantly more sensitive than the former.
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Toshiaki YAGI, Yuzuru KOBAYASHI, Munenaga NAKAMIZO, Hideharu AOKI, Tom ...
1986 Volume 79 Issue Supplement2 Pages
95-103
Published: January 25, 1986
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The topographic diagnostic significance of nystagmus was studied in 4887 patients with vertigo and/or dysequilibrium. The incidence of gaze nystagmus was 11% in the entire group. Sixty percent of patients with central pathology demonstrated gaze nystagmus. Horizontal gaze directional nystagmus indicated central disturbance and horizontal direction-fixed gaze nystagmus was also observed frequently in patients with central lesions. The incidence of positional nystagmus was 37% in the entire group. Horizontal rotatory direction-fixed positional nystagmus was demonstrated almost exclusively in patients with peripheral disorders. The incidence of direction-changing type of positional nystagmus was the same in patients with central and labyrinthine lesions. Pure rotatory positioning nystagmus was demonstrated mainly in patients with labyrinthine lesions and vertical positioning nystagmus in those with central lesions.
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Takashi TOKITA, Yoshinori TOMURA, Kyoya TAKAGI, Yatsuji ITO, Shigenori ...
1986 Volume 79 Issue Supplement2 Pages
104-112
Published: January 25, 1986
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Galvanic nystagmus and spinal reflexes were investigated in normal subjects and patients with labyrinthine disturbances.
Methods: Galvanic stimulation was performed by the biaural-bipolar method. Galvanic nystagmus was induced by application of a direct current of 3mA for 60sec. Galvanic spinal reflexes were observed with sway of the head and the body center of gravity as well as soleus muscle activities induced by the application of a direct current of 1mA for 3 or 6sec. The sway of the body center of gravity indicated an initial response (IR) toward the cathode side followed by a deviation response (DR) toward the anode side.
Results: A. Among the patients who did not respond to rotatory and caloric labyrinthine stimulation, one showed no galvanic nystagmus but normal galvanic spinal reflexes. In another patient, on the contrary, galvanic nystagmus was induced normally, while galvanic body sway was reduced. Clinical symptoms and other balance tests, such as the standing test, suggest that galvanic nystagmus is mainly a reaction of the semicircular canal system while spinal reflexes are mainly a reaction of the otolithic system.
B. The results of the galvanic spinal reflex test in 22 patients with unilateral or bilateral labyrinthine disturbances were classified from A to C. In type A, IR and DR were normal. In type B, IR was normal but DR was absent or reduced. Type C showed no IR, and DR was absent or reduced. Galvanic spinal reflexes in normal subjects suggest that IR is induced by action potentials of the vestibular nerve, which occur as the electric current is turned on, while deviation responses are due to the electrotonic effect of the galvanic current on the resting discharges of the vestibular nerve. This interpretation enabled us to localize lesions in the otolithic system.
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Tadayuki MURATA, Masaaki KITAHARA
1986 Volume 79 Issue Supplement2 Pages
113-117
Published: January 25, 1986
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By means of an unbounded strain-gauge type accelerometer, head position (in space) and tilt angle of the plank were registered, while the plank was maintained horizontally by the subject lying on it. The results obtained from 16 normal adults were considered to demonstrate righting reflex function in the dynamic state.
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Takeo KUMOI, Hiroshi MORI, Haruo WAKUTANI, Hirofumi MACHIZUKA
1986 Volume 79 Issue Supplement2 Pages
118-128
Published: January 25, 1986
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We analysed the stabilograms of subjects standing still, on a rolling platform, or with impulse stimulation. These challenges test the postural restoration reflex system which the usual stabilogram at rest cannot do. We conclude that this method i s helpful in the diagnosis of vertigo.
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Izumi KOIZUKA, Takeshi KUBO, Takayuki SHIRAISHI, Toru MATSUNAGA
1986 Volume 79 Issue Supplement2 Pages
129-138
Published: January 25, 1986
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Follow up studies were performed with use of the damped pendular rotation test (0.22Hz, Max angular velocity 100°/sec) and statokinesigraphy in 7 patients with Ménière's disease as a unilateral partial labyrinthine function loss, 4 patients with unilateral total labyrinthine function loss and 4 patients with bilateral total labyrinthine function loss.
1) Patients with Ménière's disease showed significant alterations of VOR-DP depending on their sensation of vertigo; this alteration was closely correlated with changes of the Romberg ratio of statokinesigraphy.
2) Patients with unilateral total labyrinthine function loss showed minimum changes of VOR-DP, and the high VOR-DP persisted even though the sensation of vertigo disappeared. The Romberg ratio of area, changed significantly along with changes in the sensation of vertigo.
3) Patients with bilateral total labyrinthine function loss showed higher OVR-gain (gain of Opto-Vestibular Reflex) than did those with Ménière's disease or unilateral total labyrinthine function loss. However, if the sensation of vertigo declined, patients with bilateral total labyrinthine function loss showed reduction of the high OVR-gain observed initially.
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Tetsu TABUCHI, Hideo HOSOMI, Michiyo TERAMOTO, Tetsuo HOSHINO, Ryohei ...
1986 Volume 79 Issue Supplement2 Pages
139-147
Published: January 25, 1986
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A precise history of the symptoms of vertiginous or dizzy patients suggests the correct diagnosis, which is then confined by neuro-otological examination. Appropriate examinations can be planned from an analysis of the symptoms.
We investigated the relationship between the clinical course and the incidence of neure-otological abnormalities, between the clinical course and the differential diagnosis, such as central or peripheral, functional or organic, and between the differential diagnosis and the pattern of neuro-otological abnormalities.
1) In patients with vertigo, the incidence of neuro-otological abnormalities differed greately depending on the presence or absence of vertiginous or persisting symptoms on the first examination. In patients with dizziness, there was no distinct difference.
2) Patients who complained of vertigo but had no vertiginous or persisting symptoms after the first examination, did not have posterior fossa lesions, such as tumor or degenerative disease.
3) Bilateral gaze nystagmus, apogeotropic direction changing positional nystagmus and vertical nystagmus are important findings suggestive of posterior fossa lesions.
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Takuya UEMURA, Osamu NISHIHIRA, Kenichiro NOGAMI, Hiroaki INOUE, Masah ...
1986 Volume 79 Issue Supplement2 Pages
148-155
Published: January 25, 1986
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The simple cold caloric test with 5 ml of 20°C water (simple test) and then the alternate cold and hot caloric test of Fitzgerald and Hallpike (alternate test) were performed following the spontaneous and the positional nystagmus test in 46 patients complaining of vertigo. The eye movements were recorded with eyes open in darkness on an electronystagmogram.
Canal paresis (CP) was diagnosed by the simple test and the alternate test in 35 of the 46 patients. Of the remaining 11, 3 showed CP in the simple test, but not in the alternate test, and 8 showed CP in the alternate test, but not in the simple test. In 5 of these 8 patients, the simple test demonstrated substantial differences in the maximum slow phase velocity of caloric nystagmus between the right and the left sides; however, the maximum slow phase velocities on the side showing a lesser reaction were not considered as being abnormally weak. Thirteen of the 26 patients showing spontaneous nystagmus had no DP in the alternate test, but all 13 patients showing DP had spontaneous nystagmus.
These findings demonstrate that application of the simple cold caloric test together with the spontaneous and positional nystagmus tests provides sufficient information, so that the alternate cold and hot caloric test is not necessary.
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Shigeki KAMATA, Jiro HOZAWA, Kaoru ISHIKAWA, Fumiaki FUJIWARA, Toshio ...
1986 Volume 79 Issue Supplement2 Pages
156-165
Published: January 25, 1986
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In order to clarify the labyrinthine status in aural vertigo, we analyzed the results of the trapezoid rotation test (±2, 4, 6, 8, and 10/sec
2 for 10'') with Contraves' computerized rotary chair system.
Forty six patients with aural vertigo were divided into two groups according to the test results.
Group I with an unstable labyrinthine status showed fluctuations of ipsilateral labyrinthine preponderance during their clinical course.
Group II with a relatively stable labyrinthine status showed non-fluctuating contralateral labyrinthine preponderance.
This test was thought to be useful in determining labyrinthine stability and predicting the next attack of vertigo.
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