It is well known that the otolithic organ has an otolithic membrane with numerous statoconia on the upper surface. The metabolism of the statoconia in higher vertebrates has not been clarified. In the present investigation, the otolithic membrane was observed under scanning electron microscope and X-Ray microanalyzer. At the otolithic membranes facing the sensory epithilium, there were numerous small granules embedded in the holes. The calcium contents in those granules were measured using the X-Ray microanalyzer. The small granular substance in the holes and sensory epithelium on the utricular macula were revealed as white calcium image dots. Therefore, it is clear that the granular substance and the surface of sensory epithelium contain much more calcium. On the basis of the foregoing, it is tempting to speculate that the supporting cells on the macula secrete calcium for the statoconia and that calcium filled granules are a prerequisite for normal otoconia formation.
In order to determine which of two parts of the brain, the mammillary body or the septal area, is a more important relay nucleus in regard to production of nystagmic responses of hippocampal origin we carried out the following experiments : Adrenaline was given i.v. to rabbits either with repeated electric stimulation of the medial nucleus of the mammillary body or with that of septal area, respectively, and nystagmic responses were recorded before and 10 minutes after injection of adrenaline. Effects of adrenaline in the production of nystagmic responses were then compared in each group of animals. The results obtained were as follows : Nystagmic responses after adrenaline application tended to be more marked than responses following stimulation (i.e., nystagmic responses before adrenaline) when repeated electric stimulation was given to the medial nucleus of the mammillary body. In contrast, there was no significant difference between the two types of nystagmic responses described above when the same procedure was applied to the septal area. From these findings we conclude that the medial nucleus of the mammillary body is a more important relay nucleus with regard to production of nystagmic responses of hippocampal origin. This conclusion is compatible with our previous report that nystagmic responses of hippocampal origin are induced, in close correlation with hyperexcitability of adrenergic nerve fibers involved in the neural circuits which link the hippocampus to the oculomotor system in the brain stem.
We studied posturography in the goiometry test (gravigoniometry test : G.G.T.) as well as in the static standing position. Slow angular velocity of 0.1°/sec-0.25°/sec was used in this gravigoniometric test. The examinations administered to subjects were declining-inclining-toward in four directions, (1) Forward down 10°- then reverse to 0°, (2) backward down 10°- then reverse to 0°, (3) to the left down 10°- then reverse to 0°, (4) to the right down 10°- then reverse to 0°, and each stage with eyes open and eyes closed was monitored. It was evident that in the forward-down direction, the patterns accompanied by degree of inclined plane included the three groups. These patterns were little influenced by the degree of angular velocity which was used. This was considered to provide information on the equilibrium control system, such as corresponded to the stimuli. When we compared the frequency anaylysis of body swaying to angular velocity change, the condition of the control system gradually changed with time. Frequency analysis of Y-axis component in these experiments revealed the sway of 0.8Hz to 0.9Hz on the base line. This phenomena corresponds to the frequency of walking movements in humans. Similar results were also observed in the sitting up position.
In 232 patients with peripheral disorders including 98 with unilateral Meniere's disease and 20 healthy adults, recordings of eye deviation were made utilising DC-ENG under two conditions, i.e. eyes closed (E.C.l) and eyes open in the absolute darkness (in D.). (1) The average value of in D. was significantly smaller than that of E.C. in controls and some patients with Meniere's disease. (2) Appearance of nystagmus in 5 labyrinthine lesions was compared with the direction of deviation toward and against the affected side in both conditions. (3) Concerning unilateral Meniere's disease, the relationship among deviation, nystagmus and caloric response was analysed statistically and the clinical application is discussed.
Since the development and introduction of CT for the diagnosis of brain tumors, diagnostic accuracy for acoustic neuroma extending more than 2.0cm from the porus of internal auditory canal to the posterior fossa has significantly been raised. However, for tumors confined to the internal auditory canal or those extending one centimeter into the posterior fossa, present CT still has limitations in detecting these tumors. Among eighteen cases (12 acoustic neuromas and 6 cerebellopontine angle tumors) in which the author applied CT, three cases could not be detected. Retrospectively, thirteen percent of ninety-one acoustic tumors went undetected even with application of CT. Therefore, the importance of meatocysternography using Pantopaque for early diagnosis of intracanalicular acoustic tumors is stressed. Among various tests, audiological, vestibular, radiological and neurological examinations, Stenvers view and transorbital view and measurement of stapedius reflex threshold including reflex decay test are all highly diagnostic as screening procedures. Since the recently developed metrizamide CT is still unable to detect intracanalicular acoustic tumors, meatocysternography should be done for suspected cases, even though there are no positive findings on the CT.
Square Drawing Tests (SDT) for detecting and evaluating ataxic disorders were designed by Sekitani (1974), a modification of Fukuda's vertical writing test. The purpose of this paper is to describe the procedures of tests by each hand bimanual SDT; abbreviated to B-SDT and by both hands at one time (simultaneous bimanual SDT; abbreviated to SB-SDT); and to present the results obtained from the 100 healthy adults. The basic parameters of these tests and their results are as follows : 1. Length of each line of square drawn with eyes open and with eyes closed is measured. In this group of healthy adults, there was a gradual shortening of length in each line of the square drawn after the first square. 2. Distance between the starting point and the end point of each square (Distance S-E), showed a gradual enlargement in the square aftar the first square; especially when the square was drawn with the left hand. 3. Distance between the starting point of No.1 square and the starting point of No.4 square in B-SDT (or between that of No.2 and of No.4 square in SB-SDT) (Distance 1-4, so-called “whole length”); showed in this group a shortening of the entire length with the eyes closed as compared to that seen with the eyes open. There was no marked difference in the entire length between the data obtained with drawing done with the right hand and with the left hand in SB-SDT. 4. Deviation angle of the square to the vertical line; showed some tendency to deviation rightward in both B-SDT and SB-SDT, but a deviation over 7 on the average, was not seen.5. Derangement of the drawn lines : Derangement of the drawn lines in the group of 100 healthy adults was evident in only one subject. There was no tendency toward increase in derangement with the eyes closed. These results suggest no marked differences of each square between eyes open and closed, between right hand and left hand.
Saccadic eye movements of patients with unilateral lesion of the cerebrum were quantitatively investigated. The subjects included twenty-seven patients with cerebrovascular accidents and four with brain tumor. The localization of the lesions was evaluated by CT scan and/or cerebral angiogram. Seventeen patients had lesions in the anterior cerebrum and ten in the posterior cerebrum. Saccadic eye movements were elicited by presenting a light spot in the right and left visual fields on the screen, five and ten degrees from the center and such were registered by an X-Y tracker. The amplitude and duration of the saccades as well as visual reaction time were measured. The predictive duration for 15 degrees saccade was obtained from the amplitude duration relationship in each patient. Duration of the saccade to the contralateral side of the lesion was longer than that to the ipsilateral side. However, the difference was statistically significant (p<0.05) only in the patients with lesions in the anterior cerebrum. The amplitude of the initial saccade to the contralateral side was significantly smaller (p<0.01) than that to the ipsilateral side regardless of the localization of the lesion. Visual reaction time for saccades showed no differences between the contralateral and ipsilateral sides. In only three of the twenty-seven patients was there an apparent slow saccade to the contralateral side. The characteristics of the saccade of the unilateral lesion in the cerebrum include : 1) Inaccuracy of the saccade which was usually hypometric, 2) Minimum slower saccade to the contralateral side in patients with lesions in the anterior cerebrum, and 3) No effect on visual oculomotor reaction time. The results suggest modulation of the saccade by the contralateral cerebrum.
For examination of horizontal optokinetic nystagmus a large cylinder (2m in diameter and 2m in height) was rotated electrically both right and left with an angular acceleration of 2°/sec2 for 90 seconds. Tests were carried out by binocular and monocular vision. Results are as follows : (1) In a patient with strabismus convergens et sursum vergens, nystagmus was well evoked by optokinetic stimuli to both right and left in the case of binocular vision. In monocular vision, when the cylinder was rotated from the side of open eye to that of the covered, nystagmus was induced; on the other hand, while the cylinder was rotated from the side of covered eye to that of the open, provocation of nystagmus was disturbed. Namely, monocular unidirectionality of optokinetic reflex was observed. Taking into account the work of Tokita (1956) and Guillery (1969), this abnormality may suggest the disorder of uncrossed fibers in the optic tract. (2) In a patient with strabismus convergens et alternans, on the occasion of monocular vision, when the right eye was stimulated, movement of the left was disturbed; on the other hand, when left eye was stimulated, that of the right was disturbed. This abnormality suggests a disorder of association between the right and left eye system. (3) In a patient with strabismus divergens, movement of the right eye did not occur in the same manner as that of the left. Accordingly, conjugate eye-movement was disturbed. (4) In a patient with strabismus convergens, smooth pursuit of a moving object was disturbed. This abnormality suggests a disorder in the occipital lobe. Various optokinetic abnormalities are observed in patients with strabismus and include : Optokinetic monocular unidirectionality, disorder of association between the right and left eye system, disturbance of conjugate eye-movement and disorder of smooth pursuit of a moving object.
Three cases of jumbling of objects are reported herein. These patients had difficulty with vision during head and/or body movement. However, they had no trouble if they looked straight ahead or if they sat still, and with their eyes closed, they were less unsteady and almost normal. Examination disclosed a Mann's sign and unsteady gait with eyes open. Neurotological examinations of these patients showed bilateral loss of hearing and vestibular function. Close inspection of eyes during the head movements revealed no gross nystagmus, but there were irregularities in the relative movements of the eyes as detected by the electronystagmography. When the eyes moved while the head was held still, the ocular excursions appeared smooth; when the eyes were fixed on a target and the head was moved, the relative displacement of the eyes showed irregularities. In bilateral vestibular disease, jumbling of objects might occur only during movements of either body or head, or of both together.
Mono-ocular DC-recordings of horizontal and vertical eye movements were performed to clarify the influence of eye closing on vestibular nystagmus. Eyes were elevated 55±11° upwards and adducted 13±5° by closing the eyes. During eye-closure, three types of vertical eye positions were seen in 24 normal adults; 1) holding eye position upwards, 2) fluctuating movements around an elevated eye position, 3) gradual downward turning. Caloric nystagmus, per-and post-rotatory nystagmus and spontaneous nystagmus caused by inner ear diseases, that is, vestibular nystagmus is suppressed by closing eyes. This suppression depends on the degree of eye-ball elevation. The suppression of vestibular nystagmus caused by eye-closure is the strongest when the eyes are held upwards and released by turning down from the elevated eye position.
A 35 yr. old man coplained stomach-ache dizziness and nausea. The patient has gaze deviation nystagmus, vertical spontaneous nystagmus and positional nystagmus which was combination of direction changing and direction fiexd. He had no cranial sign beside these abnormal eye movement. For lack of physical, biochemical and neurological signs, it took about 50 days to reach to deffinit diagnosis, no matter what these abnormal eye movement indicated the exsistance of some lesion in the left and dorsal side of posteriol fossa from the beginning of disease. The hemangioblastom in the left side culmen of vermis whose frontal end extended as for as the botom of the fourth ventricle was removed by suboccipital craniectomy. The post-op. course was uneventful and the patient is well at present.
We encountered a case of “relapsing polychondritis” in a 35 yr. old male who had complained of tinnitus and hearing impairment in his right ear and dizziness. Both hearing and equilibrium function were examined repeatedly using pure tone audiometry, Békésy audiometry and electronystagmography. His sensorineural hearing loss was improved to an almost normal level with ingestion of steroids. The second type of Jerger in Békésy audiogram changed to the first type. A marked improvement of vestibular disturbance was also detected in the caloric test.
This report concerns a 46 year old male with myoclonus. Involuntary rhythmic movements were observed on the palate, larynx, eyes, upper eyelids, corner of the mouth, diaphragma, and left I-II fingers, These involuntary rhythmic movements were synchronized with the frequency of 3-4 cps. Ocular myoclonus had the following characteristics : 1) Frequency of ocular myoclonus decreased slightly with eyes closed and increased with convergence. 2) Caloric response were not observed with stimulations of either 36°C or 44°C. However, the response was observed with stimulation using ice water (4°C). 3) Rotatory nystagmus indicated right directional preponderance. 4) Eye tracking test and optokinetic nystagmus pattern was of the cerebral type. 5) Minor tranquilizers were prescribed and the involuntary rhythmic movements gradually decreased.Such an improvement was not observed in cases reported elsewhere.
It is needless to say that psychosomatic aspects should alway be considered in the diagnosis and treatment of patients conplaining of dizziness. Psychosomatic aspects of these patients were studied and compared with other ear, nose and throat diseases. Patients were classified into 6 groups : (1) Meniere's disease, (2) sudden deafness, (3) vestibular, neuronitis, (4) benign paroxysmal positional vertigo (BPPV), (5) dizziness without any neurootological signs (so-called psychosomatic dizziness), (6) vertigo and dizziness caused by other diseases (for eg. vertigo accompanied by chronic otitis media, labyrinthine syphilis, posttraumatic vertigo, etc.). Cornell Medical Index (CMI) modified by Abe and Self Rating Questionnaire for Depression (SRQ-D) originated by Abe were used and the following were evaluated; (1) average scores of CMI and SRQ-D in each group (2) percentage of cases showing abnormally high scores of CMI and SRQ-D in each group (3) type classification of CMI (Abe) in each group (4) relationship between psychosomatic findings and operative treatment for vertigo and dizziness (5) relationship between psychosomatic findings and autogenic training in vertigo and dizziness Results were as follows; (1) those with so-called psychosomatic dizziness showed the highest abnormal scores of CMI and SRQ-D. (2) The scores of CMI and SRQ-D in Meniere's disease were not so high compared with those of other cases of vertigo and dizziness. (3) 22% of the so-called psychosomatic dizziness showed high abnormal scores in SRQ-D. (4) In the so-called psychosomatic dizziness, only 19.9% of the cases showed normal type (Type I) in CMI (Abe) and 50.4% showed the type indicating psychosomatic disease (Type IV). In contrast with this, 58.3% of those with vestibular neuronitis showed a normal type in CMI. (5) Patients with many complaints, but without objective neurootological signs in Meniere's disease and BPPV showed the type indicating psychosomatic disease (Type IV) in CMI. (6) Those with autogenic training showed high abnormal scores of autonomic nerve dysfunction in CMI. (7) Autogenic training had some effect on vertigo and dizziness.