Cats with restricted head motion faced a large screen on which a visual noise pattern was projected and moved in a horizontal direction at a rate of 1.5-17deg./sec. Horizontal electro-oculogram showed strongly elicited optokinetic nystagmus. Immediately after the direction of the stimulus motion was changed, almost every amplitude of the quick phases predominated slightly over those of the slow phases. Therefore, the average eye position shifted gradually in the direction of the quick phases up to the normal limitation of eye movements. The predominance of quick phases like this could be observed irrespective of the spatial or temporal patterns of the stimulations, and also in nystagmus during head rotations.
To see the characteristics of autonomic reflexes from the lumbar proprioceptors a series of experiments using rabbits were undertaken, and results were discussed from the standpoint of body equilibrium. The results obtained were as follows : 1) The pupils during electric stimulation mostly dilated when rabbits were given a single electric stimulation (10msec, 10Hz. pulse waves at 30V for 90 seconds) on the unilateral lumbar erector muscles at the level of L4. Such pupillary reaction included bilateral mydriasis with and / or without anisocoria. The appearance of mydriasis with anisocoria increased as electric stimulation was repeated.Furthermore, the more dilated side of the pupils was coincident with the side of electric stimulation. Some of the animals examined showed myosis after repeated electric stimulations and such myosis showed no sign of anisocoria. 2) By applying repeated electric stimulation on the unilateral lumbar erector muscles mydriasis with anisocoria first developed before and after electric stimulations. Furthermore, such pupillary reaction increased as the electric stimulation was repeated. With respect to the correlation between the side of electric stimulation and the more dilated side of the pupils, a similar finding was observed as described in item (1). 3) By applying repeated electric stimulation on the unilateral lumbar erector muscles nystagmic responses first appeared before and after electric stimulations, and such responses increased as electric stimulation was repeated. Furthermore, the appearance of mydriasis with anisocoria paralleled that of the nystagmic responses mentioned above. From these findings the following conclusions were drawn : 1) Both autonomic and somatic reflexes can be induced on the basis of over-excitement of the lumbar proprioceptors. 2) The above-mentioned results support the idea that disequilibrium of the eyes and body and autonomic symptoms in patients with cranio-cervical injury can be induced as the proprio-ocular and the proprio-vegetative reflexes, and thus, the cervical syndrome can be explained not only by Barre's theory but also by the theory of the neck reflex.
The stepping movement is entirely difffferent movement from walking, and observation of the body's rotating movement around the long axis of the body is Important. We, therefore, test-erected a “Kinetogravicorder” and collected data from 20 healthy men and 19 patients with Parkinson's disease for analysis and comparison. This method enables us to observe body movement as the movement of the center of gravity (which had only been visually observed in the past) is 2-dimentional recording of time passage. It was observed that a healthy person's stepping movement showed two-peaks in the Y-component recording, which showed movement of the center of grarity, the large peak occuring when the feet wereshifted from the left to right and the small peak showing the shift of the center of gravity within the foot sole when the foot touches the floor board. The left to right movement (X-component) was in the shape of flattenid sign curve, which represented the length of time the foot sole stayed on the floor and length of time needed for shifting from one foot to the other. of these contact duration and swing duration, the contact duration seemed to be signifcantly controlled by the central programing as evidenced in the loaded rhythm, etc. When the Tibial nerve was electrically stimulated to bring about spasms in the lower limb muscles and then the stepping movement was ordered, the small peak of the Y-component became deviated or disappeared. The stepping patterns of the patients with Parkinson's disease were abnormal in both the contact duration and swing duration, and the two-peak pattern was also different from that of normal people's, . This deviation of the two-peak pattern in the Y-component in Parkinson's disease was characterized by the lack of the small peak which is mainly related to the foot joint movement. We suspect that in Parkinson's disease input information of voluntary movements of joints and muscles function as irregular information for the VIM nucleus as well as for some other central movement systems. in such a way that it provides a possibility for parkinsonian patients to protect themselves by making the foot joint movement steady.
Changes in plasma levels of norepinephrine, blood pressure and pulse rate of 125 patients with vertigo were measured during the orthostatic test. Fifty nine patients (47.2%) showed patterns of orthostatic dysregulation which were evaluated with the following criteria, pulse pressure narrowing of more than 21mmHg (PP+), increase of pulse rate of more than 21 beats per mineute (P+), fall of systolic blood pressure of more than 21mmHg (SP+). Increases of plasma norepinephrine during the orthostatic test were found in all cases, although greater increases of plasma norepinephrine were found in P+ group. In this P+ group, be it coccompanied by PP+ and/or SP+, the blood pressure was not very responsive to plasma norepinephrine. Thus, it was suggested that disturbance of the adrenergic receptor, manifestation of which includes vasoconstriction, might exist in these patients showing orthostatic dysregulation.
There are many patients with central vertigo and/or equilibrium disturbance in whom neurootological examination fail to explain the site of lesion or the etiology of disturbance. In this paper the results of computed tomography (CT) performed in these patients are reported.Subjects Twenty-eight patients who complained of vertigo and/or equilibrium disturbance were evaluated in this study. These patients received neurootological examinations and it was inferred that their complaints were due to disorders of the contral nervous system.Methed The EMI 1, 000 system or 1, 010 system were utilized for the study.Results The following results were obtained. 1) Two of the 5 patients with severe standing disturbance were shown to have cerebrocerebellar atrophy. 2) Two of the 5 patients with cerebellar signs had cerebellar and brain stem atrophy. 3) All of the 5 patients with congenital nystagmus did not show any abnormal findings on CT. 4) Nine of the 13 patients with other neurootological signs showed cerebral, cerebellar and brain stem atrophy. These results lead to the following conclusions. 1) Computed tomography is of value in the diagnosis of central vertigo and equilibrium disturbance. 2) Brain atrophy is significant in the development of central vertigo and equilibrium disturbances. 3) Diagnosis of vertigo and equilibrium disturbance can be suggested by functional neurootological examination and confirmed morphologically by computed tomography.
Meniere's disease (MD) with preexisent hearing loss was studied. Twenty-five MD patients with a history of hearing loss were involved in the study. The patients were divided into three groups according to their clinical histories.Results : 1) MD with severe preexistent hearing loss was seen in 3 patients. The onset of hearing loss was most frequently found to be when the patients were about twenty years old and the interval to the onset of vertigo and hearing loss ranged from about 15 to 25 years. The causes of hearing loss were juvenile unilateral total deafness (1), parotitis (1) and acoustic trauma (1). For this group, delayed hydrops was suspected. 2) MD with moderate to slight hearing loss which preexisted was found in as many as 18 cases. The onset of hearing loss was frequent in the second to fourth decades of life and the interval between the onset of vertigo and hearing loss varied widely, i.e. from 1 year to 42 years. The causes of hearing loss were unknown (11), otitis media (3), noise (2), acoustic trauma (1) and juvenile unilateral perceptive hearing loss (1). For this group, delayed hydrops could not be assumed but a little evidence available at this moment seems to suggest that a predisposition to MD had been created by hearing loss. 3) Four cases were considered to represent a shift from sudden deafness (SD) to MD. Three of them weve accompanyied by vertigo and the remaining one was not. Hearing loss appeared at comparatively advanced ages. The interval between the onset of hearing loss and that of MD was short, ranging from 3 to 33 months. For this third group, the following 3 situations could be suggested : (1) SD shifted to MD, (2) SD had caused delayed hydrops and (3) MD from the beginning.
One hundred and twenty-two cases of benign paroxysmal positional vertigo (BPPV) were studied with respect to the duration of vertigo and nystagmus and posibilities of recurrence of vertigo. Vertigo and nystagmus disappeared from 2 days to 10 months after the attack. In 93% of BPPV, vertigo and nystagmus disappeared in 3 months. Vertiginous attacks appeared 2 to 6 times in 11 cases (two times in 9 cases, three times in one case and six times in one case). The lesion was on the same side as the first attack in 10 cases, although it was on the other side in one case. Vertigo occurred a second time 1-3 months after the first attack in 4 cases, 3-6 months in 3 cases, one year in 3 cases and 5 years after in one case. In 8 cases, unilateral caloric responses were reduced. This seems to suggest that if unilateral caloric responses remain reduced, there is a posibility of recurrence of vertigo.
1. In evaluating the diagnostic significance of the polarity of summating potentials (SP) or the SP/AP ratio in Meniere's disease, the following should be studied : 1) the electrode positions in the tympanic cavity;2) the interval of sound stimulations; and 3) the method of recording, whether it is by transtympanic or extra-tympanic recording. 2. When a double electrode recording is made via the transtympanic route, the polarity of the SP, whether it is positive or negative, depends on the electrode positions. 3. Abnormal SP's were not very closely related to the time elapsed since the onset of vertigo, audiometric pattern, or the findings of the glycerol test. 4. It is difficult to differentiate Meniere's disease from sudden deafness on the basis of large SP/AP ratios alone, which are frequently found in both diseases.5. Recovery or progression of hearing impairment was not always related to the findings of the SP.6. Positive SP's were seen in Ménière's disease at a higher incidence than in other sensorineural hearing loss.
Two patients exhibiting spontaneous pure rotatory nystagmus at frontal gaze without other specific signs are presented. Such an ocular sign is usually peculiar to the bulbar lesion especially to the vestibular nuclei lesion. Case 1 : A 48 year-old female consulted our clinic complaining only of shoulder stiffness. However, objectively a peculiar ocular sign of spontaneous pure rotatory nystagmus was observed, from which a bulbar lesion was suspected. Vertebral angiography disclosed a tumor in the medulla extending to the left cerebello-pontine angle. On operation, the tumor was disclosed to be meningioma. Case 2 : When a 36 year-old male consulted a neurosurgical department because of minor head injury, the peculiar ocular sign was detected. This patient was suspected of having a bulbar lesion as well, so that tomography of PEG was done. A soft mass was disclosed at the anterior part of the medulla. Two cases of benign extramedullary tumor at the medulla are reported. The tentative diagnosis was obtained on the basis of the specific ocular sign which was then confirmed morphologically. The mechanism of the spontaneous pure rotatory nystagmus is also discussed.
The relationship between the seeing of his own thoughts and the oculomotor function was studied in a schizophrenic who experienced the seeing of his own thoughts (Gedankensichtbarwemden). This patholgical experience was analysed in comparison with that in one case reported in Japan. 1) The patient could actually see his own thoughts or images which occurred in his mind and could change the scene or the things seen in front of his eyes according to his own will. However, he could not recognize things seen as they existed in the real world, nor see highly abstract ideas such as philosophy, realism, etc. 2) The experience of the seeing of his own thoughts was considered to be an eidetic image, but he did not appear to be a man with an eidetic disposition. 3) Upward eye movements were observed concomitant with the seeing of his own thoughts. However, such eye movements did not occur at the time when he did not experience such visions. Duning close observation for over 2.5 years, there was an apparent relationship between the pathological experience of these visions and the eye movements. 4) A large nystagmus to the left was apparent regardless of the absence or presence of the vision. 5) The slow eye deviation in the OKP test was inhibited when he experienced the seeing of his own thoughts, but was normally produced when he did not have such experiences. Smooth pursuit in the eye tracking test and normal responses in the caloric test were obtained regardless. These findings suggest that the pathological experience of the seeing of his own thoughts is closely related to abnormal functions of the oculomotor system.