It is known that the pathological mechanism of Meniere's disease is endolymphatic hydrops, and many studies have investigated the clinical effect of diuretic drugs on patients with Meniere's disease. We reviewed the past treatment of Meniere's disease with diuretic drugs (urea, acetazolamide, glycerol, furosemide and isosorbide). Especially, isosorbide, an osmotic diuretic is known to be safe and useful for relief of attacks of vertigo, tinnitus, headache and shoulder stiffness which patients with Meniere's disease have. Recently, this drug has become the first choice for treatment of chronic Meniere's disesae. In the present paper, we reviewed the clinical efficiency of isosorbide based on past data, and presented several clinical cases of Meniere's disease treated isosorbide in Department of Otorhinolaryngology, Gifu University School of Medicine.
Several types of saccadic intrusions have their own salient features, including the presence, absence or latency of intersaccadic intervals. Macrosquare-wave jerks are known to have a shorter latency of about 100 msec, suggesting the involvement of the non-visually guided reflex saccade. Spuare-wave jerks and macrosaccadic oscillations (MSOs) are generally considered to have normal intersaccadic intervals of 200 msec in the visually guided saccadic system. Conversely, Kase et al. documented a shorter latency of about 160 msec, indicating an increased gain in the corrective saccadic system in a patient with spinocerebellar degeneration and MSOs. Our recent electro-oculographic study also showed a mean intersaccadic interval of 129.5 msec in a myasthenia gravis patient with edrophonium induced MSOs. This short latency is similar to that of corrective saccades, and is consistent with our understanding that MSOs are a form of saccadic hypermetria that is followed by a sequence of corrective saccades to attain the target.
Psychological factors play an important role in the development of dizziness. Even if they are not the cause of the initial onset of dizziness, psychological factors often contribute to the continuation or aggravation of symptoms. This study sought to clarify the personality and psychosocial backgrounds of 17 patients with dizziness, in whom psychological factors were considered to be the primary cause of their symptoms. Psychotherapists at our dizziness clinic counseled all of these patients. The Cornell Medical Index (CMI) revealed a strong neurotic inclination, psychosomatic ataxia, and obsession in these patients. In addition, the Personality Inventory (INV) showed that 8 patients had a strong epilepsy temperament. The results of the Stress Coping Inventory (SCI) suggested that a low ability to cope with stress was a personality trait common among these patients. Various psychosocial backgrounds were also identified as the causes of the stress contributing to the initial onset, continuation, and aggravation of the symptoms. Our experience with these patients showed that the most appropriate method of psychotherapy for treating psychogenic dizziness or dizziness closely related to psychological factors should be based on precise knowledge of a patient's personality and psychological background
The contributions of semicircle-canal versus otolith-organ signals to the vestibulo-ocular reflex (VOR) were investigated by providing canal-only (earth vertical axis rotation: EVAR) and canal plus otolith 30-degree nose-down conditions (off-vertical axis rotation: OVAR). Horizontal and vertical eye movements were recorded in eight healthy adults, ranging in age from 28 to 40 (mean 29.5), using an infrared video recording system. Stimuli were carried out, sinusoidally, at 0.2 Hz, 0.4 Hz and 0.8 Hz in frequency and 60/s in maximum angular head velocity in both EVAR and OVER. VOR gain at 0.2 Hz showed 0.84±0.31 (mean ±S.D.) in EVAR and 0.77±0.21 in OVAR, percent gain change of which resulted in -2.6±31.5%. VOR gain at 0.4 Hz was 0.71±0.16 in EVAR and 0.61 ±0.15 in OVAR, and percent gain change was -11.5±52.1%. All subjects showed VOR gain reduction in OVAR at 0.8 Hz (0.73±0.1 in EVAR and 0.55±0.11 in OVAR). Percent gain change was -23.5±12.5%. There was a significant difference of VOR gain between EVAR and OVAR only at 0.8Hz (p<0.05). Furthermore, VOR phase lead was recognized in all subjects only at 0.8 Hz, which showed a significant difference between EVAR (-64.2±18.2 deg.) and OVAR (-99.0±22.8) (p<0.05). VOR gain reduction and phase lead in OVAR at 0.8 Hz brought about otolith, which was principally the utricle. There has not been the suitable examination to evaluate the otolith function for patients with dizziness because assessment of the otolith function by constant rotation in an off-vertical condition, which has been used so far, gave patients various symptom caused by vestibulo-spinal reflex. It was concluded that the stimulation of 0.8 Hz and 60/s in maximum angular head velocity in sinusoidal OVAR may evaluate the otolith function without discomfort for patients.
On the basis of the fact that 92% of the cases with hemifacial spasm caused by neurovascular compression (NVC) at the root entry zone of the facial nerve have dolichoectatic ipsilateral convexity of the basilar artery (BA) on a MR image (MRI), 37 of 40 vertiginous patients suspected as due to NVC were evaluated with T2-weighted MRI.MRI of 18 patients with sudden deafness or vestibular neuronitis were used as controls. The displacement and distance of the cross section of BA from the midline were assessed at the level of the internal auditory meatus in the axial view. The displacement was ipsilateral to the affected side in 32 (86.5%), contralateral in 4 (10.8%) and not recognized in one (2.5%) of 37 patients, whereas it was ipsilateral to the lesion in 4 (22.2%), contralateral in 7 (38.9%) and not recognized in 7 (38.9%) of 18 controls. The mean distance in 33 of 37 patients and 17 of 18 controls was 5.7 mm (0-11.8 mm) and 2.9 mm (0-8.9), respectively. These results showed that the ipsliateral convexity of BA in vertiginous patients suspected as due to NVC was significantly more severe and seen at a significantly high incidence. The ipsilateral displacement of BA on the axial view of MRI has been suggested to serve as a diagnosis of vertigo due to NVC.
Ninety-seven patients with sudden deafness with positional nystagmus under Frenzel's glasses were analyzed. The patients were treated with steroids, low-molecular dextran and prostaglandin E1. The positional nystagmus disappeared in 59.8% within 28 days of the onset. 23.6% of the patients were observed to have positional nystagmus continuously until sixth months from onset. The factors of poor prognosis of positional nystagmus up to sixth months seemed to be canal paresis, age group and frequent change of direction of the positional nystagmus. There was no relationship between the period from the onset to the initiation of treatment and prognosis of the positional nystagmus.
We present here a case showing paradoxical convergence during lateral gaze. A 61-year-old female complained of dizziness when she saw horaizontally moving objects. She had a 20-year history of diabetes with retinopathy, nephropathy, and neuropathy. In an attempted leftward gaze, both eyes were transiently convergent for several seconds, disturbing ocular abduction. This paradoxical eye movement sometimes occurred in an attempted rightward gaze, and was accompanied with pupilary miosis. When one eye was covered, the other eye showed no disturbance in lateral gaze. Caloric vestibular stimulation induced conjugate eye movement in both directions. MRI did not show any lesion in her brain. These findings indicated that the gaze palsy in this case was due to covergent spasm (i.e., spasm of the near reflex). The convergent spasm appearing in attempted lateral gaze was successfully treated with baclofen, an agonist of GABA-B receptor. Its pathophysiology is unclear, but we supposed an increased excitability in the supra-oculomotor parts of the vergent eye movement system. A neural command to generate horizontal saccade simultaneously enters the vergent system, which may trigger the convergent spasm of this case.
The antiphospholipid antibodies (aPL) are strongly correlated with episodes of recurrent venous and/or arterial thrombosis. Some cases of sudden sensorineural hearing loss have been reported to be associated with aPL. In this study, the association between aPL and equilibrium disorder is reported. The aPL level was studied in serum samples from patients with equilibrum disorder. The aPL was detected by the following tests: the anticardiolipin ELISA test and lupus anticoagulant test. For the anticardiolipin antibodies (aCL), IgM isotype of anticardiolipin antibodies (IgM.aCL), IgG isotype (IgG.aCL), β2 glycoprotein I dependent (β2GPI.aCL) were examined. For the lupus anticoagulant (LA), diluted-APTT (dAPTT-LA) and diluted Russell viper venom time (dRVVT-LA) were examined. Positive IgM.aCL was detected in 17 of the 74 serum samples from the patients (23%). Positive IgG.aCL in 18 of the 238 serum samples (7.6%), positive β2GPI.aCL in 4 of the 282 serum samples (1.4%), positive dAPTT-LA in 3 of the 63 serum samples (4.8%) and positive dRVVT-LA in 2 of 72 serum samples (2.8%). The serum samples from patients with recurrent episodes of equilibrium disorder showed a higher positive rate of IgG.aCL than those from patients without recurrent episodes. Samples from patients with vertigo for 20 minutes or longer also showed a higher positive rate of IgG.aCL than those from patients without vertigo for 20 minutes or longer. Based on these results, it is suggested that there may be an association between aPL and equilibrium disorder.