The purpose of the present study was to clarify the clinical features of physiologically induced dizziness and psychogenic dizziness in which psychological factors appeared to play a primary role in onset and continuation. Seventeen patients (8 males and 9 females) who had undergone psychotherapy at our clinic participated in this study. Their ages ranged from 16 to 61 years (mean, 28.1 years). On the basis of the patient's clinical records, dizziness was divided into two categories: persistent, nonrotary vertigo, e. g. a floating sensation while walking (8 cases); and conditioned dizziness that was precipitated under certain circumstances and could not be explained physiologically (9 cases). One patient complained of a vertigo attack induced by seeing a specific character, another complained that vertigo occurred when he imagined sour food, and four teenagers had dizziness attacks only during school classes. At the first consultation, all patients described their dizziness as severe, but a later questionnaire survey revealed that their physical activities in daily life, such as turning their heads, running, and walking up/down the stairs, were not significantly impaired. The survey also showed that these patients had various associated symptoms such as anxiety, tension, or fear and less frequently general fatigue, stiff shoulder, and insomnia. All these symptoms had diminished at the time of the questionnaire survey. Bilateral low-tone sensorineural hearing loss was noted in most of these patients. The findings in the present study also showed that even when dizziness did not improve after psychotherapy, the improvement in associated symptoms significantly enhanced patient satisfaction.
We report seven cases of Meniere's disease caused by work-related stress. All the patients left their jobs due to persistent cochlear symptoms. Based on the clinical courses in these patients, we suggest that not only workrelated stress can cause Meniere's disease, but also that treatment in such patients was very difficult if the source of stress is not removed.
The purpose of this study was to investigate the day-to-day reliability of evaluation parameters for the body center of pressure (BCP). The subjects were healthy young adults: 12 males and 18 females. The measurement of BCP for 1 minute was carried out 3 times with a 1 minute rest for each subject. This measurement was repeated on five consecutive days at the same time. The measurement device used was Anima's stabilometer G5500. The data were recorded every 20 milliseconds. Sixty evaluation parameters with higher trial-to-trial reliability were selected from the following domains: distance, center of pressure, distribution of amplitude, area, velocity, power spectrum, and vector for body sway. The 95% confidence intervals of the limits of agreement for repeated measurements and the coefficient of variance were ±0.008-2.018, 21.18-51, 42, respectively. The 95% confidence intervals for all parameters were not significant. The variance coefficients of mean distance, standard deviation of velocity of x and y-axis, slope by the cumulative frequency of y-axis on the distribution of amplitude, velocity, and power spectrum were relatively small. The intraclass correlation coefficients (ICC) were over 0.7 for almost all parameters. There was a significant difference among the trials during the five days in some parameters. Based on the present results, the following parameters were considered to be effective to evaluate BCP because they had a higher reliability: mean distance, area, amplitude, velocity, and power spectrum for velocity of body sway of x and y-axis, and vector for velocity of body sway.
We report here a fifty-one-year old male with ocular myoclonus due to hemorrhage in the right pontine tegment. The patient complained of a continual dizzy feeling after treatment for the acute stage of cerebral hemorrhage had been completed at an other hospital. Neurootological examination revealed saccadic smooth pursuit eye movement and slightly suppressed optokinetic nystagmus but no pathological spontaneous eye movement. However, one year after the onset, oscillopsia developed and an abnormal eye movement appeared. ENG study revealed pendular-like oscillatory eye movements in both vertical and horizontal directions. The vertical component was dominant and phase difference in both directions was observed. On follow-up studies over a 4-year period, the abnormal eye movement decreased and the high intensity noted at the right dorsal region of the pons in CT at the initial stage disappeared later. Pseudohypertrophy of the right inferior olivary nucleus was suspected based on CT findings at the later stage. The abnormal eye movement was diagnosed as ocular myoclonus due to a lesion in the Guillain-Mollaret's triangle.
We measured the visual suppression of vestibulo-ocular reflex (VOR) using manual sinusoidal rotational testing with infrared Frentzel glasses, which can provide subjects with visual stimulation during rotational testing. Utilizing these infrared Frentzel glasses made it convenient to record and analyze VOR and the visual suppression of VOR in the daily outpatient vestibular clinic. Twenty-three peripheral dysequilibrium patients and ten cerebellar dysequilibrium patients underwent examination of visual suppression of VOR by manual rotational testing and caloric testing. The visual suppression values of VOR measured by rotational testing (VSrot) were correlated with those measured by caloric testing (VScal) in the cerebellar dysequilibrium group. In the peripheral dysequilibrium group, VSrot was higher than VScal. However, in the cerebellar dysequilibrium group, VSrot was lower than VScal. Only one patient in the cerebellar dysequilibrium group showed a VSrot value that fell into the range of the mean ± 2 S.D. of VSrot of the peripheral dysequilibrium group. Thus, we considered that VSrot was a useful parameter to differentiate between peripheral and cerebellar equilibrium disorders.
In order to evaluate the effects of aging on the head and trunk movements during locomotion, 10 young (mean age 24.9 years) and 10 older (mean age 53.0 years) subjects were examined kinesiologically during walking with their eyes open (EO) and with a blindfold (EC). For this study, a 3-D motion analyzing system composed of 2 infrared digital CCD cameras and a data processor was used. In both the young and older subjects, the head translation, pitch and roll movements were significantly smaller during walking with EC than with EO. Thus, we speculated that visual deprivation impairs spatial orientation in the brain resulting in a changed locomotor pattern, and that this may enhance the sensitivity of the other sensory systems. In most young subjects, the head roll was compensatory for the trunk roll (negative correlation) during walking both with EO and EC. In many older subjects, by contrast, the head and trunk moved in the same direction (positive correlation) during walking especially with EC. The findings in the present study suggest that in young people the center of gravity is better stabilized during walking than in older people, and that young people are less dependent on visual input for spatial orientation in the brain than older people.
Damped off-vertical-axis rotation (OVAR) induces more severe vertigeous sensation compared with earth vertical axis rotation (EVAR) using the damped rotation test because three semicircular canals and otolith organs are stimulated at once. We recorded the ENG of 16 patients, whose ice-water irrigation caloric tests did not show any response in either ear, using the damped rotation test at 0 degrees and at 15 degrees tilt for off vertical axis. The etiology of the patients included inner ear anomaly, meningitis, and acoustic tumors. Our study revealed that nine patients showed perotatory and postrotatory nystagmus upon EVAR and OVAR two patients showed nystagmus up on OVAR only but no nystagmus upon EVAR. Seven patients did not show any nystagmus upon EVAR or OVAR. The modulation component, which relates to the otolith organs, was recorded in six patients. The damped off-vertical-axis rotation test is promising for further evaluation of the semicircular canal and otolithic organs.
Vestibular neuritis (VN) is most likely a partial rather than a complete vestibular paresis with predominant involvement of the horizontal and anterior semicircular canals, and a lack of auditory function. Only 50-70% of patients completely recover vestibular function as assessed by caloric and rotation tests. Management of VN is effective especially in the acute period. Treatment involves drug treatment and physical therapy. In the acute period, drug treatments are effective to suppress the sensation of vertigo and vomiting. Benzodiazepines, anticholinergic drugs (scopolamine) and glucocorticoids suppress acute vertigo by facilitation of vestibular compensation, and antihistamines prevent vomiting by inhibition of the central nervous system. Physical therapy enhances vestibular compensation by facilitating central recalibration.