The subjective visual vertical (SVV) signifies the visually determined gravitational vertical. The measurement of SVV is clinically used as a method to assess the degree of dysfunction in the otolith, primary vestibular nerves, and central graviceptive pathways. Perception of vertical, however, does not depend solely on the function of those pathways, but is affected by various factors such as visual information, head position relative to gravity, and linear acceleration forces acting on the gravity vector. In addition, it undergoes a kind of 'vestibular compensation', that is, the tilt of SVV decreases within days to weeks even if the function of the organ responsible for the tilt does not restore function. In examining the patient with vertigo or dysequilibrium, the physician must be well acquainted with those factors affecting SVV and its natural course. This article also referred to the difference between SVV tilts and room tilt illusions. The former are usually stable and chronic signs and manifest as a continuum of angle of tilt up to abut 300. In contrast, the latter occur paroxysmally or transiently in 90° steps. In clinical practice, the measurement of SVV is not so commonly carried out as compared to the recordings of nystagmus. It is expected, however, that SVV be more widely taken into account in clinical practice because the tilt of SVV and the occurrence of nystagmus do not share the same anatomical structures, thus SVV can provide a greater understanding of the patient's complaints and underlying pathologies.
A child with vertigo related to acute cerebellitis is reported. The patient was a 7-year-old boy who presented with ataxia and vertigo. Gaze nystagmus, in which the direction of nystagmus periodically alternated, was observed. This type of nystagmus was also observed in spontaneous nystagmus. MRI of the brain in the acute stage revealed no swelling of the cerebellum and no abnormal signal intensity. High serum IGM and IGG titers to Epstein-Barr virus were demonstrated. As a result of these tests and the clinical course, we diagnosed acute cerebellitis related to Epstein-Barr virus. It is very rare for young children to complain of vertigo, and it is necessary to keep in mind that vertigo and ataxia can be caused by acute cerebellitis.
The Dizziness Handicap Inventory (DHI) is a standard questionnaire for quantitative evaluation of the degrees of handicap in the daily lives of patients with vestibular disorders. It consists of 25 questions; each of which is classified as 'functional, ' 'emotional, ' or 'physical' or a subscale. The aim of the present study was to examine the validity and reliability of the Japanese translation of the DHI (DHI-J). The DHI Js returned from 79 patients suffering dizziness were analyzed. The results are summarized as follows: (1) Cronsbach's alpha coefficient, which measures the reliability based on the consistency of the questionnaire, was larger than 0.78 for each of the three subscales (functional, ' 'emotional, ' and 'physical'). (2) All of the subscale scores were significantly correlated with the corresponding visual analogue scales (VAS) (p<0.05). (3) The 'emotional' subscale score showed a significant correlation with the results of the Cornel Medical Index (CMI) and the State-Trait Anxiety Inventory (STAI). (4) The DHI J scores showed no significant correlation with the clinical signs and symptoms (presence or absence of nystagmus, presence or absence of recurrence, and duration of dizziness). These results indicated that the DHI J is a valid and reliable questionnaire that can be used to assess the degree of handicap in the daily lives of patients with vestibular disorders. We shall examine each of the questions and modify their classifications ('functional, ' 'emotional, ' or 'physical') so that they can better suit daily life in Japan.
While many patients complained of malaise in head and neck area, in many of the cases, clear physical evidence was not easily identifiable. In this study, these patients underwent a psychological analysis, performed by psychologists, with emphasis being on the patients with dizziness. Fifty-six patients complaining of malaise in head and neck area, and resistant to long-term variant medication, were analyzed using the Baum and Rorschach tests. Based on the psychological analysis, the patients were divided into three groups NG-normal group not requiring any mental treatment; BG-borderline group requiring psychological treatment; MG-mental group required psychiatric treatment. None of the patients were in the NG, while thirty-five patients were in the BG, and twenty-one patients were in the MG. Thirty-six patients (approximately 60%) in these two groups were patients suffering from dizziness. The results indicate that many patients with mental disorders visit the otorhinolaryngology physician, and the physician should recognize this fact and develop treatment for these patients.
We investigated the effects of earth fixed auditory stimulus and remembered auditory stimulus on VOR in humans. We recorded horizontal VOR 1) in darkness (control, ) 2) with an earth-fixed LED visual target, 3) with a remembered earth-fixed visual target, 4) with an earth-fixed wide band noise auditory target, and 5) with a remembered earth-fixed auditory target. The VOR gain for the auditory target was significantly larger than for the control. And The VOR phase for the auditory target and the phase for the imaginary auditory target tended to show phase lead. These phenomena were similar to the VOR gain and phase with the imaginary visual target. It suggests that auditory space location perception drives the same motor prediction system of vision.
The dissection of the vertebral artery is rare and is one of the causes of subarachnoid hemorrhage. Recently it has been reported that many cases of Wallenberg syndrome are caused by the dissection of the vertebral artery and that magnetic resonance imaging(MRI), magnetic resonance angiography(MRA) and angiography play an important role in diagnosing the dissection. We report a case of dissection of the vertebral artery diagnosed by MRA in a 63-year-old male who had occipital headache, dizziness and nausea. He had a slight rotatory horizontal nystagmus to the left at the time of the first medical examination. We could diagnose dissection of the vertebral artery on the right side by MRA after nine days of symptoms. Preservation-medical treatment by depressor was performed and the constriction of the right vertebral artery has improved gradually.
A 40-year-old male patient had a vertigo attack with vomiting; however, there was no hearing loss, headache, or palsy of arms or legs. On admission, the CT examination did not show any tumors, or infarctions of the brain, brain stem or cerebrum. Neurotological findings of an electro-nystagmography and caloric test did not show any abnormalities, except a platform test showed positive. Two days after admission, MRI examination showed a small mass (15 mm) in the left cerebellar peduncle. Previously, cavernous anginoma was considered rare, but the increasing use of MRI has demonstrated numerous cases. Typically, epileptic or other convulsive symptoms appear initially, but in our case, pathology was indicated by vertigo without other cranial nerve symptoms.