Objective: Near-infrared spectroscopy (NIRS) has been increasingly employed in psychiatry for functional neuroimaging studies of sleepiness, fatigue, personality, aging, brain activation time course, transcranial magnetic stimulation effects, and psychiatric disorders such as schizophrenia, mood disorders, panic disorder, and eating disorder, owing to its advantages over fMRI and PET such as complete noninvasiveness, small apparatus for measurements, and the natural setting for its examination. Methods: Characteristics of frontal lobe function were investigated using multichannel NIRS machines in schizophrenia, unipolar depression, and bipolar depression. Changes of oxygenated-hemoglobin concentration (oxy-Hb) were monitored every 0.1s during a verbal fluency task using a Hitachi ETG-100 and ETG-4000 system with the probes placed on the subjects' frontal and temporal regions. Results: Three psychiatric groups demonstrated different patterns of oxy-Hb changes from those in the control group. The schizophrenic group was characterized by a reduced oxy-Hb increase during the task period followed by an oxy-Hb re-increase during the post-task period, the unipolar depression group by a smaller oxy-Hb increase, and the bipolar depression group by a comparable but delayed oxy-Hb increase. Conclusion: The observed patterns of oxy-Hb changes suggest the characteristics of reactivity of frontal lobe function: inefficient, reduced, and preserved but delayed in schizophrenia, unipolar depression, and bipolar depression, respectively. NIRS can be employed as a clinical laboratory test for diagnosis and treatment of psychiatric disorders in the near future.
Peripheral vertigo is often accompanied by other symptoms such as neck/shoulder stiffness and headache. To achieve higher patient satisfaction, treatment of the accompanying symptoms is also required in addition to treating the vertigo. The present study was designed to compare the efficacy of kallidinogenase (150U/day) and adenosine triphosphate disodium (ATP, 3g/day) in treating vertigo as well as the accompanying symptoms. These agents were administered orally for 4 weeks to 40 patients with peripheral vertigo, and the VAS (visual analogue scale) and a questionnaire were used to measure the efficacy. In the kallidinogenase treatment group, VAS scores for vertigo, disequilibrium, headache, dull headache, and tinnitus improved significantly, and the questionnaire survey revealed significant alleviation of vertigo and headache. In the ATP treatment group, VAS scores for vertigo and disequilibrium improved significantly, accompanied by significant alleviation of vertigo and significant shortening of the duration of vertigo. We conclude that kallidinogenase is as effective as, or even better than, ATP in the treatment of vertiginous patients with accompanying symptoms.
It is known that gaze-evoked nystagmus, upbeat nystagmus, down beat nystagmus and pure rotatory nystagmus are associated with central lesions, but these types of nystagmus do not always appear in the acute phase of vertigo in patients with a central disorder. In this study, we retrospectively investigated acute phase nystagmus in 15 patients with cerebrovascular lesions. All patients were attending an ENT clinic because of a lack of marked findings concerning neurological dysfunction except vertigo, but finally they were diagnosed as having vascular lesions in the posterior fossa, 3 patients with medulla infarction, 3 patients with pons infarction, 8 patients with cerebellar infarction and 1 patient with cerebellar hemorrhage. At the initial visit to the ENT clinic, spontaneous nystagmus was observed in all patients with a brainstem infarction and in 3 out of 9 patients with cerebellar lesions. Their nystagmus was the horizontal type or the horizontal type with a torsional component. All patients initially were suspected of having peripheral lesions at the initial visit or on admission, but the direction and the type of nystagmus changed periodically and neurological symptoms except vertigo appeared subsequently to admission. Diagnosis of central lesion was made with MRI. It is difficult to differentiate central lesions from peripheral lesions on the grounds of the direction and type of nystagmus, but it is important to observe the changes in nystagmus and other neurological findings for the differential diagnosis of central lesions.
Purpose: The purpose of this study was the clinical evaluation of vertigo in children. We focused on diseases which caused vertigo and the results of equilibrium examinations. Methods: The patient records of 40 children who underwent equilibrium examinations at the Department of Otolaryngology, Toyama University Hospital during 2002 to 2006 were retrospectively reviewed. The ages of the subjects ranged from 4 to 15 years. Patients were classified into three groups based on the site of the disease-peripheral vestibular disorders (Group I), central nervous system disorders (Group II) and the others (Group III). Equilibrium examinations consisted of recording of nystagmus under various stimulations using electronystagmography, stabilometry, and the Schellong test. Results: The number of patients in each group were 18 (Group I), 5 (Group II) and 17 (Group III). Eighty eight percent of Group I patients showed canal paresis (CP) including a case of bilateral CP in the caloric test. Group II included patients with serious diseases comprising spinocerebellar degeneration (n=1), cerebellar tumor (n=1) and cerebral infarction (n=1). Patients in this group showed high abnormality in spontaneous nystagmus, eye tracking test, optokinetic nystagmus test, and stabilometry. The cerebellar tumor patient showed apparently weakened visual suppression to caloric nystagmus. Group III included patients with orthostatic dysregulation (n=6), benign paroxysmal vertigo (n=3) and migraine (n=1). Eighty five percent of this group showed abnormal elevation of pulse rate in the Schellong test. Conclusions: 1) Peripheral vestibular disorders occupied more than central nervous system disorders. 2) Orthostatic dysregulation and benign paroxysmal vertigo seemed to be characteristic as causes of vertigo in children. 3) Completing the examinations was not so easy for the children. However, the importance of equilibrium examinations in children for diagnosis is the same as in adults.
We report a case of Costen's syndrome that showed chewing-induced nystagmus and vertigo. A 31-year-old woman visited our hospital complaining of chewing-induced vertigo 5 days after dental therapy. During chewing a stick of gum, she complained of vertigo and showed nystagmus beating to the right, the direction of which changed to the left thereafter. No spontaneous and positional nystagmus or any abnormalities in the neurological examination could, however, be found. The chewing-induced nystagmus and vertigo gradually disappeared within 2 weeks. Costen's syndrome is associated with various symptoms due to temporomandibular dysfunction. In the case, it is suggested that malinterdigitation after dental therapy caused temporomandibular dysfunction, resulting in the chewing-induced nystagmus, therefore, Costen's syndrome was diagnosed. Eustachian tube hypothesis, Tensor tympani hypothesis and otomandibular ligament hypothesis that accounted for temporomandibular dysfunction-induced aural symptoms in patient with Costen's syndrome had been proposed, but recently were withdrew. On the other hand, it is reported that reciprocal connections between trigeminal and vestibular nuclei. The trigeminal somatosensory input associated with temporomandibular dysfunction after dental therapy may cause chewing-induced nystagmus via the trigemino-vestibular connection in the brainstem in the case.
Orthostatic vertigo (OV) is believed to occur due to hypoperfusion of the brain with the orthostatic decrease in blood pressure (BP). However, in some cases the orthostatic decrease in blood pressure is not directly involved in the onset of OV. Since the vertebral artery (VA) supplies the central vestibular system, which is involved in the onset of vertigo, we investigated the relationship between the orthostatic changes in blood pressure and the changes in VA hemodynamics to determine whether those could affect the incidence of OV. In 251 subjects, extracranial ultrasonic doppler sonography (ECD) was performed to measure the VA blood flow velocity (VAFV) in the supine and standing position, and we also examined the orthostatic changes in BP. Orthostatic hypotension (OH) was defined as a systolic BP decrease of more than 20 mmHg when standing. All subjects were classified as the OH group and the non-OH group, and the orthostatic decrease in VAFV were evaluated in the cases with OV and without OV about each group, respectively. In the OH group, the cases with OV exhibited a great orthostatic decrease in VAFV compared with those without OV. In the non-OH group, the orthostatic decrease in VAFV was significantly greater in cases with OV than those without OV. These results suggest that the decrease in VAFV induced by standing involves the incidence of OV.