Dizziness and psychogenic disorders, including depression and anxiety, are closely related. The diagnosis of dizziness includes not only an evaluation of vestibular dysfunction, but also a psychogenic evaluation. Using this approach, the following three different patterns of dizziness should be carefully identified: psychogenic, otogenic, and interactive. The common somatic symptoms in patients with chronic dizziness (N=145) were investigated using questions designed to assess headache, insomnia, diarrhea, constipation, stomachache, chest pain, palpitations, dyspnea, and general fatigue. The prevalent somatic symptom in patients with dizziness included general fatigue, insomnia, and headache. These symptoms are very similar to those reported for patients with anxiety and depression. Patients with dizziness clearly had several somatic complaints related to anxiety or depression that could be attributed to the dizziness. Treatments included pharmacotherapy and physical therapy (including rehabilitation for vestibular dysfunction), surgical intervention, pharmacotherapy, and psychotherapy for anxiety and depression. Pharmacotherapy using serotonin reuptake inhibitors and psychotherapy, such as autogenic training, were also performed.
Vertigo, or dizziness, is a known manifestation of temporal lobe epilepsy. We report a case of temporal lobe epilepsy with vertigo. A 65-year-old man had repeated vertigo attacks with right ear tinnitus. Upon undergoing an otoacoustic emissions examination, he was found to have moderate sensorineural hearing loss in the right ear, an absence of caloric responses in the right ear, and an inner auditory hearing loss in the right ear. A brain MRI examination was unremarkable. Although we treated him for peripheral vertigo during the early stage of disease, the remission of the vertigo attacks was not achieved. At three years after his first visit, the vertigo attacks were still occurring but were also accompanied by a clouding of consciousness. An electroencephalographic examination suggested temporal lobe epilepsy. An MRI examination revealed severe atrophy of the cerebrum and hippocampus. Our findings suggest that temporal lobe epilepsy is still an important part of the differential diagnosis of intractable vertigo and vertigo of unknown origin.
Cochlear implants (CIs) are associated with a potential risk for vestibular system insult or stimulation with resultant dysfunction. Twenty-six patients underwent equilibrium tests before undergoing CI surgery at our institute. As part of the equilibrium tests, a caloric test, static posturography, observation of nystagmus using an infrared CCD camera, and measurement of the vestibular-evoked myogenic potential (VEMP) were performed. Half of the patients (13 out of 26 patients) complained of vertigo or dizziness after the operation. In most patients (12 out of 13 patients), these symptoms occurred immediately after the operation and disappeared within one week. Patients who did not complain of vertigo or dizziness after the CI surgery had a statistically significant lower response for the caloric testing than the patients who experienced these symptoms. No significant differences in the static posturography, nystagmus and VEMP test results were seen between the group of patients who did not complain of vertigo or dizziness after the CI surgery and the group of patients who experienced these symptoms. This result suggests that the patients with normal peripheral vestibular functions preoperatively had a greater tendency to complain of vertigo or dizziness after the operation. The cause of postoperative vertigo or dizziness was judged to be due to the peripheral vestibular function before surgery. It is important for CI candidates to undergo equilibrium tests preoperatively as means of predicting postoperative vertigo or dizziness.
Background: The evaluation of vestibular function and symptomatic vertigo before and after cochlear implantation (CI) is important. The objective of this study was to test the vestibular function after CI and to evaluate the correlation with symptomatic vertigo and postoperative vestibular impairment as risk factors. Material and methods: Twenty-five adult patients who had undergone CI at our hospital between September 2005 and September 2010 were studied. All the patients were subjected to caloric tests and the measurement of vestibular-evoked myogenic potentials (VEMP) pre-and postoperatively. Postoperative vertigo and nystagmus were assessed and their correlations with the results of the caloric tests and the VEMP measurements were examined. Results: Ten of the 25 cases (40.0%) exhibited canal paresis on the preoperative caloric tests and 11 of the 25 cases (44.0%) exhibited low VEMP responses. Five of the 18 cases (27.8%) showed reduced caloric responses, and 4 of the 14 cases (28.6%) showed reduced VEMP responses after CI. Thirteen of the 25 cases (52.0%) complained of vertigo after CI, and 17 of the 25 cases (68.0%) showed spontaneous nystagmus postoperatively. Preoperative vertigo and the duration of hearing loss were significantly different between the patients with and those without postoperative vertigo. The patient age at the time of the operation, gender, cause of hearing loss, and type of implant device were not correlated with the change in vestibular functions, vertigo, or nystagmus after CI. Conclusion: Postoperative vertigo and nystagmus were not correlated with the pre- and postoperative caloric responses and the VEMP. Acute vertigo attacks may have been induced by acute inflammation of the labyrinth as a result of the cochleostomy and electrode insertion. Delayed vertigo attacks may have resulted from chronic changes within the inner ear, including endolymphatic hydrops.
This study was designed to investigate bone mineral density in patients with idiopathic BPPV to determine whether there is a clinical association between etiologically unknown (idiopathic) BPPV and osteoporosis. Dual energy X-ray absorptiometry was used to measure the bone mineral density (BMD) at lumbar vertebrae L2L4 in menopausal women over the age of 50 years who had been diagnosed as having idiopathic BPPV. A BMD value of less than 70% of the young adult mean (YAM) was regarded as indicating the presence of osteoporosis. The overall prevalence of osteoporosis in patients with BPPV was 27.5%, which was almost the same as that in a previously reported national survey. However, the rate of concurrent osteoporosis was higher among patients with recurrent BPPV (38.9%) than among those with non-recurrent BPPV (21.2%). Subjects with recurrent BPPV had a lower BMD (72.4% of the YAM) than those with non-recurrent BPPV. Subjects with multiple occurrences had an even lower BMD (69.4% of the YAM) and were classified as having osteoporosis. Thus, BPPV and osteoporosis may have similar pathogenetic mechanisms associated with calcium metabolism in both otoconia and bone. These results suggest that idiopathic BPPV with osteoporosis may be capable of recurring.
This study evaluated the effect of thyrotropin-releasing hormone (TRH) therapy on standing disabilities in 6 patients with spinocellular degeneration (SCD). Each patient was examined using a stabilometer before and after TRH treatment consisting of daily intravenous TRH injections for 2 weeks. The stabilography was performed while the patient's eyes were open and closed and while the patient stood with both feet together for 60 seconds. The total length, envelope area, length/area, length/time, area of root mean square (RMS) and area of rectangle were measured. A decrease in the area of the RMS after TRH treatment, compared with the baseline value, was statistically confirmed in all 6 patients. A stabilographical examination was also performed twice at an interval of 2 weeks in 6 normal subjects, but no significant differences in any of the parameters were detected between the first and second examinations. TRH therapy was assumed to be effective for the treatment of standing disabilities in patients with SCD, since the decrease in the value of the area after treatment appeared to result not from habituation, but from the effect of the therapy.