Selye H. (1936) called the body’s non-specific systemic responses to protracted stressors, “general adaptation syndrome”, and argued that in patients with this condition, the hypothalamic-pituitary-adrenocortical system is impaired and excessive cortisol secretion causes structural damage to various organ tissues. Since humans are social creatures, many of the diseases that humans suffer from can be influenced by psychological factors. In the first half of this paper, two common stress-related disorders: adjustment disorder (manifesting as psychological aspects) and psychosomatic disorders (manifesting as physical symptoms) will be outlined. In the second half, we provide an overview of neurodevelopmental disorders which are often associated with co-morbid mental and physical issues including dizziness (such patient may see an otolaryngologist instead of a psychiatrist) when he or she is exposed to workplace stress. For managing such cases, collaboration between psychiatrists and occupational physicians appears to be essential.

The risk factors for recurrent benign paroxysmal positional vertigo (BPPV) include female gender and underlying hypertension, diabetes mellitus, dyslipidemia, osteoporosis, and vitamin D deficiency. In this study, we investigated serum-active vitamin D levels in patients with recurrent BPPV. We statistically examined the age, sex, BPPV attack frequency, and serum 25-hydroxyvitamin D (serum 25(OH)D) levels in 60 patients (17 males and 43 females) with recurrent BPPV between October 2015 and February 2023. All the subjects had been diagnosed as having definite BPPV (based on diagnostic criteria).

RESULTS: The ages of the patients with recurrent BPPV ranged from to 9–90 years (median age: 66 years). Women aged 65–74 years constituted the largest proportion of patients. The median serum 25(OH)D level was 18.9 ng/ml. Insufficiency or deficiency of the levels was detected in 59 of the 60 patients (98.3%). The serum 25(OH)D levels were significantly lower in the female subjects (p = 0.015).

Low vitamin D levels have been reported to affect the severity of dyslipidemia, osteoporosis, and migraine headaches, all of which are risk factors for BPPV recurrence. Given the recent reports of numerous healthy individuals in urban areas of Japan with low serum vitamin D levels, we conclude that this study provides an opportunity to focus on vitamin D and its direct and synergistic effects on BPPV onset and recurrence in the Japanese population.

We report a case of a 70-year-old man with Ramsay Hunt syndrome and trochlear nerve palsy. He presented with vesicular lesions over the left auricle, left facial nerve palsy, left sensorineural hearing loss, and dizziness. His dizziness gradually developed despite steroid therapy. Twelve days after the first medical examination, he presented with vertical strabismus, and ophthalmological examination revealed trochlear nerve palsy. Based on the elevated titers of VZV antibodies in the cerebrospinal fluid, he was diagnosed as having polyneuropathy caused by zoster virus infection. Despite receiving high-dose acyclovir and steroid pulse therapy, he still suffered from dizziness and strabismus about half a year after the onset. Diagnosis of trochlear palsy requires visual examination of both eyes. Thus, not spontaneous gaze test using Frenzel glasses, but gaze nystagmus test is important to avoid misdiagnosing trochlear palsy.

We report the case of a 52-year-old male patient who was diagnosed as having certain Meniere’s disease complicated by ipsilateral vertebral artery occlusion. The patient had undergone aortic arch replacement surgery in year X-6 due to thoracic aortic dissection. Postoperative contrast-enhanced CT revealed complete occlusion of the origin of the left vertebral artery and significant narrowing of the distal segment, although the patient remained asymptomatic. In year X, the patient experienced spontaneous non-spinning vertigo lasting for several hours and consulted a primary care physician. Clinical examination revealed spontaneous nystagmus to the right side and moderate sensorineural hearing loss on the left side. While vertebrobasilar insufficiency was suspected, the vertigo was not induced by positional changes, and MRI did not reveal acute ischemic changes. Due to the recurrent vertigo episodes and fluctuating unilateral sensorineural hearing loss, Meniere’s disease was considered in the differential diagnosis, and the patient was referred to our department. Electronystagmography showed no evidence of a central disease and caloric testing did not reveal semicircular canal paresis. Inner ear gadolinium-enhanced MRI revealed significant endolymphatic hydrops in the left vestibule and cochlea, meeting the diagnostic criteria for definite Meniere’s disease (left side). Conservative treatments led to improvements of both the vertigo and hearing loss. Although incidental ipsilateral vertebral artery occlusion and endolymphatic hydrops could have occurred independently, we considered it possible that blood flow impairment may have contributed to the secondary endolymphatic hydrops, manifesting as the clinical symptoms of Meniere’s disease.