Equilibrium Research
Online ISSN : 1882-577X
Print ISSN : 0385-5716
ISSN-L : 0385-5716
Current issue
Displaying 1-5 of 5 articles from this issue
Original articles
  • Yukiho Kawaguchi, Kayoko Kabaya, Akina Fukushima, Sachiyo Katsumi, Shi ...
    Article type: Original article
    2024 Volume 83 Issue 2 Pages 63-70
    Published: April 30, 2024
    Released on J-STAGE: July 06, 2024
    JOURNAL FREE ACCESS FULL-TEXT HTML

    We report the case of a 46-year-old man who presented with acute vertigo and positional upbeat nystagmus and was diagnosed as having cerebellar infarction due to dissection of the posterior inferior cerebellar artery (PICA). On the day of onset, the patient suffered a 10-minute acute vertigo episode, followed by disequilibrium. On the same day, he visited the emergency department; however, there were no abnormal neurological and radiological findings, and he could walk back home. The following day, at the visit to an otolaryngologist, he was found to show positional upbeat nystagmus and mild incoordination of the right upper extremity. A head MRI was performed, which showed cerebellar infarction; furthermore, MRI revealed dissection of the PICA. Vestibular function tests showed no abnormalities. However, the saccade test showed hypometria, and visual suppression was poor. He was asymptomatic by the ninth day after symptom onset and remained on oral antiplatelet medication for the next eight months. Our case indicates that importance of close spontaneous nystagmus detection in the differential diagnosis of acute vertigo.

  • Kou Moriyama, Takaki Inui, Tatsuro Kuriyama, Yusuke Ayani, Yuko Inaka, ...
    Article type: Original article
    2024 Volume 83 Issue 2 Pages 71-78
    Published: April 30, 2024
    Released on J-STAGE: July 06, 2024
    JOURNAL FREE ACCESS FULL-TEXT HTML

    We report a case with ipsilateral delayed endolymphatic hydrops (DEH) who presented with a vertigo attack caused by contralateral acute unilateral vestibular syndrome. Gadolinium-enhanced inner ear magnetic resonance imaging (ieMRI) was useful for diagnosing the causative pathology in this case.

    A 44-year-old male patient visited our emergency department complaining of a spontaneous and sustained vertigo attack. He had suffered from hearing loss in his right ear from childhood. He had also been suffering from recurrent vertigo attacks for 15 years and been diagnosed as having ipsilateral DEH.

    He was hospitalized and received intravenous methylprednisolone treatment (total dose, 400 mg). His left ear showed a slight threshold shift as compared to five years earlier, although the patient was not clearly aware of it; he also failed to improve with the steroid treatment. The vertigo resolved within a week. Vestibular examination showed novel dysfunctions in the left ear; significant catch up saccades evoked by stimulation of all three semicircular canals in the bedside head impulse test and moderate canal paresis in the caloric test, although cervical and ocular vestibular evoked myogenic potentials showed no abnormalities. Furthermore, an ieMRI revealed significant endolymphatic hydrops in the vestibule and cochlear only in the right ear.

    The patient was diagnosed as having acute vestibulo-cochlear dysfunction, and the possibility of contralateral DEH was excluded based on the results of the examinations. Inner ear MRI may be useful to evaluate the clinical pathology in cases of acute vestibular syndrome, even in cases with a history of DEH.

  • Kazunori Matsuda, Go Sato, Junya Fukuda, Sho Takaoka, Miki Tomura, Mom ...
    Article type: Original article
    2024 Volume 83 Issue 2 Pages 79-87
    Published: April 30, 2024
    Released on J-STAGE: July 06, 2024
    JOURNAL FREE ACCESS FULL-TEXT HTML

    We report the case of a 15-year-old young man who presented with disequilibrium and leftward spontaneous nystagmus. Since the video head impulse test at the initial visit showed right lateral semicircular canal hypofunction, the patient was suspected as having peripheral vertigo due to right semicircular canal hypofunction. However, his clinical course was considered as being atypical for peripheral vertigo caused by right semicircular canal hypofunction because of his small center of gravity sway, a negative Romberg’s phenomenon. Balance testing showed failure of visual suppression of caloric nystagmus, and insufficient optokinetic nystagmus responses, suggestive of central vestibular dysfunction. Contrast-enhanced brain MR imaging showed a neoplastic lesion with contrast effect occupying the region from the right middle cranial fossa to the cerebellopontine angle, with extension into the internal auditory canal. In addition, edematous changes due to compression by the neoplastic lesion were observed in the right midbrain, pons, and cerebellum. We diagnosed radiation-induced meningioma based on the histopathology and history of radiotherapy that the patient had received for acute lymphocytic leukemia. The central disequilibrium was diagnosed as being caused by compression of the cerebellum and brainstem due to radiation-induced meningioma arising from the cerebellopontine angle. In patients with a history of having received intracranial radiation in childhood, the possibility of occurrence of central disequilibrium caused by a radiation-induced brain tumor, which is a frequent complication, should be borne in mind.

  • Mizuho Aomi, Toru Seo, Kazuaki Sugawara, Arata Kemmochi, Yosuke Koike, ...
    Article type: Original article
    2024 Volume 83 Issue 2 Pages 88-93
    Published: April 30, 2024
    Released on J-STAGE: July 06, 2024
    JOURNAL FREE ACCESS FULL-TEXT HTML

    It is well known that anxiety causes dizziness and/or vertigo. Herein, we report a rare case of vertigo caused by a specific phobia associated with repetitive sounds. The patient was a 26-year-old man who worked as a nurse. Ever since he had been around 10 years old, he had suffered from dizziness when he heard repetitive sounds, such as the sounds of train joints. When he was 26 years old, he heard an electrocardiogram alarm at work and became dizzy; he was unable to continue working and visited our clinic. Before the dizziness, he had experienced anxiety and sweating. He had no gaze or positional nystagmus, and the audiogram showed no hearing loss. The calorie test, cVEMP, and oVEMP showed no significant abnormalities. Brain MRI and ear CT showed no abnormalities. Although his total score on the dizziness handicap inventory (DHI) was not high (24 points), the emotional score was high (18 points). The Hospital Anxiety and Depression Scale (HADS) score was 11 points for anxiety and 9 points for depression. We diagnosed the vertigo as having been caused by a specific phobia associated with repeated sound stimulation. The patient was then explained the etiology and received sound exposure therapy. After three months, the dizziness resolved, and the patient was able to work again.

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