Cervical vertigo is known as vertigo due to a neck problem. However cervical vertigo remains controversial because there are neither reliable tests nor recognized signs. Supporters of cervical vertigo insist that it is the most common vertigo syndrome. Additionally, some studies demonstrated that stimuli applied to the neck induced nystagmus and dizziness. To date, pathophysiologically four different hypothetical mechanisms have been attributed to cervical vertigo: (1) sympathetic dysfunction; (2) proprioceptive dysfunction; (3) rotational vertebral artery compression (Bow hunter's syndrome); and (4) overlap with migraine associated vertigo. However there are no established tests to diagnose cervical vertigo and diagnosis mostly depends on the patient's past history or subjective complaint such as neck pain. Therefore vestibular or other neurological diseases must be excluded first. Treatment should be specified according to the cause of cervical vertigo. For sympathetic dysfunction due to cervical spondylosis, decompression therapy such as cervical disc decompression might be effective. Physical therapy is reported to be useful for proprioceptive cervical vertigo. In the case of cervical vertigo due to vertebral artery compression, conservative management, decompression surgery and endovascular therapy are major treatment methods. In the future, cervical vertigo is expected to increase due to the expansion of the use of electronic devices such as smartphones. Appropriate clinical examinations and diagnostic criteria should be established urgently.
Inspection methods for stabilometry differ between Japan and overseas countries. In Japan, the closed parallel feet position is used, whereas various positions are used abroad, such as with feet parallel to each other at some distance and with each foot placed at 30° with heels in contact with each other. Further, arm postures include arms extended laterally, the folded arms posture, and others. In the present study, we performed stabilometry tests using various feet positions. Participants were 64 healthy subjects (males, 42; females, 22; mean age, 33.5 years) without a history of vertigo or balance disorders. Stabilometry with the closed parallel feet position and each foot placed at 30° was recorded with eyes open and eyes closed for 60 seconds each. Many parameters were low with each foot placed at 30° compared to the closed parallel feet position. Further, there was a significant difference (p<0.01) in total length (cm) with eyes open and eyes closed, and a significant decrease in area (cm2) with eyes open (p<0.05) and with eyes closed (p<0.01). Using the velocity of 8 directions, we obtained a ratio of left-right/anterior-posterior vector, with the closed parallel feet position found to be significantly higher (p<0.01) than with each foot placed at 30° both with eyes open and eyes closed. These results indicate that the closed parallel feet position is an unstable posture associated with more sway than each foot placed at 30°. Therefore, the closed parallel feet position may be more suitable for clinical use because it allows the detection of minute changes in the center of posture.
Objective: Aortitis syndrome with bilateral canal paresis: a case report.
Patient: A 48-year-old man with aortitis syndrome is presented. The patient had no history of vertigo or dizziness.
Result: The patient experienced hearing loss on the left side and dizziness during the investigation for fever of an unknown origin. Sensorineural hearing loss on the left side and nystagmus beating toward the right side were detected with otological examination. Furthermore, a thoracic and abdominal enhanced CT scan revealed a thickened aorta wall, and the patient was diagnosed as having aortitis syndrome. The inner ear disorders were considered to be related to the aortitis syndrome and corticosteroids were administered. Hearing loss was completely restored, but oscillopsia during head movements persisted. A monothermal caloric test showed bilateral canal paresis. Both cervical and ocular VEMP showed no response bilaterally, indicating the dysfunction associated with bilateral otoliths. The results of a video head impulse test revealed decrease in the gain of the vestibule-ocular reflex and appearance of catch-up saccade bilaterally, indicating bilateral canal paresis.
Conclusion: In this case, the inner ear disorder was considered to be related to the patient's aortitis syndrome. Although hearing loss improved, vestibular impairment persisted. Bilateral canal paresis was demonstrated by vHIT, as well as the caloric test.
It is assumed that in this aging society, the number of patients with an uncertain diagnosis will increase. Among them, there will be some patients with undiagnosed dementia. Dementia with Lewy bodies is one of the most common types. The early diagnosis of dementia with Lewy bodies is usually difficult even by a specialist such as a neurologist. These patients sometimes suffer from repeated sudden falls and orthostatic dizziness, and may visit a department of otolaryngology. There were 3 dementia cases with Lewy bodies among 1048 patients with chronic dizziness, who were admitted for the treatment of their intractable symptoms. They had been suffering from their dizzy symptoms and tendency to fall for more than 2 years, until they were finally diagnosed as having dementia with Lewy bodies. All patients had visited physicians and had been examined in the past, but without any specific diagnosis. All patients took part in intensive inpatient vestibular rehabilitation program in our department, but no clinical improvement was obtained. After that, the patients were again referred to their physicians and finally the diagnosis of dementia was obtained.
An 82-year-old man was referred to our hospital complaining of postural instability leading to early unexplainable falls. Neurological examinations revealed horizontal gaze nystagmus, impairment of vertical gaze, abnormal eye movements such as square wave jerks and slow saccade, remarkable nuchal rigidity, mild rigidity of all four limbs, akinesia, dysarthria, slight dysphagia, and dementia. MRI/CT findings showed remarkable symmetrical atrophy of the frontal and temporal lobes, remarkable dilation of both lateral ventricles and the third ventricle. Atrophy of the posterior vermis in the cerebellum was also noticed. SPECT (123I-IMP single photo emission CT) findings revealed reduction of the blood flow to both the frontal and temporal lobes. From these findings, he was diagnosed as having frontotemporal dementia (FTD) caused by progressive supranuclear palsy (PSP). The characteristic electronystagmography (ENG) findings were as follows: (1) abnormal eye movements such as square wave jerks were recognized in the light; (2) transitory alternating saccade (TAS) in the dark: in other words, like a sine wave curve, the eye position deviated rhythmically to either lateral side with a periodicity of 0.2-0.3 Hz. Associated with this deviation was 2-8 saccades (about 2°) with each oscillation; (3) complete impairment of vertical smooth pursuit, while the horizontal pursuit was intermingled with back-up saccade (cogwheel-pursuit); (4) Either horizontal or vertical OKN were scarcely induced; Finally, (5) Vestibular caloric nystagmus was poorly induced bilaterally. Visual suppression of caloric nystagmus deteriorated remarkably bilaterally. On the contrary, caloric nystagmus was enhanced during fixation in light.
To the best of our knowledge, there are no clinical reports in the literature on TAS in a case with FTD-PSP. Although the definite mechanism of TAS still remains unclear, the impairments to the vestibulocerebellar function (posterior vermis or fastigial nucleus) could be apparently responsible for these abnormal eye movements.
This paper is a preliminary report about a software application for analyzing stabilometry signals, which we developed using Microsoft Excel. Signals from three force plate pressure sensors (Unimec Co. Ltd.) were amplified and stored in a computer by way of an analog to digital (AD) converter. These signals were converted to comma-separated values format with software (Wizard Analyze System) and manually transferred to the Excel worksheets. This software is able to analyze 100Hz or 20Hz sampling data. The analysis consists of two parts. Part I examines Coordinates and mean values of foot pressure center position, Enveloped area, Rectangular area, Root mean square area, Length of sway path during 60 seconds and 1 second, Length of sway path per unit area, Amplitude histogram and skew/kurtosis, Romberg quotient, Velocity vector in 8 directions, Location vector in 8 directions, and Fast Fourier Transform. In clinical stabilometric examination, Part I items are mandated by the health insurance system. Part II examines the Area of 95% confidence ellipse, Velocity chart during 60 seconds, Velocity vector in 8 directions during 15 seconds, Discrete Fourier transformation, Estimation of body movement at the level of the waist using inverse discrete Fourier transformation, Short-time Fourier transformation, Autocorrelation function graph, Cross correlation function graph, Animation of Statokinesiogram, and so on. Part II analysis items were included to better understand the Part I analysis results and to further develop them. Using Microsoft Excel to analyze stabilometry data offers new analyses that could not previously be performed.