Vestibular primary afferent projection to the cerebellum of the rabbit.

The vestibular primary afferent projection to the cerebellum of the rabbit was studied with retrograde and orthograde tracers. We injected individual lobules of the cerebellum with horseradish peroxidase (HRP) or wheat germ agglutinin-HRP (WGA-HRP). Following these injections the numbers of labeled and unlabeled cells in Scarpa's ganglion were counted. Approximately 64-89% of the cells in Scarpa's ganglion were labeled retrogradely following uvula-nodular injections. About 2% of the cells in the ipsilateral Scarpa's ganglion were labeled after injections of the flocculus. Virtually no cells were labeled following injections of the ventral paraflocculus. The vestibular primary afferent projection to the uvula-nodulus is so extensive that it must be part of a collateral system that also innervates the vestibular nuclei. This collateral projection pattern was confirmed by using fluorescent tracers injected into the uvula-nodulus and vestibular complex. Fluorogold was injected into the uvula-nodulus and peroxidase-rhodamine isothiocyanate was injected into the vestibular complex. More than 50% of the neurons in Scarpa's ganglion were double labeled by these subtotal injections. The dense vestibular primary afferent projection to the uvula-nodulus was confirmed by using the C fragment of tetanus toxin (TTC) injected into the labyrinth as an orthograde tracer. With the TTC technique, the vestibular primary afferent projection to the uvula-nodulus terminated exclusively in the ipsilateral granule cell layer of lobules 9d and 10. Much sparser vestibular primary afferent projections were found in the banks of major cerebellar sulci. A barely detectable projection was found to the flocculus and ventral paraflocculus.

Secondary vestibular cholinergic projection to the cerebellum of rabbit and rat as revealed by choline acetyltransferase immunohistochemistry, retrograde and orthograde tracers.

Previously we have shown that four regions of the cerebellum, the uvula-nodulus, flocculus, ventral paraflocculus, and anterior lobe 1, receive extensive, but not exclusive, cholinergic mossy fiber projections. In the present experiment we have studied the origin of three of these projections in the rat and rabbit (uvula-nodulus, flocculus, ventral paraflocculus), using choline acetyltransferase (ChAT) immunohistochemistry in combination with a double label, retrogradely transported horseradish peroxidase (HRP). We have demonstrated that in both the rat and rabbit the caudal medial vestibular nucleus (MVN) and to a lesser extent the nucleus prepositus hypoglossus (NPH) contain ChAT-positive neurons. Neurons of the caudal MVN are double-labeled following HRP injections into the uvula-nodulus. HRP injections into the uvula-nodulus also labeled less than 5% of the neurons in the cholinergic vestibular efferent complex. Fewer ChAT-positive neurons in the MVN and some ChAT-positive neurons in the NPH are double-labeled following HRP injections into the flocculus. Almost no ChAT-positive neurons in the MVN and some ChAT-positive neurons in the NPH are double-labeled following HRP injections into the ventral paraflocculus. Injections of Phaseolus leucoagglutinin (PHA-L) into the caudal MVN of both the rat and rabbit demonstrated projection patterns to the uvula-nodulus and flocculus that were qualitatively similar to those observed using ChAT immunohistochemistry. We conclude that the cholinergic mossy fiber pathway to the cerebellum in general and the uvula-nodulus in particular is likely to mediate secondary vestibular information related to postural adjustments.

Vestibularly induced slow oscillations in climbing fiber responses of Purkinje cells in the cerebellar nodulus of the rabbit.

In this report we describe an interesting form of plasticity in climbing fiber responses evoked in Purkinje cells of the rabbit cerebellum by periodic vestibular stimulation. The cerebellar nodulus receives a vestibular as well as a visual climbing fiber afferent input from the contralateral inferior olive. The vestibular input to the inferior olive originates from the ipsilateral medial and descending vestibular nuclei and terminates within the beta-nucleus. This projection to the beta-nucleus from secondary vestibular neurons is GABAergic. This means that vestibularly evoked activity of neurons in the beta-nucleus is controlled by modulation of an inhibitory input, rather than by modification of an excitatory input. We have recorded the climbing fiber responses of single Purkinje cells in the uvula-nodulus (lobules 9c, 9d and 10) of rabbits and we have characterized the climbing fiber response of each Purkinje cell from which we recorded by testing its sensitivity to otolithic stimulation, semicircular canal stimulation and optokinetic stimulation. Vestibularly evoked climbing fiber responses recorded from the left nodulus were stationary. They were repeatedly evoked, for tens of minutes, by sinusoidally rotating the rabbit about the longitudinal axis onto its left side (Fig. 1B). When the vestibular stimulus was stopped the discharge of these climbing fiber responses returned to non-periodic spontaneous levels. However, the vestibularly evoked climbing fiber discharge of approximately 5% of Purkinje cells was not stationary.(ABSTRACT TRUNCATED AT 250 WORDS)

Topographical distribution of Purkinje cells in the uvula and the nodulus projecting to the vestibular nuclei in cats.

The localization of the Purkinje cells in the uvula and nodulus projecting to the vestibular nuclei and the prepositus hypoglossal nucleus (PH) was studied by means of retrograde axonal transport of horseradish peroxidase in cats. Findings indicate a zonal organization in the uvula and nodulus projecting to the vestibular nuclei as follows; the Purkinje cells located in the medial half of the uvula except for the area along the posterolateral fissure project to the middle part of the inferior vestibular nucleus (IV) (middle IV zone); those in the lateral half of the uvula other than the laterocaudal part project to the caudal part of the IV (caudal IV zone); those in the mediorostral part of the nodulus and the middle part of the nodulus project to the middle part of the medial vestibular nucleus (MV) (middle MV zone); those in the lateral part of the nodulus project to the caudal part of the MV (caudal MV zone); those in the medial part of the uvula and nodulus along the posterolateral fissure project to the dorsal peripheral part of the superior vestibular nucleus (SV) (SV zone). There is no specific projection zone in the uvula and nodulus projecting to the lateral vestibular nucleus, the ventral peripheral and the central part of the SV, the rostral part of the MV, the rostral part and the caudal pole of the IV, the caudal one-third of the group f, the group x and the PH.

Neuronal pathway from floccular caudal zone contributing to vertical eye movements in cats--role of group y nucleus of vestibular nuclei.

In ketamine-anesthetized cats, electric microstimulation of the group y nucleus of the vestibular nuclei evoked a slow and smooth upward eye movement. Destruction of the group y nucleus eliminated a slow and smooth downward eye movement evoked by stimulation of the caudal zone of the flocculus. These data support the interpretation that Purkinje cell activity in the caudal zone of the flocculus can evoke vertical eye movements by inhibiting the activity of neurons of the group y nucleus.

Vestibular and visual signals in the ventral paraflocculus of the cerebellum in rabbits.

Extracellular microelectrode recordings from single cerebellar neurons were made in the ventral paraflocculus of anesthetized, paralyzed pigmented rabbits during vestibular and visual stimulation. The discharge of 6 out of 207 neurons was modulated during vestibular or visual stimulation. The activity of 5 neurons was modulated during vertical vestibular stimulation. The discharge of only one neuron was modulated exclusively during vertical optokinetic stimulation. The information from both the vestibular and visual systems which is received by the ventral paraflocculus appears to differ from that which is received by the flocculus in rabbits.

Cerebral autoregulation in patients with orthostatic hypotension.

The present study was conducted to determine the relationship between autonomic nervous function and cerebral autoregulation in 17 patients with vertigo or dizziness. Autonomic nervous function was examined by measuring systolic blood pressure response and dynamic electrocardiogram R-peak to R-peak response upon standing up. Regional cerebral autoregulation was examined by comparing cerebral blood flow in both supine and standing positions with single photon emission computed tomography. Moreover, the relationship of each of these three measures to postural provocation of symptoms was studied. The findings indicated that autonomic nervous dysfunction does not influence cerebral autoregulation, but autonomic nervous dysfunction was related to postural provocation of symptoms. This might indicate that impaired autoregulation in the brain stem or the peripheral vestibule, which could not be detected by the single photon emission computed tomography, played a role in inducing vertigo or dizziness in patients with orthostatic hypotension.

MR sialographic evaluation of sialectasia of Stensen's duct: comparison with X-ray sialography and ultrasonography.

We describe a patient with unilateral sialectasia of Stensen's duct. X-ray sialography, MR sialography, and ultrasonography showed multiple stenoses and rosary dilatation of Stensen's duct during stimulation of the parotid gland. Before stimulation, Stensen's duct showed focal dilatation as indicated by MR sialography and ultrasonography. The patient also had ipsilateral masseter hypertrophy (BMH), which may be a cause of sialectasia.

Use of MR angiography in a pregnant patient with thalamic AVM.

A 32-year-old pregnant woman at 29 gestational weeks suffered from the acute onset of severe headache. Brain CT, MRI, and MR angiography (MRA) showed intraventricular and thalamic hemorrhage, ruptured from a thalamic AVM. Based on these findings, conservative treatment was continued until delivery. After cesarean delivery at 34 gestational weeks, conventional cerebral angiography was performed, followed later by gamma-knife therapy. In pregnant patients with suspected cerebrovascular disorders, MRI and MRA should be the first of choice method to evaluate information on the diseased vessels and associated lesions since there is no radiation risk or side effects of contrast medium.

Malignant gastrointestinal stromal tumor of the small intestine: radiologic-pathologic correlation.

Neoplasms of the small intestine are very rare. Gastrointestinal stromal tumors (GISTs) are one of the new undifferentiated stromal tumors of the gastrointestinal tract diagnosed by immunohistochemistry. We present a case of a malignant GIST arising from the small intestine and report the radiologic characteristics of the tumor and pathological correlation. CT showed a very large, enhancing mass with extensive central necrosis located on the mesenteric side of the jejunum. A perforation into the jejunal lumen was observed by upper GI series. MRI showed a very large tumor which was hypointense on T2-weighted images. Ultrasound revealed a mixed solid and cystic mass. Grossly, the tumor was solid peripherally with extensive central necrosis. Microscopically, it consisted of spindle and epithelioid cells. Immunohistochemically, the cells stained positive for CD34, which is diagnostic of GIST.

Clinical study of elderly patients with Meniere's and related diseases.

In order to study the characteristics of elderly patients (70 or over at onset) with endolymphatic hydrops disorders, we selected six patients with Meniere's disease (MD), five patients with delayed endolymphatic hydrops (DEH), and two patients with syphilis of the labyrinth (SL) from 7112 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital during 1979-1998. Clinical features were characterized as follows: (1) Since 1990, the proportion of elderly patients increased as lifespans lengthened. (2) A narrow fluctuation in hearing, low positive rate on glycerol test, high positive rate of dominant-SP in EcochG, and the moderate abnormal rate of the oculomotor system tests were found. (3) The prognosis was relatively good. From these neurotological observations, it could be concluded that elderly patients with endolymphatic hydrops disorders were characterized by the multipathological finding of the endolymphatic hydrops and the complications of CNS disorders.

Visual otolith-ocular reflex in normal subjects. A preliminary report.

The influence of the otolith-ocular reflex (OOR) induced by the linear (along Y-axis) acceleration was evaluated 12 healthy subjects. The elicited maximum eye velocity (MV) was comparatively analyzed under three stimulus conditions; (1) sinusoidal linear acceleration with eyes covered, (2) sinusoidal optokinetic stimulus and (3) sinusoidal linear acceleration with eyes open (visual-vestibular interaction). By the linear acceleration level of 78 cm2, i.e. 0.08 G, the MV of the optokinetic response (OKR) showed no change in spite of the existence of the OOR.

Pre-operative embolisation of the thyroid artery in a patient with a large papillary carcinoma of the thyroid.

OBJECTIVE: To demonstrate the usefulness of pre-operative selective embolisation of the thyroid arteries in an unusual case with a large, vascular thyroid tumour. CASE REPORT: A 29-year-old man presented with a large papillary carcinoma of the thyroid (weighing approximately 300 g on palpation) with extension to the mediastinum and compression of the trachea. A computed tomography scan of the neck and thorax revealed a large tumour the solid part of which was enhanced after contrast medium application, indicating a substantial vascular supply. Pre-operative selective embolisation of both superior thyroid arteries and one inferior thyroid artery, using gelatin sponge particles, was performed 4 days before surgery, under conventional angiography. After selective embolisation of these thyroid arteries, the patient experienced mild anterior neck pain and mild fever. This procedure allowed a significant reduction in blood perfusion to the tumour, which facilitated its surgical removal without blood transfusion. CONCLUSION: Pre-operative selective embolisation of both superior thyroid arteries and one inferior thyroid artery may be an effective, minimally invasive procedure for patients with a large, vascular thyroid tumour.

The prevalence of definite cases of Menière's disease in the Hida and Nishikubiki districts of central Japan: a survey of relatively isolated areas of medical care.

In order to evaluate the prevalence of definite cases of Menière's disease (MD), we performed a 1-year survey in 1994 of patients in the Hida and Nishikubiki districts, where a majority of the patients are thought to seek treatment at the medical facilities within these areas for geographical reasons. As a result of the cooperation of all ENT departments of the general hospitals and ENT clinics (general practitioners) in these districts, 67 patients were diagnosed as definite cases of MD according to the diagnostic criteria proposed by The Menière's Disease Research Committee of Japan. Annual prevalence was estimated at 36.6 per 100,000 population in the Hida district and at 21.4 per 100,000 population in the Nishikubiki district, which is higher than those reported in previous Japanese surveys.

Vestibular and visual climbing fiber signals evoked in the uvula-nodulus of the rabbit cerebellum by natural stimulation.

1. The cerebellar uvula-nodulus receives vestibular projections from primary and secondary vestibular afferents as well as vestibularly related climbing fibers. It also receives visually related information from climbing fiber pathways. In this experiment we investigated how this information is mapped onto the uvula-nodulus. We studied the specificity, dynamics, and topographic distribution of climbing fiber responses (CFRs), simple spike responses, and mossy fiber terminal responses evoked by vestibular and optokinetic stimulation in rabbits anesthetized with alpha-chloralose. 2. Vestibularly evoked CFRs were found in the ventral uvula and nodulus. These responses were evoked during static roll tilt of the rabbit about a longitudinal axis and by sinusoidal oscillation about the longitudinal axis. Purely static responses were attributed to stimulation of the utricular otolith by the linear acceleration of gravity. CFRs that lacked a static component were attributed to activation of the semicircular canals. 3. Using a "null technique" we showed that the canal-sensitive CFRs were caused by stimulation of the anterior or posterior semicircular canals. Of the CFRs classified as canal related, 96% could be attributed to stimulation of the vertical semicircular canals. 4. Increases in CFRs were correlated with decreases in simple spike responses in half the Purkinje cells from which we recorded. These climbing-fiber-induced pauses in simple spikes occurred during spontaneous climbing fiber discharge as well as during climbing fiber discharge evoked by vestibular stimulation. The duration of this pause was inversely proportional to the spontaneous level of simple spikes before the occurrence of a CFR. In the other half of the recorded population of Purkinje cells, vestibularly driven CFRs did not alter the simple spike responses. 5. Vestibularly and visually mediated CFRs were topographically represented on the surface of the uvula-nodulus. CFRs driven by ipsilateral otolithic inputs were distributed over the entire mediolateral surface of the uvula-nodulus. CFRs driven by the ipsilateral posterior semicircular canal were distributed in a sagittal strip approximately 1.5 mm wide, extending laterally from the midline of the nodulus. CFRs driven exclusively by horizontal, posterior-->anterior optokinetic stimulation of the ipsilateral eye were distributed in a sagittal strip approximately 0.5 mm wide located 0.5-1.0 mm from the midline and restricted to the ventral nodulus. CFRs driven by the ipsilateral anterior semicircular canal were found in a sagittal strip approximately 1.0 mm wide extending 1.0-2.0 mm from the midline. 6. The sagittal, topographically arrayed climbing fiber strips effectively map a mediolateral gradient of possible postural responses based on vestibular and optokinetic information.

Facial nerve palsy as a complication of parotid gland surgery and its prevention.

The incidence of postoperative facial palsy in 73 patients who had under-gone surgery for parotid gland tumor is reported. Slight facial palsy occurred in 9 (14%) of 66 benign tumors but recovered completely within 3 months following surgery. However, in 7 patients with malignant tumors, 3 (43%) developed permanent palsy and 1 (14%) temporary palsy. The incidence of benign tumors depends on the tumor size and localization. However, the incidence decreased considerably in the last 6 years compared to the first 6 years. This is considered to be due to routine use of computed tomography with sialography and microsurgery during parotidectomy.

Optokinetic nystagmus elicited by a random dot pattern and a wide interval stripe pattern in normal subjects.

In optokinetic stimulus in practical living conditions, not only the central fovea but also the peripheral retina are strongly stimulated. In order to investigate the influence of this stimulus on the peripheral retina in optokinetic nystagmus (OKN), we tested OKN elicited by a pattern of numerous random dots (ROKN) in 30 normal subjects and compared the results with those of OKN elicited by a wide interval stripe pattern. The most significant difference between the two response patterns was the correlation between slow phase velocity and slow and fast phase amplitude. In ROKN, the nystagmus amplitude was highly correlated with slow phase velocity. On the other hand, in SOKN there were two types of correlation between slow phase velocity and nystagmus amplitude. One indicated low correlation, which was extremely predominant, and the other, high correlation as in ROKN. This tendency was more marked in the fast phase amplitude. Although it is generally accepted that OKN fast phase in SOKN is controlled by voluntary saccade, our results indicate that ROKN is more strongly controlled by reflective resetting eye movements, which is similar to the nystagmus fast phase in vestibular nystagmus.

Influence of vestibular and visual climbing fiber signals on Purkinje cell discharge in the cerebellar nodulus of the rabbit.

Extracellular recordings of the climbing fiber responses (CFRs) of single Purkinje cells were made in the cerebellar nodulus and ventral uvula of anesthetized pigmented rabbits. Natural vestibular and optokinetic stimuli were used to evoke responses from these Purkinje cells. Using a null response technique we sorted vestibularly-evoked CFRs into two canal-related categories. CFRs were related to either the ipsilateral anterior and contralateral posterior semicircular canal (iAC+cPC) or to the ipsilateral posterior and contralateral anterior semicircular canal (iPC+cAC). Both canal-related CFRs also responded to downward optokinetic stimulation.

Clinical usefulness of glycerol vestibular-evoked myogenic potentials: preliminary report.

The detection of intense sound-induced vestibular-evoked myogenic potentials (VEMPs) on the sternocleidomastoid muscle comprises the basis of the saccular function test. In order to evaluate the endolymphatic hydrops (EH) of the saccule of the inner ear, a glycerol VEMP (GVEMP) test was performed in 15 patients with unilateral typical Ménière's disease (UMD) and 7 with delayed endolymphatic hydrops (DEH). Using the GVEMP test, 8 of the 15 patients (53%) with UMD were evaluated as being abnormal. In addition, a greater number of patients (67%) were judged to be abnormal when the results of the GVEMP test were combined with those from a glycerol dehydration test, trans-tympanic electrocochleography (ECochG) or furosemide vestibulo-ocular reflex test (FVOR). Four of the 7 patients with DEH (57%) showed abnormal results in the GVEMP test. In particular, in patients with the ipsilateral type of DEH, only the GVEMP test was able to detect the affected side. These findings suggest that the GVEMP test is a new and useful test for EH, and that a test battery comprising the GVEMP test together with one of the other three tests is useful for diagnosing EH of the inner ear.