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1.
Article de Anglais | WPRIM | ID: wpr-1043291

RÉSUMÉ

Background@#and PurposeThe neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been identified as useful biomarkers for assessing the inflammatory response and for predicting the prognosis of various diseases. This study aimed to determine the clinical significance and effects on prognostic prediction of NLR and PLR in acute unilateral vestibulopathy (AUV). @*Methods@#We retrospectively recruited 128 patients who were diagnosed with AUV from July 2016 to April 2021, and compared NLR and PLR values between these patients with AUV and age- and sex-matched healthy subjects. We also analyzed the correlations of various clinical parameters with NLR and PLR. @*Results@#NLR and PLR in the AUV group were 3.41±2.80 (mean±standard deviation) and 128.86±67.06, respectively, with only NLR being significantly higher than that in the control group (1.55±0.60, p<0.001). The gain asymmetry of the horizontal vestibulo-ocular reflex (VOR) was slightly larger in patients with high NLR (n=52) than in those with normal NLR (n=76) (41.9%±20.2% vs. 33.6%±17.4%, p=0.048). However, the hospitalization period, preceding infection, canal paresis, and absolute horizontal VOR gain did not differ between patients with high and normal NLR and PLR values. The correlation analyses also revealed that none of the clinical parameters were significantly correlated with NLR or PLR. At 3-month follow-up examinations, NLR and PLR did not differ significantly between patients with and without function recovery of the horizontal VOR. @*Conclusions@#This study found a high NLR in AUV, suggesting an acute inflammatory status in the vestibular organ. However, the usefulness of NLR and PLR as prognostic markers remains unclear.

2.
Article de 0 | WPRIM | ID: wpr-833618

RÉSUMÉ

Background@#and PurposeWe aimed to determine the patterns and mechanisms of persistent nystagmus (PN) lasting >1 year in lateral medullary infarction (LMI). @*Methods@#We recruited 13 patients with PN due to LMI and another 13 with transient nystagmus (TN) (<1 year) as control. All patients underwent oculography, rotatory chair test, caloric test, bedside head impulse test, dizziness handicap inventory (DHI), and brain MRI. @*Results@#All patients had spontaneous, contralesional, horizontal-torsional nystagmus during the acute phase. Although two patients exhibited consistent contralesional torsional nystagmus, most patients (11/13, 85%) with PN evolved from the initial contralesional to ipsilesional nystagmus. During horizontal gaze, the patterns of ipsilesional PN were diverse; torsional (n=5), torsional-downbeat (n=2), horizontal (n=2), and horizontal nystagmus while looking at the lesion side, and torsional nystagmus while looking at the opposite side (n=2). During rotatory chair test, the gains of the vestibulo-ocular reflex in the PN group were lower than those in the TN group to the lesion side at 0.02 and 0.64 Hz. The caudal and ventrolateral parts of the vestibular nuclei were mostly involved in patients with PN. The DHI score did not differ between the groups. @*Conclusions@#PN patterns frequently change in LMI. Resultant vestibular asymmetry after vestibular afferents or cerebellar inhibitory pathway damage and/or inappropriate vestibular compensation may be responsible for PN in LMI. Impairment of the horizontal or vertical neural integrators may be another cause. The presence of PN does not necessarily indicate more severe dizziness in LMI.

3.
Article de Coréen | WPRIM | ID: wpr-761302

RÉSUMÉ

OBJECTIVES: Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulopathy, we analyzed the questionnaires and functional status before and after treatment. METHODS: Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck's depression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular rehabilitation. RESULTS: The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment. CONCLUSIONS: Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual peculiarities is the most important for vestibular rehabilitation.


Sujet(s)
Humains , Mâle , Activités de la vie quotidienne , Compliance , Obscurité , Dépression , Sensation vertigineuse , Exercice physique , Démarche , Projets pilotes , Posture , Réadaptation , Études rétrospectives , Acuité visuelle , Marche à pied
6.
Article de Coréen | WPRIM | ID: wpr-761229

RÉSUMÉ

Scrub typhus is an infective acute febrile disorder caused by the intracellular parasite Orientia tsutsugamushi. Neurological manifestations of scrub typhus are meningoencephalitis, cerebellitis, transverse myelitis, papilledema, and cranial nerve palsy. However, opsoclonus-myoclonus syndrome associated with scrub typhus has been rarely reported. A 59-year-old man developed vertigo, nausea, vomiting, and imbalance following scrub typhus infection for eight days. Examination showed eschar at the axilla, decreased mentality, and opsoclonus-myoclonus syndrome. Video-oculography disclosed opsoclonus with an amplitude of 15°–20° and a frequency of 6–8 Hz. The serum antibody titers to Orientia tsutsugamushi were 1:5,120, and cerebrospinal fluid analysis revealed pleocytosis. Brain magnetic resonance imaging was normal. Neurological symptoms and signs completely improved by systemic steroid and antibiotics treatment. Various mechanisms including direct disseminating inflammation or indirect immune modulation may give rise to neurological complications following scrub typhus.


Sujet(s)
Humains , Adulte d'âge moyen , Antibactériens , Aisselle , Encéphale , Liquide cérébrospinal , Atteintes des nerfs crâniens , Encéphalite , Inflammation , Hyperleucocytose , Imagerie par résonance magnétique , Méningoencéphalite , Myélite transverse , Nausée , Manifestations neurologiques , Troubles de la motilité oculaire , Syndrome opsomyoclonique , Orientia tsutsugamushi , Oedème papillaire , Parasites , Fièvre fluviale du Japon , Vertige , Vomissement
7.
Article de Anglais | WPRIM | ID: wpr-180369

RÉSUMÉ

Episodic ataxia (EA) is a clinically heterogeneous group of disorders that are characterized by recurrent spells of truncal ataxia and incoordination lasting minutes to hours. Most have an autosomal dominant inheritance pattern. To date, 8 subtypes have been defined according to clinical and genetic characteristics, and five genes are known to be linked to EAs. Both EA1 and EA2, which are caused by mutations in KCNA1 and CACNA1A, account for the majority of EA, but many patients with no identified mutations still exhibit EA-like clinical features. Furthermore, genetically confirmed EAs have mostly been identified in Caucasian families. In this article, we review the current knowledge on the clinical and genetic characteristics of EAs. Additionally, we summarize the phenotypic features of the genetically confirmed EA2 families in Korea.


Sujet(s)
Humains , Ataxie , Modes de transmission héréditaire , Corée
8.
Article de Coréen | WPRIM | ID: wpr-761164

RÉSUMÉ

Cogan's syndrome is a rare chronic inflammatory disease Characterized by non-syphilitic keratitis and vestibuloauditory dysfunction. Although the precise pathogenesis of Cogan's syndrome is unknown, it is thought to develop from vasculitis involving multiple organ system. It can be accompanied with various systemic diseases including arthritis, lymphadenopathy, splenomegaly, and aortitis with insufficiency. We report a case of typical Cogan's syndrome with multiple cerebral infarctions.


Sujet(s)
Aortite , Arthrite , Infarctus cérébral , Syndrome de Cogan , Kératite , Maladies lymphatiques , Splénomégalie , Vascularite
9.
Article de Anglais | WPRIM | ID: wpr-53244

RÉSUMÉ

BACKGROUND: Patients who develop horizontal and vertical saccadic palsy after cardiac surgery have rarely been described. Although most such patients exhibit distinct neurological deficits, their brain MRI findings are almost normal. In addition, functional neuroimaging of such patients has never been reported. CASE REPORT: A 43-year-old woman with dysarthria, dysphagia, and horizontal and vertical saccadic palsy after cardiac surgery was followed up for about 6 years; serial brain MRIs has been performed during this period, including susceptibility-weighted imaging (SWI) and [18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). Multiple microbleeds in the cerebral cortex, cerebellum, and brainstem, and glucose hypometabolism in the brainstem, cerebellum, and multiple cortical areas. CONCLUSIONS: To the best of our knowledge, this is the first reported case of saccadic palsy after cardiac surgery with serial SWI and [18F]-FDG-PET performed to explore the possible cerebral lesions.


Sujet(s)
Adulte , Femelle , Humains , Encéphale , Tronc cérébral , Cervelet , Cortex cérébral , Troubles de la déglutition , Dysarthrie , Études de suivi , Neuroimagerie fonctionnelle , Glucose , Imagerie par résonance magnétique , Neuroimagerie , Paralysie , Tomographie par émission de positons , Saccades , Chirurgie thoracique
10.
Article de Coréen | WPRIM | ID: wpr-761130

RÉSUMÉ

Body lateropulsion is a common manifestation of lateral medullary infarction (LMI), and usually associated with vertigo, limb ataxia, sensory disturbance, and Horner's syndrome. However, isolated body lateropulsion as a presenting symptom of LMI is rare, and the responsible lesion for lateropulsion remains uncertain. We report a 71-year-old woman who showed isolated body lateropulsion as a presenting symptom of LMI. Ipsilateral body lateropulsion in our patient may be ascribed to the involvement of the ascending dorsal spinocerebellar tract rather than the descending lateral vestibulospinal tract, which runs more ventromedially.


Sujet(s)
Femelle , Humains , Ataxie , Syndrome de Claude Bernard-Horner , Infarctus , Tractus spinocérébelleux , Vertige
11.
Article de Anglais | WPRIM | ID: wpr-761137

RÉSUMÉ

Vestibular schwannoma (VS) are benign neoplasms that arise from Schwann cells of the eighth cranial nerve. Although progressive unilateral hearing loss with dizziness or disequilibrium provides a high suspicion index of VS, vertigo is the symptom causing the most pronounced negative effect on quality of life in patients with VS. We report a 55-year-old woman with recurrent paroxysmal vertigo and hyperventilation-induced nystagmus due to VS, which improved by oxcarbazepine treatment. We suggest that episodic vertigo in VS may be ascribed to the ectopic paroxysmal neuronal discharge from the partially demyelinated vestibular nerve due to tumor compression.


Sujet(s)
Femelle , Humains , Carbamazépine , Sensation vertigineuse , Perte auditive unilatérale , Neurinome de l'acoustique , Neurones , Qualité de vie , Cellules de Schwann , Vertige , Nerf vestibulaire , Nerf vestibulocochléaire
12.
Article de Coréen | WPRIM | ID: wpr-50539

RÉSUMÉ

Saccades are rapid eye movements that shift the line of sight between successive points of fixation. The cerebellum calibrates saccadic amplitude (dorsal vermis and fastigial nucleus) and the saccadic pulse-step match (flocculus) for optimal visuo-ocular motor behavior. Based on electrophysiology and the pharmacological inactivation studies, early activity in one fastigial nucleus could be important for accelerating the eyes at the beginning of a saccade, and the later activity in the other fastigial nucleus could be critical for stopping the eye on target, which is controlled by inhibitory projection from the dorsal vermis. The cerebellum could monitor a corollary discharge of the saccadic command and terminate the eye movement when it is calculated to be on target. The fastigial nucleus and dorsal vermis also participate in the adaptive control of saccadic accuracy.


Sujet(s)
Cervelet , Électrophysiologie , Mouvements oculaires , Saccades , Sommeil paradoxal
13.
Article de Coréen | WPRIM | ID: wpr-211786

RÉSUMÉ

Moyamoya disease is a cerebrovascular disorder characterized by progressive stenosis of the distal internal carotid arteries, and in rare cases can occur in association with optic disc coloboma. We describe a 31-year-old man with transient left-sided weakness caused by steno-occlusion of the bilateral internal carotid arteries. A fundoscopic examination revealed a coloboma involving the optic disc of the right eye. Clinicians should be aware of the possibility of moyamoya disease in patients with optic disc coloboma, even when other classic symptoms of this disease are absent.


Sujet(s)
Adulte , Humains , Artère carotide interne , Angiopathies intracrâniennes , Colobome , Sténose pathologique , Oeil , Maladie de Moya-Moya
14.
Article de Coréen | WPRIM | ID: wpr-761077

RÉSUMÉ

Congenital inner ear malformations are frequently found in patients with sensorineural hearing loss, but isolated vestibular anomalies with normal cochlear development have been rarely reported. We report a 20-year-old man with recurrent dizziness and disequlibrium without hearing impairment. Neuro-otological evaluations showed a left peripheral vestibulopathy with normal hearing function. Three dimensional volume rendering image using magnetic resonance constructive interference in steady state sequence demonstrated isolated vestibular anomalies involving bilateral horizontal semicircular canals. Isolated vestibular anomalies might not be as rare as previously thought among patients with recurrent dizziness, and should be carefully evaluated through various imaging techniques.


Sujet(s)
Humains , Jeune adulte , Sensation vertigineuse , Oreille interne , Ouïe , Perte d'audition , Surdité neurosensorielle , Spectroscopie par résonance magnétique , Canaux semicirculaires osseux
15.
Article de Coréen | WPRIM | ID: wpr-30459

RÉSUMÉ

PURPOSE: To describe the clinical characteristics and endovascular management outcomes of Dural carotid cavernous sinus fistula (Dural CCF). METHODS: Ocular symptoms, signs, and complications of 15 eyes from 14 patients confirmed with Dural CCF by angiography were examined. The medical records of patients who underwent endovascular management were analyzed retrospectively. RESULTS: The mean age of the patients was 50.6 +/- 14.2 years; 4 were men and 10 were women. The eye consisted of 7 right eyes and 8 left eyes. Two eyes were of hypertension patients. The chief clinical symptoms on the first visit were diplopia, injection, ocular pain, proptosis, ptosis, and tinnitus. On cerebral angiography, Barrow Type D was the most common consisting of 12 cases (80%). Endovascular embolization was performed in 13 eyes and the average number of times received was 1. Signs and symptoms improved over a mean of 4.5 months of clinical follow-up in 12 eyes. There were no ocular complications related to endovascular embolization. CONCLUSIONS: Dural CCF should be suspected in a middle-aged woman with injection or diplopia. Endovascular embolization is considered minimally invasive and highly successful for the treatment of Dural CCF.


Sujet(s)
Femelle , Humains , Mâle , Angiographie , Fistule carotidocaverneuse , Grottes , Angiographie cérébrale , Diplopie , Exophtalmie , Oeil , Fistule , Études de suivi , Hypertension artérielle , Dossiers médicaux , Acouphène
16.
Article de Coréen | WPRIM | ID: wpr-188690

RÉSUMÉ

A 24-year-old woman presented with headache and left-sided tinnitus. Evaluations demonstrated left sensorineural hearing loss and cerebral venous thrombosis (CVT) with normal intracranial pressure. Unilateral hearing loss has rarely been reported in patients with CVT. It is thought that the unilateral hearing loss in this case was caused by impaired drainage of the cochlear veins into the lateral sinus.


Sujet(s)
Femelle , Humains , Jeune adulte , Drainage , Céphalée , Perte d'audition , Surdité neurosensorielle , Perte auditive unilatérale , Pression intracrânienne , Acouphène , Sinus transverses , Veines , Thrombose veineuse
17.
Article de Coréen | WPRIM | ID: wpr-761017

RÉSUMÉ

No abstract available.


Sujet(s)
Vertige
18.
Article de Coréen | WPRIM | ID: wpr-201449

RÉSUMÉ

A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage.


Sujet(s)
Adulte , Femelle , Humains , Anévrysme , Artères , Diplopie , Oedème , Hémorragie , Cou , Examen neurologique , Troubles de la motilité oculaire , Hémorragie meningée
19.
Article de Coréen | WPRIM | ID: wpr-113738

RÉSUMÉ

Spontaneous carotid artery dissection is an important cause of ischemic stroke in young patients. There are some genetic or environmental factors associated with risks for spontaneous arterial dissection. Although thyroid hormone may affect the vascular system, the predisposition for arterial dissection remains unknown in thyrotoxicosis. We present a patient with uncontrolled Graves' disease, who developed bilateral internal carotid artery dissections.


Sujet(s)
Humains , Artères carotides , Artère carotide interne , Maladie de Basedow , Accident vasculaire cérébral , Glande thyroide , Thyréotoxicose
20.
Article de Coréen | WPRIM | ID: wpr-23314

RÉSUMÉ

Vestibular neuritis is the second most common cause of peripheral vestibular vertigo. The key signs and symptoms are the acute onset of sustained rotatory vertigo without hearing loss, postural imbalance with Romberg's sign, and peripheral type nystagmus. Head thrust and caloric tests show ipsilateral hyporesponsiveness, but hearing test shows normal. Either an inflammation of the vestibular nerve or labyrinthine ischemia was proposed as a cause of vestibular neuritis. Recovery after vestibular neuritis is usually incomplete. Despite the assumed viral cause, the effects of corticosteroids, antiviral agents, or the two in combination are uncertain. Bilateral vestibulopathy is a rare disorder of the peripheral labyrinth or the eighth nerve. The most frequent etiologies include ototoxicity, autoimmune disorders, meningitis, neuropathies, sequential vestibular neuritis, cerebellar degeneration, tumors, and miscellaneous otological diseases. The two key symptoms are unsteadiness of gait and oscillopsia associated with head movements or when walking. The diagnosis is made with the simple bedside tests for defective vestibulo-ocular reflex (head thrust and dynamic visual acuity tests). Bilateral vestibulopathy is confirmed by the absence of nystagmus reaction to both caloric and rotatory chair tests. The spontaneous recovery is relatively rare and incomplete. Vestibular rehabilitation is supportive of the improvement, but the efficacy of physical therapy is limited.


Sujet(s)
Hormones corticosurrénaliennes , Antiviraux , Épreuves vestibulaires caloriques , Maladies des oreilles , Oreille interne , Démarche , Tête , Mouvements de la tête , Perte d'audition , Tests auditifs , Inflammation , Ischémie , Méningite , Réflexe vestibulo-oculaire , Vertige , Nerf vestibulaire , Névrite vestibulaire , Acuité visuelle , Marche à pied
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