Alexander's Law Revisited

2008 ◽  
Vol 19 (08) ◽  
pp. 630-638 ◽  
Author(s):  
Gary P. Jacobson ◽  
Devin L. McCaslin ◽  
David M. Kaylie
Keyword(s):  
Eye Movement ◽  
Vestibular System ◽  
Case Reports ◽  
Spontaneous Nystagmus ◽  
Ocular Motility ◽  
Vestibular Evoked Myogenic Potential ◽  
Data Collection And Analysis ◽  
Alexander’S Law ◽  
Neuro Imaging ◽  
Case Data

Background: It is a common occurrence in the balance function laboratory to evaluate patients in the post-acute period following unilateral vestibular system impairment. It is important to be able to differentiate spontaneous nystagmus (SN) emanating from peripheral vestibular system impairments from asymmetric gaze-evoked nystagmus (GEN) that originates from central ocular motility impairment. Purpose: To describe the three elements of Alexander's Law (AL) that have been used to define SN from unilateral peripheral impairment. Additionally, a fourth element is described (i.e., augmentation of spontaneous nystagmus from unilateral peripheral vestibular system impairment) that differentiates nystagmus of peripheral vestibular system origin from nystagmus that originates from a central eye movement disorder. Research Design: Case reports Study Sample: Case data were obtained from two patients both showing a nystagmus that followed AL. Intervention: None Data Collection And Analysis: Videonystagmography (VNG), rotational, vestibular evoked myogenic potential (VEMP), and neuro-imaging studies were presented for each patient. Results: The nystagmus in Case 1 occurred as a result of a unilateral, peripheral, vestibular system impairment. The nystagmus was direction-fixed and intensified in the vision-denied condition. The nystagmus in Case 2, by appearance identical to that in Case 1, was an asymmetric gaze-evoked nystagmus originating from a space-occupying lesion in the cerebello-pontine angle. Unlike Case 1, the nystagmus did not augment in the vision-denied condition. Conclusions: Although nystagmus following AL usually occurs in acute peripheral vestibular system impairment, it can occur in cases of central eye movement impairment. The key element is whether the SN that follows AL is attenuated or augmented in the vision-denied condition. The SN from a unilateral peripheral vestibular system impairment should augment in the vision denied condition. An asymmetric GEN will either not augment, decrease in magnitude, or disappear entirely, in the vision-denied condition.

Periodic Alternating Nystagmus

1988 ◽  
Vol 99 (6) ◽  
pp. 552-557 ◽  
Author(s):  
Joseph R. Dibartolomeo ◽  
Robert D. Yee
Keyword(s):  
Opposite Direction ◽  
Vestibular System ◽  
Case Reports ◽  
Specific Pattern ◽  
Recent Case ◽  
Spontaneous Nystagmus ◽  
Cerebellar Disease ◽  
Similar Length ◽  
Loss Of Vision ◽  
Primary Direction

Horizontal jerk nystagmus is indicative of a disorder involving the vestibular system. Periodic alternating nystagmus is a form of spontaneous nystagmus with a specific pattern. It is identified by the presence of spontaneous nystagmus in the primary direction of gaze, which beats in one direction for 1 or 2 minutes, followed by a null period, and then reappearance of the nystagmus in the opposite direction for a similar length of time. It may be congenital or acquired, and may be seen in association with vestibular-cerebellar disease or loss of vision. Recent case reports indicate that some forms of periodic alternating nystagmus may respond favorably to baclofen therapy.

scholarly journals Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Andreas Rembert Koczulla ◽  
Antje Stegemann ◽  
Rainer Gloeckl ◽  
Sandra Winterkamp ◽  
Bernd Sczepanski ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Eye Movement ◽  
Case Reports ◽  
White Male ◽  
Chronic Fatigue ◽  
White Female ◽  
Rapid Eye Movement ◽  
Pressure Therapy ◽  
Fatigue Syndrome ◽  
Case Presentations

Abstract Background Coronavirus disease 2019 has become a health problem spreading worldwide with pandemic characteristics since March 2020. Post coronavirus disease 2019 symptoms are more frequent than initially expected, with fatigue as an often-mentioned issue. Case presentations We describe a 32-year-old white male and a 55-year-old white female who suffered from post coronavirus disease 2019 fatigue syndrome. On polysomnography, rapid eye movement associated sleep apnea with an increased hypopnea index during rapid eye movement phases of 36.8 and 19.5 events per hour was found. Based on the patients’ burdensome fatigue symptoms, we initiated automatic positive airway pressure therapy, which diminished sleep apnea (rapid eye movement index: 0.0 in both patients) and, consequently, also the fatigue symptoms. Conclusions Since sleep apnea and coronavirus disease 2019 are both associated with fatigue, a screening for sleep apnea might be considered in coronavirus disease 2019 patients with fatigue syndrome.

Vestibular Signals in Self-Orientation and Eye Movement Control

Physiology ◽  
2001 ◽  
Vol 16 (5) ◽  
pp. 234-238 ◽  
Author(s):  
Bernhard J. M. Hess
Keyword(s):  
Signal Processing ◽  
Eye Movement ◽  
Vestibular System ◽  
Retinal Image ◽  
Internal Model ◽  
Movement Control ◽  
Head Position ◽  
Head Motion ◽  
Afferent Information ◽  
The Brain

The central vestibular system receives afferent information about head position as well as rotation and translation. This information is used to prevent blurring of the retinal image but also to control self-orientation and motion in space. Vestibular signal processing in the brain stem appears to be linked to an internal model of head motion in space.

scholarly journals Introducing a New Feature to Allergy and Rhinology

2014 ◽  
Vol 5 (1) ◽  
pp. 215265671400500
Keyword(s):  
Case Reports ◽  
Short Review ◽  
Final Diagnosis ◽  
Open Access Journal ◽  
Original Research ◽  
Tissue Samples ◽  
Case Presentation ◽  
New Type ◽  
New Feature ◽  
Case Data

In this issue of Allergy and Rhinology, we are pleased to introduce a new type of article, “Pathology Quiz Case,” to complement the original research articles, case reports, and reviews that we currently publish. This special submission should consist of a case presentation that includes the following elements – 1) patient history, exam and initial case data, 2) pathological description of tissue samples, 3) differential diagnosis, 4) final diagnosis, and 5) a short review of the disease entity and the patient course. This feature should be educational for all trainees and practicing otolaryngologists. In particular, we welcome medical student, resident, and fellow submissions from otolaryngology training programs. Allergy and Rhinology is an open access journal cited in PubMed.

scholarly journals Vestibular Function in Psoriasis Patients

2020 ◽  
pp. 014556132097068
Author(s):  
Abdullah Kınar ◽  
Abdulkadir Bucak ◽  
Şahin Ulu ◽  
Nilay Duman ◽  
Nur Betül Baştuğ
Keyword(s):  
Vestibular System ◽  
Inflammatory Disease ◽  
Vestibular Function ◽  
Control Group ◽  
Distortion Product Otoacoustic Emission ◽  
Duration Of Treatment ◽  
Vestibular Evoked Myogenic Potential ◽  
Cross Sectional ◽  
Distortion Product ◽  
Immune Mediated

Introduction: Psoriasis is an inflammatory skin disease that is characterized by T-cell-mediated hyperproliferation of the keratinocytes. It develops through immune-mediated mechanisms and is defined as an immune-mediated inflammatory disease. The inner ear is susceptible to inflammatory attacks, and vertigo and dizziness can occur as a complication. There is little information about psoriasis and the vestibular system. Objective: This study aimed to investigate the cervical vestibular-evoked myogenic potential (cVEMP) results of psoriasis patients and the effect of psoriasis on the vestibular system. Materials and Methods: Randomly selected and included in the study were patients who had been admitted to the Dermatology Outpatient Clinic of the Afyon Kocatepe University Medical Faculty, between November 15, 2017, and March 15, 2018, with the diagnosis of psoriasis, in addition to a healthy control group. This research was designed as cross-sectional study. Ethics committee permission was received. Both cVEMP and distortion product otoacoustic emission (DPOAE) tests were administered to all of the participants. Values were compared between the control group and psoriasis patients. Results: The study included 43 psoriasis patients and 40 controls. The duration of treatment of the patients and the drugs that they were using were noted. The psoriasis patients had lower p13–n23 amplitude differences in their cVEMP tests ( P < .05). These patients also had lower signal to noise ratio values, at 4 and 6 kHz, on their DPOAE tests ( P < .05). Conclusion: Psoriasis is an immune-mediated inflammatory disease that can be associated with vestibulocochlear dysfunction.

A series of case reports on abnormal sensation on eye movement associated with paroxetine discontinuation

2006 ◽  
Vol 21 (4) ◽  
pp. A29-A30 ◽  
Author(s):  
Masataka Wakeno ◽  
Masaki Kato ◽  
Yoshiteru Takekita ◽  
Gaku Okugawa ◽  
Tsuyoshi Fukuda ◽  
...  
Keyword(s):  
Eye Movement ◽  
Case Reports

Vibration-Induced Nystagmus in Patients with Vestibular Disorders

2003 ◽  
Vol 129 (3) ◽  
pp. 255-258 ◽  
Author(s):  
Masafumi Ohki ◽  
Toshihisa Murofushi ◽  
Haruka Nakahara ◽  
Keiko Sugasawa
Keyword(s):  
Clinical Significance ◽  
Vestibular Dysfunction ◽  
Spontaneous Nystagmus ◽  
Clinical Test ◽  
Vestibular Disorders ◽  
Vestibular Evoked Myogenic Potential ◽  
Canal Paresis ◽  
Caloric Testing ◽  
Myogenic Potential ◽  
Healthy Side

OBJECTIVE: Our goal was to clarify the clinical significance of vibration-induced nystagmus (VIN). METHODS: One hundred patients with unilateral vestibulocochlear disorders were enrolled into this study. However, patients with spontaneous nystagmus were excluded. Vibratory stimuli (approximately 100 Hz) were presented to the mastoids and the forehead. Patients also underwent caloric testing and vestibular evoked myogenic potential testing. RESULTS: Of the 100 patients, 60 (60%) showed VIN. The nystagmus was mainly horizontal. VIN was more frequently evoked on the mastoids than the forehead. In the majority of patients, the direction of VIN was toward the healthy side, whereas some patients, especially patients with Meniere's disease, showed nystagmus toward the affected side. VIN was frequently evoked in patients with severe unilateral vestibular damages (canal paresis >50%) (39 of 43, or 90%). CONCLUSION: VIN testing is a simple and sensitive clinical test that indicates unilateral vestibular dysfunction.

Vestibular-Evoked Myogenic Potential Testing in Vestibular Localization and Diagnosis

2020 ◽  
Vol 40 (01) ◽  
pp. 018-032 ◽  
Author(s):  
Rachael L. Taylor ◽  
Miriam S. Welgampola ◽  
Benjamin Nham ◽  
Sally M. Rosengren
Keyword(s):  
Vestibular System ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vestibular Disorders ◽  
Complementary Information ◽  
Vestibular Evoked Myogenic Potential ◽  
Myogenic Potential ◽  
Superior Canal Dehiscence ◽  
Otolith Function ◽  
Utricular Function ◽  
Canal Dehiscence

AbstractVestibular-evoked myogenic potentials (VEMPs) are short-latency, otolith-dependent reflexes recorded from the neck and eye muscles. They are widely used in neuro-otology clinics as tests of otolith function. Cervical VEMPs are recorded from the neck muscles and reflect predominantly saccular function, while ocular VEMPs are reflexes of the extraocular muscles and reflect utricular function. They have an important role in the diagnosis of superior canal dehiscence syndrome and provide complementary information about otolith function that is useful in the diagnosis of other vestibular disorders. Like other evoked potentials, they can provide important localizing information about lesions that may occur along the VEMP pathway. This review will describe the VEMP abnormalities seen in common disorders of the vestibular system and its pathways.

Case Study: Depersonalization and Vestibular Impairment

2021 ◽  
Author(s):  
Yini Sun ◽  
Allison Coltisor ◽  
Gary P. Jacobson ◽  
Richard A. Roberts
Keyword(s):  
Vestibular Function ◽  
Retrospective Chart Review ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Vestibular Evoked Myogenic Potential ◽  
Episodic Vertigo ◽  
Data Collection And Analysis ◽  
Vestibular Function Testing ◽  
Function Testing

Abstract Background We describe herein the case of a patient whose primary complaints were episodic vertigo and “depersonalization,” a sensation of detachment from his own body. Purpose This case study aims to further clinical knowledge and insight into the clinical evaluation of vertiginous patients with complaints of depersonalization. Research Design This is a case study. Data Collection and Analysis A retrospective chart review of vestibular function testing done on a vertiginous patient with complaints of depersonalization was performed. Results Vestibular function testing revealed absent cervical and ocular vestibular evoked myogenic potentials on the left side with normal vHIT or video Head Impulse Test, videonystagmography, and rotational chair results, suggesting peripheral vestibular impairment isolated to the left saccule and utricle. Conclusion The otolith end organ impairment explains the patient's postural deviation to the left side during attempts to ambulate. We recommend that clinicians should be attentive to patient complaints of depersonalization and perform vestibular evoked myogenic potential testing to determine whether evidence of at least a unilateral peripheral otolith end organ impairment exists.

Labyrinthine Fistula in Chronic Mastoiditis

1984 ◽  
Vol 93 (4_suppl) ◽  
pp. 138-141 ◽  
Author(s):  
Brian F. McCabe
Keyword(s):  
Eye Movement ◽  
Vestibular System ◽  
Semicircular Canal ◽  
Large Series ◽  
Otic Capsule ◽  
Lateral Semicircular Canal ◽  
Precise Location ◽  
Labyrinthine Fistula ◽  
Primary Difference ◽  
Fistula Site

A series of 79 otic capsule fistulae occurring in 792 consecutive cases of chronic mastoiditis undergoing mastoidectomy was analyzed. The incidence (10%) is the same as in other large series, the primary difference being the location of the fistula. In all series cited, 90% of fistulae were in the lateral semicircular canal whereas in this series the comparable incidence was 75%. The 20 (25%) fistulae located in areas other than the lateral semicircular canal enabled us to document a method of “reading” the fistula test preoperatively to establish its precise location. Eye responses to the test and the fistula site were entirely consonant with the physiology of the vestibular system. The location of the fistula, in other words, can be reliably predicted by the eye movement. Clinicopathologic correlates are cited.

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