Cases reported "Dizziness"

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1/13. Downbeat nystagmus caused by thiamine deficiency: an unusual presentation of CNS localization of large cell anaplastic CD 30-positive non-Hodgkin's lymphoma.

    A 24-year-old woman with a large cell anaplastic CD 30-positive T-cell non-Hodgkin's lymphoma (NHL) developed downbeat nystagmus, anisocoria, and oscillopsia. Prior to overt cerebral invasion by NHL, she had a thiamine deficiency with very low thiamine concentrations in the CSF, probably caused by protracted vomiting and increased vitamin B1 consumption by intrathecal tumor cells. We believe that her neurologic symptoms were caused -- at least partly -- by thiamine deficiency, as she reacted well to thiamine supplementation at the beginning of treatment.
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keywords = nystagmus
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2/13. multiple system atrophy manifested as dizziness and imbalance: a report of two cases.

    multiple system atrophy (MSA) is a progressive neurodegenerative disease of undetermined origin that occasionally manifests as dizziness and imbalance. It is not often considered in clinical situations, especially not by neuro-otological consultants. Hence, we report our recent experience with two cases of MSA. One is that of a 62-year-old man with MSA with a predominant cerebellar feature, and the other is that of a 72-year-old man with MSA with a predominant parkinsonian feature. The results of the syncopic study correlated with orthostatic hypotension. The neuro-otological study in both patients revealed an abnormal eye tracking test, abnormal optokinetic nystagmus test and loss of visual suppression in the caloric nystagmus. These indicate that the central vestibular system, e.g., the cerebellum or brain stem, is affected by MSA, contributing to dizziness and imbalance. Therefore, diagnosis of MSA should be kept in mind by neuro-otological consultants when dealing with patients with dizziness and imbalance, especially when this is accompanied by orthostatic hypotension.
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keywords = nystagmus
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3/13. Drop attacks secondary to superior canal dehiscence syndrome.

    Two patients with unprovoked drop attacks were found to have dehiscence of the superior semicircular canal on CT of the temporal bone. Both had conductive hearing loss, preservation of stapedius reflex, and abnormal vestibular evoked myogenic potentials. Neither had sound- or pressure-induced nystagmus. Repair of the dehiscence in one case stopped the drop attacks, supporting a causal relationship between the dehiscence and the drop attacks.
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keywords = nystagmus
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4/13. Positional nystagmus of central origin.

    Audiometric, electrophysiologic, and radiographic findings for a 68-year-old male with an "imbalance" concern are presented. This paper has a two-fold purpose: (1) to present an unusual electronystagmography case study and (2) to highlight the importance of test conditions in lesion localization. The specific disease pathophysiology remains obscure. Repeated hearing tests documented a known hearing impairment with worsening word-recognition ability of the right ear. An initial electronystagmographic exam was normal except for a mild ageotropic direction-changing positional nystagmus with eyes open and fixed. No repeatable click-evoked auditory brainstem response waveforms could be collected. A magnetic resonance imaging of the brain documents diffuse ischemic white matter disease. A repeated vestibular examination some months later supports the initial findings. The case illustrates the importance of following diagnostic protocol, of repeated measures, and of using both a visual fixation and a nonfixation condition for select electronystagmographic subtests.
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keywords = nystagmus
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5/13. Aseptic meningoencephalitis presenting with bilateral vestibular ataxia: a case report.

    Bilateral vestibular dysfunction is a rare condition, of which peripheral disorders are most common, whereas central disorders are extremely rare. A 35-year-old woman developed fever, headache, dizziness, convulsion, and disturbance of consciousness at the same time. MRI findings were normal. Based on the neurological findings and laboratory abnormalities, she was diagnosed as having aseptic meningoencephalitis. Steroid pulse therapy successfully ameliorated her encephalitis sign. However, isolated bilateral vestibular ataxia and dizziness, together with severe decrease of Caloric nystagmus, became apparent and lasted for the following 3 months, without cerebellar/brainstem involvement.
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keywords = nystagmus
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6/13. Optokinetic suppression of aberrant vestibular reactions: an observation.

    It has long been known that optokinetic nystagmus may be modified by vestibular inputs. We have suppressed an aberrant vestibular response and associated gastrointestinal sensations by use of an optokinetic stimulus simultaneous to the positional stimulus in a patient with paroxysmal positional vertigo. This single subject study utilized several optokinetic conditions, and patterned its stimulus presentations to control for visual fixation and vestibular habituation. Objective recordings of eye movements (ENG) were made simultaneously with subjective evaluation of "dizziness" on a simple magnitude estimation scale.
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keywords = nystagmus
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7/13. Clinical features of cisplatin vestibulotoxicity and hearing loss.

    patients treated with cisplatin were observed in an otoneurological study with special reference to cochlear and vestibular toxicity. Toxicity-related symptoms appeared to be almost all transient. As with leukopenia, hearing loss and dizziness often occurred after several weeks of administration. In the equilibrium examinations, some abnormal findings such as spontaneous nystagmus and positional nystagmus were seen. caloric tests and body sway tests detected abnormal findings in the early stages of cisplatin-related vestibulotoxicity.
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ranking = 0.4
keywords = nystagmus
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8/13. Voluntary nystagmus masquerading as Tullio's Phenomenon.

    Nystagmoid eye movements elicited by humming loudly was initially misdiagnosed as Tullio's phenomenon (abnormal acoustical stimulation of the vestibular apparatus owing to labyrinthine fistula). Further workup lead to a final diagnosis of a form of voluntary nystagmus characterized in some reports as "hysterical mystagmus". Some of the characteristics of this example of voluntary nystagmus differed from generally accepted descriptions.
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ranking = 1.2
keywords = nystagmus
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9/13. Slow build-up of optokinetic nystagmus associated with downbeat nystagmus.

    Eye movement recordings in two patients with downbeat nystagmus demonstrated an unusual finding of severely impaired smooth pursuit and relatively unimpaired optokinetic nystagmus (OKN). OKN was characterized by a remarkable, slow build-up of slow-component velocity, similar to that found in afoveate animals. Optokinetic after-nystagmus (OKAN), or transient persistence of nystagmus after cessation of visual stimulation, typical of the optokinetic response of normal human subjects, was also preserved in these patients. These observations suggest that the normal contribution of smooth pursuit to the ocular motor response to rotation of the visual environment can be selectively removed by a lesion at the level of the craniocervical junction.
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ranking = 2.4
keywords = nystagmus
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10/13. Periodic alternating skew deviation.

    A 78-year-old hypertensive woman suddenly developed blurred vision, followed shortly by dizziness, difficulty walking with a tendency to veer to the left, and vertical diplopia. Examination 3 weeks later revealed a unique neuro-ophthalmologic motility pattern, which may be described as periodic alternating skew deviation. This previously unreported motility disturbance was associated with downbeat nystagmus in our patient, and a focal lesion at the level of the interstitial nucleus of Cajal was demonstrated on computed tomography. The spectrum of physiologically related motility patterns--including periodic alternating nystagmus, cyclic oculomotor paralysis, see-saw nystagmus, periodic alternating gaze deviation, "ping-pong" gaze, and intermittent aperiodic alternating skew deviation--has been considered and is helpful in topical neuro-ophthalmologic diagnosis.
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ranking = 0.6
keywords = nystagmus
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