Cases reported "Labyrinth Diseases"

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11/36. Prospective study of positional nystagmus in 100 consecutive patients.

    OBJECTIVES: The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus. methods: Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness. RESULTS: One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV. CONCLUSIONS: A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.
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12/36. Rotatory recovery nystagmus: an important localizing sign in endolymphatic hydrops.

    Localizing the ear responsible for vertigo attacks may be exceedingly difficult in patients with delayed endolymphatic hydrops, vestibular Meniere's disease or bilateral Meniere's disease. This has important clinical implications when planning operative treatment. We present a case of delayed endolymphatic hydrops to exemplify these difficulties and demonstrate the localizing value of recovery nystagmus. We stress the importance when possible of monitoring patients with endolymphatic hydrops for recovery nystagmus during acute vertigo attacks. Monitoring should include direct eye observation as pure rotatory nystagmus escapes detection on electronystagmography.
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ranking = 0.36842105263158
keywords = nystagmus
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13/36. Subjective oscillopsia ("jiggling" vision) presumably due to aminoglycoside ototoxicity. A report of two cases.

    Following aminoglycoside antibiotic therapy, two patients developed self-limited subjective oscillopsia in the absence of a detectable ocular motility disturbance (nystagmus or opsoclonus). Oscillopsia represents a rare, but highly distressing symptom resulting from disruption of the vestibulo-ocular reflex, producing profound illusory movement of the visual environment. Although the differential diagnosis includes vascular, inflammatory, and structural disorders impacting on either the central or peripheral projections of this brainstem reflex, iatrogenic aminoglycoside ototoxicity was the likely explanation in the two patients presented. Ways of minimizing the risk of aminoglycoside toxicity are briefly reviewed.
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ranking = 0.052631578947368
keywords = nystagmus
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14/36. Electronystagmographic criteria in neuro-otological diagnosis. 2. central nervous system lesions.

    Direct current electronystagmographic recordings of spontaneous nystagmus in light, in darkness, and with eye closure have been carried out on (a) 33 patients with acoustic neurinomata pressing on the brain stem, and (b) 10 patients with lesions involving the brain stem at a high level. Patterns of response characteristics of each group have been identified in 21 out of 28 cases of group a, the spontaneous nystagmus present in light was abolished by eye closure and inhibited in darkness, nystagmus being absent in the remaining five; in group b the greater proportion (70-80%) of patients presented with spontaneous nystagmus in light which was abolished by both eye closure and darkness.
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ranking = 0.21052631578947
keywords = nystagmus
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15/36. Acute vestibular paralysis in herpes zoster oticus.

    A case of herpes zoster oticus is presented in which the lateral and superior semicircular canals of the labyrinth were affected unilaterally. The results of several electronystagmographic examinations are described and correlated with the patient's description of symptoms. This case study indicates that disease affecting the lateral semicircular canal is reliably detected by the conventional caloric test. However, the fact that the posterior semicircular canal remained intact could not be inferred from the results of the caloric test in this case. Also the appearance of nystagmus upon eye closure appears to have been a more sensitive index of the state of the disease process than was the caloric test.
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ranking = 0.052631578947368
keywords = nystagmus
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16/36. Periodic alternating nystagmus.

    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.
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ranking = 0.52631578947368
keywords = nystagmus
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17/36. Lateropulsion and upbeat nystagmus are manifestations of central vestibular dysfunction.

    An elderly man presented with acute onset of gait instability, characterized by leaning to the left while walking, vertigo, diplopia, and transient facial numbness. The examination was remarkable for ocular lateropulsion and primary position upbeat nystagmus. Computed tomography of the brain revealed a right-hemispheric cerebellar infarction. This report illustrates that lateropulsion can occur in cerebellar lesions, but that it may be contralateral to the cerebellar hemisphere involved. Primary position upbeat nystagmus and lateropulsion may represent forms of central vestibular dysfunction due to interruption of vestibulo-ocular pathways.
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ranking = 0.31578947368421
keywords = nystagmus
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18/36. Neuro-ophthalmologic findings in vestibulocerebellar ataxia.

    A young adult who presents with periodic vertigo, diplopia, and tinnitus, later followed by progressive ataxia, may not have multiple sclerosis as might initially be suspected, but rather may represent a type of familial spinocerebellar degeneration previously described by Farmer and Mustian as "vestibulocerebellar ataxia." We recently encountered a patient who presented with these symptoms, and who was found to have downbeat nystagmus, ocular dysmetria, skew deviation, optokinetic dissociation, and a vertical gain bias on horizontal eye movements. Although family involvement was specifically denied by the patient, seven members of her family representing four generations were examined, and found to have similar findings. The importance of a careful neuro-ophthalmologic examination in each available family member of any patient presenting with this constellation of symptoms is emphasized. A discussion of the spinocerebellar degenerations, differential diagnosis, and literature review are included.
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ranking = 0.052631578947368
keywords = nystagmus
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19/36. Medical treatment of nystagmus and ocular motor disorders.

    An increased compendium of drugs useful in ocular motor system dysfunction has expanded our capacity to treat selected ocular motility disorders. Adjunctive therapeutic modes (e.g., Fresnel prisms and orthoptic exercises) can also be beneficial. PAN and see-saw nystagmus can be treated with baclofen. Downbeat nystagmus may respond to clonazepam therapy, and prisms may help if the nystagmus can be modified with convergence. Congenital nystagmus may respond minimally to drugs (e.g., baclofen), but prisms or surgical procedures, or both, are still the primary treatment modalities. Innovar may be helpful in patients with severe, incapacitating vestibular disorders, and scopolamine alone or in combination with promethazine may be beneficial in patients with milder ambulatory acute peripheral vestibular disorders. Benign positional vertigo is best treated initially with positional exercises before drug therapy is instituted. Opsoclonus and ocular flutter have been treated successfully with corticosteroids, propranolol, and clonazepam, while microflutter, an extremely rare disorder, can resolve with baclofen. Although therapy with carbamazepine, 5-hydroxtryptophan, and scopolamine has been useful in selected patients with ocular palatal myoclonus, most do not respond to drug treatment. It is not usually necessary to treat voluntary nystagmus, but Fresnel prism lenses should be remembered in refractory patients. Potentially reversible and pseudointernuclear ophthalmoplegias also were discussed. Orthoptic exercises can be beneficial in posttraumatic internuclear ophthalmoplegia. Selected supranuclear palsies can be improved completely with the proper drug regimen. Lastly, superior oblique myokymia can be treated successfully with carbamazepine, with tight surveillance for possible adverse side effects. Descriptive phenomenology and pathophysiological localization must be correlated with brain stem neurochemistry and neuropharmacology to medically treat additional ocular motor system disorders.
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ranking = 0.47368421052632
keywords = nystagmus
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20/36. Benign paroxysmal vertigo of childhood.

    Benign paroxysmal vertigo of childhood is a vestibular disorder characterized by multiple sudden brief episodes of true vertigo with nystagmus usually beginning after the age of 4. The diagnosis is based on the characteristic history, because the otologic and neurologic examinations, electronystagmogram, audiogram, and electroencephalogram are usually normal. The etiology of the disorder remains unknown, although a vascular disturbance of the posterior circulation with ischemia of the labyrinth or vestibular nuclei is most commonly postulated. A review of the literature and five new cases are used to acquaint otolaryngologists with this entity, review the characteristic clinical history, discuss differential diagnosis, and emphasize the usual clinical course.
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ranking = 0.052631578947368
keywords = nystagmus
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