ASN » Neurootological tests

Brain mapping activity during 3d virtual reality stimulation in vertigo patients

admin — Wed, 01 Jan 2003 00:00:00 +0000

Cortical activity has been analyzed on 238 patients consulting on vertigo and motion sickness, who were studied through Vestibular Cortical Evoked Potentials Mapping, Brain Mapping in rest state and Brain Mapping under 3D Virtual Reality Stimulation.The comparative study of the different terms obtained shows changes on the cortical electrical activity under different stimulations.

There is an occipito-parietal cerebral area related with spatial orientation of the individual which establishes an interrelation among sensorial kinaesthetic, vestibular and visual afferentias.
The Virtual Reality Stimulation in Motion Sickness Patients implies the beginning of a new way for the study of the modulation of vestibular cortical activity under visual 3D stimulations.

Neurosensorial deficits in patients within 1 year and more than a year past myocardial infarction

admin — Wed, 01 Jan 2003 00:00:00 +0000

Myocardial infarction comprises gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. Myocardial infarction may occur when coronary vessels are narrowed or occlude, as the blood supply to the infarcted heart muscle is seriously impaired. Cardiovascular diseases are extremely wide spread and often also cause vestibular system dysfunctions. They are related mainly to the organic lesions of the brain.
It has been established that true vertigo occurs mainly in patients with bad circulation in vertebrobasilar base and may be objectivized by various types of vestibular deficiencies: either peripheral, or central, or both. As the cardiovascular system may be concerned, it is argued whether individuals with cardiovascular diseases are prone to develop a sensorineural deafness. Hearing impairment parallels the incidence of coronary heart disease. But all cardiac patients do not develop hearing loss.
For investigating the neurootological functional changes after myocardial infarction two samples from our patients were compared of whom group a.) suffered of a myocardial infarction only within one year prior to our neurootmetric investigation (42 persons, 92,86% males and 7,14% females) and group b.) with an infarction more than one year before examination (104 patients, 81,73% males and 18,27% females). Counting the 6 most important vertigo symptoms per patient in group a.) 1,48 signs per patient and in group b.) 2.02 signs per patient were found. With respect to the acoustic symptoms they complained in group a.) 45,24% about tinnitus and 52,38% about hearing loss and in group b.) 48,08% about tinnitus and 58,65% about hearing loss. The functional neurootometric measurements unveil the following pathologies: in group a.) 80,95% in the butterfly-calorigrams, 64,29% in stepping-CCG, 40,48% in bone conductional audiometry in the right side and 52,38% in the left ear audiograms and in group b.) 78,85% in the butterfly-calorigrams, 61,54% in stepping-CCGs, 28,85% in right and 41,35% in left bone conductional audiograms.

Neurootological aspects of posttraumatic complaints after severe head trauma

admin — Wed, 01 Jan 2003 00:00:00 +0000

Concussion of the brain describes a violent jar or shock, or the condition which results from such an injury. Loss of consciousness obviously appears as the result of a blow to the head.
In mild concussion there is transient loss of consciousness with possible impairment of the higher mental functions, such as retrograde amnesia and emotional lability.
In severe concussion there is prolonged unconsciousness with impairment of the functions of the brain stem, such as transient loss of respiratory reflex, vasomotor activity, and dilatation of the pupils. Concussion is sometimes differentiated from contusion in that in the former the injury is functional, whereas in the latter it is organic. Contusion is due to a bruise, an injury of a part without a break in the skin. Posttraumatic cerebral syndrome occurs in the recovery phase and for months thereafter. In relation there maybe complaints of headache, vertigo, tinnitus, hearing loss, giddiness, easy fatigability, memory defects, impaired ability to concentrate, dizziness and personality changes. It is more common after serious head injuries. But severe symptoms maybe produced by relatively minor injuries as well.
For this study 102 cases with posttraumatic complaints due to an earlier head trauma were investigated (79,41% males, 20,59% females). When analysing the history on the basis of NODEC the 6 major vertigo symptoms statistically were found with a frequency of 1,58 signs per patient and the total of 11 vertigo and nausea symptoms with a frequency of 2,05 signs per patient. Tinnitus were reported in 43,14% and hearing loss in 50,98%.
By means of objective and quantitative neurootometry the following rates of functional neurosensorial disturbances were observed: butterfly calorigram of the polygraphic ENG 75,49%, stepping-CCGs 76,47%, pure tone audiometry of bone conduction in the right 40,20% and in the left ear 49,02%.

Vertigo, dizziness, tinnitus after otobasal fractures

admin — Wed, 01 Jan 2003 00:00:00 +0000

About 15% of temporal bone fractures are produced by blows to the occiput. The fracture line begins in the posterior fossa, at or near the foramen magnum, crosses the petrous ridge through the internal auditory canal and/or the otic capsule. Therefore it is thus called a transverse fracture. In transverse fractures of temporal bone, due to automobile accident or other causes of head injury, the labyrinth is involved more frequently than in longitudinal fractures. Severe vertigo with severe or total hearing loss is not uncommon with such injuries. In milder injuries, labyrinthine “concussion” may occur, with transitory auditory-vestibular symptoms. The force which causes the fracture is so great that it not only results in the fracture of the base of the skull, but may also cause a lesion of the brain stem, resulting in a combined peripheral and central lesion. According to Alexander and Scholl 15% of the patients having suffered this kind of trauma demonstrate signs of cerebral injury and 33% have hearing loss.
61 cases of neurootological patients suffering from sequalae of otobasal fractures (81,97% males, 18,03% females) were evaluated. Out of the 6 principle vertigo-symptoms they suffered from 1,69 signs per patient. 40,98% complained about tinnitus and 52,82% about hearing loss. Due to our experimental neurootometric investigations pathological changes were found in 75,41% of the butterfly calorigrams, 72,13% of the stepping-CCGs and 32,79% on the right and 39,34% of the left ear in bone conduction audiometry.

Vertigo in relation to postraumatic cervical syndromes

admin — Wed, 01 Jan 2003 00:00:00 +0000

Cervical syndrome is a condition caused by irritation or compression of the cervical structures including spines, spinal cord, nerves and muscles, marked by pain in the neck radiating into the shoulder, arm, or forearm, depending on which nerve root is affected or neurosensorial signs like vertigo, tinnitus, blurred vision etc. due to the cervical-encephalic irritations of the neurosensorial system. Whiplash is a popular term for an acute acceleration extension injury of the cervical spine. The severity of the posttraumatic symptoms depends on the site of the cervical lesions and the extend of the damage to the spinal bones, the soft tissues of the neck, the cervical blood vessels and although trauma to the spinal cord and the brain. Four types of posttraumatic whiplash syndromes can be differentiated: cervical syndrome, cervicobrachial syndrome, cervicomedullary syndrome, cervicoencephalic syndrome. The latter is most important for the field of neurootology.
Cranio-corpography (CCG) allows us to observe separately but also simultaneously the impaired head as well as the neck movements. Tinnitus, hypacusia and vertigo can appear separately or together; suddenly or as the worsening of chronic complaints. The causes of vertigo, hypacusia and tinnitus can appear as central or peripheral lesions.
For this study 426 cases (48,12% males, 51,88% females) were investigated. In our neurootological history NODEC out of the 6 most important vertigo symptoms occurring 2,02 signs per patient and out of the total of 11 symptoms of vertigo and nausea (vestibulo- vegetative) 2,99 signs per patient were found. Tinnitus existed in 57,04% and hearing loss in 53,76%.
When applying modern neurootometry the following gross functional pathology was found in: ENG of caloric nystagmus 69,48%, stepping-CCG 73,94%, bone conductional audiometry 29,34% in the right and 38,73% in the left ear.

Neurosensorial complaints of patients with diabetes receiving oral versus insulin treatment

admin — Wed, 01 Jan 2003 00:00:00 +0000

Diabetes mellitus is a chronic syndrome of impaired carbohydrate, protein, and fat metabolism secondary to insufficient secretion of insulin or to target tissue insulin resistance.
The most common and most overlooked cause of vertigo is the impairment of carbohydrate metabolism. It is important that the patient with vertigo must be investigated from a metabolic point of view because the vascular complications of diabetes are reversible in the presence of good blood sugar control in the early, so called occult diabetic cases. Vertigo is a cry of alarm of the balance system in distress – even more sensitive a register than is fluctuating hearing loss. Disturbances of carbohydrate and insulin metabolism explained the mystery of the 64% of Meniere’s patients heretofore classified as “idiopathic”.
For the present neurootological study we are compairing two samples of diabetic patients: a.) patients with insulin antidiabetic treatment (29 persons, 55,2% males and 44,8% females) and b.) patients with oral antidiabetic treatment (79 cases, 50.6% males and 49,4% females). When checking for the average number of vertigo symptoms per patient group a.) exhibits 2,21 and group b.) 2,10 signs per patients. Furthermore group a.) complains in 55,17% of tinnitus and in 58,62% of hearing loss and group b.) in 59,49% of tinnitus and 55,70% of hearing loss. The experimental neurootologic investigations show pathology in group a.) caloric butterfly 72,41%, step-CCG 75,86% and pure tone bone conduction audiometry right 27,59% and left 37,93% ear and group b.) ENG with butterfly 69,62%, steptest-CCG 70,89% and bone conduction pure tone audiometry on the right side 34,18% and 41,77% on the left side.

Depressive disorders in relation to neurootological complaints like vertigo, dizziness, hearingloss and tinnitus

admin — Wed, 01 Jan 2003 00:00:00 +0000

Depression is a mental state of depressed mood characterised by feelings of sadness, despair, and discouragement. Depression ranges from normal feelings of “the blues” through dysthymia to major depression. It in many ways resembles the grief and mourning that follow bereavement. There are often feelings of low self-esteem, guilt, and somatic symptoms such as eating and sleep disturbances.
Endogenous depression defines any depression that is not a reactive depression. The term implies that some intrinsic biological process rather than environmental influences is the cause. Endogenous depression has been identified with a specific symptom complex – psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment – that is roughly equivalent to major depression or major depression with melancholia, although there is not much correlation between this symptom complex and the presence or absence of precipitating life events. Reactive depression means a depression that is precipitated by stressful life event.
In the field of depression an overlapping medical activity between psychiatry and neurootology nowadays is to be seen.
Our sample comprises 134 cases (39,55% males, 60,45% females), who were either classified by psychiatrists or neurologists to suffer from depression.
Evaluating our history NODEC in the chapter of the 6 principle vertigo symptoms a frequency of 2,10 signs per patient were found. When extending the list to 11 vertigo and nausea signs together 2,93 signs per case were exhibited.
All the patients underwent an objective and quantitative neurootometric analysis. The following rates of abnormal findings were observed: butterfly calorigram of polygraphic ENG 69,40%, stepping-CCGs 69,40%, bone conductional pure tone audiometry of the right 28,36% and of the left ear 36,57%.

Indagine posturografica su un campione de atleti

admin — Wed, 01 Jan 2003 00:00:00 +0000

L’ equilibrio attua un coordinamento costante tra input visivi, labirintici, somatosensoriali ed uditivi, al fine di ottenere un controllo ottimale della posizione degli occhi e del corpo nello spazio.
Le finalità dell’ equilibrio sono il controllo muscolare in statica e dinamica, la stabilizzazione della funzione visiva, la percezione dei movimenti e l’ organizzazione della sensibilità nello spazio.
Nell’ evoluzione della crescita nel bambino vi è una predominanza della sollecitazione labirintica scanalare. Con l’ avanzare della crescita il bambino trae piacere dai giochi di coordinazione visuo manuale, dando vita a quella stretta interdipendenza tra sistema visivo e sistema propiocettivo. Fino ad arrivare ad una completa e più stretta iterazione tra i sistemi sensoriale e il movimento delle corse. Al momento del completamento dello sviluppo sensoriale ed intersensoriale il bambino è pronto alla percezione dei limiti ed al piacere del superamento dei propri limiti ed in questo sta l’ essenza dello sport.
Negli sport acquatici per es. gli otoliti, che sono i recettori di gravità, registrano una situazione di normalità e programmano i muscoli antigravitari. La spinta di Archimede determina una modificazione di attività nei recettori propiocettivi osteo/muscolo/articolari. L’ ostacolo maggiore è rappresentato dalle modificazioni delle sincinesie (movimenti associati) motorie tra muscoli tonici antigravitari e fasici dinamici.
Nello sport con appoggio plantare nelle discipline atletiche l’ esistenza di una contro reazione è indispensabile per sviluppare il gesto atletico della corsa; l’ informazione uditiva è irrilevante e quella otolitica stabile; quella scanalare è importante solo quando si inizia il movimento; quella visiva è stabile poiché serve all’ identificazione dell’ obiettivo da raggiungere; l’ informazione plantare anche se non è costante è ripetitiva e prevedibile.
Qualunque gesto sportivo è frutto di una complessa partecipazione di varie componenti, a seconda della disciplina può prevalere la componente muscolare nelle sue varie espressioni (forza potenza resistenza), o la componente psiconeurosensoriale nelle sue varie espressioni (concentrazione coordinazione precisione riflessi).

Vestibular migraine

admin — Wed, 01 Jan 2003 00:00:00 +0000

Migraine is rather often disorder affecting 5-18% of population. And though there is no vestibular migraine in the International Statistical Classification of Deseases (ICD-10), this pathology is under discussion in the neurootological literature. That is why the item of our study has been the correlation between vestibular dysfunction and migraine. Special attention being paid to the criteria when vestibular dysfunction may trigger migraine attacks.
637 persons with average age of 39,6 ± 12,2 y.o. have been examined with established diagnosis – vestibular dysfunction, most of them being Chornobyl clean-uppers and station stuff.
The anamnesis has been carefully recorded with specific attention to vertigo, dizziness and headache. For standardization of the complaints NOASC questionnaire being used. To make the diagnostics objective clinical tests (Uemura, Fukuda) united into 20-score battery have been used. Instrumental methods: vestibular, auditory, visual, somatosensory evoked potentials, ECG with Takahashi maneuver, ENG have been routinely applied for the vestibular dysfunction documentation.
Headaches are reported in 92,4% patients, in 35% of all the patients being typically migrainous (frontal – 46%, occipital – 37%, parietal – 27%, temporal – 24%, related to neck – 30% and with the hand irradiation – 20%).
Vestibular dysfunction has been reported in all the patients. In the complaints structure long-lasting episodes of dizziness, either provoked or augmented by head movements are dominating. According to NOASC the symptom expression index for dizziness being 4, the highest value in the whole symptoms structure. 20-score battery shown 9,7 (normative up to 5), thus indicating mild and middle degree of the dysfunction. Vestibular evoked potentials have shown the increase of all the peak latencies, especially significant for the N1 98.4±30.8 ms. Nystagmography usually reported directional preponderance with labyrintine asymmetry. ECG shown pulse rate increase after Takahashi maneuver. Treatment of the patients been conducted with Tanakan (EGB 761), Arlevert, Vertigoheel, Natil, – with up to 80% positive efficacy. Preliminary data with Betaserk seem to be also optimistic.
So, vertigo-dizziness complaints, disequilibrium documented with postulography or clinical tests, vestibular evoked potentials might be the criteria for establishment of the diagnosis – vestibular migraine with specific for vestibular disorders therapy.

Endolymphatic hydrops patients with benign paroxysmal positioning vertigo

admin — Wed, 01 Jan 2003 00:00:00 +0000

Objective: Amongst the reasons causing the inner ear pathology being accompanied by fits of giddiness, the most frequently occurring are the endolymphatic hydrops & benign paroxysmal positioning vertigo (BPPV). In the whole number of scientific articles there may be found the mentioning of patients with the combination of BPPV & Menier’s Disease. The reasons & probably the mechanisms for both conditions’ origin are somewhat similar within the frameworks of known theories.
The purpose of the present research is the scrutiny of labyrinth hydrops occurrence amongst the patients suffering from BPPV.

Methods: Within the course of the present work to diagnose the disease we used the whole battery of tests & examinations performed by neurotologist & neurologist. The investigation of the vestibular system state & condition has been carried out with the use of VISUAL EYES – videonystamography complex with the infra-red registering of eyes’ movements (By Micromedical Technologies). The examination of hearing has been performed in audiological laboratory, whilst the endolymphatic hydrops has been registered by method of extratympanic electrocochleography upon the system BRAVO (by NICOLET) with the application of the generally accepted criteria.

Results: We have examined the patients’ group with BPPV – totaling 94 patients. Amongst them 28 patients (29,8%) with endolymphatic hydrops has been discovered. Distribution by gender: 2 males and 26 females. The average age within the examined group of patients with the combination of hydrops & BPPV – 49.75 years old. The duration of disease: from 1 month to 16 years.

Within the afore group of patients the following reasons for the development of disease has been discovered: idiopathic – 75%, virus infection -–10.7%, acute stress – 7.1%, trauma – 7.1%.

The outset of disease has been accompanied by the following symptoms:
Spinning-32.1%, positional spinning – 32.1%, dizzy – 46.6%, noise in ears – 10.7%, reduction of hearing – 2%, the loss of conscience – 3.6%.
From 28 patients of the said group – 2 has been diagnosed with the Menier’s disease, 26 – with the secondary hydrops.

Within the afore group of patients the pathology of only the posterior semicircular channels has been registered (from the right in 39.3%, from the left – in 57.1%, of both – 3.6%). The distribution of the hydrops localizing in relation towards the BPPV pathology side was the following: while with the otolithiasis of the right posterior semicircular channel the hydrops has been registered from the right in 14.3% of cases, from the left in 14,3% of cases, from both sides – in 10.7%. Whilst with the otolithiasis from the left – the hydrops has been registered in left ear in 28.6% of cases, from the right – in 7.1%, and in both ears – 21.4%.

Considering the presence of both pathological conditions, the following therapy tactics has been chosen by ourselves. Upon the first stage we have used the rehabilitation manoeuvres, exercises & their combinations designed for BPPV correction. Thus the Epley manoeuvre has been applied in 85,7% of cases. The exercises of Brandt-Daroff – in 42,9% of cases.

The significant element for the successful therapy within the afore group of patients as per our judgement – has been the complex therapy of the second stage. The above therapy consisted in the use of special diet, short course of diuretics, Betaserk & its combination with other medications depending upon the character of the attendant diseases. Some patients have been treated with the course of osteopathic correction, massage from the alterations in the cervical part of the vertebral spine.

Conclusion: Taking into account the frequently occurring combination of BPPV & labyrinth hydrops we strongly recommend the inclusion of EcoG into the programm for examination of patient with the positional vertigo, especially with the persisting dizzy symptoms after performing of the rehabilitational manoeuvre. We have not discovered the combination of inner ear hydrops & BPPV by the localizing side. The course specially designed to manage the said patient with the whole combination of diseases has to obligatorily include the rehabilitational treatment methods co-jointly with the medicational therapy.