Vertical components of head-shaking nystagmus in vestibular neuritis, Meniere's disease and migrainous vertigo. 2014

C H Kim, and J E Shin, and C I Song, and M H Yoo, and H J Park
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

OBJECTIVE To describe vertical and horizontal components of head-shaking nystagmus (HSN) in various vestibular disorders. METHODS Retrospective case review. METHODS Tertiary care academic referral centre. METHODS Head-shaking nystagmus was assessed in 66 vestibular neuritis (VN) patients at acute (<7 days) and follow-up (2 months), and 65 Meniere's disease (MD) and 76 migrainous vertigo (MV) in interictal period. METHODS Head-shaking nystagmus was categorised as pure horizontal, pure vertical or mixed. Horizontal HSN was classified as monophasic or biphasic and paretic or recovery. Vertical HSN was classified as upbeat or downbeat. RESULTS Abnormal HSN (pathologic monophasic, biphasic or delayed-peak HSN) showed different positive rates depending on the vestibular disorders and compensation (94% in acute VN; 89% in FU VN; 78% in MD; 50% in MV). Paretic HSN with the nystagmus towards the lesioned side was the most common type in VN and MD; however, recovery HSN with the nystagmus towards the intact side could be rarely observed especially in patients with MD or compensated VN. Vertical nystagmus could be combined with horizontal HSN, and upbeat HSN was observed in most (83%) of the patients with acute VN, but downbeat HSN was common in follow-up VN (83%), MD (97%) and MV (85%). Weak perverted HSN, which is assumed to be a central nystagmus, was rarely observed in MD and MV (6-9%), but not in VN. CONCLUSIONS Head-shaking nystagmus (HSN) in horizontal plane is a valuable tool in the assessment of vestibular imbalance. Common observation of upbeat HSN in acute VN and downbeat HSN in follow-up VN, MD and MV suggests that vertical components are possibly related to the involvement of vestibular apparatus and compensation. Weak perverted HSN and delayed-peak HSN were rarely observed in MD and MV, and never observed in VN, suggesting that it is possibly related to either asymmetrically impaired vertical canals or misorientation of the velocity-storage system.

UI MeSH Term Description Entries
D008297 Male Males
D008575 Meniere Disease A disease of the inner ear (LABYRINTH) that is characterized by fluctuating SENSORINEURAL HEARING LOSS; TINNITUS; episodic VERTIGO; and aural fullness. It is the most common form of endolymphatic hydrops. Meniere's Disease,Meniere's Syndrome,Vertigo, Aural,Auditory Vertigo,Aural Vertigo,Ménière Disease,Ménière's Disease,Ménière's Vertigo,Otogenic Vertigo,Auditory Vertigos,Disease, Meniere,Disease, Meniere's,Disease, Ménière,Disease, Ménière's,Diseases, Ménière,Diseases, Ménière's,Meniere Syndrome,Menieres Disease,Menieres Syndrome,Ménière Diseases,Ménière Vertigo,Ménière's Diseases,Ménière's Vertigos,Ménières Disease,Ménières Vertigo,Otogenic Vertigos,Syndrome, Meniere's,Vertigo, Auditory,Vertigo, Ménière's,Vertigo, Otogenic,Vertigos, Auditory,Vertigos, Ménière's,Vertigos, Otogenic
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D008881 Migraine Disorders A class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches. The two major subtypes are common migraine (without aura) and classic migraine (with aura or neurological symptoms). (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1) Acute Confusional Migraine,Headache, Migraine,Status Migrainosus,Abdominal Migraine,Cervical Migraine Syndrome,Hemicrania Migraine,Migraine,Migraine Headache,Migraine Variant,Sick Headache,Abdominal Migraines,Acute Confusional Migraines,Cervical Migraine Syndromes,Disorder, Migraine,Disorders, Migraine,Headache, Sick,Headaches, Migraine,Headaches, Sick,Hemicrania Migraines,Migraine Disorder,Migraine Headaches,Migraine Syndrome, Cervical,Migraine Syndromes, Cervical,Migraine Variants,Migraine, Abdominal,Migraine, Acute Confusional,Migraine, Hemicrania,Migraines,Migraines, Abdominal,Migraines, Acute Confusional,Migraines, Hemicrania,Sick Headaches,Variant, Migraine,Variants, Migraine
D009759 Nystagmus, Pathologic Involuntary movements of the eye that are divided into two types, jerk and pendular. Jerk nystagmus has a slow phase in one direction followed by a corrective fast phase in the opposite direction, and is usually caused by central or peripheral vestibular dysfunction. Pendular nystagmus features oscillations that are of equal velocity in both directions and this condition is often associated with visual loss early in life. (Adams et al., Principles of Neurology, 6th ed, p272) Convergence Nystagmus,Horizontal Nystagmus,Jerk Nystagmus,Pendular Nystagmus,Periodic Alternating Nystagmus,Rotary Nystagmus,See-Saw Nystagmus,Vertical Nystagmus,Conjugate Nystagmus,Dissociated Nystagmus,Fatigable Positional Nystagmus,Multidirectional Nystagmus,Non-Fatigable Positional Nystagmus,Permanent Nystagmus,Rebound Nystagmus,Retraction Nystagmus,Rotational Nystagmus,Spontaneous Ocular Nystagmus,Symptomatic Nystagmus,Temporary Nystagmus,Unidirectional Nystagmus,Non Fatigable Positional Nystagmus,Nystagmus, Conjugate,Nystagmus, Convergence,Nystagmus, Dissociated,Nystagmus, Fatigable Positional,Nystagmus, Horizontal,Nystagmus, Jerk,Nystagmus, Multidirectional,Nystagmus, Non-Fatigable Positional,Nystagmus, Pendular,Nystagmus, Periodic Alternating,Nystagmus, Permanent,Nystagmus, Rebound,Nystagmus, Retraction,Nystagmus, Rotary,Nystagmus, Rotational,Nystagmus, See-Saw,Nystagmus, Spontaneous Ocular,Nystagmus, Symptomatic,Nystagmus, Temporary,Nystagmus, Unidirectional,Nystagmus, Vertical,Ocular Nystagmus, Spontaneous,Pathologic Nystagmus,Positional Nystagmus, Non-Fatigable,See Saw Nystagmus
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014717 Vertigo An illusion of movement, either of the external world revolving around the individual or of the individual revolving in space. Vertigo may be associated with disorders of the inner ear (EAR, INNER); VESTIBULAR NERVE; BRAINSTEM; or CEREBRAL CORTEX. Lesions in the TEMPORAL LOBE and PARIETAL LOBE may be associated with FOCAL SEIZURES that may feature vertigo as an ictal manifestation. (From Adams et al., Principles of Neurology, 6th ed, pp300-1) CNS Origin Vertigo,Central Nervous System Origin Vertigo,Positional Vertigo,Spinning Sensation,Vertigo, Brain Stem,Vertigo, Brainstem,Vertigo, Central Nervous System Origin,Vertigo, Central Origin,Vertigo, Constant,Vertigo, Essential,Vertigo, Intermittant,Vertigo, Paroxysmal,Vertigo, Peripheral,Vertigo, Subjective,Brain Stem Vertigo,Brain Stem Vertigos,Brainstem Vertigo,Brainstem Vertigos,CNS Origin Vertigos,Central Origin Vertigo,Central Origin Vertigos,Constant Vertigo,Constant Vertigos,Essential Vertigo,Essential Vertigos,Intermittant Vertigo,Intermittant Vertigos,Origin Vertigo, CNS,Origin Vertigo, Central,Origin Vertigos, CNS,Origin Vertigos, Central,Paroxysmal Vertigo,Paroxysmal Vertigos,Peripheral Vertigo,Peripheral Vertigos,Sensation, Spinning,Sensations, Spinning,Spinning Sensations,Subjective Vertigo,Subjective Vertigos,Vertigo, CNS Origin,Vertigo, Positional,Vertigos,Vertigos, Brain Stem,Vertigos, Brainstem,Vertigos, CNS Origin,Vertigos, Central Origin,Vertigos, Constant,Vertigos, Essential,Vertigos, Intermittant,Vertigos, Paroxysmal,Vertigos, Peripheral,Vertigos, Subjective
D014724 Vestibular Function Tests A number of tests used to determine if the brain or balance portion of the inner ear are causing dizziness. Function Test, Vestibular,Function Tests, Vestibular,Test, Vestibular Function,Tests, Vestibular Function,Vestibular Function Test

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