1
|
Lee SU, Bae YJ, Kim HJ, Choi JY, Song JJ, Choi BY, Choi BS, Koo JW, Kim JS. Intralabyrinthine Schwannoma: Distinct Features for Differential Diagnosis. Front Neurol 2019; 10:750. [PMID: 31396141 PMCID: PMC6664015 DOI: 10.3389/fneur.2019.00750] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to delineate the clinical and laboratory features suggestive of intralabyrinthine schwannoma (ILS). Methods: We compared the clinical features of 16 patients with ILS, who had been diagnosed at the Seoul National University Bundang Hospital from 2003 to 2018, with those of 18 patients with symptomatic unilateral intracanalicular schwannoma and randomly selected 20 patients with definite or probable unilateral Meniere's disease (MD). Results: Patients with ILS presented with either recurrent spontaneous dizziness/vertigo combined with auditory symptoms (n = 8), isolated auditory symptoms without dizziness/vertigo (n = 7), or recurrent spontaneous dizziness/vertigo without auditory symptoms (n = 1). Most patients reported no improvement (n = 11) or worsening (n = 1) of the symptoms despite medical treatments including intratympanic (n = 5) or intravenous steroids (n = 2). Conventional brain MRIs failed to detect ILS in about a half of the patients (7/16, 44%). However, ILS showed a filling defect on 3-dimensional (3D) heavily T2-weighted MRIs (n = 12), and nodular enhancement on 3D contrast-enhanced T1 (n = 15) or FLAIR MRIs (n = 13) targeted for the inner ear. Compared to MD or intracanalicular schwannoma, ILS showed mostly abnormal head-impulse tests (HITs, p = 0.001). In contrast, the incidence of canal paresis did not differ among the groups (p = 0.513). Conclusion: ILS may mimic MD by presenting recurrent dizziness/vertigo and auditory symptoms. ILS should be suspected in patients with recurrent audiovestibulopathy especially when (1) the duration of the dizziness is not typical for MD, (2) the patients do not respond to medical treatments, or (3) HITs are abnormal.
Collapse
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jae-Jin Song
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung Yoon Choi
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung-Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ja-Won Koo
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| |
Collapse
|
2
|
Jung I, Ahn SH, Lee J, Lee SU, Oh HJ, Kim HJ, Choi JY, Kim JS. Age-related deterioration of saccule-related neural function is associated with decreased estimated glomerular filtration rate and increased free thyroxine. Clin Neurophysiol 2019; 130:795-801. [DOI: 10.1016/j.clinph.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/31/2018] [Accepted: 02/03/2019] [Indexed: 01/30/2023]
|
3
|
Lee SU, Kim HJ, Choi JH, Choi JY, Kim JS. Comparison of Ocular Motor Findings Between Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis Involving the Brainstem and Cerebellum. THE CEREBELLUM 2019; 18:511-518. [DOI: 10.1007/s12311-019-01018-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
4
|
Lee SU, Kim HJ, Koo JW, Choi JY, Kim JS. Vertigo Induced During Coitus. Front Neurol 2019; 9:1187. [PMID: 30687228 PMCID: PMC6336730 DOI: 10.3389/fneur.2018.01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/24/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to describe the clinical features of vertigo developed during sexual intercourse. Methods: We retrospectively reviewed the clinical and laboratory findings of seven patients who reported recurrent vertigo during sexual intercourse. Results: All the patients reported spinning sensation for a few minutes to 1 h, which developed during the coitus. Most patients (6/7, 86%) reported associated auditory symptoms including tinnitus (n = 4), ear fullness (n = 2), autophony (n = 1), hearing impairment (n = 1), or hyperacusis (n = 1). Four patients reported the vertigo to occur exclusively during sexual intercourse or masturbation while the other three patients also experienced vertigo during other physical activities. Underlying disorders included Meniere's disease (n = 3), superior canal dehiscence (n = 1), and high jugular bulb anomaly (n = 1) while the remaining two patients had no identifiable causes. Conclusions: Various disorders may cause coital vertigo probably due to disruption of the mechanism that normally refrains the increased intracranial pressure from being directly transferred to the peripheral vestibular organs.
Collapse
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ja-Won Koo
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
5
|
Liqun Z, Park KH, Kim HJ, Lee SU, Choi JY, Kim JS. Acute Unilateral Audiovestibulopathy due to Embolic Labyrinthine Infarction. Front Neurol 2018; 9:311. [PMID: 29770122 PMCID: PMC5940739 DOI: 10.3389/fneur.2018.00311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/19/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Labyrinthine infarction is a cause of acute audiovestibulopathy, but can be diagnosed only in association with other infarctions involving the brainstem or cerebellar areas supplied by the anterior inferior cerebellar artery (AICA) since current imaging techniques cannot visualize an infarction confined to the labyrinth. This case series aimed to establish embolic labyrinthine infarction as a mechanism of isolated acute audiovestibulopathy. Methods We analyzed clinical features, imaging findings, and mechanisms of embolism in 10 patients (8 men, age range: 38–76) who had developed acute audiovestibulopathy in association with an obvious source of embolism and concurrent acute embolic infarctions in the non-anterior inferior cerebellar artery territories. The presence of audiovestibulopathy was defined when bedside or laboratory evaluation documented unilateral vestibular (head-impulse tests or caloric tests) or auditory loss (audiometry). Results Six patients showed combined audiovestibulopathy while three had isolated vestibulopathy. One patient presented isolated hearing loss. Audiovestibular findings were the only abnormalities observed in nine patients. In all patients, MRIs documented single or multiple infarctions in the cerebellum (n = 5) or cerebral hemispheres (n = 5). Especially three patients showed single or scattered foci of tiny acute infarctions only in the cerebral hemispheres. Cardiac sources of embolism were found in eight, and artery-to-artery embolism was presumed in two patients. Conclusion Selective embolism to the labyrinth may be considered in patients with acute unilateral audiovestibulopathy and concurrent acute infarctions in the non-AICA territories.
Collapse
Affiliation(s)
- Zhong Liqun
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Kee-Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Seoul National University College Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
6
|
Lee SU, Park SH, Park JJ, Kim HJ, Han MK, Bae HJ, Kim JS. Dorsal Medullary Infarction. Stroke 2015; 46:3081-7. [DOI: 10.1161/strokeaha.115.010972] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/09/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Sun-Uk Lee
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| | - Seong-Ho Park
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| | - Jeong-Jin Park
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| | - Hyo Jung Kim
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| | - Moon-Ku Han
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| | - Hee-Joon Bae
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| | - Ji-Soo Kim
- From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.)
| |
Collapse
|
7
|
Park HK, Kim JS, Strupp M, Zee DS. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 2013; 260:1576-82. [PMID: 23370610 DOI: 10.1007/s00415-013-6837-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 01/02/2013] [Accepted: 01/07/2013] [Indexed: 12/19/2022]
Abstract
Isolated floccular infarction is extremely rare, and impairments of the vestibulo-ocular reflex (VOR) have not been explored in humans with isolated floccular lesions. The purpose of this study was to examine and report selective impairment of VOR in response to high acceleration using head impulse in a patient with isolated floccular infarction. The patient underwent bedside and laboratory evaluation of vestibular function, which included video-oculography, ocular torsion and the subjective visual vertical, cervical and ocular vestibular-evoked myogenic potentials, bithermal caloric irrigation, rotatory chair test, and the head impulse test (HIT) using search coils. A 70-year-old woman with a unilateral floccular infarction presented with an acute vestibular syndrome with spontaneous nystagmus beating to the lesion side, impaired ipsilesional pursuit, contraversive ocular torsion and tilt of the subjective visual vertical. With rotatory chair testing at low frequencies, horizontal VOR gains were increased. However, VOR gains were decreased with the higher-frequency, higher-speed HIT. While HIT is often normal in patients with central vestibular disorders, decreased HIT responses do not exclude an isolated cerebellar lesion as a cause of the acute vestibular syndrome.
Collapse
Affiliation(s)
- Hong-Kyun Park
- Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea
| | | | | | | |
Collapse
|
8
|
Brainstem representation of vestibular evoked myogenic potentials. Clin Neurophysiol 2010; 121:1102-8. [DOI: 10.1016/j.clinph.2010.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 01/25/2010] [Accepted: 02/07/2010] [Indexed: 11/19/2022]
|
9
|
Kim S, Lee HS, Kim JS. Medial vestibulospinal tract lesions impair sacculo-collic reflexes. J Neurol 2010; 257:825-32. [DOI: 10.1007/s00415-009-5427-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 12/19/2022]
|