Many kinds of aging processes are known in the central nervous system in human beings. In the eye movement system, it has been recognized that the eye speed of saccade becomes slow and the smoothness of the smooth pursuit eye movement system becomes irregular with aging. We analyzed this aging process in 44 normal volunteers by recording vertical optokinetic nystagmus (OKN).1. In the vertical OKN, the number of beats of nystagmus and the slow phase velocity of nystagmus tended to be constant through the 7 th decade.2. The temporal profile of the mean slow phase velocity of vertical OKN was strongly influenced by aging.
Although unilateral loss of hearing and vestibular function is relatively common, bilateral auditory and vestibular dysfunction rarely occurs. We report a patient with bilateral auditory and vestibular dysfunction with simultaneous onset and describe the otological manifestations of this case. A 54-year-old man was admitted to hospital complaining of headache and fever. After hospitalization, he experienced vertigo, which consisted of a sensation of moving vertically and noticed bilateral hearing loss, which increased gradually. The patient was referred to our University Hospital because vertigo and hearing loss persisted after therapy, although his headache and fever improved. On the first visit to our clinic, skin eruptions suggestive of herpes virus infection were noted on the right cheek and around the angles of the mouth. Pure-tone audiometry revealed moderate to severe bilateral sensorineural hearing loss. Right-beating nystagmus with horizontal and torsional components was observed on gaze, positional and positioning nystagmus tests. A caloric test showed severe hypofunction of the bilateral semicircular canals. Hematological examination revealed an elevated antibody titer against herpes simplex virus. Steroid tapering treatment and prostaglandin treatment were performed and the he hearing level improved to 63.8dB on the right and 32.5dB on the left, and nystagmus on gaze, positional and positioning conditions disappeared. A caloric test after therapy showed mild canal dysfunction on the right and severe canal palsy on the left. At present, the patient does not have any marked disabilities in daily life. We speculated that the sudden loss of bilateral auditory and vestibular function was caused by herpes simplex viral meningitis because of the skin eruptions on the face and elevated antibody titer against herpes simplex virus.
Aortitis syndrome is known to be an autoimmune disease, which has many symptoms of occulusive thromboaortopathy. It has recently been reported that the patients with systemic autoimmune diseases may have sensorineural hearing loss and that steroid therapy should be effective not only for the original disorder but also for the associated hearing disturbance.Eleven patients (3 males and 8 females) with aortitis syndrome and sensorineural hearing loss have been treated in Kitasato University Hospital during the 16 years since the opening of the hospital.The onset of hearing impairment was at 32 to 48 years of age, 10 years older than the mean age of onset of the aortitis syndrome reported in the literatures.Various types of hearing impairment were noted : slight hearing loss, total deafness of sudden onset and fluctuating type. Tinnitus was associated with hearing loss in many cases.Several patients also had vertigo and dysequilibrium, and in some of them the diagnosis was peripheral vestibular hearing loss, although in the cases of aortitis syndrome with hearing loss reported in the literature neither vertigo nor dizziness was mentioned.The usual treatment for acute stage sudden deafness was not effective in most of our patients. However, one female patient treated with long-term steroid therapy for systemic arteritis showed marked improvement of both her hearing and her general condition.We cannot conclude that the origin of sensorineural hearing loss is arteritis in the inner ear in all cases of aortitis syndrome with hearing loss. However, our cases of aortitis syndrome with steroid-dependant hearing loss indicate that the possibility remains of hearing loss due to arteritis of the labyrinthine artery in aortitis syndrome.
Nystagmus towards the upper ear in both lateral head positions is usually considered to appear in patients with central nervous system lesions, especially those in the brain stem or cerebellar posterior vermis. However, its pathogenesis is still obscure, since several reports have suggested that such positional nystagmus may occur in patients with peripheral vestibular disturbances.This report describes a patient with positional nystagmus of this type after head trauma. X-ray examination revealed temporal bone fracture. The origin of positional nystagmus in this case was thought to be a peripheral vestibular lesion because the nystagmus was transient and there was no clinical evidence of any disturbance of the central nervous system. Seven cases of such positional nystagmus seen during the last 3 years in Kitasato University Hospital are summarized. Positional nystagmus towards the upper ear is assumed to be an important sign of central nervous system disturbance, but it may occur with peripheral vestibular lesions. It is necessary in the latter case for the positional nystagmus to disappear in the course of time, and other vestibular and neurological findings may indicate the character of the peripheral vestibular disturbance.
Vestibular stimulation is a popular clinical treatment for enhancing the acquisition of central compensation in cases of unilateral vestibular disturbance (BPPV, Vestibular neuritis etc…), but it is not often used for bilateral vestibular disturbances. A 37-year-old woman, given 20g of Streptomysin sulfate intramuscularly, suffered from dizziness and oscillopsia for about 20 years. Her caloric test indicated almost total canal paralysis bilaterally, so it was thought to be a bilateral vestibular disturbance. She was trained by a new combination of vestibular, visual and proprioceptive stimulation for 32 days. Our training was useful of disequilibrium and dizziness in reducing complaints. We evaluated the effects of training on equilibrium by stabilometry, stepping test, and gait test.
We report two patients with cerebral infarction, and severe vertigo at the onset, died in spite of emergency treatment.The first patient was a 66-years-old man who had been suffering from aplastic anemia and hypertension. Though those chronic diseases were well controlled, he had a vertiginous attack of tinnitus in the right ear. Otolaryngological and neurological examination revealed the disturbance of the periperhal vestibular type without any neurological sign at the beginning. On the next day the patient died of a the second stroke.The second patient was a 63-year-old woman, and her chief co m plaints were vertigo, vomiting and headache. A brain X-ray CT and neurological examination were almost normal 4 days after the first attack. The result of neuro-otological test showed a disturbance of the peripheral vestibular type after 12 days. However, the patient died of reccurrence of brain stroke 13 days later.It is necessary to differentiate transient ischemic attacks from a peripheral vestibular disturbance associated with vertigo but without any other neurological sign.
Positional nystagmus of the direction changing type, especially nystagmus towards the side of the upper ear in the lateral head position, is considered to appear in patients with disorders of the central nervous system. However, it might also occur in patients with peripheral vestibular disturbances.The pathogenesis of nystagmus directed towards the upper ear side remains obscure because controversial results have been reported in several papers.This paper discribes two patients with positional nystagmus directed towards the upper ear side, which was provoked after a short latency in both lateral head positions and disppeared within a few days. In both patients neurological and neurootological examinations indicated the presence of peripheral vestibular disorders.A fragment of statoconia adhering temporarily to the cupula of the lateral semicircular canal might be the cause of the nystagmus in our two patients.
