• Journal of Audiology & Otology
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• v.25 no.1
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• pp.43-48
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• 2021

Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

• Korean Journal of Audiology
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• v.25 no.1
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• pp.43-48
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• 2021

Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

• Annals of Clinical Neurophysiology
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• v.6 no.1
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• pp.39-42
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• 2004

A 20-year-old man with bilateral medial medullary infarction showed transition of bowtie and upbeat nystagmus into hemi-seesaw nystagmus. Follow-up MRI revealed near complete resolution of the right medullary lesion. This transition of nystagmus suggests that the upbeat nystagmus was generated by bilateral lesions in the ascending pathways from both anterior semicircular canals (SCC), and that the hemi-seesaw nystagmus was caused by damage to the pathway from the left anterior SCC.

• Journal of Audiology & Otology
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• v.23 no.1
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• pp.33-38
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• 2019

Background and Objectives: Determination of the lesion side based on the direction of the nystagmus could result in confusions to the clinicians due to mismatch between the vestibular function tests and also between vestibular and audiologic features. To minimize these mistakes, we elucidated the clinical manifestation and vestibular function test results in cases with recovery spontaneous nystagmus (rSN). Subjects and Methods: Patients who visited ENT clinic of tertiary referral hospital for acute onset continuous vertigo from January 2008 to December 2011 were enrolled. In these patients, we assessed onset time of vertigo, time point of paralytic spontaneous nystagmus (SN) and time point of rSN. At each time point of SN, vestibular function tests and hearing function tests were performed. Results: We confirmed the rSN among patients with unilateral vestibulopathy and demonstrated that high gain of the rotatory chair test (slow harmonic acceleration) and/or mismatch of the SN direction and contralateral caloric weakness could indicate the recovery state of patients and nystagmus observed in this stage is recovery phase nystagmus. Conclusions: In acute vestibulopathy patients, recovery phase nystagmus was observed and on this stage of disease vestibular function tests shows several features that could predict recovery state.

• Korean Journal of Audiology
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• v.23 no.1
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• pp.33-38
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• 2019

Background and Objectives: Determination of the lesion side based on the direction of the nystagmus could result in confusions to the clinicians due to mismatch between the vestibular function tests and also between vestibular and audiologic features. To minimize these mistakes, we elucidated the clinical manifestation and vestibular function test results in cases with recovery spontaneous nystagmus (rSN). Subjects and Methods: Patients who visited ENT clinic of tertiary referral hospital for acute onset continuous vertigo from January 2008 to December 2011 were enrolled. In these patients, we assessed onset time of vertigo, time point of paralytic spontaneous nystagmus (SN) and time point of rSN. At each time point of SN, vestibular function tests and hearing function tests were performed. Results: We confirmed the rSN among patients with unilateral vestibulopathy and demonstrated that high gain of the rotatory chair test (slow harmonic acceleration) and/or mismatch of the SN direction and contralateral caloric weakness could indicate the recovery state of patients and nystagmus observed in this stage is recovery phase nystagmus. Conclusions: In acute vestibulopathy patients, recovery phase nystagmus was observed and on this stage of disease vestibular function tests shows several features that could predict recovery state.

• Annals of Clinical Neurophysiology
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• v.8 no.2
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• pp.179-181
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• 2006

Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system. The ocular manifestation includes optic neuritis, internuclear opthalmoplegia and nystagmus. Upbeat nystagmus is a rare manifestation of multiple sclerosis. We report a patient with relapsing multiple sclerosis who presented with upbeat nystagmus from a circumscribed lesion in the caudal medulla.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.190-192
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• 2007

Rarely, downbeat nystagmus can occur due to compression of the lower brainstem by the ectatic vertebral artery and be resolved by microvascular decompression. We present a case of a 67-year-old man with downbeat nystagmus associated with brainstem compression by ectatic vertebral artery. He presented with oscillopsia and vertigo. When he turned his head upward, his symptoms were aggravated and a gait disturbance occurred. Magnetic resonance imaging and computed tomographic angiography demonstrated compression of the medulla oblongata by the left ectatic vertebral artery and other medical causes of downbeat nystagmus were ruled out. Retromastoid craniotomy was performed and after lifting the vertebral artery off the medulla, a trough-shaped indentation in the lower brainstem was identified. The ectatic vertebral artery was repositioned and a Teflon was inserted between the brainstem and the ectatic vertebral artery. Postoperatively, downbeat nystagmus had disappeared.

• The Journal of Korean Academy of Sensory Integration
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• v.3 no.1
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• pp.1-11
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• 2005

Objective : The purpose of this study was to get the mean of duration of post-rotatory nystagmus test in normal children and to differentiate the duration of post-rotatory nystagmus test between normal children and children with pervasive developmental disorder. Method : 84 subjects were between 3 and 5 years of age and consisted of 64 normal children and 20 children with the pervasive developmental disorder. Analysis of the data was done by using t-test and ANOVA. Results : The results were as follows: 1. Range of duration of post-rotatory nyatagmus test in normal children was $5{\sim}22$second on left and $7{\sim}21$ second on right and the mean was 12.63 second on left and 12.59 second on right. 2. Range of duration of post-rotatory nystagmus test in children with the pervasive developmental disorder was $3{\sim}11$ second on both and the mean was 5.65 second on left and 5.60 second on right. 3. There was no significant difference between males and females with normal children in duration of post-rotatory nystagmus test. However, there was a significant difference of the mean duration between 3 and 5 years old normal group. 4. Children with pervasive developmental disorder significantly have relatively lower duration than the duration of post-rotatory nystagmus test of normal children. Conclusions : The results of the study showed significant difference between normal children and children with pervasive developmental disorder in duration of post-rotatory nystagmus test and suggest that they could be applied to the baseline of clinical therapy.

• Research in Vestibular Science
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• v.17 no.4
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• pp.167-169
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• 2018

Rotatory vertebral artery syndrome (RVAS) is characterized by recurrent attacks of vertigo, nystagmus, and syncope induced by compression of the vertebral artery during head rotation. A 60-year-old man with atlas vertebrae fracture presented recurrent attacks of positional vertigo. Left-beat, upbeat and count clock-wise torsional nystagmus occurred after lying down and bilateral head roll (HR) showing no latency or fatigue. Magnetic resonance imaging revealed foramen magnum stenosis (FMS) and dominancy of right vertebral artery (VA). The flow of the right VA on transcranial Doppler decreased significantly during left HR. The slower the velocity was, the more the nystagmus was aggravated. RVAS can be evoked by FMS causing compression of the VA. And the nystagmus might be aggravated according to the blood flow insufficiency.

• Proceedings of the KIPE Conference
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• 2002.07a
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• pp.455-458
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• 2002

A control of the body posture and movement is maintained by the vestibular system, vision, and proprioceptors. Especially, vestibular system has a very important function that controls the eye movement through vestibuloocular reflex and contraction of skeletal muscles through vestibulospinal reflex. However, postural disturbance caused by loss of vestibular function results in nausea, vomiting, vertigo and loss of craving for life. Lose of vestibular function leads to abnormal reflex of eye movements named nystagmus. Analysis of the nystagmus is needed to diagnose the vertigo, which is performed by means of electronystagmography (ENG). The purpose of this study is to develop a computerized system for data processing and an algorithm for the automatic evaluation of the slow component velocity (SCV) of nystagmus Induced by optokinetic(OKN) stimulation system. A new algorithm using recursive least square method (RLSM) to detect SCV of nystagmus is suggested in this paper. This method allows a fast and precise evaluation of the nystagmus, through artifact rejection techniques. The results are depicted in this paper.