Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects

Annals of Otology Rhinology & Laryngology 121 (10), 682-8 (Oct 2012)

Balatsouras DG, Ganelis P, Aspris A, Economou NC, Moukos A, Koukoutsis G 

OBJECTIVES  We studied the demographic, pathogenetic, and clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. 

METHODS  The medical records of patients with BPPV associated with Meniere's disease were reviewed. In all patients, results of a complete otolaryngological, audiological, and neurotologic evaluation, including nystagmography, were available. Patients with idiopathic BPPV were used as a control group. 

RESULTS Twenty-nine patients with both disorders were found and were compared with 233 patients with idiopathic BPPV. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV: 1) a higher percentage of female patients; 2) a longer duration of symptoms; 3) common involvement of the horizontal semicircular canal; 4) a greater incidence of canal paresis; and 5) more therapeutic sessions needed for cure and a higher rate of recurrence. 

CONCLUSIONS The BPPV associated with Meniere's disease differs from idiopathic BPPV in regard to several epidemiological and clinical features, may follow a different course, and responds less effectively to treatment.

Vertigo and Stroke: A National Database Survey

Otology & Neurotology (Aug 2012)

Huon LK, Wang TC, Fang TY, Chuang LJ, Wang PC 

OBJECTIVE: To investigate the association between vertigo and stroke in Taiwan using the Bureau of National Health Insurance research database. 

METHODS: Information on adult patients with an index vertigo attack in 2006 was retrieved from Bureau of National Health Insurance research database. All patients with specific diagnostic codes for vertigo were included. Occurrence of stroke during a 1-year follow-up period was identified. Risk factors for stroke were examined. Using χ test, t test, and a multilevel logistic regression model, patients with vertigo were categorized into stroke and nonstroke groups for comparative analyses. An age- and sex- matched control cohort was prepared for comparison. 

RESULTS: Patients with vertigo (n = 527,807) (mean age, 55.1 yr) accounted for 3.1% of the general Taiwanese adult population. The prevalence of stroke among vertigo patients of 0.5% (mean age, 67.8 yr) was slightly higher than that of the control group (0.3%; mean age, 72.3 yr; p<0 .0001=".0001" 3.36-4.23="3.36-4.23" 3.77="3.77" 95="95" a="a" age="age" and="and" artery="artery" atrial="atrial" comorbid="comorbid" conditions="conditions" confidence="confidence" coronary="coronary" diabetes="diabetes" disease="disease" dyslipidemia="dyslipidemia" fibrillation="fibrillation" had="had" hemorrhage="hemorrhage" higher="higher" hypertension="hypertension" increased="increased" interval="interval" ischemic="ischemic" mellitus="mellitus" most="most" nbsp="nbsp" nontypical="nontypical" o:p="o:p" odds="odds" of="of" or="or" p="p" patients="patients" predictor="predictor" prevalence="prevalence" ratio="ratio" significant="significant" stroke="stroke" the="the" those="those" types="types" vertigo="vertigo" was="was" were="were" with="with">

CONCLUSION: Patients with vertigo had higher chance to develop stroke than the control group. Some strokes may initially manifest as peripheral vertigo, and some central vertigo may eventually evolve into a stroke. Middle aged male, diabetes, hypertension, dyslipidemia, coronary artery disease, and atrial fibrillation are risk factors for subsequent stroke in vertigo patients.

MRI Magnetic Field Stimulates Rotational Sensors of the Brain

Current Biology, 22 September 2011
Copyright © 2011 Elsevier Ltd All rights reserved.
10.1016/j.cub.2011.08.029

Authors

Dale C. Roberts,Vincenzo Marcelli,Joseph S. Gillen,John P. Carey,Charles C. Della Santina,David S. ZeeSee Affiliations

• Highlights
• All subjects in an MRI machine develop a robust nystagmus and often a sense of motion
• Nystagmus strength depends on static field strength, not motion through the field
• Horizontal nystagmus direction depends on head pitch angle and MRI field polarity
• Modeling suggests that MRI nystagmus is due to Lorentz forces pushing on the cupula

Summary

Vertigo in and around magnetic resonance imaging (MRI) machines has been noted for years [1,2]. Several mechanisms have been suggested to explain these sensations [3,4], yet without direct, objective measures, the cause is unknown. We found that all of our healthy human subjects developed a robust nystagmus while simply lying in the static magnetic field of an MRI machine. Patients lacking labyrinthine function did not. We use the pattern of eye movements as a measure of vestibular stimulation to show that the stimulation is static (continuous, proportional to static magnetic field strength, requiring neither head movement nor dynamic change in magnetic field strength) and directional (sensitive to magnetic field polarity and head orientation). Our calculations and geometric model suggest that magnetic vestibular stimulation (MVS) derives from a Lorentz force resulting from interaction between the magnetic field and naturally occurring ionic currents in the labyrinthine endolymph fluid. This force pushes on the semicircular canal cupula, leading to nystagmus. We emphasize that the unique, dual role of endolymph in the delivery of both ionic current and fluid pressure, coupled with the cupula's function as a pressure sensor, makes magnetic-field-induced nystagmus and vertigo possible. Such effects could confound functional MRI studies of brain behavior, including resting-state brain activity.

Association between Type 1 Diabetes Mellitus and Deposits in the Semicircular Canals

Otolaryngology - Head and Neck Surgery (May 2011)

Yoda S, Cureoglu S, Yildirim-Baylan M, Morita N, Fukushima H, Harada T, Paparella MM

Objective. To compare the prevalence of cupular and free-floating deposits in the semicircular canals between temporal bones of type 1 diabetes mellitus patients and normal controls. Study Design. Case-control histopathologic human temporal bone study. Setting. Otopathology laboratory in a tertiary academic medical center. 

Subjects and Methods. Twenty-eight temporal bones from 14 patients with type 1 diabetes mellitus and 56 normal temporal bones from 28 age-matched individuals were histopathologically examined. The cupula and lumina of the semicircular canals were examined for evidence of deposits. 

Results. The prevalence of cupular and free-floating deposits in the lateral and posterior semicircular canals was significantly higher in type 1 diabetes mellitus patients compared with normal temporal bones (lateral, cupular deposits, odds ratio [OR], 5.47; 95% confidence interval [CI], 1.43 to 21.02; free-floating deposits, OR, 8.25; 95% CI, 2.42 to 27.85; posterior, cupular deposits, OR, 41.73; 95% CI, 5.96 to 275.50; free-floating deposits, OR, 7.44; 95% CI, 1.91 to 28.53). The 

prevalence of these deposits was associated with the duration of disease rather than with aging.


Conclusion. The findings suggest that type 1 diabetes mellitus is associated with cupular and free-floating deposits in the semicircular canals. The patients with type 1 diabetes mellitus with a longer duration of disease have an increased probability of suffering from benign paroxysmal positional vertigo.

Association between Type 1 Diabetes Mellitus and Deposits in the Semicircular Canals

Otolaryngology - Head and Neck Surgery (May 2011)

Yoda S, Cureoglu S, Yildirim-Baylan M, Morita N, Fukushima H, Harada T, Paparella MM

Objective. To compare the prevalence of cupular and free-floating deposits in the semicircular canals between temporal bones of type 1 diabetes mellitus patients and normal controls. Study Design. Case-control histopathologic human temporal bone study. Setting. Otopathology laboratory in a tertiary academic medical center. 

Subjects and Methods. Twenty-eight temporal bones from 14 patients with type 1 diabetes mellitus and 56 normal temporal bones from 28 age-matched individuals were histopathologically examined. The cupula and lumina of the semicircular canals were examined for evidence of deposits. 

Results. The prevalence of cupular and free-floating deposits in the lateral and posterior semicircular canals was significantly higher in type 1 diabetes mellitus patients compared with normal temporal bones (lateral, cupular deposits, odds ratio [OR], 5.47; 95% confidence interval [CI], 1.43 to 21.02; free-floating deposits, OR, 8.25; 95% CI, 2.42 to 27.85; posterior, cupular deposits, OR, 41.73; 95% CI, 5.96 to 275.50; free-floating deposits, OR, 7.44; 95% CI, 1.91 to 28.53). The 

prevalence of these deposits was associated with the duration of disease rather than with aging. Conclusion. The findings suggest that type 1 diabetes mellitus is associated with cupular and free-floating deposits in the semicircular canals. The patients with type 1 diabetes mellitus with a longer duration of disease have an increased probability of suffering from benign paroxysmal positional vertigo.

Vestibular-Evoked Myogenic Potentials in Migrainous Vertigo

Otolaryngology - Head and Neck Surgery 144 (2), 284-287 (Feb 2011)

Hong SM, Kim SK, Park CH, Lee JH

Objective. Patients with migraine headaches have a high prevalence of episodic vertigo, and several studies support the clinical association of migraine and vertigo. Various tests have been conducted in patients with migrainous vertigo; however, only a few studies have been reported on otolith function. The aim of the present study was to increase the understanding of migrainous vertigo pathophysiology by assessing the sacculocollic pathway in patients with migrainous vertigo using vestibular-evoked myogenic potentials testing (VEMPs). Study Design. Prospective study. 
Setting. Tertiary referral center. Subjects and Methods. VEMP testing was performed in 30 patients with migrainous vertigo and 31 healthy volunteers using 90- and 100-dB tone-pip stimuli. We compared hearing, p13 and n23 latency, VEMP asymmetry, and VEMP formation rate between the patient and control groups. Results. No between-group difference was observed in p13 and n23 latency or VEMP asymmetry. The rate of normal VEMP wave formation in both ears was significantly lower in the patient group compared with that of the control group in response to the 90-dB stimulus. Furthermore, VEMP wave formation was absent in both ears at 100 dB in significantly more patients than in control subjects. 


Conclusion. The results indicate that patients with migrainous vertigo show abnormal VEMP findings, suggesting that migrainous vertigo might have a lesion at the sacculocollic pathway.

Prognostic assessments of medical therapy and vestibular testing in post-traumatic migraine-associated dizziness patients

Otolaryngology - Head and Neck Surgery 143 (6), 820-5 (Dec 2010)

Donaldson CJ, Hoffer ME, Balough BJ, Gottshall KR

OBJECTIVE: The aim of this study was to characterize our clinical population of patients suffering with post-traumatic migraine-associated dizziness (PTMAD) and determine any associations with medical interventions and vestibular testing metrics to help predict response to treatments. 

STUDY DESIGN: Retrospective chart review. 

SETTING: Tertiary referral center. 

SUBJECTS AND METHODS: The electronic medical records of 83 patients presenting to a tertiary referral center who were given a diagnosis of PTMAD and who had been treated were retrospectively reviewed. General characteristics, clinical treatment, pre- and post-vestibular therapy testing metrics, and success and failure outcomes were assessed. Patients were assigned into responder and nonresponder groups related to their headaches and evaluated at two specific time points. Medication failures and vestibular test metrics were compared to identify and predict clinical outcomes. RESULTS: Seventy-two of 82 patients (88%) were analyzed at two time points. Use of verapamil, topiramate, gabapentin, amitryptiline, and valproic acid showed no comparative treatment benefit in responders compared to nonresponders (P = 0.294). Findings associated with successful treatments include response to initial medication (P = 0.001), final dynamic gait index (DGI) scores (P = 0.029), final vertical dynamic visual acuity test (DVAT) scores (up, 0.007; down, 0.006), and both final and change in computerized dynamic posturography-sensory organization test (CDP-SOT) scores (P = 0.001, P = 0.032). The antipsychotic quetiapine was specifically associated with outcome failures (P = 0.003). 

CONCLUSION: Specific prophylactic antimigraine medications were not associated with improved outcomes in PTMAD patients. Initial clinical responses and vestibular test metrics may guide physicians to predict successful outcomes.