Search

Background: Dizziness and vertigo rank among the top 10 reasons for emergency and clinical referrals to neurologists. Chronic dizziness and imbalance not only reduce quality of life, but also increase mortality. While the Mediterranean diet has long been considered beneficial for human and planetary health, its effects on chronic dizziness or imbalance are understudied. We investigated the associations of adherence to the Mediterranean diet with chronic dizziness and imbalance. Methods: This study used data from the Korea National Health and Nutrition Examination Survey 2019–2021 and included 4,183 adults aged 40 years and older with complete information from diet, dizziness, and neurotology questionnaires. The alternate Mediterranean diet score (aMed) for nine food groups was calculated from 24-hour dietary recall data. Based on questionnaire responses, chronic dizziness was categorized as either isolated or chronic dizziness with imbalance, characterized by a cluster of difficulties maintaining a standing position, walking, or falling. Results: In a multivariable-adjusted model, the prevalence of chronic imbalance was lower in the top aMed tertile than in the bottom tertile (OR 0.37; 95% CI, 0.18–0.74; p-trend = 0.01). Among the individual aMed components, the intake of whole grains and nuts exhibited an inverse relationship with chronic imbalance (OR 0.50; 95% CI, 0.27–0.93 for whole grains; OR 0.55; 95% CI, 0.31–1.01 for nuts). The aMed score was not associated with isolated chronic dizziness. Conclusions: Greater adherence to the Mediterranean diet may reduce chronic imbalance, particularly with an adequate intake of whole grains and nuts. [ABSTRACT FROM AUTHOR]

Research Background: Vitamin D insufficiency/deficiency is known to be related to occurrences and recurrences of benign paroxysmal positional vertigo (BPPV). However, the efficacy of vitamin D supplementation in reducing recurrences of BPPV remains to be established. We performed a meta-analysis to determine the therapeutic effects of vitamin D supplementation, with or without calcium, for preventing recurrences of BPPV. Methods: We searched the PubMed, the Embase, the Web of Science and the reference lists of the articles. We included randomized or non-randomized trials that determined the efficacy of supplementing vitamin D or related compounds, alone or with calcium, in comparison to placebo or no intervention in preventing recurrences of BPPV. The primary outcome was the number of patients with BPPV recurrences. Data were collected and pooled using a weighted relative risk (RR) with corresponding 95% CIs, where possible, by adopting the fixed-effect or random-effect model according to the heterogeneity among the studies. The between-study heterogeneity was tested using the χ2 test and the I2 statistic, and funnel plots were used to evaluate any publication bias. Results: We included five trials (four non-randomized trials and one randomized controlled trial) with a total of 1250 participants. The analyses showed a significant preventive effect on the recurrences of BPPV (RR = 0.37; 95% CI = 0.18–0.76; p = 0.007 with the random-effects model) with supplementation of vitamin D. Although a considerable heterogeneity was detected among the studies, the sensitivity analyses showed the reliability and stability of our results. Conclusions: Vitamin D supplementation provides a benefit for secondary prevention of BPPV. Supplementation of vitamin D should be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal. [ABSTRACT FROM AUTHOR]

This letter, published in the Journal of Neurology, presents a case report and literature review on central paroxysmal positional nystagmus (CPN) mimicking posterior canal benign paroxysmal positional vertigo (BPPV) in pontine infarction. The report describes a 67-year-old man who presented with acute vertigo and nystagmus, initially diagnosed as right acute unilateral peripheral vestibulopathy with posterior canal BPPV. However, further examination revealed features of central vestibulopathy, and brain MRI confirmed an acute infarction in the lateral pontine tegmentum. The patient's symptoms resolved after two days, and follow-up showed no positional nystagmus. The authors discuss the characteristics of CPN and differentiate it from BPPV based on nystagmus patterns and response to treatment. [Extracted from the article]

Neuromyelitis optica spectrum disorders (NMOSD) can cause various ocular motor disorders in addition to optic neuritis. Ocular motor findings associated with NMOSD include spontaneous vertical and gaze-evoked nystagmus, wall-eyed bilateral internuclear ophthalmoplegia, and trochlear nerve palsy. The association between dorsal midbrain syndrome and anti-aquaporin-4 antibody seropositivity has not been reported. Here, we report a patient displaying typical dorsal midbrain syndrome and anti-aquaporin-4 antibody seropositivity. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated an association of osteopenia/osteoporosis with idiopathic benign paroxysmal positional vertigo (BPPV). Since vitamin D takes part in the regulation of calcium and phosphorus found in the body and plays an important role in maintaining proper bone structure, decreased bone mineral density in patients with BPPV may be related to decreased serum vitamin D. We measured the serum levels of 25-hydroxyvitamin D in 100 patients (63 women and 37 men, mean age ± SD = 61.8 ± 11.6) with idiopathic BPPV and compared the data with those of 192 controls (101 women and 91 men, mean age ± SD = 60.3 ± 11.3) who had lived in the same community without dizziness or imbalance during the preceding year. The selection of the controls and acquisition of clinical information were done using the data from the Fourth Korean National Health and Nutrition Examination Survey, 2008. The serum level of 25-hydroxyvitamin D was lower in the patients with BPPV than in the controls (mean ± SD = 14.4 ± 8.4 versus 19.1 ± 6.8 ng/ml, p = 0.001). Furthermore, patients with BPPV showed a higher prevalence of decreased serum vitamin D (<20 ng/ml, 80.0 vs. 60.1 %, p < 0.001) than the controls. Multiple logistic regression analyses adjusted for age, sex, body mass index, hypertension, diabetes, proteinuria, regular exercise and the existence of decreased bone mineral density demonstrated that vitamin D insufficiency (10-20 ng/ml) and deficiency (<10 ng/ml) were associated with BPPV with the odds ratios of 3.8 (95 % confidence interval = 1.51-9.38, p = 0.004) and 23.0 (95 % confidence interval = 6.88-77.05, p < 0.001). Our study demonstrated an association between idiopathic BPPV and decreased serum vitamin D. Decreased serum vitamin D may be a risk factor of BPPV. [ABSTRACT FROM AUTHOR]

To explore the patterns and mechanisms of jerky seesaw nystagmus in internuclear ophthalmoplegia (INO), we analyzed the nystagmus patterns in 33 patients with dissociated torsional-vertical nystagmus and INO. In 11 (33%) patients, the nystagmus was ipsiversive torsional in both eyes with vertical components in the opposite directions. In contrast, 18 (55%) patients showed ipsiversive torsional nystagmus with a larger upbeat component in the contralesional eye. Four (12%) patients exhibited ipsiversive torsional nystagmus with a greater downbeat component in the ipsilesional eye. At least one component of contraversive ocular tilt reaction was associated in most patients (30/33, 91%). The patterns of jerky seesaw nystagmus in INO suggest a disruption of neural pathways from the contralateral vertical semicircular canals with or without concomitant damage to the fibers from the contralateral utricle in or near the medial longitudinal fasciculus. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 59-year-old woman who had suffered from recurrent vertigo for 2 months and later found out to have cerebellopontine angle (CPA) meningioma that mimicked vestibular paroxysmia. The meningioma originating from the CPA has showed recurrent paroxysmal spontaneous vertigo that mimicked vestibular paroxysmia. The patient was placed on carbamazepine per day and discharged 4 days later.

Abstract: The relation between pulse pressure (PP) and Alzheimer disease (AD) remains unclear. We performed this study to investigate the relation between PP and AD and the impact of PP to impair cognitive performance on this relationship. It is a cross-sectional study from the Neurology Memory Clinic of Chungnam National University Hospital and five senior welfare centers in the city of Taejon, Korea. A cohort of 75 patients with AD and 117 control subjects were enrolled for the study. PP was significantly higher whereas mean arterial pressure (MAP) was lower in patients with AD than those of control subjects. Elevated serum total cholesterol (TC) level was significantly associated with both PP and MAP in control subjects as well as patients with AD. We found a significant relationship between PP and cerebral white matter changes (WMCs) in AD. PP changes correlate with leukoaraiosis in AD. [Copyright &y& Elsevier]

A correction is presented to the article correcting errors in Table 1 of a case report and literature review discussing central paroxysmal positional nystagmus mimicking posterior canal benign paroxysmal positional vertigo in pontine infarction.

A letter to the editor is presented in response to the article "Trochleitis with superior oblique myositis" by L. Tychsen, D.T. Tse, K. Ossoinig and R. L. Anderson published in a 1984 issue of the periodical "Ophthalmology."

Background and objectives: Weight gain is associated with imbalance in older people. In contrast, overweightness or mild obesity is less common in patients with chronic dizziness. This paradox may be, at least in part, related to differences in the body composition indices adopted in the previous studies. This study aimed to determine any association between the predicted body composition and chronic dizziness or imbalance of unknown causes. Methods: We measured the lean body mass, body fat mass, and appendicular skeletal mass in 9243 people who participated in the Korean National Health and Nutrition Examination Survey 2019–2021. Sarcopenia was defined according to the Asian Working Group for Sarcopenia's guidelines. Obesity was defined as a body fat percentage of ≥ 25% for men and ≥ 35% for women. Results: The participants with chronic dizziness had a lower body mass index than those without (p = 0.001). Furthermore, sarcopenia was more common in those with chronic dizziness. In contrast, the degree of obesity was comparable in both groups. Multiple logistic regression analysis showed that sarcopenia was associated with a higher risk of chronic dizziness (odds ratio = 1.6, 95% confidence interval: 1.1–2.5; p = 0.026). Discussion: Given the association of sarcopenia with chronic dizziness or imbalance, muscle mass may play a role in maintaining balance and stability. Physical exercise could be recommended to increase muscle mass in patients with chronic dizziness/imbalance and sarcopenia. Additional research is required to establish a causal relationship between chronic dizziness and sarcopenia. [ABSTRACT FROM AUTHOR]

Abstract: Even though pendular seesaw nystagmus (PSN) or periodic alternating nystagmus (PAN) has been reported in blind persons, the co-occurrence of PSN and PAN has not been described. A 69-year-old woman with progressive visual loss to only light perception in both eyes showed PSN with a conjugate torsional component and the vertical components in the opposite directions in both eyes. In complete darkness, she also exhibited PAN in addition to PSN. PSN remained unchanged in darkness. The rest of the neurological examination, testing for mitochondrial mutations of Leber''s hereditary optic neuropathy, fluorescent angiography, electroretinogram, and brain MRI were normal except for bilateral optic atrophy. Deprivation of the visual inputs, which are required to calibrate normal eye motion, may produce various ocular motor abnormalities in blindness. Although the co-occurrence of PSN and PAN in our patient with visual loss indicates a common etiology, the different effects of darkness on nystagmus intensity suggest a distinct pathomechanism. [Copyright &y& Elsevier]

Differentiation of spinocerebellar ataxia type 17 (SCA17) from Huntington's disease (HD) is often challenging since they share the clinical features of chorea, parkinsonism, and dystonia. The ocular motor findings remain to be elucidated in SCA17, and may help differentiating SCA17 from HD. We retrospectively compared the ocular motor findings of 11 patients with SCA17 with those of 10 patients with HD. In SCA17, abnormal ocular motor findings included impaired smooth pursuit (9/11, 82%), dysmetric saccades (9/11, 82%), central positional nystagmus (CPN, 7/11, 64%), abnormal head-impulse tests (4/11, 36%), and horizontal gaze-evoked nystagmus (GEN, 3/11, 27%). Among these, CPN was more frequently observed in SCA17 than in HD (7/11 (64%) vs. 0/10 (0%), p = 0.004) while saccadic slowing was more frequently observed in HD than in SCA17 (8/10 (80%) vs. 2/11 (18%), p = 0.009). Of six patients with follow-up evaluation, five later developed bilateral saccadic hypermetria (n = 4), GEN (n = 1), CPN (n = 1), bilaterally abnormal smooth pursuit (n = 1), and hyperactive head-impulse responses (n = 1) along with a clinical decline. Ocular motor abnormalities can be utilized as a diagnostic marker for differentiation of SCA17 from HD as well as a surrogate marker for clinical decline in SCA17. [ABSTRACT FROM AUTHOR]

Abstract: Background: In benign paroxysmal positional vertigo involving the horizontal canal (HC-BPPV), nystagmus may be induced by neck flexion in the pitch plane while sitting (head-bending nystagmus). Objective: To determine the characteristics and lateralizing value of head-bending nystagmus in HC-BPPV. Methods: Using video-oculography, head-bending nystagmus was recorded in 54 patients with HC-BPPV (32 canalolithiasis and 22 cupulolithiasis). Lesion side was determined by comparing intensity of the nystagmus induced by lateral head turning (head-turning nystagmus) in supine. Results: Head-bending nystagmus was observed in 39 patients (72.2%) and lying-down nystagmus in 41 (75.9%). Thirty three patients (61.1%) showed both types of nystagmus while six (11.1%) had only head-bending and another eight (14.8%) showed only lying-down nystagmus. In 45 patients with asymmetrical head-turning nystagmus, the direction of head-bending nystagmus was mostly toward the affected ear in canalolithasis (88.9%) and toward the intact ear in cupulolithasis (80.0%). In 9 (16.7%) patients whose affected ear could not be determined due to symmetrical head-turning nystagmus, the particle repositioning maneuver based on the direction of head-bending or lying-down nystagmus resulted in the resolution of symptom. Two patients showed a transition from canalo- to cupulolithiasis during head-bending posture. Conclusion: In HC-BPPV, neck flexion in the pitch plane while sitting may generate nystagmus by inducing ampullopetal migration of the otolithic debris in the horizontal canal or by ampullofugal deflection of the cupula by the attached otolithic debris. Head-bending nystagmus may be a valuable sign for lateralizing the involved canal in HC-BPPV, especially when patients show symmetrical head-turning nystagmus. Conversion of canalo- into cupulolithiasis by the neck flexion supports the current explanation of the mechanisms of HC-BPPV. [Copyright &y& Elsevier]

Abstract: Pathophysiological aspects of dementia and its rate of cognitive deterioration could be dependent on disease subtype, Alzheimer''s dementia (AD), vascular dementia (VaD), and Parkinson''s disease with dementia (PDD). 150 patients diagnosed at the Chungnam National University Hospital (87 women and 63 men) memory clinic. The participants consisted of 68 patients with AD, 23 patients with VaD, and 59 patients with PDD, who were diagnosed by the individual criteria, respectively. Cognitive screening was evaluated using the Korean version of the mini-mental state examination (MMSE). Repeated evaluations were conducted at 6-month, 1 year, and 2 years after initial baseline assessment. Rates of cognitive decline were calculated by dividing MMSE score differences by the number of months lapsed. No difference was found between the three dementia subtypes with respect to baseline MMSE scores. Cognitive decline was not obvious up to 6-month of the follow-up, but by 12-month of follow-ups was significant regardless of the dementia subtype. Furthermore, the rate of cognitive decline in the AD group was significantly faster than in the PDD or VaD groups. This study suggests that rate of cognitive deterioration in dementia is not linear over time and that dementia subtypes have different rates of cognitive deterioration. [Copyright &y& Elsevier]

To define the prevalence and characteristics of single ocular motor nerve palsy (OMNP) associated with positive serum anti-GQ1b antibody. We performed a prospective multicenter study that recruited 82 patients with single OMNP without identifiable causes from the history and neuroimaging in six neurology clinics of university hospitals. We measured serum anti-GQ1b antibody in all participants. Twelve patients with multiple OMNP and 30 with identifiable causes served as the controls. Overall, the prevalence of anti-GQ1b antibody syndrome was 10% (8/82) in patients with single OMNP and 6% (5/78) in those with single OMNP in isolation. None of the 14 patients with OMNP with identifiable causes showed positive serum anti-GQ1b antibody. The prevalence of anti-GQ1b antibody syndrome was much higher in patients with multiple OMNP than in those with single OMNP (50% vs. 10%, p < 0.01). Patients with single OMNP and positive anti-GQ1b antibody are younger (42 ± 16 vs. 58 ± 15, p < 0.05) and had a significantly higher frequency of preceding infection (75 vs. 19%, p < 0.05) and other neurological signs (38 vs. 1%, p < 0.05) than those with negative antibody. Eight patients with single OMNP and positive serum anti-GQ1b antibody involved the abducens (n = 6), trochlear (n = 1), or oculomotor nerve (n = 1). Single OMNP accompanying other neurological signs and multiple OMNP are more likely to be associated with anti-GQ1b antibody. Anti-GQ1b antibody syndrome should be considered even in patients with single OMNP, especially when antecedent infection was associated in younger patients. [ABSTRACT FROM AUTHOR]

The aim of this work is to elucidate underlying etiologies, lesion locations, and outcomes of inferior rectus (IR) palsy of acquired origin. Retrospective search identified 44 patients with acquired IR palsy between April 2006 and May 2011 from four Neurology and two Ophthalmology Clinics in Korea. We analyzed clinical features, the results of radiological and laboratory evaluation, and prognosis. The most common causes were vascular ( n = 16, 36 %) and trauma ( n = 12, 27 %). Vascular disorders included microvascular ischemia ( n = 10, 23 %), cerebral infarction ( n = 5, 11 %), and dural arterio-venous fistula ( n = 1, 2 %). Other causes were inflammation ( n = 7, 16 %), myasthenia gravis ( n = 5, 11 %), and thyroid ophthalmopathy ( n = 1, 2 %). We were unable to determine the etiology in the remaining three patients (7 %). Most patients (95 %) showed a complete recovery with or without treatment. Acquired IR palsy mostly occurs with brainstem or orbital lesions, and has an excellent prognosis. [ABSTRACT FROM AUTHOR]

Abstract: The CDT requires a patient to draw the face of a clock, insert all the numbers and set the hands for a specified time. This task engages a number of cognitive abilities including verbal understanding, memory, spatially coded knowledge, planning, concentration and visuoconstructive skills. Although CDT has been regarded as a simple and useful screening tool in dementia, little is known about the longitudinal changes in CDT performance and error types, according to dementia subtypes and their severity. Materials and methods: Two hundred thirty-five consecutive patients with dementia (Alzheimer disease=AD, n =94, Parkinson''s disease with dementia (PDD), n =119, Vascular dementia=VaD, n =22) were recruited from the memory clinic at Chungnam University hospital from January 2005 to July 2009. The Korean version of the mini-mental state examination (MMSE-K) and CDT were performed by all participants every 6 months. Scoring of the CDT performance was in accordance with the method of Mano and Wu. Error types of CDT were classified as follows: stimulus-bound response (SBR), conceptual deficit (CD), spatial and/or planning deficit (SPD) and perseveration error (PE). We divided patients into 3 groups by their initial MMSE-K score (severe, MMSE-K≤17; moderate, 18≤MMSE-K<24; mild, 24≤MMSE-K). Comparisons of CDT scores and error types in the three dementia subtypes and three cognitive groups were conducted. Results: Longitudinal changes on CDT and MMSE-K scores were not different between the three dementia subtypes. From the analysis of CDT error type, the most common error type was SPD in patients with mild to moderate dementia. In contrast, CD error was the most frequent in severe dementia group. The order of error frequency in all subjects from baseline to the last follow-up was as follows: SPD, CD, SBR and PE except CD was the most frequent error type in AD patients after 18 months from baseline. Conclusion: Longitudinal analysis of error on CDT may reflect different characteristics of cognitive deterioration according to dementia subtypes and dementia stages. [Copyright &y& Elsevier]

Background: Fisher syndrome (FS) is characterized by a triad of ophthalmoplegia, ataxia, and areflexia. The lesion sites responsible for ataxia and ophthalmoplegia in FS require further exploration. The aim of this study was to determine involvement of the central nervous system in FS using 18F-fluorodeoxyglucose positron emission tomography (PET). Methods: Cerebral glucose metabolism of 10 patients with FS was compared with that of 60 age- and gendermatched normal controls using PET. For individual analyses, 15 age- and gender-matched controls were selected from the control group. Patients also underwent MRI of the brain and measurement of serum anti-GQ1b antibody. Results: Group analyses revealed increased metabolism in the cerebellar vermis and hemispheres, pontine tegmentum, midbrain tectum, left thalamus and right inferior frontal cortex (P<0.001, uncorrected). In contrast, the visual association cortices (Brodmann areas 18 and 19) showed decreased metabolism bilaterally. Individual analyses disclosed hypermetabolism in the cerebellar vermis or hemispheres (n=7), inferior frontal cortex (n=5) and brainstem (n=4, P<0.005, uncorrected). We also found a negative correlation between the cerebellar hypermetabolism and the interval from symptom onset to PET (r =-0.745, P=.0013). The hypermetabolism was normalized on follow-up PET with an improvement of the ophthalmoplegia and ataxia in one patient. Conclusions: These findings indicate an involvement of the central nervous system in FS, and the hypermetabolism in the cerebellum and brainstem suggests an antibody-associated acute inflammatory process as a mechanism of this autoimmune disorder. [ABSTRACT FROM AUTHOR]

Abstract: Double saccadic pulses (DSP) are saccadic intrusions that consist of an initial saccade away from a fixation followed immediately by a return saccade back to the fixation. DSP have been reported in patients with presumed multiple sclerosis and metabolic encephalopathy. However, DSP have not been described in a circumscribed brain lesion. We report a man who developed almost continuous DSP with intervening macrosaccadic oscillations from a circumscribed lesion in the dorsal pontine tegmentum which extended up to the midbrain level and spared the nucleus raphe interpositus where the pause cells reside. Damage to the projections from the superior colliculus to omnipause neurons and resultant dysfunction of omnipause neuron may be a mechanism of saccadic intrusions and oscillations observed in our patient with a circumscribed brainstem lesion. [Copyright &y& Elsevier]

Abstract: Decreased BMI has been reported that it may be associated with cognitive decline in the elderly. Weight loss is common in patients with PD. However, studies comparing cognitive changes according to BMI changes in PD have not been done yet. We performed this study to know a relationship between BMI changes and the rate of cognitive decline in PD. PD patients were recruited retrospectively. The patients (n =104) were divided into two groups according to BMI changes during initial 6 months of follow-up: decreased (n =52) vs. stable BMI groups (n =52). Cognitive functions were repeated until 36 months of follow-up using the Korean version of the Mini-Mental State Examination (K-MMSE) and the modified Mini-Mental State (3MS) test. We calculated the rate of cognitive decline (K-MMSE and 3MS score changes/month) and compared it between the two groups. The decreased BMI group showed lower level of cognitive function than that of stable BMI group, especially at the 36th month of follow-up (p <0.05). In addition, the rate of cognitive decline was also significantly faster in the decreased BMI group, particularly at the 36th month of follow-up (p <0.05). This study suggests that decreased BMI during initial 6 months of follow-up in PD might be a useful indicator for future risk of dementia and let clinicians predict faster rate of cognitive decline in patients with PD. [Copyright &y& Elsevier]

The original version of this article unfortunately contained a mistake. [ABSTRACT FROM AUTHOR]