Journal of Vestibular Research - Volume 22, issue 4

Authors: Lempert, Thomas | Olesen, Jes | Furman, Joseph | Waterston, John | Seemungal, Barry | Carey, John | Bisdorff, Alexander | Versino, Maurizio | Evers, Stefan | Newman-Toker, David

Article Type: Research Article

Abstract: This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is …based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours. Show more

Keywords: Migraine, vertigo, dizziness, vestibular, diagnostic criteria, Bárány Society, International Headache Society

DOI: 10.3233/VES-2012-0453

Citation: Journal of Vestibular Research, vol. 22, no. 4, pp. 167-172, 2012

Authors: Israël, I. | Giannopulu, I.

Article Type: Research Article

Abstract: The internal representation of the body is intimately related to postural orientation. This assists us to correctly identify our position relative to the earth-vertical. The postural orientation about the pitch-Y axis is by default forward tilted while there is no such default about the roll-X axis. We hypothetized that the internal representation of body position would be different between the Y and X axes. We designed a study to assess the accuracy of self-driven whole-body orienting to the horizontal and the vertical about the X (roll) and Y (pitch) axes, with healthy seated subjects in complete darkness. Consistent with our …hypothesis, the results showed that when trying to reach the horizontal with the X-axis, subjects remained on the same tilted direction as the initial posture. On the return way to the vertical, the subjects did not cross this (vertical) line. Whereas when reaching the horizontal with the Y-axis, there was an undershoot on the supine direction, and an overshoot on the prone direction: this discrepancy could be due to somatosensory cues to subjects in seated posture. The relevant mechanisms related to the internal representation of the body and graviceptive systems underlying the construction of an head-foot line are discussed. Show more

Keywords: Internal representation, vestibular system, somatosensory system, multisensory interactions

DOI: 10.3233/VES-2012-0450

Citation: Journal of Vestibular Research, vol. 22, no. 4, pp. 173-180, 2012

Authors: Correia Grácio, Bruno J. | Bos, Jelte E.

Article Type: Research Article

Abstract: Humans are able to estimate the vertical direction of an Earth fixed reference frame, which estimate is known as the subjective vertical (SV). To identify the SV, a distinction must be made between accelerations due to self-motion and gravity. Previous studies on this topic measured the SV using a variety of methods possibly affecting the outcome differently. In this study subjects were sinusoidally moved around their naso-occipital axis and their SV was dynamically measured using a joystick. In half the experimental conditions, the joystick was moved with the motion and was kept vertical on other experimental conditions, thus moving against …self-motion. Although physically indicating the same angle, the average perceived angle was larger when moving the joystick with the motion than against. The difference can be explained by assuming an idiotropic vector being at issue when measuring the subjective vertical, and not when measuring subjective tilt. Show more

Keywords: Motion perception, spatial orientation, subjective vertical, subjective tilt, joystick, phase measurement

DOI: 10.3233/VES-2012-0454

Citation: Journal of Vestibular Research, vol. 22, no. 4, pp. 181-189, 2012

Authors: Cohen, Helen S. | Kimball, Kay T. | Mulavara, Ajitkumar P. | Bloomberg, Jacob J. | Paloski, William H.

Article Type: Research Article

Abstract: The currently approved objective clinical measure of standing balance in astronauts after space flight is the Sensory Organization Test battery of computerized dynamic posturography. No tests of walking balance are currently approved for standard clinical testing of astronauts. This study determined the sensitivity and specificity of standing and walking balance tests for astronauts before and after long-duration space flight. Astronauts were tested on an obstacle avoidance test known as the Functional Mobility Test (FMT) and on the Sensory Organization Test using sway-referenced support surface motion with eyes closed (SOT 5) before and six months after (n=15) space flight on the …International Space Station. They were tested two to seven days after landing. Scores on SOT tests decreased and scores on FMT increased significantly from pre- to post-flight. In other words, post-flight scores were worse than pre-flight scores. SOT and FMT scores were not significantly related. ROC analyses indicated supra-clinical cut-points for SOT 5 and for FMT. The standard clinical cut-point for SOT 5 had low sensitivity to post-flight astronauts. Higher cut-points increased sensitivity to post-flight astronauts but decreased specificity to pre-flight astronauts. Using an FMT cut-point that was moderately highly sensitive and highly specific plus SOT 5 at the standard clinical cut-point was no more sensitive than SOT 5, alone. FMT plus SOT 5 at higher cut-points was more specific and more sensitive. The total correctly classified was highest for FMT, alone, and for FMT plus SOT 5 at the highest cut-point. These findings indicate that standard clinical comparisons are not useful for identifying problems. Testing both standing and walking balance will be more likely to identify balance deficits. Show more

Keywords: Functional mobility, space flight, locomotion, adaptation, recovery, astronauts

DOI: 10.3233/VES-2012-0456

Citation: Journal of Vestibular Research, vol. 22, no. 4, pp. 191-196, 2012

Authors: Shigeno, Kohichiro | Ogita, Hideaki | Funabiki, Kazuo

Article Type: Research Article

Abstract: To determine whether any particular head positions during sleep are associated with BPPV, head position during sleep was monitored for 3 days in 50 BPPV patients after the disappearance of positional nystagmus and in 25 normal control subjects. A gravity sensor was attached to the center of the subject's forehead at home. The positional angle of the head was measured at 5-second intervals during sleep. In BPPV, the posterior semicircular canal was involved in 40 patients and the lateral semicircular canal in 10 patients. Recurrence was found in 22 of 50 BPPV patients. BPPV patients with recurrence were significantly more …likely to sleep in the affected-ear-down 45-degree head position than were patients with no history of recurrence (P< 0.02). When the head is in the affected-ear-down 45-degree head position, the non-ampullated half of the posterior semicircular canal and the non-ampullated half of the lateral semicircular canal are nearly in the earth-vertical position, making it easier for detached otoconia to fall into the posterior or lateral semicircular canal and to agglomerate and attain a certain size in the lowest portion of each semicircular canal. Our findings showed that the affected-ear-down 45-degree head position during sleep could be an etiological factor of BPPV, more particularly in patients with recurrent BPPV. Show more

Keywords: Benign paroxysmal positional vertigo, recurrence, head positions, sleep

DOI: 10.3233/VES-2012-0457

Citation: Journal of Vestibular Research, vol. 22, no. 4, pp. 197-203, 2012

Authors: Ogawa, Yasuo | Otsuka, Koji | Shimizu, Shigetaka | Inagaki, Taro | Kondo, Takahito | Suzuki, Mamoru

Article Type: Research Article

Abstract: Objective: To determine the subjective visual vertical (SVV) perception in patients with vestibular neuritis (VN) and sudden sensorineural hearing loss (SSHL) using the SVV test and other neuro-otological examinations, namely, the vestibular evoked myogenic potential (VEMP) and caloric tests, and to clarify which vestibular nerve function is associated with an SVV shift. Patients and methods: We performed the SVV test in 36 VN patients and 80 SSHL patients. Thereafter, we investigated directional changes in the SVV in the VN and SSHL patients, and compared the results of the SVV test with those of the VEMP and caloric tests. …Results: Abnormal SVV (> 2° was found at a rate of 69.4% in the VN patients and 26.3% in the SSHL patients. In all except 1 VN patient, the SVV tilted to the lesion side. The rate of abnormal SVV was significantly higher in patients with complete canal paresis (CP) than in patients with partial CP. There was no significant relationship between the rates of abnormal SVV and VEMP. In the SSHL patients, neither the SVV nor the VEMP affected the hearing outcome and patients with abnormal VEMP tended to show abnormal SVV. Conclusion: VN patients showed a higher rate of abnormal SVV than SSHL patients. From the results, it is speculated that the superior vestibular nerve function mainly affects the SVV tilt, although the inferior vestibular nerve function may also have an effect. Show more

Keywords: Otoliths, sacculus, semicircular canal, subjective visual horizontal, subjective visual vertical, utriculus

DOI: 10.3233/VES-2012-0447

Citation: Journal of Vestibular Research, vol. 22, no. 4, pp. 205-211, 2012