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Recurrent spontaneous vertigo with interictal headshaking nystagmus.
Neurology. 2018 06 12; 90(24):e2135-e2145.Neur

Abstract

OBJECTIVE

To define a disorder characterized by recurrent spontaneous vertigo (RSV) of unknown etiology and interictal headshaking nystagmus (HSN).

METHODS

We characterized HSN in 35 patients with RSV-HSN compared to that recorded in randomly selected patients with compensated vestibular neuritis (VN), vestibular migraine (VM), and Ménière disease (MD).

RESULTS

The estimated time constant (TC) of the primary phase of HSN was 12 seconds (95% confidence interval [CI] 12-13) in patients with RSV-HSN, which was larger than those in patients with VN (5 seconds, 95% CI 4-5), VM (5 seconds, 95% CI 5-6), or MD (6 seconds, 95% CI 5-6). TCs of the horizontal vestibulo-ocular reflex were also larger during the rotatory chair test in patients with RSV-HSN. Among the 35 patients with RSV-HSN, 7 showed vigorous long-lasting HSN with a peak slow-phase velocity >50.0°/s. In 5 patients (5 of 7, 71%) with vigorous HSN, HSN could have been induced even with headshaking for only 2 to 5 seconds. Long-term prognosis was favorable, with a resolution or improvement of the symptoms in more than half of the patients during the median follow-up of 12 (range 2-58) years from symptom onset. None developed VM, MD, or cerebellar dysfunction during the follow-up.

CONCLUSION

The clinical features and characteristics of HSN in our patients indicate a hyperactive and asymmetric velocity-storage mechanism that gives rise to intermittent attacks of spontaneous vertigo probably when marginal compensation of underlying pathology is disrupted by endogenous or exogenous factors.

Authors+Show Affiliations

From the Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center (S.-U.L., J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam, South Korea.From the Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center (S.-U.L., J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam, South Korea.From the Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center (S.-U.L., J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam, South Korea.From the Department of Neurology (S.-U.L., J.-Y.C., J.-S.K.), Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center (S.-U.L., J.-Y.C., J.-S.K.), Clinical Neuroscience Center, and Research Administration Team (H.-J.K.), Seoul National University Bundang Hospital, Seongnam, South Korea. jisookim@snu.ac.kr.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29792303

Citation

Lee, Sun-Uk, et al. "Recurrent Spontaneous Vertigo With Interictal Headshaking Nystagmus." Neurology, vol. 90, no. 24, 2018, pp. e2135-e2145.
Lee SU, Choi JY, Kim HJ, et al. Recurrent spontaneous vertigo with interictal headshaking nystagmus. Neurology. 2018;90(24):e2135-e2145.
Lee, S. U., Choi, J. Y., Kim, H. J., & Kim, J. S. (2018). Recurrent spontaneous vertigo with interictal headshaking nystagmus. Neurology, 90(24), e2135-e2145. https://doi.org/10.1212/WNL.0000000000005689
Lee SU, et al. Recurrent Spontaneous Vertigo With Interictal Headshaking Nystagmus. Neurology. 2018 06 12;90(24):e2135-e2145. PubMed PMID: 29792303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent spontaneous vertigo with interictal headshaking nystagmus. AU - Lee,Sun-Uk, AU - Choi,Jeong-Yoon, AU - Kim,Hyo-Jung, AU - Kim,Ji-Soo, Y1 - 2018/05/23/ PY - 2017/12/03/received PY - 2018/03/21/accepted PY - 2018/5/25/pubmed PY - 2019/8/14/medline PY - 2018/5/25/entrez SP - e2135 EP - e2145 JF - Neurology JO - Neurology VL - 90 IS - 24 N2 - OBJECTIVE: To define a disorder characterized by recurrent spontaneous vertigo (RSV) of unknown etiology and interictal headshaking nystagmus (HSN). METHODS: We characterized HSN in 35 patients with RSV-HSN compared to that recorded in randomly selected patients with compensated vestibular neuritis (VN), vestibular migraine (VM), and Ménière disease (MD). RESULTS: The estimated time constant (TC) of the primary phase of HSN was 12 seconds (95% confidence interval [CI] 12-13) in patients with RSV-HSN, which was larger than those in patients with VN (5 seconds, 95% CI 4-5), VM (5 seconds, 95% CI 5-6), or MD (6 seconds, 95% CI 5-6). TCs of the horizontal vestibulo-ocular reflex were also larger during the rotatory chair test in patients with RSV-HSN. Among the 35 patients with RSV-HSN, 7 showed vigorous long-lasting HSN with a peak slow-phase velocity >50.0°/s. In 5 patients (5 of 7, 71%) with vigorous HSN, HSN could have been induced even with headshaking for only 2 to 5 seconds. Long-term prognosis was favorable, with a resolution or improvement of the symptoms in more than half of the patients during the median follow-up of 12 (range 2-58) years from symptom onset. None developed VM, MD, or cerebellar dysfunction during the follow-up. CONCLUSION: The clinical features and characteristics of HSN in our patients indicate a hyperactive and asymmetric velocity-storage mechanism that gives rise to intermittent attacks of spontaneous vertigo probably when marginal compensation of underlying pathology is disrupted by endogenous or exogenous factors. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/29792303/Recurrent_spontaneous_vertigo_with_interictal_headshaking_nystagmus_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=29792303 DB - PRIME DP - Unbound Medicine ER -