著者

國弘 幸伸 相馬 啓子

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.73, no.3, pp.174-186, 2014-06-30 (Released:2014-08-01)

参考文献数

10

被引用文献数

3

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Postural, tension-type headache is the most prominent symptom of cerebrospinal fluid leakage. However, in otoneurological practice, dizziness and not headache is the most frequent presenting symptom in patients with this disorder. Affected patients usually describe their dizziness as a floating sensation. Rotatory vertigo occurs quite rarely. Their complaint is substantiated by high degrees of postural unsteadiness. Some patients cannot stand still even with their eyes open. They stumble and totter while walking. In contrast to such high degrees of postural ataxia, oculomotor disorders such as nystagmus, saccadic pursuit, and decrease of oculomotor nystagmus are not seen. As with other symptoms, dizziness and postural unsteadiness are influenced by the weather, and get worse when the weather is bad. The authors speculate that unsteadiness in both peripheral and central nervous systems involved in spatial orientation (integration of visual, vestibular, and proprioceptive input) underlies the dizziness, postural unsteadiness, and a variety of other symptoms of cerebrospinal fluid leakage.

著者

國弘 幸伸 相馬 啓子

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.70, no.3, pp.176-188, 2011 (Released:2011-08-01)

参考文献数

11

被引用文献数

3 1 3

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The most prominent symptom of spinal cerebrospinal fluid (CSF) leakage is an orthostatic, tension-type headache. Other well-known symptoms include nausea, vomiting, photophobia, diplopia, depression, and amnesia. The authors address other commonly encountered symptoms such as dizziness, hearing disturbances, cerebrospinal fluid rhinorrhea, and gustatory and olfactory disturbances.The dizziness experienced in this disorder is essentially characterized as a kind of “floating sensation” or “walking on the clouds” and is associated with a high degree of unsteadiness. A considerable percentage of patients cannot remain standing even when their eyes are open; to-and-fro perturbations are particularly prominent in these patients. Rotatory vertigo attacks can occur in a small portion of patients, but usually only during the early stages of the disease. As with the headache, dizziness is aggravated by an upright or standing position. The weather also influences the intensity of both the headaches and dizziness: both are exacerbated when the atmospheric pressure is low or is falling rapidly. Water intake and/or the drip infusion of a physiological salt solution may temporarily improve dizziness and other symptoms.The usefulness of MRI for diagnosing spinal cerebrospinal fluid leakage is limited. MRI findings are equivocal in most cases; therefore, the authors perform 111In-DTPA scintigraphy for each patient in whom this disorder is suspected.The first choice of treatment for this disorder is bed rest and water intake and/or drip infusion. When these treatments are ineffective, an epidural autologous blood patch is attempted. However, not all patients are cured by this procedure, and dizziness, hearing, and/or tinnitus may worsen after treatment. In some patients, an exploratory tympanotomy is required to rule out associated or treatment-induced perilymphatic fistula.In conclusion, spinal CSF leakage is not a rare disorder, and because this disorder presents with an extremely wide spectrum of symptoms, all physicians in any field of specialization may encounter a patient with this disorder. All physicians should keep this disorder in mind.

著者

相馬 啓子

出版者

特定非営利活動法人 日本歯科放射線学会

雑誌

歯科放射線 (ISSN:03899705)

巻号頁・発行日

vol.61, no.1, pp.6-11, 2021 (Released:2021-09-30)

参考文献数

5

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I introduce the diagnosis and treatment of the lacrimal drainage system obstruction which causes epiphora.The obstruction of the lacrimal drainage pathway at any point from the punctum to the nasolacrimal duct induces epiphora. Not only ophthalmologic factors but also rhinological factors such as a post-maxillary sinus surgery cause the obstruction.In recent years, a number of researchers have reported the obstruction due to the side effects of oral anticancer drug TS1.Slit lamp microscopy examination, irrigation test, dacryoendoscopy and dacryocystgraphy are used to diagnose this disease. Small-diameter dacryoendoscope enabled us to observe the inside condition of lacrimal passage. Corn Beam CT dacryocystography is available for diagnosis of the obstructed site of tear route and paranasal sinuses disease.Re-opening or making a new tear route through the lacrimal drainage pathway can relieve the epiphora. Dacryoendoscopic surgery for the obstruction without severe inflammation is one of the initial methods to penetrate the stenosis and obstruction of the lacrimal drainage pathway.There are two methods, endoscopic endonasal dacryocystorhinostomy (END-DCR) and external dacryocystorhinostomy (EXT-DCR), which make a new tear route. Both methods have been accepted technique and showed high success rates, especially for obstructions at the nasolacrimal duct. However, clinical comfort defined by patients is higher in END-DCR. A sutureless surgical area with less pain is advantage of this method.

著者

伊藤 まり 相馬 啓子 小関 芳宏 池上 奈歩

出版者

一般社団法人 日本耳科学会

雑誌

Otology Japan (ISSN:09172025)

巻号頁・発行日

vol.20, no.3, pp.186-189, 2010 (Released:2011-11-30)

参考文献数

14

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他覚的耳鳴は身体内部に耳鳴となる明らかな音源がある場合で、他覚的耳鳴は筋性耳鳴、血管性(拍動性)耳鳴、その他に分けられる。血管性(拍動性)耳鳴は脈拍と一致しており、原因疾患として局所疾患と全身疾患に分けられ、全身疾患による拍動性耳鳴は循環動態の変化と関係があり、貧血や甲状腺機能亢進、beri-beri(ビタミンB1欠乏症)、褐色細胞腫、妊娠が挙げられる。全身疾患による拍動性耳鳴が他覚的に聴取されることは極めて稀である。今回、我々は子宮筋腫に伴う不正出血、貧血により、左他覚的拍動性耳鳴を引き起こし、子宮筋腫摘出術後、貧血の改善に伴い耳鳴が改善した症例を経験し、その耳鳴音を記録、解析し得たので報告する。

著者

安田 知久 相馬 啓子 國弘 幸伸 安田 宏一

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.78, no.1, pp.39-42, 2019-02-28 (Released:2019-04-01)

参考文献数

11

被引用文献数

1

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Ten healthy volunteers were spun passively on a revolving chair (0.5 Hz left-winded 7 rotation), asked to stand up immediately thereafter and take 30 steps with their eyes closed. The observations revealed that subjects having an anteverted posture turned to the right, whereas those with a retroverted posture turned to the left. To ascertain the reason for this directional switch, volunteers carried a 10-kg weight on their front or back while keeping their axis vertical. The front-weighted subjects turned to the right like the subjects with the anteverted posture, while the back-weighted subjects turned to the left like those with the retroverted posture. The results indicated that shifting of the center of gravity, and not the posture, was the reason for the difference. When the subjects kept their arms up forward horizontally and the legs high up as in Fukuda's stepping test, they turned to the right, because their horizontal arms and highly up legs set the weight forward. The neutral pose, with the arms hanging down along the side of the body and stepping low, was scarcely associated with any turning.