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

---

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

青木 光広 林 寿光 若岡 敬紀 西堀 丈純 久世 文也 水田 啓介 伊藤 八次

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.76, no.4, pp.270-276, 2017-08-31 (Released:2017-10-01)

参考文献数

18

被引用文献数

1

---

The superior semicircular canal dehiscence syndrome (SCDS), which presents with comprehensive symptoms such as hyperacusis, autophony, and pressure-induced vertigo, has been recently recognized in Japan. Three patients with SCDS, in whom severe vestibular symptoms were unable to be controlled with conservative treatments, underwent capping surgery through the middle fossa approach. The preoperatively air-bone gap (AB gap) in the audiometry, the decreased threshold of cervical vestibular evoked myogenic potentials (cVEMP) and bone dehiscence of the superior semicircular canal could be observed in all patients on CT imaging. All patients suffered from positional vertigo for about one week after the operation. However, their cochlear and vestibular symptoms associated with the SCDS were relieved within a few months after the operation. The capping procedure decreased the AB gaps and increased the thresholds of cVEMP in all patients. We suggest that capping surgery via the middle fossa approach for the SCDS is an efficient procedure without severe side effects.

著者

吉田 友英

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.69, no.3, pp.147-150, 2010 (Released:2010-08-01)

参考文献数

9

被引用文献数

6 3

著者

角南 貴司子

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.82, no.2, pp.61-67, 2023-04-30 (Released:2023-06-14)

参考文献数

19

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Progressive supranuclear palsy (PSP) has been reported as a disorder mainly characterized by a tendency to fall, vertical supranuclear gaze palsy, and constriction of the body axis, akinesia, and cognitive impairment. Patients presenting with these typical clinical features are diagnosed as having the PSP-Richardson syndrome (PSP-RS). Electronystagmography (ENG) is useful for the detection of ocular motility disorder, which is the main feature of PSP. In cases of PSP, ocular motility disorder in the vertical direction occurs from the initial stage of the disease, and is characterized by prolonged latency and reduced velocity of the saccadic eye movement in the vertical direction. Horizontal saccadic eye movement disorder also occurs after the intermediate stage. Square wave jerks (SWJ) are often recognized from the initial stage of the disease. In terms of nystagmus, the quick phase is impaired due to impaired saccadic eye movements, and impairment of optokinetic nystagmus also starts from the quick phase movements. Pursuit (smooth) eye movement may also be impaired as the disease progresses. On the other hand, the vestibulo-ocular reflex is maintained even after disease progression to a late stage.

著者

今井 貴夫

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.82, no.2, pp.105-113, 2023-04-30 (Released:2023-06-14)

参考文献数

13

---

Electrophysiological measurement of the eye rotation axis using stimulation of a single semicircular canal nerve showed that the eye rotated around the axis perpendicular to the plane of the stimulated semicircular canal. Therefore, the affected semicircular canal can be identified by analyzing the eye rotation axis in cases of abnormal nystagmus. When the main component of the abnormal nystagmus is horizontal, the origin of the nystagmus is the lateral semicircular canal. When the main component of the abnormal nystagmus is torsional, the origin of the nystagmus is the anterior and/or posterior semicircular canal. The eye rotation axis in cases of excitatory nystagmus is quite the same as that in cases of inhibitory nystagmus, although the direction of eye rotation is opposite between cases of excitatory and inhibitory nystagmus. Vestibular neuritis mostly involves the superior vestibular nerve. The superior vestibular nerve transmits sensory information transmitted by from the vestibular hair cells located in the anterior and lateral semicircular canals. Therefore, patients with vestibular neuritis exhibit nystagmus with both horizontal and torsional components caused by inhibition of both the anterior and lateral semicircular canals. In patients with Ménière's disease, during a vertigo attack, excitatory nystagmus of anterior and/or posterior and/or lateral semicircular canal origin can be seen. Because the involving ratio of each contributing ratios of the three semicircular canals to nystagmus can vary, the ratio of the torsional component of the nystagmus to the horizontal component also varies. While nystagmus is purely horizontal in some cases, it is purely torsional in others. In the posterior canal type of BPPV, during the Dix-Hallpike maneuver, transient torsional nystagmus with the torsional component directed toward the affected side can be seen. In the lateral canal type of BPPV (canalolithiasis), geotropic positional nystagmus can be seen when the patient is supine. In the lateral canal type of BPPV (cupulolithiasis), apogeotropic positional nystagmus can be seen when the patient is supine.

著者

一般社団法人日本めまい平衡医学会 学会のあり方委員会 担当理事: 宇佐美 真一 内藤 泰 室伏 利久 委員長: 北原 糺 委員: 牛尾 宗貫 城倉 健 関根 和教 中村 正 伏木 宏彰

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.77, no.1, pp.43-46, 2018-02-28 (Released:2018-04-04)

参考文献数

3

被引用文献数

8 2

著者

田村 敦 田所 慎

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.4, pp.242-253, 2019-08-31 (Released:2019-10-02)

参考文献数

66

被引用文献数

1

---

A major purpose of aeromedicine as a specialty is the prevention of aircraft accidents. Only prevention can save lives. From the earliest days of aviation, almost all aviation accidents have been attributed to the human factor called spatial disorientation. To understand spatial disorientation, one must comprehend how the human body interacts and interprets the environment of flight. This understanding can help to provide control and prevent loss of spatial orientation that can lead to aviation accidents.

著者

関根 和教 今井 貴夫 立花 文寿 松田 和徳 佐藤 豪 武田 憲昭

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.69, no.1, pp.47-51, 2010 (Released:2010-04-01)

参考文献数

15

---

We report a case of Costen's syndrome that showed chewing-induced nystagmus and vertigo. A 31-year-old woman visited our hospital complaining of chewing-induced vertigo 5 days after dental therapy. During chewing a stick of gum, she complained of vertigo and showed nystagmus beating to the right, the direction of which changed to the left thereafter. No spontaneous and positional nystagmus or any abnormalities in the neurological examination could, however, be found. The chewing-induced nystagmus and vertigo gradually disappeared within 2 weeks. Costen's syndrome is associated with various symptoms due to temporomandibular dysfunction. In the case, it is suggested that malinterdigitation after dental therapy caused temporomandibular dysfunction, resulting in the chewing-induced nystagmus, therefore, Costen's syndrome was diagnosed.Eustachian tube hypothesis, Tensor tympani hypothesis and otomandibular ligament hypothesis that accounted for temporomandibular dysfunction-induced aural symptoms in patient with Costen's syndrome had been proposed, but recently were withdrew. On the other hand, it is reported that reciprocal connections between trigeminal and vestibular nuclei. The trigeminal somatosensory input associated with temporomandibular dysfunction after dental therapy may cause chewing-induced nystagmus via the trigemino-vestibular connection in the brainstem in the case.

著者

塚田 愛 池本 英志 井上 達貴 小島 衣里加 福岡 聖也 砂川 正隆

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.80, no.4, pp.296-302, 2021-08-31 (Released:2021-10-02)

参考文献数

37

---

Several Japanese herbal medicines (Kampo), including Yokukansan, Yokukansankachimpihange, Shigyakusan, Kososan, Kamishoyosan, Kamikihito, Saikokaryukotsuboreito, Keishikaryukotsuboreito, Hangekobokuto, and Rikkunshito, are clinically used for patients with stress-related symptoms and diseases, according to the patient's constitution and symptoms (`Sho' in Oriental medicine). Kamikihito and Yokukansan are prescribed for the treatment of insomnia and neurosis in Japan. However, the precise mechanisms of actions of these products remain unclear. We investigated their possible antistress effects and involvement of oxytocin in the mechanisms of their actions in an animal model of stress. Oxytocin is a posterior pituitary hormone related to uterine contraction and milking. In recent years, its effects in the central nervous system-including its antistress effect-have been attracting interest. Oxytocin is reported to reduce stress levels via regulation of activities in the hypothalamic-pituitary-adrenal axis. Administration of Kamikihito or Yokukansan significantly increased the secretion of oxytocin in acute stress situations and exerted an antistress effect. Furthermore, the effects of these drugs were partially abrogated by administration of an oxytocin receptor antagonist. These results suggest that Kamikihito and Yokukansan have antistress activity and that increased oxytocin secretion may be involved in the mechanism underlying this effect. In clinical practice, the target candidates for these two drugs are different. Although both are used for irritability, anger and insomnia, Kamikihito is generally prescribed to patients who are physically weak, have weak digestive functions, or complain of mental anxiety. Yokukansan, on the other hand, is prescribed to patients with moderate physical strength, who are sensitive, and easily excited. These Kampo medicines may also be useful for stress-induced symptoms and illnesses.

著者

堀井 新

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.75, no.2, pp.33-40, 2016-04-30 (Released:2016-06-01)

参考文献数

32

被引用文献数

4 1

---

It is well known that stress induces or aggravates vertigo/dizziness and that dizzy patients have often comorbid psychiatric diseases such as anxiety and depression. Dizziness-associated psychiatric disease is not idiopathic but is usually an adjustment disorder to stressful life events. Stress can be divided into two groups: physical and psychological stress. Psychological stress activates the amygdala, which is a center for emotion discriminating discomfort from comfort, followed by hypothalamic-pituitary-adrenal axis (HPA axis) activation. In dizzy patients, sensory mismatch signals arising from multimodal sensory systems, including the vestibular, visual, and proprioceptive systems, would also activate the amygdala. Together with psychological stress, sensory mismatch signals judged as discomfort signals by the amygdala may drive the HPA axis and bring about dizziness. This scheme can well explain why psychological stress induces or aggravates vertigo and dizziness. In treating dizzy patients with stress-induced anxiety and depression, it is important to take care of comorbid psychiatric diseases and the cause of stress regardless of the existence or absence of organic vestibular diseases.

著者

一般社団法人日本めまい平衡医学会 診断基準化委員会 担当理事: 池園 哲郎 堀井 新 委員長: 今井 貴夫 副委員長: 中村 正 委員: 渡辺 行雄 重野 浩一郎 高橋 幸治 浅井 正嗣 山本 昌彦 武井 泰彦 池田 卓生 橋本 誠

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.3, pp.228-229, 2019-06-30 (Released:2019-08-02)

被引用文献数

9

著者

山中 敏彰

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.75, no.4, pp.219-227, 2016-08-31 (Released:2016-10-01)

参考文献数

26

被引用文献数

1 1

---

Some patients with uncompensated vestibular hypofunction present with a long history of persistent severe problems in posture and mobility that are intractable to any treatment. We examined whether graded vestibular balance rehabilitation would alleviate the dizziness and balance problems, and increase the safety and independence of patients with chronic balance disorders following unilateral vestibular loss. The stepwise treatment program for vestibular balance rehabilitation developed at our clinic consists of vestibular adaptation training (Step 1), sensory reweighing training (Step 2), and vestibular substitution training (Step 3). This rehabilitation program is intended at promoting the central vestibular adaptation process, altering the vestibular, visual and somatosensory inputs, and encouraging the use of the sensory substitution system with a human (brain)-machine interface as a substitute for the diminished vestibular input, for transmitting information about the patient's head position to the tongue. Clinical trials were performed to investigate the degree to which the stepwise multimodal approach might be effective for chronic balance disorder in subjects with unilateral decompensated vestibular loss. Some interventions for rehabilitation were selected and customized for each patient in accordance with the level of their compensation for postural control and sensory dependence. Improvements in the balance performance were noted in 64.4% of all the subjects after the Step 1 training. Of the 31 subjects (35.6%) who failed to improve with the step 1 program, 14 (45.2%) showed improvements after the Step 2 training. All of the subjects who failed to show improvement after the Step 1 and 2 training programs showed pronounced improvements after the Step 3 training. These results suggest that programmatic stepwise multimodal approach to vestibular rehabilitation yields beneficial effect in patients with balance disorder secondary to vestibular decompensation.

著者

増村 千佐子 今井 貴夫 真貝 佳代子 滝本 泰光 奥村 朋子 太田 有美 森鼻 哲生 佐藤 崇 岡崎 鈴代 鎌倉 武史 猪原 秀典

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.76, no.2, pp.72-78, 2017-04-30 (Released:2017-06-01)

参考文献数

15

---

The differential diagnosis for positional dizziness/vertigo, such as vertigo upon waking up or standing up, includes benign paroxysmal positional vertigo (BPPV), orthostatic hypotension (OH), autonomic dysfunction, and so on. A correct and efficient diagnosis of this condition is important. The purposes of this study were to clarify in which cases is a Schellong test the optimal means of diagnosing OH among patients with positional vertigo and to obtain specific answers to our original questionnaire on dizziness/vertigo among OH patients. All the patients who visited our office complaining of dizziness/vertigo between 2012 and 2015 were asked to perform the Schellong test and to complete our questionnaire. We used a conventional BPPV diagnostic maneuver to diagnosis BPPV. The results were analyzed statistically. A total of 309 cases returned analyzable questionnaire results. Overall, 38 cases were finally diagnosed as having certain BPPV based on the observation of positional nystagmus; 104 cases tested positive using the Schellong test. None of the items in the questionnaire were correlated with either a positive or negative Schellong test result. When 13 Schellong test-positive cases were excluded from the certain BPPV group, three answers to the questions in the questionnaire differed significantly between the certain BPPV group and the Schellong test-positive group. These answers were as follows: a waking up/lying down movement or rolling over in a supine position triggers vertigo, and a specific head position exacerbates vertigo. In conclusion, when a patient complains of vertigo upon waking up or standing up, the following two specific questions should be asked: “Is your vertigo triggered by waking up/lying down or by rolling over in a supine position?” and “Does a specific head position exacerbate your vertigo?” If a patient answers ‘yes’ to either of these questions and positional nystagmus is not observed, a Schellong test should be performed to diagnose OH.

著者

中村 節子

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.71, no.3, pp.182-184, 2012 (Released:2012-08-01)

参考文献数

24

著者

高橋 正紘

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.157-157, 2014-06-30 (Released:2014-08-01)

著者

田中 英高

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.71, no.2, pp.53-60, 2012 (Released:2012-06-01)

参考文献数

25

---

Dizziness is not an uncommon medical problem in children. When a child develops various physical symptoms in addition to dizziness, clinicians should include orthostatic dysregulation (OD) in their diagnosis. OD is composed of four different subsets, instantaneous orthostatic hypotension (INOH), postural tachycardia syndrome (POTS), neurally-mediated syncope and delayed orthostatic hypotension, and the former two are dominant. INOH involves dysfunction of the high-pressure system in the neural baroreflex pathway, and the low-pressure system in the case of POTS. Children with OD show a decrease in cerebral blood flow compared with unaffected children, and this might be associated with the mechanism responsible for dizziness. Further studies are anticipated in relation to OD and vestibular function.

著者

小川 恭生

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.82, no.2, pp.114-119, 2023-04-30 (Released:2023-06-14)

参考文献数

6

---

Differentiation of central from peripheral lesions is important when examining patients with dizziness or vertigo. Nystagmus is one of the most important clues to the differential diagnosis between central and peripheral lesions. It is not rare in patients with central lesions to have no neurologic symptoms other than nystagmus in the acute phase. Direction-changing gaze-evoked nystagmus, upbeat nystagmus, downbeat nystagmus and direction-changing apogeotropic positional nystagmus are known as characteristic findings of central vertigo. In this article, we report a case with direction-changing gaze-evoked nystagmus, a case with upbeat nystagmus, a case with downbeat nystagmus, and a case with direction-changing apogeotropic positional nystagmus, and explain/speculate on the mechanism of nystagmus in each case.

著者

中島 務 中田 隆文 片山 直美 杉浦 彩子 内田 育恵 寺西 正明 吉田 忠雄

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.79, no.3, pp.156-163, 2020-06-30 (Released:2020-08-05)

参考文献数

32

---

We investigated the risk factors for vertigo from the results of health checkups conducted in Yakumo town. The subjects of this investigation included 525 persons (299 women and 226 men), aged 40 to 88 years (average 63.78 years). Among these, 397 persons (75.6%) had no vertigo, 116 persons (22.1%) had vertigo sometimes, and 12 persons (2.3%) suffered from vertigo frequently. Ninety-four women (31.4%) and 34 men (15.0%) had vertigo. Twenty-one (51.2%) of the 41 women in their 40s had vertigo. Logistic regression analysis revealed that subjective hearing loss, a low value of the mean corpuscular hemoglobin concentration (MCHC), headache, high level of serum creatinine and frequent urination were significantly associated with the risk of vertigo, after adjustments for age and sex. Listening difficulties in conversations between four or five people were reported more frequently than those in one-to-one conversations. Anemia should be considered in the differential diagnosis of vertigo. In the diagnosis of vertigo, information about the presence/absence of headache and the status of the headache, if any, may be necessary. In our study, migraine and headache on the ipsilateral side were associated with vertigo, but bilateral headache was not associated with vertigo. Our analysis, did not reveal smoking, drinking, exercise habit, sleep time, body mass index (BMI), body fat percentage, hemoglobin A1c, blood glucose, serum triglyceride, serum LDL cholesterol, or serum HDL cholesterol as being significantly associated with the risk of occurrence of vertigo, after adjustments for age and sex.

著者

田浦 晶子

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.77, no.2, pp.47-57, 2018-04-30 (Released:2018-06-01)

参考文献数

63

被引用文献数

1

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Cervical vertigo is known as vertigo due to a neck problem. However cervical vertigo remains controversial because there are neither reliable tests nor recognized signs. Supporters of cervical vertigo insist that it is the most common vertigo syndrome. Additionally, some studies demonstrated that stimuli applied to the neck induced nystagmus and dizziness. To date, pathophysiologically four different hypothetical mechanisms have been attributed to cervical vertigo: (1) sympathetic dysfunction; (2) proprioceptive dysfunction; (3) rotational vertebral artery compression (Bow hunter's syndrome); and (4) overlap with migraine associated vertigo. However there are no established tests to diagnose cervical vertigo and diagnosis mostly depends on the patient's past history or subjective complaint such as neck pain. Therefore vestibular or other neurological diseases must be excluded first. Treatment should be specified according to the cause of cervical vertigo. For sympathetic dysfunction due to cervical spondylosis, decompression therapy such as cervical disc decompression might be effective. Physical therapy is reported to be useful for proprioceptive cervical vertigo. In the case of cervical vertigo due to vertebral artery compression, conservative management, decompression surgery and endovascular therapy are major treatment methods. In the future, cervical vertigo is expected to increase due to the expansion of the use of electronic devices such as smartphones. Appropriate clinical examinations and diagnostic criteria should be established urgently.

著者

前田 佑輔 伏木 宏彰 角田 玲子 木下 修 阿部 靖 遠藤 まゆみ 西村 信子

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.76, no.6, pp.692-697, 2017-12-31 (Released:2018-02-03)

参考文献数

7

被引用文献数

4 1

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In the United States of America, physiotherapists are involved in vestibular rehabilitation. With the aim of clarifying the degree of interest in Japanese physiotherapists regarding vestibular rehabilitation, this study used a questionnaire to survey physiotherapists who had previously been exposed to equilibrium research at workshops and physiotherapists who had not been exposed as a control group. Approximately 80% of those in the control group were interested in vestibular rehabilitation. However, most physiotherapists had very few opportunities to receive education regarding the pathophysiology of the vestibular system and related diseases in a clinical setting. Physiotherapists who participated in workshops received this education from senior physiotherapists as their instructors. The small number of physiotherapists who were given such opportunities was engaged in vestibular system rehabilitation based on requests from otolaryngologists for a small number of cases. A question regarding vestibular rehabilitation was on the national examination for physiotherapists in 2015. However, there are few opportunities for education regarding vestibular system before and after graduation.