Non-invasive evaluation of vertebral artery blood flow in cervical spondylosis with and without vertigo and association with degenerative changes

Clinical Rheumatology  0770-3198 (Print) 1434-9949 (Online), Published online: 16 February 2010 Remzi Cevik1 , Aslan Bilici2, Kemal Nas1, Zeynep Demircan1 and Rojbin Ceylan Tekin2(1) Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey
(2) Department of Radiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey 
Received: 31 May 2009 Revised: 4 January 2010 Accepted: 8 January 2010
 
Abstract Cervical spondylosis is a common disease that results from degenerative changes of the cervical spine and vertigo may occur in this process.
The aim of the present study was to assess the blood flow measurements of the vertebral artery (VA) using color Doppler ultrasonography (CDUS) in patients who have cervical spondylosis with and without vertigo. The study population included 101 patients with vertigo and spondylosis, 66 patients with spondylosis without vertigo, and 62 healthy controls. A bilateral decrease in the VA blood flow velocities were measured in patients with cervical spondylosis.
A negative correlation was found between the stage of cervical degenerative changes and the flow velocities in patients with vertigo, while this relationship was not found in patients without vertigo.
The CDUS evaluation of the pretransverse and transverse segments of VAs demonstrated significantly reduced flow velocities in patients with spondylosis.

The degenerative changes in the cervical spine seem to be related to these velocity changes in the subgroup of patients who are also affected with vertigo. The pretransverse segment of the VA provides valuable measurements as well as transverse segment of the VA, and it can be used as an appropriate segment for CDUS examination in cervical spondylosis and associated vertigo.

Nystagmus during Attacks of Vestibular Migraine: An Aid in Diagnosis

Audiology & Neurotology 

Vol. 15, No. 4, 2010  
Sharon Hartman Polensek (E-Mail sshartm@emory.edu), Ronald J. Tusa^{a, b,} Departments of ^aNeurology and ^bOtolaryngology, 
Emory University, Atlanta, Ga., USA

 Abstract

Introduction: An estimated one-fourth to one-third of patients with migraine will experience vertigo associated with their migraine attacks. Vestibular migraine frequently presents as a diagnostic challenge as objective neurological findings consistent with this entity have not been well described. Objective: The aim of this study is to characterize eye movements of patients presenting with nystagmus during attacks of migrainous vertigo. Design: A retrospective study of 26 patients presenting with nystagmus during an acute vestibular migraine was performed. All patients were examined while symptomatic during a migraine spell, and also while asymptomatic. All patients underwent tests of vestibular function with either bithermal water caloric or rotary chair electronystagmography. Results: The most common patient was a female of perimenopausal age. Spontaneous nystagmus was seen in 19% of patients and nystagmus provoked by horizontal headshaking was seen in 35%. Nystagmus could be provoked with positional testing in 100% of symptomatic patients with fixation blocked. The positional nystagmus most commonly was sustained, of low velocity, and could be horizontal, vertical or torsional. Bithermal water caloric or rotary chair tests obtained during symptom-free intervals were normal in all patients.

Conclusions:Although nystagmus characteristics are quite variable during vestibular migraine, the finding on examination of low-velocity, sustained nystagmus with positional testing in a young to middle-aged adult patient presenting with vertigo, nausea and headache is highly suggestive of vestibular migraine as long as the nystagmus dissipates when the patient is free of symptoms.

Copyright © 2009 S. Karger AG, Basel

Nystagmus during Attacks of Vestibular Migraine: An Aid in Diagnosis

Audiology And Neurotology Vol. 15, No. 4, 2010 
Sharon Hartman Polensek, Ronald J. Tusa Departments of Neurology and Otolaryngology, Emory University, Atlanta, Ga., USA

Author Contacts

Sharon Hartman Polensek, MD, PhD Emory University 1441 Clifton Rd. NE No. 239 Atlanta, GA 30322 (USA)
Tel. +1 40 4712 1976, Fax +1 40 4712 1927, E-Mail sshartm@emory.edu

Audiol Neurotol 2010;15:241-246 (DOI: 10.1159/000255440)

Abstract

Introduction: An estimated one-fourth to one-third of patients with migraine will experience vertigo associated with their migraine attacks. Vestibular migraine frequently presents as a diagnostic challenge as objective neurological findings consistent with this entity have not been well described. Objective: The aim of this study is to characterize eye movements of patients presenting with nystagmus during attacks of migrainous vertigo. Design: A retrospective study of 26 patients presenting with nystagmus during an acute vestibular migraine was performed. All patients were examined while symptomatic during a migraine spell, and also while asymptomatic. All patients underwent tests of vestibular function with either bithermal water caloric or rotary chair electronystagmography. Results: The most common patient was a female of perimenopausal age. Spontaneous nystagmus was seen in 19% of patients and nystagmus provoked by horizontal headshaking was seen in 35%. Nystagmus could be provoked with positional testing in 100% of symptomatic patients with fixation blocked. The positional nystagmus most commonly was sustained, of low velocity, and could be horizontal, vertical or torsional. Bithermal water caloric or rotary chair tests obtained during symptom-free intervals were normal in all patients. Conclusions:Although nystagmus characteristics are quite variable during vestibular migraine, the finding on examination of low-velocity, sustained nystagmus with positional testing in a young to middle-aged adult patient presenting with vertigo, nausea and headache is highly suggestive of vestibular migraine as long as the nystagmus dissipates when the patient is free of symptoms.

Copyright © 2009 S. Karger AG, Basel

‘Honeycomb’ tegmen: multiple tegmen defects associated with superior semicircular canal dehiscence

The Journal of Laryngology & Otology Cambridge University Press

Copyright © JLO (1984) Limited 2009

doi:10.1017/S0022215109991411

R Suryanarayanan^{a1 c1} and T H Lesser^a1

^a1 Department of Otolaryngology, Aintree University Hospitals National Health Service Foundation Trust, Liverpool, UK

Clinical Record

Abstract

Objective: To report the coexistence of multiple tegmen defects, forming a ‘honeycomb’ pattern, together with dehiscence of the superior semicircular canal.

Case reports: We describe three cases in which the above findings were noted, and we review the relevant literature.

Conclusion: Superior semicircular canal dehiscence is defined as the absence of portions of bone over the canal along the floor of the middle fossa. Most published articles describe the defect as an isolated finding which is either unilateral or bilateral. Studies on temporal bones show either a defect over the superior semicircular canal or isolated defects over the tegmen. We describe three cases in which we found multiple tegmen defects, giving a characteristic honeycomb appearance, coexisting with dehiscence over the superior semicircular canal. This finding, which supports the theory of a developmental defect as the origin of the condition, has not previously been reported. A literature review is presented, with discussion of the aetiology and management of superior semicircular canal dehiscence.

(Accepted June 15 2009)