脳幹虚血性病変を認めた発作性頭位めまい例

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  • Paroxysmal Positional Vertigo in a Patient with an Ischemic Brain Stem Lesion Detected by MRI.

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A 64-year-old woman had a 15-year history of intermittent vertigo when her head was in the lateral position. The vertigo disappeared in a week with medication, but recently the intervals between the vertigo attacks have become shorter. This time she complained that the positional vertigo had continued for over a month. The vertigo was not accomplained by tinnitus or hearing loss. The patient had hypertension for two years and has taken an anti-hypertension drug. In addition, hyperlipidemia was detected several years ago. She showed positional nystagmus of the direction changing type directed towards the upper ear in the lateral head position. Her nystagmus has a latent period and is continuous. Habituation with test repetition was not seen. The caroric test induced excessive nystagmus, and visual suppression was poor. These otoneurological findings suggest that inhibition of the vestibulo-occular system by the cereellum was not functioning well. MRI showed a small ischemic lesion in her brain stem as a pontine high signal (T2 high intensity, T1 normal).<br>Bruns first described paroxysmal positional nystagmus which was due to disorders of the central nervous system. Kornhuber reported that this form of nystagmus is related to the inhibitory role of the cerebellum. Sakata called it “paroxysmal positional vertigo of the malignant type. (MPPV)” These reports described the nodulus and the cerebellar tonsils as the sites of lesions which induced the symptom. The lesion detected by MRI in our case differed from previously reported lesions. Sakata also suggested that a disorder in the vestibulo-cerebellum pathway might cause the symptoms. In this case, paroxysmal positional vertigo arose from a disorder of the inhibitory system of the cerebellum.

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