Biomedical subjects

Krister Brantberg

Publications and source records attributed to Krister Brantberg.

12 recordsLinked to original sources

PubMed2006

Posterior canal dehiscence syndrome caused by an apex cholesteatoma.

OBJECTIVE: To compare audio-vestibular findings caused by a dehiscence of the posterior semicircular canal with those found in the superior canal dehiscence syndrome. STUDY DESIGN: Case report. SETTING: University hospital, tertiary referral center. PATIENT: The 44-year-old woman suffered from a gradual hearing loss with pulse-synchronous tinnitus as well as sound and pressure-induced vertigo. INTERVENTION: Audio-vestibular testing and high-resolution computed tomography. MAIN OUTCOME MEASURE: The superior canal dehiscence syndrome is caused by failure of normal postnatal bone development in the middle cranial fossa leading to absence of bone at the most superior part of the superior semicircular canal. The typical features for this syndrome are sound- and pressure-induced vertigo with torsional eye movements, pulse synchronous tinnitus and apparent conductive hearing loss in spite of normal middle-ear function. We present a patient with very similar symptoms and findings who, instead, had a posterior semicircular canal dehiscence caused by an apex cholesteatoma. CONCLUSION: Patients with semicircular canal dehiscence have common auditory-vestibular features regardless of which of the two vertical semicircular canals is affected. The only obvious difference between the two is the vertical component of the sound and pressure-induced eye movements (which beats in opposite directions).

Adult↗

PubMed2005

Drop attacks secondary to superior canal dehiscence syndrome.

Two patients with unprovoked drop attacks were found to have dehiscence of the superior semicircular canal on CT of the temporal bone. Both had conductive hearing loss, preservation of stapedius reflex, and abnormal vestibular evoked myogenic potentials. Neither had sound- or pressure-induced nystagmus. Repair of the dehiscence in one case stopped the drop attacks, supporting a causal relationship between the dehiscence and the drop attacks.

Aged↗

PubMed2005

Migraine-associated vertigo.

CONCLUSIONS: It is probably not wise to demand a temporal relationship between migraine symptoms and vertigo for the definition of migrainous vertigo. When recurrent vertigo attacks begin at an early age in a patient with normal hearing and migraine, there are few diagnoses other than migraine that need to be considered. OBJECTIVE: The clinical association between migraine and vestibular symptoms, such as dizziness, motion intolerance and spontaneous attacks of vertigo, is well documented. Recently, investigators have attempted to develop diagnostic criteria for this association. We hypothesized that there are multiple migraine-associated vestibular syndromes and studied a more homogenous subset of them (benign recurrent vertigo). MATERIAL AND METHODS: A structured interview was conducted over the telephone with 40 patients who presented to our neurotology clinic with benign recurrent vertigo and met the International Headache Society criteria for migraine. The structured interview was also conducted with 40 relatives of the patients who reported the same symptoms. RESULTS: A marked female predominance was found. Most of the patients had vertigo attacks lasting minutes or hours and most were completely free of dizziness between attacks. Imbalance and nausea typically accompanied the vertigo. However, in half of the cases, vertigo occurred without an association with headache.

Adult↗

PubMed2004

Function of semicircular canals, utricles and saccules in deaf children.

OBJECTIVE: To study vestibular function in deaf children. MATERIAL AND METHODS: In 36 deaf children the function of the semicircular canals, saccules and utricles was measured by means of caloric testing, recordings of vestibular-evoked myogenic potentials (VEMPs) and measurements of the subjective visual horizontal (SVH) at different body tilts, respectively. RESULTS: In total, 30% of subjects had caloric hypo- or areflexia and 24% had a caloric asymmetry. VEMPs were weak or absent bilaterally in 22% of cases, and asymmetric in 19%. Regarding the utricle, 17% of subjects had a pathologically reduced perception of roll tilt to both sides and 25% had an asymmetry. In total, 30% of subjects were pathologic in all 3 tests and 30% were completely normal. Semicircular canal function correlated best with the function of the saccule. If hearing was better than 90 dB (pure-tone average of 0.5, 1.0 and 2.0 kHz) vestibular function was often normal. For hearing levels of 100-120 dB, otolith function declined significantly. CONCLUSIONS: Vestibular function tends to be preserved up to a point where hearing is nearly extinct. Hearing level correlates more closely with otolith function, especially that of the utricle, than with semicircular canal function.

Adolescent↗

PubMed2004

Subarcuate venous malformation causing audio-vestibular symptoms similar to those in superior canal dehiscence syndrome.

OBJECTIVE: To present a patient with symptoms similar to those of superior canal dehiscence syndrome due to another cause. STUDY DESIGN: Case report. SETTING: University hospital, tertiary referral center. PATIENT: The 65-year-old woman had suffered for 4 years from hearing loss, tinnitus, and pressure-induced vertigo. INTERVENTION: Audio-vestibular testing, high-resolution computed tomography, and magnetic resonance angiography. MAIN OUTCOME MEASURE: The superior canal dehiscence syndrome is caused by failure of normal postnatal bone development in the middle cranial fossa leading to absence of bone at the most superior part of the superior semicircular canal. The typical features for this syndrome are sound and pressure-induced vertigo with torsional eye movements, pulse synchronous tinnitus and apparent conductive hearing loss in spite of normal middle ear function. We present a patient with very similar symptoms and findings, who instead had a superior canal dehiscence close to the common crus. Neuroradiologic findings suggested that the dehiscence was related to a venous malformation. CONCLUSIONS: Symptoms and findings suggesting superior canal dehiscence syndrome can have a different cause.

Aged↗

PubMed2004

Preservation of tap vestibular evoked myogenic potentials despite resection of the inferior vestibular nerve.

Sound and skull-tap induced vestibular evoked myogenic potentials (VEMP) were studied in a 43-year-old man following inferior vestibular neurectomy. Surgery was performed because of a small acoustic neuroma. Postoperative caloric testing suggested sparing of superior vestibular nerve function on the operated side. In response to sound stimulation there were no VEMP on the operated side, irrespective of whether sounds were presented by air- or bone-conduction. This suggests sound-induced VEMP to be critically dependent on inferior vestibular nerve function and this is in agreement with present knowledge. However, VEMP were obtained in response to forehead skull taps, i.e. positive-negative VEMP not only on the healthy side but also on the operated side. This suggests remnant vestibular function on the operated side of importance for forehead skull tap VEMP, because with complete unilateral vestibular loss there are no (positive-negative) VEMP on the lesioned side. Thus, forehead skull-tap VEMP depend, at least partly, on the superior vestibular nerve function.

Acoustic Stimulation↗

PubMed2003

Familial early-onset progressive vestibulopathy without hearing impairment.

A family with early-onset vestibulopathy is presented. The 34-year-old father had experienced brief attacks of vertigo and currently suffers from unsteadiness and oscillopsia during head movements. His two young sons also experience brief attacks of spontaneous vertigo. In vestibular testing all three subjects showed reduced caloric responses. However, only the father showed reduced otolith function (as reflected by the vestibular-evoked myogenic potentials). Further, all three subjects had walked before the age of 1 year and none of them had had any auditory symptoms. It is suggested that they have familial early-onset progressive vestibulopathy affecting the canals before the otoliths but sparing cochlear function.

Adult↗

PubMed2003

Autism and auditory brain stem responses.

OBJECTIVE: To study a controversy that has been discussed for more than two decades: whether or not children with autism have abnormalities affecting the cochlear nerve or the auditory pathway in the brain stem and, if so, to describe these abnormalities. DESIGN: A group of 153 children and adolescents with autistic disorder were included in an investigation of auditory brain stem responses (ABR). Two thirds of this group, 101 individuals (75 boys, 26 girls), had normal hearing and they were selected for an in-depth ABR study. The results from the study group were compared with those of an age-matched comparison group. RESULTS: The III-V interpeak latency (IPL) was significantly prolonged in both boys and girls with autism, compared with the controls. The latencies of ABR waves I and V were also significantly lengthened in the study groups. The individual test results showed that more than half of this normal-hearing autistic disorder group (58%) had abnormalities of one or more of eight ABR parameters studied. The most common abnormalities were prolongation of wave V (38%), and of I-V IPL (28%). A lengthening of the I-V IPL was also recorded in 27% of 49 children who were difficult to test or who had hearing loss. Abnormal left-right differences of ABR latencies were found in 18% of autism cases with normal hearing. CONCLUSIONS: Possible causes of the reported ABR abnormalities, observed here as well as in other studies, are discussed. Brain stem lesion, occult cochlear dysfunction, and involvement of the cochlear efferent system are probable factors that can explain the ABR findings

Adolescent↗

PubMed2003

Vestibular evoked myogenic potentials in response to skull taps for patients with vestibular neuritis.

In recent years it has been demonstrated that loud clicks generate short latency vestibular evoked myogenic potentials (VEMP). It has also been demonstrated that skull tap stimulation evokes similar VEMP. In the present study, the differences between the click-induced and the skull-tap induced VEMP were studied in 18 patients at onset of vestibular neuritis. Gentle skull taps were delivered manually above each ear on the side of the skull and on the forehead midline. The muscular responses were recorded over both sternocleidomastoid muscles using skin electrodes. Abnormal skull tap VEMP were found in the majority of the patients (10/18, 56%). However, only 4/18 (22%) showed asymmetry in the click-induced VEMP. The high percentage of abnormal skull tap VEMP might suggest that this response is not only dependent on the inferior division of the vestibular nerve, because the inferior division of this nerve is usually spared in vestibular neuritis. Moreover, the patients with abnormal skull tap VEMP differed from those with normal VEMP in their settings of the subjective visual horizontal with static head tilt in the roll plane. This might suggest that skull tap VEMP are (also) related to utricular function.

Acoustic Stimulation↗

PubMed2002

Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report.

A 75-year-old man with incapacitating anterior canal benign paroxysmal positional vertigo (BPPV) was relieved of symptoms following anterior semicircular canal occlusion using a transmastoid approach. The preoperative symptoms were similar to those of posterior canal BPPV. The preoperative findings on Dix-Hallpike's maneuver were a paroxysmal torsional nystagmus with a down-beating component that increased when the patient's gaze was directed towards the affected ear. The most provoking head movement for the vertigo/nystagmus was Dix-Hallpike's maneuver with the affected ear lowermost.

Aged↗

PubMed2002

Vestibular evoked myogenic potentials in response to laterally directed skull taps.

In recent years it has been demonstrated that loud clicks generate short latency vestibular evoked myogenic potentials (VEMP). It has also been demonstrated that midline forehead skull tap stimulation evokes similar VEMP. In the present study, the influence of skull tap direction on VEMP was studied in 13 normal subjects and in five patients with unilateral vestibular loss. Gentle skull taps were delivered manually above each ear on the side of the skull. The muscular responses were recorded over both sternocleidomastoid muscles using skin electrodes. Among the normals, laterally directed skull taps evoked "coordinated contraction-relaxation responses", i.e. skull taps on one side evoked a negative-positive "inverted" VEMP on that side and a positive-negative "normal" VEMP on the other side. Among patients with unilateral vestibular function loss, skull taps above the lesioned ear evoked similar coordinated contraction-relaxation responses. However, skull taps above the healthy ear did not evoke that type of response. These findings suggest that laterally directed skull taps activate mainly the contralateral labyrinth.

Acoustic Stimulation↗

PubMedDate not supplied

Large vestibular evoked myogenic potentials in response to bone-conducted sounds in patients with superior canal dehiscence syndrome.

Dehiscence of the superior semicircular canal is a 'new' vestibular entity. Among these patients, the vestibular evoked myogenic potentials (VEMP) in response to air-conducted sounds are large. In the present study, VEMP in response to bone-conducted sounds were studied in 5 normal subjects, in 3 patients after (unilateral) labyrinthectomy and in 4 patients with (unilateral) superior canal dehiscence syndrome. The bone-conducted sound stimulus was a 250- and a 500- tone burst delivered monaurally on the mastoid using standard bone conductors. Among the normals, bone-conducted sounds delivered monaurally caused VEMP bilaterally. There was, however, a transcranial attenuation for the 500-Hz stimulus, but less so for the 250-Hz stimulus. Among the patients with labyrinthectomy there were VEMP on the healthy side, but not on the lesioned side, irrespective of whether the bone-conducted sounds were presented behind the healthy or the operated ear. Among the patients with superior canal dehiscence syndrome, the VEMP on the affected side were larger than on the healthy side. This suggests that there is also vestibular hypersensitivity for bone-conducted sounds in these patients.

Adult↗