Byung-Hoon Ahn

Sudden deafness with vertigo as a sole manifestation of anterior inferior cerebellar artery infarction

Sudden deafness without associated neurological symptoms and signs is typically attributed to a viral inflammation of the labyrinth. Although sudden deafness occurs with anterior inferior cerebellar artery (AICA) infarction, the deafness is usually associated with other brainstem or cerebellum signs such as crossed sensory loss, lateral gaze palsy, facial palsy, Horner syndrome or cerebellar dysmetria. An 84-year-old woman suddenly developed right-sided tinnitus, hearing loss, vertigo and vomiting. Audiometry and electronystagmography documented absent auditory and vestibular function on the right side. T2-weighted and diffusion-weighted MRI showed a tiny infarct in the right lateral inferior pontine tegmentum. AICA occlusion can cause sudden deafness and vertigo without brainstem or cerebellar signs.

Sudden deafness as a sign of stroke with normal diffusion-weighted brain MRI.

Sudden deafness without associated neurological signs and symptoms is typically attributed to a viral inflammation of the labyrinth. Sudden deafness as a heralding manifestation of basilar occlusion has rarely been described. A 60-year-old male with hypertension presented with an acute onset of isolated sudden deafness with vertigo. On admission, initial brain MRI, including diffusion-weighted images, was normal. Two days after the onset of symptoms, the patient presented with an exacerbation of vertigo. A follow-up MRI scan revealed new infarcts involving the right middle cerebellar peduncle, right dorsolateral pons and right anterior cerebellum. In this patient, the acute onset of isolated sudden deafness with vertigo may have been a heralding manifestation of the pontocerebellar infarction.

Effects of berberine on hippocampal neuronal damage and matrix metalloproteinase-9 activity following transient global cerebral ischemia.

Berberine, an isoquinoline alkaloid with a long history of use in Chinese medicine, has several important pharmacological effects. Several studies have revealed that berberine has neuroprotective and neuropsychiatric effects. However, there are few reports regarding the protective effect of berberine against neuronal damage following transient global cerebral ischemia. In this study, mice were subjected to 20 min of global brain ischemia and sacrificed 72 hr later. Berberine was administered for 7 days prior to ischemia and daily until sacrifice. Mice treated with berberine showed reduced matrix metalloproteinase‐9 (MMP‐9) activity. Berberine inhibited gelatinase activity directly in in situ zymography and reduced neuronal damage following global ischemia. Laminin expression and NeuN expression were markedly reduced in CA1 and CA2 areas after ischemia, and berberine reduced the laminin degradation and neuronal loss. In the TUNEL assay, damaged neurons were also apparent in the CA1 and CA2 areas, and berberine reduced TUNEL‐positive cells. These data demonstrate that berberine, a plant alkaloid, may protect from hippocampal neuronal damage following transient global ischemia by reducing MMP‐9 activity.

Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy

Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We studied the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. Group was divided into Menieres syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Menieres syndrome.

Abnormal cervical vestibular-evoked myogenic potential in anterior inferior cerebellar artery territory infarction: Frequency, pattern, and a determinant

BACKGROUND There has been no systematic study that carefully investigates the characteristic features of abnormal cervical vestibular-evoked myogenic potential (cVEMP) response associated with the AICA territory infarction. OBJECTIVES To investigate the frequency, the characteristic patterns of abnormal cVEMP associated with AICA territory infarction, and the crucial site for producing abnormal cVEMP response in the AICA territory infarction. METHODS We studied 16 consecutive cases of unilateral AICA territory infarction diagnosed by brain MRI. VEMP was induced by a short click sound and was recorded in contracting sternocleidomastoid muscle. Each patient underwent a quantitative audiovestibular evaluation, including bithermal caloric test and pure tone audiogram. RESULTS Eight patients (50%) exhibited abnormal cVEMP response on the side of the AICA territory infarction. All patients with abnormal cVEMP showed an absent or decreased response in amplitude but no difference in latency. Patients with abnormal VEMP were significantly more likely to have canal paresis (CP), sensorineural hearing loss, or both compared with patients who had normal cVEMP. Conversely, abnormal cVEMP was more frequently observed among patients with CP than among those without CP. There was no difference in lesion sites according to brain MRI among patients with or without abnormal cVEMP response. CONCLUSIONS Our findings suggest that the peripheral vestibular structure with the inner ear probably plays a crucial role in producing abnormal cVEMP response associated with AICA territory infarction.

Mouse model of Aspergillus and Alternaria induced rhinosinusitis

OBJECTIVE Fungi are known to induce the production of chemical mediators from respiratory epithelial cells and have been increasingly recognized as important pathogens in sinusitis. However, the exact role of fungi in the pathogenesis of rhinosinusitis has not been clearly established. This study was performed to improve our understanding of the role of fungi in the pathogenesis of rhinosinusitis by developing an animal model of fungus induced rhinosinusitis. METHODS Fifty mice (C57BL6/J) were divided into five groups. Sham-operated group was the first group. In the second group, Aspergillus versicolor (Group IIa) and Alternaria alternata (Group IIb) (10(6)spores/ml) were inoculated into the nasal cavity. In the third group, fungi were inoculated into the nasal cavity in the presence of mucosal scratch (Group IIIa,b) and the fourth group was a nasal mucosal scratch only (Group IV). The fifth was a negative control (Group V). The fungi were inoculated once a week on six occasions and then the animals were sacrificed at 7 weeks. The histological sections were examined in a blind manner for the appearance of neutrophil clusters and epithelial thickness with hematoxylin-eosin stain, and mucus secreting glands using the Alcian blue/periodic acid Schiff stain. RESULTS Non-invasive fungal sinusitis had been induced with increased numbers of neutrophil clusters after Aspergillus and Alternaria exposure. The mice with the mucosal scratch wounds had significantly more inflammatory cell infiltration and epithelial thickening; but eosinophils were not commonly found. The mice with fungal sinusitis had goblet cell hyperplasia and increased mucus secretion in the sinonasal cavity. CONCLUSIONS Inoculation of fungi in the nasal cavity induced rhinosinusitis in C57BL6/J mice. This mouse model may be used for better understanding of the role of fungi in the pathogenesis of rhinosinusitis.

Prevalence of ocular symptoms in patients with allergic rhinitis: Korean multicenter study.

Background Allergic rhinitis (AR) is often accompanied by multiple ocular symptoms. This study aimed to evaluate the prevalence of ocular symptoms and the impact of ocular symptoms on the quality of life in patients with AR. Methods One thousand one hundred seventy-four patients with AR were enrolled from 24 centers in Korea. They were classified into four groups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline and also classified into perennial AR (PAR) and seasonal AR groups. All patients were asked to complete the questionnaire regarding the presence of ocular symptoms, such as eye itching, watery eyes, and red eyes. The correlation between ocular symptoms and the rest of the quality-of-life areas in the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) was also asked. Results Seven hundred nineteen (61.2%) of 1174 patients had ocular symptoms. In detail, the numbers of patients with eye itching, watery eyes, red eyes, and other ocular symptoms were 605 (51.5%), 313 (26.7%), 207 (17.6%), and 66 (5.6%), respectively. Female patients (72.5%) complained of ocular symptoms more commonly than male patients (55.1%). The patients with moderate–severe persistent AR showed the highest prevalence of ocular symptoms. The correlation coefficients between ocular symptoms and the rest of the quality-of-life areas in the Mini-RQLQ were statistically significant (p < 0.05). Conclusion Sixty-one percent of Korean AR patients experienced ocular symptoms. The patients who were women and had PAR and more severe AR showed higher prevalence of ocular symptoms. The ocular symptoms might have a significant impact on the quality of life in patients with AR.

R137: Topical Antibiotics in Mouse Model of Acute Rhinosinusitis

PROBLEM: Admistration of antibiotics is an essential modality to treat acute rhinosinusitis. Although intranasal inoculation of antibiotics does not have definite bioavailability, it is a very effective method to treat this disease. A mouse model of rhinosinusitis was treated by inoculation of Streptococcus pneumoniae and the authors then administered time-dependent antibiotics or concentration-dependent antibiotics in a topical manner. Their effectiveness was then investigated. METHODS: Fifty ten-week-old male C57BL/6 mice were used for the acute rhinosinusitis model by inoculating Streptococcus pneumoniae. From the 6th day to 10th day a negative control group was formed by inoculation of normal saline (Group I), the antibiotics group by inoculation of cefmenoxime & vancomycin (Group II) or ofloxacin & tobramycin (Group III), and a positive control group (Group IV). On the 11th day, all mice were sacrificed and the effectiveness of antibiotics was estimated by comparison of nasal lavage colony count and neutrophil count of sinonasal tissue. RESULTS: Minimum bactericidal concentration (MBC) of each antibiotic was cefmenoxime 20ug/ml, ofloxacin 80ug/ml, tobramycin 25ug/ml, vancomycin 12.5ug/ml. By nasal lavage, antibiotics inoculation group (Group ?,?) showed more decreased bacterial growth than positive control, and it was statistically significant(p 0.037). In comparision between the group administrated with concentration-dependent antibiotics and time-dependent antibiotics, clusters of neutrophil decreased in two groups compared to the positive control; the group administrated with concentration-dependent antibiotics had fewer clusters of neutrophil than the group administrated with time-dependent antibiotics, and this finding was statistically significant. CONCLUSION: Local inoculation of concentration-dependent antibiotics could be a more effective way to treat acute rhinosinusitis induced by Streptococcus pneumoniae than time-dependent antibiotics. SIGNIFICANCE: When considering delivering antibiotics into the human sinonasal cavity, concentration-dependent antibiotics might be helpful.

P183: Topical Antibiotics to Mouse Model of Acute Rhinosinusitis

placed and comminuted right anterior table frontal sinus fracture with a large fragment partially occluding the frontal sinus outflow tract. Using endoscopic and fluoroscopic guidance, a sinus balloon was introduced into the injured frontal sinus. Repeated adjustment and inflation of the balloon under fluoroscopy suggested that the fragment was reduced and the frontal sinus outflow tract was enlarged. The sinus was filled with Merogel injectable after the balloon was removed. RESULTS: Postoperative maxillofacial CT revealed reduction of the largest bony fragments and a patent frontal sinus outflow tract. At one month follow-up the patient had no functional or cosmetic abnormalities. CONCLUSIONS: Balloon sinuplasty should be considered in the treatment of select internally displaced anterior table frontal sinus fractures involving the frontal sinus outflow tract. The technique and considerations for its use are described.