Keisuke Uesugi

Head Shaking Nystagmus in the Patient with Idiopathic Unilateral Peripheral Facial Palsy.

A case of idiopathic unilateral peripheral facial palsy showing unique findings and time course of the head shaking nystagmus was reported.A 15 year-old woman complained of right facial paralysis. She was admitted to our hospital for treatment using a drip infusion of steroids. Three days after onset of the paralysis, she complained of vertigo. At that time she showed no spontaneous or positional nystagmus but manifested right beating nystagmus 5 seconds after the cessation of head shaking stimulation. Six days after onset of the vertigo, right beating nystagmus was also observed but it appeared 40 seconds after the cessation of head shaking. It is assumed that she showed only the 2nd phase of head shaking nystagmus without the 1st phase because of the long latency period. She showed a mild increase in complement fixing antibody titer to the varicella-zoster virus.The head shaking test is well known to be quite sensitive in the detection of unilateral vestibular disorders. Since the 1st phase of head shaking nystagmus is due to velocity storage, any process that interferes with velocity storage can alter the pattern of nystagmus. When velocity storage is very poor, the 1st phase of head shaking nystagmus may be brief or absent. Thus, it is assumed that the patient in the present report had a lesion in the central vestibular system, presumably in the velocity storage mechanism due to varicella-zoster virus infection.

Prophylaxis by Ketotifen Given Orally and by Aqueous Nasal Spray to Prevent Japanese Cedar Pollinosis.

We studied for two seasons the prophylactic and the rapeutic effect of ketotifen in patients with Japanese cedar pollinosis. We administered ketotifen orally to patients before the beginning of the dispersion of pollen. Ketotifenaqueous nasal spray (ketotifen-ANS) was administered to those with a poor-response to the prophylaxis. Of the patients examined during the season 51.4% showed a marked or moderate prophylactic effective. The poor-response patients were treated with ketotifen-ANS, and in 72.2% there was marked or moderate improvement. Thus, ketotifen-ANS was useful in patients whose symptoms were not prevented by oral ketotifen. The only side effect was sleepiness in 3 patients receiving oral ketotifen. Ketotifen-ANS caused none.Oral ketotifen and aqueous nasal spray ketotifen are considered to be excellent for the prophylaxis and therapy of Japanese cedar pollihosis.