Masataka Edo

Gait analysis in patients with vertigo.

SummaryGait analysis utilizing foot switches and electromyography of antigravity muscles was performed on 31 patients with vertigo. Twenty-one cases had peripheral vestibular lesions (such as vestibular neuronitis, Menieres disease, traumatic labyrinthitis, small acoustic neuroma), and 10 cases had central lesions (such as spinocerebellar degeneration, pontine glioma, cerebellar tumor and giant acoustic neuroma). Parameters employed for analysis included time from heel strike to forefoot strike (HA-I), time from heel off to forefoot off (HA-II) as well as durations of stance, swing and (initial) double supports (DS). Fourteen healthy adults served as controls. The overall incidence of abnormality was highest in HA-1, followed by stance and swing. The occurrence of abnormalities in stance, swing and DS was higher in the central lesion when compared with the group having peripheral lesions. The significance and usefulness of gait analysis for dizzy patients are discussed.

Analysis of Gait in Patients with Peripheral Vestibular Disorders

Analysis of gait in patients with acute unilateral peripheral vestibular disorders was performed using foot switches and electromyography, with the aid of a telemetry system. Among the eight parameters set for the analysis, the occurrence rate of abnormality in the coefficient of variation (CV) was the highest (78%) for the time from heel strike to forefoot strike, followed by that of the location of maximum monophasic contraction of the gastrocnemius during stance, swing and stance. No significant laterality concerning the abnormally increased CV value in those parameters was found except for swing of the foot contralateral to the lesion side. The CV value of each parameter was significantly increased by removing visual cues, suggesting the importance of visual input for steady locomotion. No significant change in CV values of double support was obtained during the acute stage of vestibular neuronitis, indicating that weight transfer from one leg to the other could be smooth even though some difficulty was expected. Abnormal parameters at an acute stage returned to normal limits at recovery stage. The physiological background of the obtained results is discussed.

Clinical observation of 32 cases of vestibular neuronitis.

Clinical observations were made on 32 patients with vestibular neuronitis in the last 5 years: 14 male and 18 female, ranging from 15-76 years, the average being 46.3. Within the age distribution of the cases, two peaks were observed: a younger and an older group. Five patients (15%) had recently contracted infection of the upper respiratory tract before the onset of the disease, and two developed benign paroxysmal positional vertigo during the recovery period. Spontaneous nystagmus was observed in 19 cases (59%) in the first medical examination. There were several patients in whom there was the possibility of central lesions based upon the findings of equilibrium examinations. No relation was found between the degree of canal paresis and the time required for recuperation; however, the older patients took much longer to recover from the disease. Our results showed that there were considerable individual variations regarding the clinical findings, which may suggest that the pathological entity that creates this disease is not simple.

Characteristics of Human Gait Related Variables in Association with Vestibular System Disorders

Gait analysis was performed in patients with vestibular system disorders, using foot switches and electromyography. They were divided into three groups: 11 cases with vestibular neuronitis (VN), 10 cases with large acoustic neuroma (LAN) who had central lesion evidenced by neurotological examinations, and 10 cases with olivopontocerebellar atrophy (OPCA). A total of 14 healthy adults served as controls. Results showed that time from heel strike to forefoot strike was the most sensitive variable to indicate gait abnormality but had no specificity. As for the variables of stance, swing, and time to reach the initial peak of the tibialis anteriors activity from forefoot off, occurrence rate of abnormality was high in the OPCA group, followed by the LAN and VN groups. Concerning the double support period which is related with body weight transfer from one leg to the other, the LAN and OPCA groups showed higher occurrence rate of abnormality than the VN group. These differences among the three groups could reflect different effects to the gait control systems caused by lesion.

Conductive deafness in aglossia

Aglossia is a rare anomaly often accompanied with several congenital defects including varying degrees of limb deficiency, micrognathia and oral synechiae. We report on a girl with aglossia and persistent anterior buccopharyngeal membrane. Other anomalies observed on the patient were oesophageal atresia, hypoplastic epiglottis, ptosis of the left eyelid, and conductive deafness which is probably an additional symptom of this syndrome group.

Comparative Study on Gait Abnormality in Patients with Vestibular Neuronitis and Patients with Large Acoustic Neuroma

A comparative study on gait analysis comprising 11 patients with vestibular neuronitis and 10 patients with large acoustic neuroma was undertaken by the use of foot switches and electromyography. Central disorders in the neuroma group were evidenced by neurotological examinations. Fourteen healthy adults served as controls. Variables employed for the analysis were time from heel strike to forefoot strike (HA-I), time from heel off to forefoot off (HA-II) as well as duration of stance, swing and double supports (DS), location of maximum contraction of the gastrocnemius during stance, and location of the first and second peak of muscle contraction of the tibialis anterior from early swing phase (TA-off) to early stance phase (TA-on). The occurrence rate of abnormality of HA-I was the highest in both groups and most of the variables showed a higher rate in the large acoustic neuroma cases. In addition, a significantly higher CV value was obtained in HA-II of the lesion sides foot in the AN group. These changes could reflect the pathophysiological difference in the gait control systems between the two groups.

A Giant Juvenile Nasopharyngeal Angiofibroma

A 10-year-old male with giant juvenile angiofibroma with a suspicion of intracranial extension is reported. Preoperative embolization of the bilateral maxillary arteries was performed 7 days before tumor resection at another institution and the operation was performed under hypothermic anesthesia. A transfacial approach through an extended Moure incision was undertaken. The tumor was completely resected under high magnification using wide field high power ( x 4.5) loops. Blood loss totalled 1218 g. The patient has remained asymptomatic with no evidence of recurrence for the 2 years since surgery. Appropriate treatment for patients with juvenile nasopharyngeal angiofibroma (JNA) is discussed in the context of a literature review.