Teruo Toi

Repeated Attacks of Dizziness Caused by a Rare Mitochondrial Encephalomyopathy

Cases of dizziness caused by multiple sclerosis are commonly reported, but those caused by mitochondrial encephalomyopathy have been rarely reported. Particularly, the description of eye nystagmography (ENG) using caloric and optokinetic nystagmus tests has not been reported to date. We encountered the case of a 40-year-old woman with mitochondrial encephalomyopathy who visited us with the chief complaint of dizziness. At first, we considered multiple sclerosis based on the magnetic resonance imaging (MRI) findings and dizziness. Repeated attacks of dizziness and serum lactic acid levels suggested mitochondrial encephalomyopathy. A muscle biopsy confirmed the diagnosis. ENG findings suggested central vestibular disorder of the cerebellum and brainstem. This case suggests that we should not rule out the differential diagnosis of a very rare mitochondrial encephalomyopathy in patients who experience dizziness with MRI findings indicative of multiple sclerosis.

Relationship of physical distress to dizziness in patients with fibromyalgia

Abstract Conclusions: The feelings of dizziness and unsteadiness of the patients with fibromyalgia supposed specifically amplified by the hypersensitivity mechanism of CSS (central sensitivity syndrome) of them. The severity of subjective pain and physical distress according to the questionnaires were not correlated with the objective body sway on the stabilometer. Objectives: Fibromyalgia manifests primarily as chronic pain of the entire body, but is also often associated with a variety of physical symptoms including dizziness and unsteadiness. This study assessed whether objective measures of body sway and unsteadiness of them are associated with their subjective dizziness findings. Method: Subjects were 24 patients diagnosed with fibromyalgia, but one patient who had the past history of sudden deafness was excluded. The 23 patients were assessed by a stabilometer as the objective measures of body sway, and JFIQ (Japanese version of the fibromyalgia impact questionnaire), DHI (dizziness handicap inventory) and ABC (activities-specific balance confidence) as the subjective questionnaires. Results: The significant correlations were shown between the scores of JFIQ and DHI, JFIQ and ABC, and DHI and ABC. Then, the body sway index of stabilometer environmental area was significantly correlated with DHI score. However, the stabilometer index was not correlated neither with JFIQ or ABC.

A case of metastatic cerebellar breast cancer that had positional vertigo as its chief complaint

With vertigo patients, it is important that we pay attention to vertigo caused by central lesions as there are different diagnoses. Vertigo caused by central lesions such as brain tumors and cerebellar infarction sometimes appear as if the lesions were peripheral ones. The patient in the present study was a 50 y.o. female, with cerebellar metastasis caused by breast cancer and whose chief complaint was positional vertigo at a glance. However, detailed interview, past history, and careful neuro-otological findings based on nystagmus and the results of electric nystagmography led us to diagnose vertigo caused by a central lesion. Subsequent MRI findings revealed a cerebello-pontine angle lesion as a metastatic tumor. The ratio of brain tumors, especially metastatic tumors, among vertigo patients is low. However, this case indicated that MRI might be useful for patients who have a past history of cancer.