Vestibular findings in a young woman who developed dizziness and nausea following an airplane flight.A 23-year-old woman presented with a chief complaint of dizziness of 4 months' duration. Her symptoms began after she had taken an airplane trip. She had not experienced any problem with her ears during the flight and landing. Shortly afterward, however, she began to experience a light-headed feeling, slight dizziness, pressure in her head, and slight nausea. When her symptoms began in the morning, they would last for approximately 1 hour. When her symptoms began in the afternoon, they would last until she went to sleep. Not all of her episodes included head pressure and nausea. During the first month, she experienced 15 episodes; her attacks became daily during the next 2 months. During the fourth month, she began to feel as if she would pass out while walking; this feeling was different from the feeling she experienced during her original bouts of dizziness. She reported no hearing loss, tinnitus Tinnitus Definition Tinnitus is hearing ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head. , or aural fullness. She had been taking oral contraceptives Oral Contraceptives Definition Oral contraceptives are medicines taken by mouth to help prevent pregnancy. They are also known as the Pill, OCs, or birth control pills. for 9 months. Findings on clinical examination were normal except during the sharpened tandem Romberg's test, when the patient experienced slight difficulty with the right foot forward. When she stood on foam, her difficulty became quite apparent with either foot forward. Electronystagmography detected no spontaneous, positional, or neck-torsion nystagmus Nystagmus Definition Rhythmic, oscillating motions of the eyes are called nystagmus. The to-and-fro motion is generally involuntary. Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often, but not necessarily, a sign of . The alternate binaural binaural /bi·nau·ral/ (bi-naw´r'l) pertaining to both ears. bin·au·ral adj. Having or relating to both ears. binaural pertaining to both ears. bithermal caloric test elicited a 0% reduced vestibular response and a 0% directional preponderance. The simultaneous binaural bithermal stimulus elicited a type 4 response, with a marked left-beating nystagmus during simultaneous cool stimulus. The features of this case are typical of an evolving vestibular problem that becomes symptomatic only as a result of the acceleration associated with air travel. Symptoms generally continue for a variable period of time until central compensation takes over and the symptoms decrease. A vestibular abnormality becomes apparent only on simultaneous cool stimulation, when there is an asynchronous Refers to events that are not synchronized, or coordinated, in time. The following are considered asynchronous operations. The interval between transmitting A and B is not the same as between B and C. The ability to initiate a transmission at either end. input from the vestibular labyrinths sufficient to stimulate the medial longitudinal fasciculus medial longitudinal fasciculus n. A longitudinal bundle of fibers extending from the upper border of the mesencephalon into the cervical segments of the spinal cord, composed largely of fibers from the vestibular nuclei ascending to the motor neurons to produce nystagmus. Without this testing, this patient's vestibular function might have been considered to be normal, and her symptoms might have been erroneously attributed to psychological factors. Kenneth H. Brookler, MD From Neurotologic Associates, PC, New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . |
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