Computerized dynamic platform posturography.

Computerized dynamic platform posturography is defined in this technology assessment. The review discusses what computerized dynamic platform posturography measures, what the reliability and validity of the information are, and the uniqueness of the information provided. The clinical contribution and indications for testing are discussed.

Urogenital involvement by desmoplastic small round-cell tumor.

Purpose: We strove to characterize the clinicopathologic features of a rare malignant tumor involving the urogenital system.

Materials And Methods: Of 109 reported cases of desmoplastic small round-cell tumor, 25 have involved organs ordinarily evaluated and treated by urologists. Experience based on these cases plus 2 from our files forms the basis of this review.

Otolith-ocular responses in familial episodic ataxia linked to chromosome 19p.

We evaluated several members of a family with episodic ataxia type 2 linked to chromosome 19p by using a battery of vestibulo-ocular reflex (VOR) tests. Testing focused on the otolith-ocular reflex and semicircular canal-otolith interaction. Our aims were to improve understanding of the structures important for the VOR and to define further the range of vestibulo-ocular, in particular otolith-ocular, manifestations within a family with episodic ataxia.

Plasticity of responses to off-vertical axis rotation.

This study assessed whether a change in the magnitude of the angular vestibulo-ocular reflex (VOR) influences the magnitude of the linear VOR, thereby suggesting a common gain element for these reflexes. The responses to linear acceleration using yaw off-vertical axis rotation (OVAR) at 30 degrees tilt were recorded before and after an adaptation protocol designed to increase the angular VOR gain. Subjects included eight asymptomatic healthy young individuals.

Surface dependence: a balance control strategy in panic disorder with agoraphobia.

Objective: Previous studies have reported vestibular dysfunction and impaired balance in patients with agoraphobia. Vestibular dysfunction may lead to an information processing strategy focusing on spatial stimuli from two nonvestibular sensory channels, vision and proprioception. This nonvestibular balance control strategy may in turn lead to discomfort in situations involving inadequate visual or proprioceptive spatial cues (space and motion discomfort).

Vestibular compensation in a patient with a cerebellar infarction.

We report the case of a 67-year-old man who suffered a traumatic unilateral peripheral vestibular injury subsequent to an unrelated prior cerebellar infarction that occurred at least 2 years earlier. The patient's clinical course was marked by poor compensation for his peripheral vestibular loss. Four months after his vestibular injury, his symptoms of dizziness had not resolved.

Migraine-related vestibulopathy.

Migraine has been associated with specific vestibular disorders, including benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults. Migraine may also play a role in chronic nonspecific vestibulopathy. Because scant data exist that describe the clinical findings and vestibular function abnormalities in suspected migraine-related vestibulopathy, we reviewed the history, physical examination, vestibular tests (electronystagmography, rotational chair, posturography), and response to treatment of 100 patients with diagnoses of migraine-related vestibulopathy.

Familial episodic ataxia: clinical heterogeneity in four families linked to chromosome 19p.

We describe the clinical and oculographic findings in 4 families with episodic ataxia and interictal nystagmus (EA-2) linked to chromosome 19p. Episodes varied from pure ataxia to combinations of symptoms suggesting involvement of the cerebellum, brainstem, and cortex. Some affected individuals exhibited a progressive ataxia syndrome phenotypically indistinguishable from the dominantly inherited spinocerebellar ataxia (SCA) syndromes.

Time-varying characteristics of visually induced postural sway.

To study potential time-varying dynamics of postural sway as measured via center-of-pressure (COP) under the feet, we applied time-frequency analysis to COP data from ten vestibularly impaired subjects and 13 nonimpaired controls, during quiet stance and in response to visual perturbation. This analysis revealed that 1) the spectral characteristics of COP change over time; 2) there are time-dependent and frequency-dependent differences in COP between impaired and nonimpaired populations during visual perturbation, and 3) there is no difference in COP during quiet stance (eyes opne) between impaired and nonimpaired populations for the parameters investigated. A novel finding of this research is that controls appear to adapt to constant frequency visual perturbation, while vestibularly impaired subjects do not.

The nested variant of transitional cell carcinoma: an aggressive neoplasm with innocuous histology.

The nested variant of transitional cell carcinoma (TCC-NV) is a rare neoplasm; only eight cases have been described. This report reviews the clinicopathologic features of 16 additional examples. The cases were collected from consultations received during a 13-year period.

Functional reach and single leg stance in patients with peripheral vestibular disorders.

The purpose of this study was to compare functional reach distance and right single leg stance time in patients who had peripheral vestibular disease. Twenty-eight patients (15 female, 13 male) between the ages of 35 and 84 were asked to perform 3 trials each of functional reach (FR) and right single leg stance (SLS). SLS times were measured by a Kistler static force platform on line with a Caspar personal computer.

Influence of otolith organs, semicircular canals, and neck afferents on post-rotatory nystagmus.

The duration of post-rotatory nystagmus is known to be shortened by head tilt, a phenomenon that has been attributed to rapid discharge of the velocity storage mechanism. The relative importance of the various sensory signals associated with post-rotatory head tilt is unknown. Using both earth-vertical axis and off-vertical axis rotation, we investigated this issue in humans by combining sudden termination of constant velocity rotation with several post-rotatory maneuvers that stimulated combinations of otolith organ, somatosensory, and vertical semicircular canal afferents.

Primary primitive neuroectodermal tumor of the kidney. Case report and review of the literature.

Small cell tumors are a heterogeneous group of neoplasms with similar morphologic features. They include lymphomas, carcinomas with variable degrees of neuroendocrine differentiation, rhabdomyosarcomas, and neuroblastomas. The authors describe a rare case of primitive neuroectodermal tumor (PNET) located in the kidney that was thoroughly studied with modern diagnostic techniques, including expression of protein P 30/32 MIC2 with the antibody 013 with subsequent demonstration of a genetic translocation consistent with t(11;22).

Functional outcome of vestibular rehabilitation in patients with abnormal sensory-organization testing.

A goal of vestibular rehabilitation is to improve the functional status of patients with balance disorders. Despite the focus of vestibular rehabilitation on function, few objective data describe the outcome of vestibular rehabilitation in terms of balance function. In this prospective observational study, we tested a well-defined patient cohort (n = 67) with abnormal pretreatment sensory-organization testing who were undergoing vestibular rehabilitation.

Galvanic-induced postural movements as a test of vestibular function in humans.

Galvanic stimulation produces a postural sway and eye movements in humans. Since galvanic currents are thought to exert their effect at the trigger zone of the vestibular nerve, an intact vestibular nerve should be necessary to produce a response. We have used galvanic stimulation in humans to test the hypothesis that intact vestibular nerve fibers are required to obtain a postural away response.

Panic, agoraphobia, and vestibular dysfunction.

Objective: Otoneurological abnormalities have been reported in panic disorder. The purpose of this investigation was to determine the prevalence of such findings in panic disorder with and without agoraphobia and to discern whether vestibular dysfunction was associated with specific symptoms.

Method: Clinical audiological and vestibular tests were administered to 30 patients with uncomplicated panic disorder (without agoraphobia or with only mild agoraphobia), 29 patients with panic disorder with moderate to severe agoraphobia, 27 patients with anxiety but no history of panic attacks, 13 patients with depressive disorders but no history of anxiety or panic attacks, and 45 normal comparison subjects.

Visual-vestibular interaction during off-vertical axis rotation.

The aim of this study was to further define the eye movement response to combined visual and vestibular stimulation, especially during linear acceleration. Subjects included 15 asymptomatic healthy individuals (8 females and 7 males) between the ages of 20 and 31 years. Vestibular stimulation consisted of earth-vertical axis rotation and off-vertical axis rotation (OVAR).

3-Benzisothiazolylpiperazine derivatives as potential atypical antipsychotic agents.

A series of substituted phenethyl derivatives of 3-benzisothiazolylpiperazine incorporating potent D2 and 5-HT2A antagonist activity was investigated as an approach to a novel atypical antipsychotic agent. The in vitro profile of 8e from this series is a combination of D2 receptor affinity comparable to the typical antipsychotic agent haloperidol and a 5-HT2A/D2 ratio comparable to the atypical agent clozapine. In vivo 8e possesses activity consistent with an efficacious antipsychotic agent with less tendency to induce extrapyramidal side effects in man.

Effect of otitis media on the vestibular system in children.

Forty-one children with otitis media (OM) were evaluated by moving platform posturography (Equitest, NeuroCom) before and after insertion of tympanostomy tubes, and were compared to children with no ear disease (N = 50). Velocity of sway increased with increasing difficulty of test conditions (I-VI) for both groups of children (p < .001), and children less than 7 years of age had a higher velocity than children 7 years old or older (p < .

Head-only rotational testing: influence of volition and vision.

Head-only rotational testing has been suggested as a method of assessing the vestibuloocular reflex in patients with reduced vestibular function as a result of ototoxicity. The purpose of this study was to investigate the influence of vision and volition on horizontal vestibuloocular reflex responses during head-only rotation in normal subjects to better define the test parameters for future clinical application. Ten asymptomatic, healthy subjects were tested using various combinations of volitional and visual conditions during head-only rotation.

Recent advances in clinical neurotology.

In recent years, owing to significant technological developments and an increased number of investigators entering the field, there have been spectacular advances in our understanding of the basic anatomy and physiology of the vestibular system. Unfortunately, these advances in basic science are slow to impact the clinical management of patients. We have selected a few important advances in clinical neurotology that have impacted the diagnosis and treatment of patients with vestibular disorders.

Time-frequency analysis of postural sway.

Postural sway during quiet stance has been used to characterize the postural control system. Most studies have used center of pressure (COP) measurements and have assumed stationarity, however, recent research has indicated that COP is not stationary. The purpose of this study is to introduce and demonstrate a nonstationary spectral estimation technique to examine the time-varying nature of postural sway.

A practical work-up for vertigo.

Specific elements in the history and physical examination direct the work-up of the "dizzy" patient toward or away from a vestibular disorder. When a disorder of this type is suspected, the differential diagnosis includes benign positional vertigo, vestibular neuritis, vertebrobasilar insufficiency, migraine, and endolymphatic hydrops, which is the pathologic condition thought to underlie Meniere's disease. Anxiety is well recognized as a potential component of vestibular abnormalities or as the primary problem.

Role of posturography in the management of vestibular patients.

Computerized dynamic posturography uses a force platform that can both translate and rotate. When combined with visual stimuli, it can be used to determine the relative importance of the various sensory inputs critical for balance, namely vision, somatosensation, and vestibular sensation. Studies to date have shown several patterns of abnormalities on posturography, the best recognized being the vestibular pattern.