한국인 자발 하방안진의 임상 특성: 218예의 분석
Clinical Characteristics of Spontaneous Downbeat Nystagmus in Koreans: Analysis of 218 Cases
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Downbeat nystagmus is the most-common type of central nystagmus. However, no published study has attempted to analyze the etiology and clinical features of downbeat nystagmus in a large sample of Korean patients. Methods: We analyzed the demographic and clinical features of spontaneous downbeat nystagmus in 218 Korean patients who had been evaluated at the Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014. Results: All patients were aged from 15 to 92 years (mean±SD: 58.7±18.0 years), and they included 117 (53.7%) men. Underlying causes were found in 162 patients (74.3%, secondary group), while no etiology was identified in the remaining patients (idiopathic group). The age and sex distributions did not differ between the idiopathic and secondary groups. The underlying etiology included hereditary disorders (n＝48, 22.0%), vascular diseases (n＝46, 21.1%), and inflammatory diseases (n＝19, 8.7%). Infarctions (n＝34, 15.6%) and episodic ataxia (n＝32, 14.7%) were the most-frequent underlying disorders. The most-common site of lesions identified by MRI was the cerebellum (68.9%), followed by the brainstem (28.6%). Among the 74 patients with lesions confirmed by MRI, 25 (33.7%) showed an isolated cerebellar involvement, while 35 (47.6%) had lesions in multiple areas. Conclusions: This study extends the clinical features of spontaneous downbeat nystagmus to Korean patients. Cerebellum is the most-common lesion site, which is consistent with the results of previous studies. The prevalence of Arnold-Chiari malformation is relatively low, which may be a distinct finding relative to those of previous studies involving other ethnic populations.
Abstract
Background: Downbeat nystagmus is the most-common type of central nystagmus. However, no published study has attempted to analyze the etiology and clinical features of downbeat nystagmus in a large sample of Korean patients. Methods: We analyzed the demographic and clinical features of spontaneous downbeat nystagmus in 218 Korean patients who had been evaluated at the Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014. Results: All patients were aged from 15 to 92 years (mean±SD: 58.7±18.0 years), and they included 117 (53.7%) men. Underlying causes were found in 162 patients (74.3%, secondary group), while no etiology was identified in the remaining patients (idiopathic group). The age and sex distributions did not differ between the idiopathic and secondary groups. The underlying etiology included hereditary disorders (n＝48, 22.0%), vascular diseases (n＝46, 21.1%), and inflammatory diseases (n＝19, 8.7%). Infarctions (n＝34, 15.6%) and episodic ataxia (n＝32, 14.7%) were the most-frequent underlying disorders. The most-common site of lesions identified by MRI was the cerebellum (68.9%), followed by the brainstem (28.6%). Among the 74 patients with lesions confirmed by MRI, 25 (33.7%) showed an isolated cerebellar involvement, while 35 (47.6%) had lesions in multiple areas. Conclusions: This study extends the clinical features of spontaneous downbeat nystagmus to Korean patients. Cerebellum is the most-common lesion site, which is consistent with the results of previous studies. The prevalence of Arnold-Chiari malformation is relatively low, which may be a distinct finding relative to those of previous studies involving other ethnic populations.
참고문헌 (20)
- Yee RD, "Downbeat nystagmus: characteristics and localization of lesions", Trans Am Ophthalmol Soc, 87, pp.984~1032 (1989)
- 김지수, "안진", 대한신경과학회지, 22(3), pp.177~191 (2004), 대한신경과학회
- Choi JH, "Pure upbeat nystagmus in association with bilateral internuclear ophthalmoplegia", J Neurol Sci, 317, pp.148~150 (2012)
- Corbett JJ, "Downbeating nystagmus and other ocular motor defects caused by lithium toxicity", Neurology, 39, pp.481~487 (1989)
- Oh SY, "Downbeat, positional, and perverted head-shaking nystagmus associated with lamotrigine toxicity", J Clin Neurol, 2, pp.283~285 (2006)
- 신현준, "Arnold-Chiari기형에서 3,4-디아미노피리딘(3,4-Diaminopyridine)을 이용한 하향안진의 치료", 대한신경과학회지, 32(3), pp.206~209 (2014), 대한신경과학회
- Choi JH, "Ictal downbeat nystagmus in cardiogenic vertigo", Neurology, 75, pp.2129~2130 (2010)
- Ki-Hyoung Moon, "Downbeat Nystagmus Associated With Brainstem Compression by Vertebral Artery", 대한신경외과학회지, 41(3), pp.190~192 (2007), 대한신경외과학회
- Halmagyi GM, "Downbeating nystagmus. A review of 62 cases", Arch Neurol, 40, pp.777~784 (1983)
- Bronstein AM, "Down beating nystagmus:magnetic resonance imaging and neuro-otological findings", J Neurol Sci, 81, pp.173~184 (1987)
- Wagner JN, "Downbeat nystagmus: aetiology and comorbidity in 117 patients", J Neurol Neurosurg Psychiatry, 79, pp.672~677 (2008)
- Zee DS, "The mechanism of downbeat nystagmus", Arch Neurol, 30, pp.227~237 (1974)
- Marti S, "The origin of downbeat nystagmus:an asymmetry in the distribution of on-directions of vertical gaze-velocity Purkinje cells", Ann N Y Acad Sci, 1039, pp.548~553 (2005)
- Cogan DG, "Down-beat nystagmus", Arch Ophthalmol, 80, pp.757~768 (1968)
- Caetano de Barros M, "Basilar impression and Arnold-Chiari malformation. A study of 66 cases", J Neurol Neurosurg Psychiatry, 31, pp.596~605 (1968)
- Baloh RW, "Downbeat nystagmus: a type of central vestibular nystagmus", Neurology, 31, pp.304~310 (1981)
- Nakamagoe K, "Evidence for brainstem structures participating in oculomotor integration", Science, 288, pp.857~859 (2000)
- Bohmer A, "Pathomechanism of mammalian downbeat nystagmus due to cerebellar lesion: a simple hypothesis", Neurosci Lett, 250, pp.127~130 (1998)
- Marti S, "A model-based theory on the origin of downbeat nystagmus", Exp Brain Res, 188, pp.613~631 (2008)
- Hufner K, "Structural and functional MRIs disclose cerebellar pathologies in idiopathic downbeat nystagmus", Neurology, 69, pp.1128~1135 (2007)