Publications
429 results found
Bronstein AM, Faldon M, Rothwell J, et al., 1995, Clinical and electrophysiological findings in the Tullio phenomenon., Acta Otolaryngol Suppl, Vol: 520 Pt 1, Pages: 209-211, ISSN: 0365-5237
A 55 year old female with idiopathic Tullio phenomenon is presented. Binocular, scleral search eye coil recordings demonstrated a predominantly torsional left-beating and vertical down-beating nystagmus in response to sound intensities over 100 dB HL to the left ear, increasing in amplitude and slow phase velocity with sound intensity and removal of visual fixation. The vertical ocular movement was conjugate, i.e. without skew deviation. Neuro-imaging, all other neuro-otological features, including ipsilateral-contralateral stapedius muscle reflexes, and surgical exploration of the middle ear, were normal. Click-evoked vestibulo-collic potentials were normal from the right ear but showed low threshold (70 dB) and increased amplitude from the left. There was no evidence that the Tullio phenomenon in this patient arises from stapes footplate hypermobility. The findings suggest that some cases of the Tullio phenomenon may be due to a hyperexcitability of the normal vestibular response to sound.
MORLAND AB, BRONSTEIN AM, RUDDOCK KH, 1995, Vision during motion in patients with absent vestibular function, 18th Barany-Society Meeting on Vestibular and Equilibrium Research - Basic and Clinical Implications, Pages: 338-342
We have measured a spatial visual response and visual velocity discrimination in 3 patients with long standing vestibular loss and 6 controls. The spatial response was measured during; i) body and visual display stationary conditions, ii) whole-body oscillation (1Hz +/- 50 degrees/s) and iii) visual stimulus oscillation (1Hz +/- 50 degrees/s). Velocity discrimination was assessed during conditions i) and ii). The visual tests applied were selected on the basis that the spatial response is known to reflect peripheral processes of the retina, whereas velocity processing is more central in origin. Patients had normal spatial responses under static conditions and they suffered a degradation in their spatial responses during whole-body oscillation, whereas, normals' responses remained unaltered. During oscillation of the visual display both patients and normals suffered a degradation in their spatial responses, and for patients the change was very similar to that observed during whole-body oscillation. The changes in the spatial responses were dependent on the gain of the rye movements which compensated for the whole-body or visual display oscillation. In 3 patients and all controls whole-body oscillation did not alter the discrimination of velocity of a vertically moving horizontally orientated grating compared with when the subjects were stationary. One patient suffered a severe reduction in the ability to discriminate velocity under whole-body oscillation, which suggests that central suppression of motion perception reduces oscillopsia.
Bronstein AM, Morland AB, Ruddock KH, et al., 1995, Recovery from bilateral vestibular failure: implications for visual and cervico-ocular function., Acta Otolaryngol Suppl, Vol: 520 Pt 2, Pages: 405-407, ISSN: 0365-5237
We report a patient who sustained severe bilateral labyrinthine lesions during Streptococcus suis meningitis but considerably recovered vestibular function over a 7 month period. This unique case allowed us to examine the cervico-ocular reflex (COR) and visual function at various levels of activity of his vestibular system. The slow phase COR, elicited by trunk oscillation (0.2 Hz) with the head earth-stationary, was negligible immediately after the acute vestibular loss but rose to a gain of 0.51 one month after. Seven months later, when vestibular function was improved, COR gain dropped to a gain of 0.15. Measurements of spatial visual function during whole body oscillation in the acute stage and after 6 months showed marked improvement which correlated entirely with VOR measurements in the dark and during optic fixation. This patient also showed the unique feature that, in the acute stage, eye movement gain and visual function were poorer during whole body motion than during identical visual target motion. These findings suggest that: i) the COR may be inhibited by the presence of vestibular signals, ii) spatial vision measurements provide accurate assessment of the patient's visual blur during head motion, and iii) the severe oscillopsia experienced by patients in the acute stage of vestibular loss may not only be due to the absence of the VOR; additional degradation in eye movements during head motion, perhaps arising from acutely distorted labyrinthine signals, may also play a part.
Lopez LI, Gresty MA, Bronstein AM, et al., 1995, Acquired pendular nystagmus: oculomotor and MRI findings., Acta Otolaryngol Suppl, Vol: 520 Pt 2, Pages: 285-287, ISSN: 0365-5237
The clinical, oculomotor and ophthalmological features of 27 patients with pendular nystagmus were studied in whom 22 also had MR imaging of the brainstem. The nystagmus was predominately horizontal in 4 patients, torsional in 5, vertical in 3 and mixed in trajectory in 8. Fifteen patients had conjugate nystagmus. Twelve patients had disconjugate nystagmus. Eight patients had INO. In 16 patients visual acuity was 6/12 or worse. Acuity and the presence of INO were unrelated to the conjugacy of the nystagmus. The MRI cuts at the medullary, pontine and midbrain levels were analysed statistically to determine the areas where there was significant (< 0.05%) overlap between areas of abnormal signal in different patients. Significant target areas for lesions causing the nystagmus were: in the pons the medial vestibular nucleus, central tegmental and paramedian tracts; in the medulla the inferior olivary nucleus, reticular formation, dorsal accessory olivary nucleus, central tegmental tracts and olivo-cerebellar fibres; in the midbrain the red nucleus and central tegmental tracts. Horizontal pendular nystagmus was preferentially associated with pontine lesions and torsional nystagmus with medullary lesions. Patients with conjugate nystagmus had a tendency to have bilateral mirror image MRI lesions (p = 0.028). The prevalence of lesions in our patients raises a possibility that more than one neuronal mechanism must be affected to produce pendular nystagmus. The inferior olive may be responsible for the rhythm of ocular oscillation. The disruption of pathways proximal to the oculomotor nuclei may determine the instability in terms of individual eye movement.
Kanayama R, Bronstein AM, Gresty MA, et al., 1995, Perceptual studies in patients with vestibular neurectomy., Acta Otolaryngol Suppl, Vol: 520 Pt 2, Pages: 408-411, ISSN: 0365-5237
Twelve patients undergoing unilateral vestibular neurectomy for the treatment of refractory vertigo were investigated. Vestibular motion perception was assessed using a self-rotational task and "vestibular remembered saccades". Cervical perception was also measured with remembered saccades. The tests were performed pre- and post-operatively to examine changes in vestibular and cervical perception following an acute vestibular lesion, and to monitor the progress of vestibular compensation. These perception tests were carried out in conjunction with a conventional evaluation of the vestibular ocular reflex (VOR), using electro-oculography. The patients' subjective symptoms at each stage of testing were also quantified with questionnaires. Generally, in the vestibular tests, for stimulation to the operated side, responses became strongly hypometric directly after the neurectomy, with a partial recovery during convalescence. In the cervical test, responses were bilaterally reduced immediately after operation. Results from both of the vestibular perception tests were significantly correlated with the VOR assessment of vestibular function. Scores for the patients' subjective symptoms of "vertigo" were only significantly correlated with the vestibular perception tests, and not with the conventional measures of vestibular function. Perceptual measurements afford useful complementary information in the assessment of vestibular patients.
BISDORFF AR, BRONSTEIN AM, GRESTY MA, 1994, RESPONSES IN NECK AND FACIAL-MUSCLES TO SUDDEN FREE-FALL AND A STARTLING AUDITORY STIMULUS, ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY, Vol: 93, Pages: 409-416, ISSN: 0013-4694
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- Citations: 46
BRONSTEIN AM, GRESTY MA, 1994, PENDULAR PSEUDONYSTAGMUS - REPLY, NEUROLOGY, Vol: 44, Pages: 1188-1189, ISSN: 0028-3878
BISDORFF AR, BRONSTEIN AM, GRESTY MA, et al., 1994, SUBJECTIVE POSTURAL VERTICAL IN PERIPHERAL AND CENTRAL VESTIBULAR DISORDERS AND PARKINSONS DISEASE, 12th International Symposium on Posture and gait, Publisher: ELSEVIER SCIENCE PUBL B V, Pages: 615-618, ISSN: 0531-5131
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- Citations: 4
BISDORFF AR, BRONSTEIN AM, GRESTY MA, et al., 1994, EMG-RESPONSES TO SUDDEN ONSET FREE FALL, 12th International Symposium on Posture and gait, Publisher: ELSEVIER SCIENCE PUBL B V, Pages: 469-472, ISSN: 0531-5131
ISRAEL I, BRONSTEIN AM, KANAYAMA R, et al., 1994, VISUAL AND VESTIBULAR FACTORS INFLUENCING ACCURACY DURING VESTIBULAR NAVIGATION, 12th International Symposium on Posture and gait, Publisher: ELSEVIER SCIENCE PUBL B V, Pages: 521-524, ISSN: 0531-5131
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- Citations: 3
KANAYA T, GRESTY MA, BRONSTEIN AM, 1994, STABILITY OF THE HEAD IN RESPONSE TO SUDDEN TILTS OF THE BODY FROM UPRIGHT - A COMPARISON OF NORMAL AND LABYRINTHINE DEFECTIVE HUMAN SUBJECTS, 12th International Symposium on Posture and gait, Publisher: ELSEVIER SCIENCE PUBL B V, Pages: 461-464, ISSN: 0531-5131
MOSSMAN SS, BRONSTEIN AM, RUDGE P, et al., 1993, ACQUIRED PENDULAR NYSTAGMUS SUPPRESSED BY ALCOHOL, NEURO-OPHTHALMOLOGY, Vol: 13, Pages: 99-106, ISSN: 0165-8107
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- Citations: 9
Lopez L, Bronstein AM, Gresty MA, et al., 1992, Torsional nystagmus. A neuro-otological and MRI study of thirty-five cases., Brain, Vol: 115 ( Pt 4), Pages: 1107-1124, ISSN: 0006-8950
Thirty-five patients with torsional nystagmus (TN) underwent vestibular and ocular motor assessment and magnetic resonance image (MRI) scanning of the head. Patients were divided into two groups according to whether TN was predominant and present in primary gaze (Group I, 23 patients) or elicited by head positioning or gaze deviation and less prominent than other concurrent nystagmus (Group II, 12 patients). The main aetiologies in both groups were demyelination, vascular disease and posterior fossa tumours. In Group I, a frequent pattern of findings, occurring in 30-50% of cases, was a caloric canal paresis contralateral to the direction of the fast phases ('beat') of the TN, whereas the duration of horizontal caloric/rotational nystagmus and the slow-phase eye velocity of pursuit and of optokinetic nystagmus were all reduced in the direction of beating. The TN was more frequently and consistently modulated by vertical canal stimuli (head oscillation in roll) than by otolith stimuli (static tilt). Statistical analysis of the MRI showed significant overlap of abnormal MRI signals in the area of the vestibular nuclei, on the side opposite to the beat direction of TN. These results suggest that TN originates in a central imbalance of vertical semicircular canal function, resulting from lesions involving the vestibular nuclei on the opposite side of the TN. Group II was heterogeneous with no consistent pattern of neuro-otological findings, although lesions ipsilateral to the TN were frequent occurrence; in these cases cerebellar system lesions may have produced ipsilateral vestibular nuclei disinhibition.
LOPEZ L, BRONSTEIN AM, GRESTY MA, et al., 1992, TORSIONAL NYSTAGMUS - A NEURO-OTOLOGIC AND MRI STUDY OF 35 CASES, BRAIN, Vol: 115, Pages: 1107-1124, ISSN: 0006-8950
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- Citations: 55
BRONSTEIN AM, GRESTY MA, MOSSMAN SS, 1992, PENDULAR PSEUDONYSTAGMUS ARISING AS A COMBINATION OF HEAD TREMOR AND VESTIBULAR FAILURE, NEUROLOGY, Vol: 42, Pages: 1527-1531, ISSN: 0028-3878
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- Citations: 21
GRESTY MA, BRONSTEIN AM, 1992, VISUALLY CONTROLLED SPATIAL STABILIZATION OF THE HUMAN HEAD - COMPENSATION FOR THE EYES LIMITED ABILITY TO ROLL, NEUROSCIENCE LETTERS, Vol: 140, Pages: 63-66, ISSN: 0304-3940
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- Citations: 21
Gresty MA, Bronstein AM, Brandt T, et al., 1992, Neurology of otolith function. Peripheral and central disorders., Brain, Vol: 115 ( Pt 3), Pages: 647-673, ISSN: 0006-8950
The otolith organs detect gravitoinertial forces acting on the head providing signals to the brain which are essential for spatial orientation, sensing motion and organizing motor behaviour. Although the pathophysiology of otolithic dysfunction is poorly understood, a disorder of otolith function, at a peripheral or central level, may be suspected when a patient describes symptoms of false sensations of linear motion or tilt or shows signs of specific derangements of ocular motor and postural, orienting and balancing responses. When disorientation is severe the patient may describe symptoms which sound bizarre, raising doubts over the organic basis of the disease. Our recognition of an otolithic disorder and understanding otolithic involvement in a wider neurological context may be guided by knowledge of otolith physiology and of the characteristics of the few proven otolithic syndromes.
GRESTY MA, BRONSTEIN AM, BRANDT T, et al., 1992, NEUROLOGY OF OTOLITH FUNCTION - PERIPHERAL AND CENTRAL DISORDERS, BRAIN, Vol: 115, Pages: 647-673, ISSN: 0006-8950
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- Citations: 99
BRONSTEIN AM, GRESTY MA, 1992, EYE-MOVEMENTS IN RESPONSE TO CANAL AND OTOLITH SIGNALS IN OPPOSING DIRECTIONS, ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, Vol: 656, Pages: 814-816, ISSN: 0077-8923
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- Citations: 1
Gresty MA, Bronstein AM, 1992, Testing otolith function., Br J Audiol, Vol: 26, Pages: 125-136, ISSN: 0300-5364
Otolithic signals contribute to; (1) perception of orientation and linear motion, (2) generate compensatory eye movements in response to linear acceleration of the head and (3) participate in the co-ordination of movement and balance. Tests of these functions shown to be useful in identifying clinical disorders have been reviewed: (1) Evaluation of orientation to gravity, as estimated by adjustment of the visual vertical, indicates deranged otolith function at a peripheral or central level and the sensitivity of this test can be enhanced by performing estimates during centrifugation on a motorised turntable. Estimation of thresholds of self motion on a parallel swing identifies global reduction or unilateral loss of peripheral function, with central disorders awaiting study. (2) Otolith ocular reflexes to linear head translation can be used to demonstrate overall integrity of peripheral function and reveal central abnormalities. Counter-rolling responses to head roll-tilt and measurements of cyclodeviation of the eyes demonstrate functional asymmetries, with some lateralising value, particularly in central lesions. Global function and asymmetries may also be evaluated by 'head eccentric' rotational testing, which adds a tangential linear acceleration to the angular stimulus. The linear acceleration enhances the canal response by adding an otolith component. (3) Latency and amplitude of surface electro-myography (EMG) responses in the limbs to sudden falls, which can be recorded with the subject suspended on a hinged bed, indicate gross peripheral abnormality of function and can lateralize disorders of CNS motor pathways. It is concluded that some tests of otolith function can be of use in indicating global loss of peripheral otolith function, others are capable of lateralizing a marked loss of function and all have the potential to give information about central disorders. They all have to be interpreted within the clinical context and, unfortunately, none have yet
BRONSTEIN AM, GRESTY MA, 1992, EYE-MOVEMENTS IN RESPONSE TO CANAL AND OTOLITH SIGNALS IN OPPOSING DIRECTIONS, CONF ON SENSING AND CONTROLLING MOTION : VESTIBULAR AND SENSORIMOTOR FUNCTION, Publisher: NEW YORK ACAD SCIENCES, Pages: 814-816
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- Citations: 1
BRONSTEIN A, RUDDOCK KH, WOODING DS, 1992, SPATIAL VISION DURING MOTION IN THE ABSENCE OF VESTIBULAR FUNCTIONS IN MAN, JOURNAL OF PHYSIOLOGY-LONDON, Vol: 452, Pages: P40-P40, ISSN: 0022-3751
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- Citations: 1
GRESTY MA, BRONSTEIN AM, PAGE NG, et al., 1991, CONGENITAL-TYPE NYSTAGMUS EMERGING IN LATER LIFE, NEUROLOGY, Vol: 41, Pages: 653-656, ISSN: 0028-3878
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- Citations: 26
KENDALL B, MOSSMAN SS, BRONSTEIN AM, et al., 1991, CONVERGENCE NYSTAGMUS ASSOCIATED WITH ARNOLD-CHIARI MALFORMATION - REPLY, ARCHIVES OF NEUROLOGY, Vol: 48, Pages: 132-132, ISSN: 0003-9942
BRONSTEIN AM, GRESTY MA, BROOKES GB, 1991, COMPENSATORY OTOLITHIC SLOW PHASE EYE-MOVEMENT RESPONSES TO ABRUPT LINEAR HEAD MOTION IN THE LATERAL DIRECTION - FINDINGS IN PATIENTS WITH LABYRINTHINE AND NEUROLOGICAL LESIONS, Publisher: INFORMA HEALTHCARE, Pages: 42-46, ISSN: 0001-6489
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- Citations: 24
BROOKES GB, BRONSTEIN AM, GRESTY MA, 1991, OTOLITH-OCULAR REFLEXES IN PATIENTS WITH UNILATERAL AND BILATERAL LOSS OF LABYRINTHINE FUNCTION, 14TH WORLD CONGRESS OF OTORHINALARYNGOLOGY, HEAD AND NECK SURGERY, Publisher: KUGLER PUBLICATIONS / GHEDINI EDITORE, Pages: 805-808
BRONSTEIN AM, GRESTY MA, 1991, COMPENSATORY EYE-MOVEMENTS IN THE PRESENCE OF CONFLICTING CANAL AND OTOLITH SIGNALS, EXPERIMENTAL BRAIN RESEARCH, Vol: 85, Pages: 697-700, ISSN: 0014-4819
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- Citations: 28
Bronstein AM, Gresty MA, Brookes GB, 1991, Compensatory otolithic slow phase eye movement responses to abrupt linear head motion in the lateral direction. Findings in patients with labyrinthine and neurological lesions., Acta Otolaryngol Suppl, Vol: 481, Pages: 42-46, ISSN: 0365-5237
BRONSTEIN AM, HOOD JD, GRESTY MA, et al., 1990, VISUAL CONTROL OF BALANCE IN CEREBELLAR AND PARKINSONIAN SYNDROMES, BRAIN, Vol: 113, Pages: 767-779, ISSN: 0006-8950
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- Citations: 200
Bronstein AM, Hood JD, Gresty MA, et al., 1990, Visual control of balance in cerebellar and parkinsonian syndromes., Brain, Vol: 113 ( Pt 3), Pages: 767-779, ISSN: 0006-8950
The role of vision in the control of balance in patients with Parkinson's disease (PD) and cerebellar disease (CD) was studied by measuring body sway with eyes open, closed, and in response to visual stimuli generated by discrete lateral displacements of a moveable room which enclosed the subjects. In response to room movement, normal subjects swayed by an amount intermediate between sway with eyes open and eyes closed and their response attenuated on repetition of the movement, a process depending on shifting from predominantly visual to proprioceptive control. CD patients swayed more than controls with eyes open or closed and as shown by high 'Romberg quotients' (eyes closed/eyes open sway ratio) were able to use visual information to control much of their unsteadiness. CD patients had a normal attenuation of response to repetition of the room movement. PD patients had normal sway with eyes open or closed but their responses to room movement were abnormal, being proportionately larger and failing to attenuate during successive stimuli. The results indicate that cerebellar lesions seem largely to spare the visuopostural loop and also spare the ability to shift from a visual to a proprioceptive control of postural sway. In contrast, the findings in PD suggest that the visuopostural loop is hyperactive and that its influence cannot easily be de-emphasized when visual information is misleading. The latter finding suggests that basal ganglia participation in posture is concerned with the reweighting of the various sensorimotor loops controlling posture in the process of adapting to novel situations.
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