Journal of Yeungnam Medical Science

Volume 31(1); June 2014

Review

Differential diagnosis of peripheral vertigo.: Chang Hoon Bae; Yeungnam Univ J Med. 2014;31(1):1-8. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.1

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Dizziness can be classified mainly into 4 types: vertigo, disequilibrium, presyncope, and lightheadedness. Among these types, vertigo is a sensation of movement or motion due to various causes. The main causes of peripheral vertigo are benign paroxysmal positional vertigo (BPPV), acute vestibular neuritis (AVN), and Meniere's disease. BPPV is one of the most common causes of peripheral vertigo. It is characterized by brief episodes of mild to intense vertigo, which are triggered by specific changes in the position of the head. BPPV is diagnosed from the characteristic symptoms and by observing the nystagmus such as in the Dix-Hallpike test. BPPV is treated with several canalith repositioning procedures. AVN is the second most common cause of peripheral vertigo. Its key symptom is the acute onset of sustained rotatory vertigo without hearing loss. It is treated with symptomatic therapy with antihistamines, anticholinergic agents, antidopaminergic agents, and gamma-aminobutyric acid-enhancing agents that are used for symptoms of acute vertigo. Meniere's disease is characterized by episodic vertigo, fluctuating hearing loss, and tinnitus. It is traditionally relieved with life-style modification, a low-salt diet, and prescription of diuretics. However, diagnosis and treatment of the peripheral vertigo can be difficult without knowledge of BPPV, AVN, and Meniere's disease. This article provides information on the differential diagnosis of peripheral vertigo in BPPV, AVN, and Meniere's disease.

Citations

Citations to this article as recorded by

The Effect of Banhabaekchulcheonma-tang on Benign Paroxysmal Positional Vertigo: A Systematic Review Using the CNKI Database
Gi-hyeon Gwon, Seo-hye Oh, Eun-soo Park, Mi-hyeon Kim, Seung-hyo Hong, Geum-ju Song, Eun-young Park
The Journal of Internal Korean Medicine.2021; 42(4): 572. CrossRef
Korean Medicine Interventions for Benign Paroxysmal Positional Vertigo: A Systematic Review of Clinical Studies Published in Korea
Jun-su Jung, Sung-heon Jung, Min-joo Kim, Jang-kyung Park, Kwang-ho Bae, Kyung-hwan Kong, Ho-yeon Ko
The Journal of Internal Korean Medicine.2017; 38(4): 479. CrossRef
Clinical significance of saccade test, smooth pursuit test, and optokinetic nystagmus test in nystagmography
Yoon Seok Choi, Hyung Gyun Na, Si Youn Song, Yong Dae Kim, Chang Hoon Bae
Yeungnam University Journal of Medicine.2017; 34(1): 29. CrossRef

Case Reports

Died immediately after corrective surgery for right ventricular acute myocardial infarction and ventricular septal rupture.: Su Mi Kim, Sung Yun Jung, Min Jung Kim, Tae Hun Kwon, Kang Un Choi, Byung Jun Kim, Jang Won Sohn, Gue Ru Hong; Yeungnam Univ J Med. 2014;31(1):9-12. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.9

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Abstract PDF: Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.

Dual left anterior descending coronary artery originating from left main stem and right coronary sinus.: Dong Hwi Kim, Keon Woong Moon, Eun Hee Kim, Gihyeon Woo, Jin Kyeong Shin, Ji Yeun Jang, Sungeun Ha, Joo Young Lee; Yeungnam Univ J Med. 2014;31(1):13-16. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.13

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Abstract PDF: Congenital abnormalities of the coronary arteries are found in 0.6% to 1.3% of patients in coronary angiography. Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is incidentally detected during coronary angiography. We report a case of a 65-year-old female with a rare coronary anomaly who was diagnosed with dual LAD via coronary computed tomography and coronary angiography. The imaging studies revealed dual LAD originating from the left main stem and right coronary sinus. These angiographic findings were considered to be consistent with the type IV variety of dual LAD by Spindola-Franco classification. Recognition of dual LAD is important to prevent errors of interpretation of the coronary angiogram and for optimal surgery.

Non-surgical treatment of hemorrhagic shock caused by rupture of iatrogenic pseudoaneurysm.: Soon Young Kim, Tae Jun Kim, Seong Kyun Na, Seung Ah Park, Dong Min Jung, Yong Kyun Kim, Sang Ho Jo; Yeungnam Univ J Med. 2014;31(1):17-20. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.17

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Abstract PDF: Iatrogenic femoral artery pseudoaneurysm is a complication in patients undergoing catheterization. The risk increased when large-bore sheaths, concomitant anticoagulation therapy, and antiplatelet therapy are used during the intervention. Ultrasound-guided thrombin injection has become the treatment of choice. Rapid expansion, rupture, infection, and mass effect resulting in distal or cutaneous ischaemia or peripheral neuropathy, as well as failure of other treatment options are all indications for surgery. We report a 48-year-old man who developed hemorrhagic shock due to femoral pseudoaneurysm rupture after coronary angiography, and successfully treated by ultrasound-guided thrombin injection.

Furosemide induced medullary nephrocalcinosis mimicking Bartter syndrome.: Sohee Kim, Chanhee Kyung, Yong Hoon Kim, Jang Ho Cho, Changhyeok Hwang, Jung Eun Lee; Yeungnam Univ J Med. 2014;31(1):21-24. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.21

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Abstract PDF: Clinical presentation of Bartter syndrome is similar to surrepitious vomiting or use of diuretics. Therefore, precise differential diagnosis of Bartter syndrome is crucial. We report a case of medullary nephrocalcinosis (MNC) induced by furosemide mimicking Bartter syndrome. A 55-year-old female patient visited our hospital with renal dysfunction on basis of hypokalemia and metabolic alkalosis. She had no history of hypertension or drug use except allopurinol and atorvastatin. She did not complain of nausea or vomiting on presentation and the serum magnesium level was normal. We performed ultrasonography, that showed MNC. For these reasons, we suspected Bartter syndrome and corrected the electrolyte imbalance. During outpatient follow up, we found that the patient had been taking 400 mg of furosemide daily for 30 years. We could diagnose furosemide induced MNC, and recommended to her to reduce the amount of furosemide.

Incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis patient.: Yo Han Jeong, Jun Young Do, Mun Ju Hwang, Min Jung Kim, Min Geun Gu, Byung Sam Park, Jung Eun Choi, Tae Woo Kim; Yeungnam Univ J Med. 2014;31(1):25-27. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.25

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Abstract PDF

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.

Citations

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Clinical benefits of routine examination and synchronous repair of occult inguinal hernia during laparoscopic peritoneal dialysis catheter insertion: a single-center experience
H.-W. Kou, C.-N. Yeh, C.-Y. Tsai, J.-T. Hsu, S.-Y. Wang, C.-W. Lee, M.-C. Yu, T.-L. Hwang
Hernia.2021; 25(5): 1317. CrossRef

Treatment of pulmonary thromboembolism using Arrow-Trerotola percutaneous thrombolytic device.: Tae Kyun Kim, Ji Young Park, Jun Ho Bae, Jae Woong Choi, Sung Kee Ryu, Min Jung Kim, Jun Bong Kim, Jang Won Sohn; Yeungnam Univ J Med. 2014;31(1):28-32. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.28

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Abstract PDF

Pulmonary thromboembolism (PTE) increases the pressure of the right ventricle and leads to symptoms and signs, such as dyspnea and hypoxia. If PTE causes hemodynamic instability, thrombolytic therapy should be considered. A mechanical thrombectomy is an alternative treatment to thrombolytic therapy and should be considered when thrombolytic therapy is contraindicated. Various devices are used in mechanical maceration and catheter-directed thrombolysis, but there is no standard mechanical device for PTE as yet. We report here on 2 clinical experiences of mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombolytic device to remove residual clots after systemic thrombolysis in patients with massive PTE.

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Pulmonary thromboembolism combined with intracardiac thrombus occurred during the steroid reduction in nephrotic syndrome patient
Se Jin Lee, Ji Young Park, Sung Kee Ryu, Jae Woong Choi, Won Young Chae, Hee Yun Ryu, Min Seok Yoo, Yoon Suk Bak
Yeungnam University Journal of Medicine.2016; 33(1): 25. CrossRef

Recurrent acinic cell carcinoma in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy.: Sung Yun Jung, Dong Won Lee, Min Geun Gu, Tae Hun Kwon, Sung Ae Ko, Joon Hyuk Choi, Jang Won Sohn, Myung Soo Hyun; Yeungnam Univ J Med. 2014;31(1):33-37. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.33

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Abstract PDF: Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.

Cardiovascular beriberi: rare cause of reversible pulmonary hypertension.: Joon Hyuk Song, Sang Soo Cheon, Myung Hwan Bae, Jang Hoon Lee, Dong Heon Yang, Hun Sik Park, Yongkeun Cho, Shung Chull Chae; Yeungnam Univ J Med. 2014;31(1):38-42. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.38

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Cardiovascular beriberi is caused by thiamine deficiency and usually presents as high cardiac output failure associated with predominantly right-sided heart failure and rapid recovery after treatment with thiamine. Because of its rarity in developed countries, the diagnosis can often be delayed and missed. We recently experienced a case of cardiovascular beriberi with pulmonary hypertension which successfully treated with thiamine infusion. A 50-year-old man with chronic heavy alcoholics was refered to our department for dyspnea with mental change. Echocardiography showed marked right ventricular (RV) dilatation and flattening of the interventricular septum with a D-shaped deformation of the left ventricle. Moderate tricuspid valve regurgitation was found and estimated RV systolic pressure was 52 mm Hg. Because of his confused mentality and history of chronic alcohol intake, neurological disorder due to thiamine deficiency was suspected and intravenous thiamine was administered and he continuously received a daily dose of 100 mg of thiamine. Follow up echocardiography showed marked reduction of RV dilatation and improvement of a D-shaped deformation of the left ventricle. He finally diagnosed as cardiovascular beriberi on the basis of dramatic response to intravenous thiamine. Thiamine deficiency can cause reversible pulmonary hypertension, and can still be encountered in the clinical setting. Thus high index of suspicion is critically needed for diagnosis.

Citations

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Beriberi: A Reversible Cause of Acute Severe Pulmonary Hypertension
Mei L Tan, Christopher G Willis
Cureus.2022;[Epub] CrossRef
Mechanical ventilation-associated pneumothorax presenting with paroxysmal supraventricular tachycardia in patients with acute respiratory failure
Jeong Ho Eom, Myung Goo Lee, Chang Youl Lee, Kyong Min Kwak, Won Jae Shin, Jung Wook Lee, Seong Hoon Kim, Sang Hyeon Choi, So Young Park
Yeungnam University Journal of Medicine.2015; 32(2): 106. CrossRef

Relapsed plasmacytoma in central nervous system after complete remission of extramedullary plasmacytoma.: Sun Mi Kang, Seong Gyu Kim, Ji Ho Seo, Ji Yoon Kim, Woo Jung Sung, Sung Hwa Bae, Hun Mo Ryoo; Yeungnam Univ J Med. 2014;31(1):43-47. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.43

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Abstract PDF: Extramedullary plasmacytoma (EMP) is a rare disease that occurs in 3% to 5% of patients with plasma cell disorder. It occurs most commonly in the upper respiratory tract and the oral cavity. Very few EMP cases have been reported in the central nervous system (CNS). We report herein an unusual case of EMP in the nasal cavity that recurred in the CNS without systemic involvement. A 67-year-old man visited our hospital due to a month-long bout with exophthalmos. He was diagnosed with EMP in the nasal cavity, paranasal sinus, and orbital cavity. He received radiotherapy to which he had complete responses. After 2 years, he visited our hospital because of a month-long headache. He was diagnosed with EMP recurrence in the CNS via brain magnetic resonance imaging and cerebrospinal fluid analysis. He was treated with whole brain radiotherapy and intrathecal chemotherapy with methotrexate, but he expired due to pneumonia.

Fast-growing multiple symmetric lipomatosis.: Jin Hwa Choi, Byung Su Kim, Seung Hyun Sohng, Hyo Jin Lee, Dong Hoon Shin, Jong Soo Choi, Young Kyung Bae; Yeungnam Univ J Med. 2014;31(1):48-51. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.48

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Abstract PDF: Multiple symmetric lipomatosis (MSL) is a rare disease characterized by symmetrical massive fatty deposits on the face, neck, shoulders, and upper trunk. We report a 74-year-old man who complained of painless subcutaneous nodules on his posterior neck that developed 3 weeks earlier. In a week, variably-sized similar lesions developed on both his shoulders and upper extremities. At the time of his hospital visit, several firm nodules as big as a walnut to a child's fist and with the normal-skin-hue were observed on his posterior neck, both shoulders, upper extremities, and trunk. The histological examination of his upper left arm revealed more mature adipocytes without encapsulation in the subcutaneous tissue. MSL was generally known to occur slowly over months or years. However, this is an unusual case that showed a fast-growing nature.

Hereditary protein S deficiency presenting acute pulmonary embolism.: Jiwan Kim, Sung Hea Kim, Sang Man Jung, Sooyoun Park, Hyungmin Yu, Sanghee An, Seonghui Kang, Hyun Joong Kim; Yeungnam Univ J Med. 2014;31(1):52-55. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.52

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Abstract PDF: Protein S deficiency is one of the several risk factors for thrombophilia and can cause blood clotting disorders such as deep vein thrombosis and pulmonary embolism. A 54-year-old man was admitted with the complaint of dyspnea and was diagnosed with pulmonary embolism. The patient had very low level of free protein S, total protein S antigen, and protein S activity (type I protein S deficiency). In history taking, we found that his mother, 78 year old, had a history of same disease 10 years ago, and confirmed the pronounced low level of protein S. The patient's son also had very low level of protein S, however there had not been any history of pulmonary embolism yet. This case study suggests that asymptomatic persons with a family history of protein S deficiency and pulmonary embolism should be checked regularly for early detection of the disease, as protein S deficiency can be suspected.

Hepatic portal venous gas in paralytic ileus.: Ji Eun Lee, Min Soo Sohn, Jun Ho Hur, Sun Young Cho, Sun Taek Choi, Young Ho Sung; Yeungnam Univ J Med. 2014;31(1):56-60. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.56

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Abstract PDF: Hepatic portal venous gas (HPVG) is a rare radiographic finding associated with severe intra-abdominal disease and fatal outcome. Most cases of HPVG are historically related to mesenteric ischemia accompanied by bowel necrosis. The current spread of computed tomography scan promotes not only the early detection of related severe diseases but also the identification of other causes of HPVG. It has been reported in many non-fatal conditions, such as inflammatory bowel disease, intra-abdominal abscess, bowel obstruction, paralytic ileus, endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, and gastric dilatation. Among these, paralytic ileus is a very rare condition, with no case yet reported in South Korea. Reported herein is a case of HPVG in paralytic ileus, which was treated well internally and was promptly resolved.

Panhypopituitarism due to craniopharyngioma with bilateral slipped capital femoral epiphysis.: Sun Woo Kim, Young Jin Song, Eun Jeong Choi, Dong Hee Han, Hyun Yon Jung, Sung Hoon Yu, Hyung Joon Yoo, Jae Myung Yu; Yeungnam Univ J Med. 2014;31(1):61-64. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.61

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Abstract PDF

Craniopharyngiomas are rare primary intracranial tumors. Despite their benign histological appearance, they are often associated with an unfavorable prognosis. The typical manifestations upon diagnosis are headache, visual impairment, polyuria/polydypsia, growth retardation, disturbance of pubertal development, and significant weight gain. The treatment options include radical surgery or radiotherapy, or a combination of these modalities. Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder. SCFE occurs when the capital femoral epiphysis displaces posteriorly on the femoral neck at the level of the physis. The etiology of SCFE is thought to be multifactorial and may include obesity, growth surges, and less common endocrine disorders. The related endocrine disorders include hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Reported herein is a case of panhypopituitarism caused by craniopharyngioma combined with SCFE.

Citations

Citations to this article as recorded by

A Case of Slipped Capital Femoral Epiphysis in Association With Craniopharyngioma
Mehran Soleymanha, Ali Karimi, Seyed Mojtaba Mehrdad
Trauma Monthly.2015;[Epub] CrossRef

Surgical treatment of recurrent pseudochylothorax occurring after therapy of tuberculous pleurisy.: Jae Ryung Yi, Woo Sik Kim, Eun Jung Jeong, Yu Na Jung, Hee Sook Lee, Gi Ho Jo, Ji Yeon Lee; Yeungnam Univ J Med. 2014;31(1):65-68. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.65

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Abstract PDF: Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.

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