Virtual reality (VR) increasingly causes motion sickness, yet physiological mechanisms and individual susceptibility factors remain unclear. Understanding autonomic nervous system responses and their relationship to vestibular function is crucial for developing safer VR applications. This study aimed to characterize autonomic responses to visually induced motion sickness (VIMS) exposure through heart rate variability (HRV) analysis and determine correlations between vestibular function and motion sickness susceptibility. Thirty participants underwent finger PPG monitoring during baseline, VR exposure, and recovery phases, and additionally completed motion sickness questionnaires and vestibular evoked myogenic potential (VEMP) testing. HRV parameters were analyzed using a mixed-design ANOVA, with Pearson correlations examining vestibular-autonomic relationships. VR exposure significantly increased heart rate (3.67%, [Formula: see text]) and HRV parameters (SDNN: + 41.12 ms, RMSSD: + 43.50 ms), followed by pronounced recovery decreases. High motion sickness susceptibility individuals showed the greatest autonomic reactivity. Associations emerged between VR symptoms and ocular VEMP amplitudes ([Formula: see text], [Formula: see text]), and between vestibular function and autonomic responses during VR ([Formula: see text], [Formula: see text]); these are interpreted as hypothesis-generating findings. VR exposure triggers measurable autonomic responses that correlate with individual motion sickness susceptibility and vestibular function. These findings support using HRV monitoring and vestibular assessment as candidate markers of VR-induced discomfort.

Neurosyphilis is an infectious disease of the central nervous system (CNS) caused by Treponema pallidum, which presents with a wide variety of symptoms depending on the affected CNS structures. We describe two cases of neurosyphilis with ocular motor nerve palsy (OMNP) defined as palsy involving cranial nerves (CNs) III, IV, and/or VI, and provide a systemic review of the literature on OMNP associated with neurosyphilis. We describe two patients who presented with unilateral palsy of CN III caused by neurosyphilis. We performed a systematic literature search according to PRISMA guidelines, for all patients with neurosyphilis presenting as OMNP and with available clinical data. Case 1 presented with left pupil-involving CN III palsy and enhancement of the left CN III in magnetic resonance imaging (MRI), and recovered completely after intravenous penicillin and steroid. Case 2 showed bilateral optic atrophy and right pupil-involving CN III palsy, and exhibited partial recovery after intravenous penicillin and steroid. We screened 55 studies, and finally included 31 articles involving 43 patients. Unilateral single OMNP involving CN III or VI was the most common type (n = 30, 70

BACKGROUND:This study aimed to identify associations of sarcopenia, obesity and low bone mineral density (BMD) with morning positional vertigo (PV) and to examine whether these associations differ according to vestibular function status in a nationally representative sample of Korean adults. METHODS:We analysed data from 8512 adults aged ≥ 40 years (50.03% women, mean ± standard error [SE] = 54.06 ± 0.19) who participated in the Korean National Health and Nutrition Examination Survey 2008-2010. Morning PV was defined as severe vertigo when turning in bed or rising in the morning within the past year. Vestibular impairment was assessed using the modified Romberg test (eyes closed, standing on a compliant foam surface). Participants were classified into three groups: controls (no dizziness), morning PV with normal Romberg test results and morning PV with abnormal Romberg test results (suggesting vestibular dysfunction). Body composition-including appendicular skeletal muscle mass, fat mass and BMD-was measured. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria, and abnormal BMD was defined as T-score < 1.0. Weighted multinomial logistic regression analyses were adjusted for age, sex, income, comorbidities, lifestyle and psychosocial variables. RESULTS:The weighted 1-year prevalence of morning PV was 12.58% (95% confidence interval [CI], 11.38-13.89). Abnormal Romberg performance, indicating vestibular dysfunction, was present in 0.96% of all survey respondents and in 7.66% of those with morning PV. Participants with vestibular-impaired morning PV were older (mean age ± SE = 66.47 ± 1.49), predominantly women, and had higher rates of sarcopenia (38.33%) and low BMD (86.39%) than controls. In adjusted models, sarcopenia independently predicted vestibular-impaired morning PV (odds ratio [OR], 1.94; 95% CI, 1.14-3.29; p = 0.014). Sensitivity analysis restricted to current morning PV confirmed the association between sarcopenia and vestibular impairment (OR, 2.97; 95% CI, 1.08-8.12; p = 0.035) and demonstrated that lower BMD (minimum T-score) was inversely associated with vestibular dysfunction (OR, 0.49; 95% CI, 0.25-0.99; p = 0.046). CONCLUSIONS:Morning PV is common among middle-aged and older adults and is associated with systemic frailty markers, particularly sarcopenia and bone loss, in the presence of vestibular dysfunction. These associations were more pronounced in older adults, suggesting a vestibulo-musculoskeletal interaction that may contribute to balance impairment and functional decline with aging. Screening for sarcopenia and bone health, along with vestibular and lifestyle interventions, may help reduce recurrent vertigo and improve functional aging.

BACKGROUND:Body composition disorders such as sarcopenia, obesity, and osteoporosis are common; however, the body composition of patients with dizziness and vestibular dysfunction (VD) has not been thoroughly assessed. METHODS:This cross-sectional study included 9,682 participants aged over 40. Based on the results of a dizziness questionnaire and modified Romberg test, they were classified into three groups: dizziness associated with VD, dizziness without VD, and controls. A body composition analysis focused on muscles, bones, and fats. RESULTS:Multivariate regression analysis revealed that sarcopenia was associated with a higher risk of dizziness with VD when compared to dizziness without VD (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09-2.49; P = 0.017) and the control group (OR, 1.92; 95% CI, 1.28-2.88; P = 0.002). The proportions of bone mineral and fat were comparable among the groups. CONCLUSION:Sarcopenia was found to be significantly associated with dizziness in the group with VD but not in those without it. While this study does not establish a causal relationship, maintaining muscle mass through proper diet and physical activity may be beneficial for individuals with VD. Such efforts could help manage overall health, potentially reducing risks associated with sarcopenia and improving balance. Further longitudinal studies are necessary to explore the potential causal pathways between VD and sarcopenia.

BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and its prevalence is substantial. While primary BPPV has been well studied, the understanding of secondary BPPV is still limited.ObjectiveTo investigate the prevalence and clinical characteristics of secondary BPPV in a national multicenter retrospective analysis.MethodsThe study involved a retrospective analysis of medical records from 17 institutions across South Korea, between January and June 2022. We evaluated clinical features, presumed etiologies, involvement of semicircular canals, response to canalith repositioning procedures (CRPs), presence of residual dizziness, recurrence, and results of auditory and vestibular function tests for both primary and secondary BPPV cases.ResultsOf the total 1363 BPPV cases, 14.5% (198 patients) were categorized as secondary BPPV. The most prevalent etiology for secondary BPPV was head trauma. Secondary BPPV was associated with a higher prevalence of comorbidities including diabetes and inner ear diseases. Patients with secondary BPPV demonstrated more frequent involvement of multiple semicircular canals, necessitated a greater number of CRPs for resolution, and experienced a higher incidence of residual dizziness compared to primary BPPV cases. Furthermore, secondary BPPV patients exhibited more frequent abnormalities in auditory and vestibular function tests.ConclusionsSecondary BPPV accounts for a significant proportion of BPPV cases, with distinct clinical characteristics compared to primary BPPV.

Objectives: When we see patients with a history of positional vertigo (PV), many patients are diagnosed with benign paroxysmal PV (BPPV) by performing a typical history and nystagmus during a positioning maneuver. Recent studies reported that Otolin-1 can be detected in serum and that its levels significantly increase with age and BPPV. Herein, we tried to study the relationship between serum otolin-1 level and the other clinical aspects in patients with PV.Methods: We measured the serum levels of otolin-1 in 117 BPPV patients (82 females; age range, 43–92 years; mean age±standard deviation [SD], 68.5±10.5 years), referred to as the BPPV group; and nine patients (seven females; age range, 61–79 years; mean age±SD, 66.9±5.9 years) with PV not compatible with BPPV, referred to as another PV group. All the BPPV patients were treated with an appropriate canal repositioning maneuver followed by blood sampling within 1 week. Results: The serum levels of otolin-1 were higher in the BPPV group than in another PV group (mean±SD, 350.1±319.1 pg/mL vs. 183.6±134.1 pg/mL, respectively; p=0.037). However, there were no differences in both laboratory findings (serum vitamin D, C-telopeptide of type collagen, and bone mineral density) and clinical findings (age, sex, vertigo duration, ear disease, ear symptom, migraine, motion sickness, trauma, and previous BPPV) between these two groups. Conclusions: Serum otolin-1 level could help predict the current existence of BPPV in patients with PV. However, further validation studies are needed.

Lung-recruitment maneuvers (LRM) have been shown to reduce postoperative pain after laparoscopic surgery. This study aimed to investigate the association of LRM with the incidence of shoulder pain after laparoscopic cholecystectomy. A randomized controlled study was conducted with 110 patients undergoing elective laparoscopic cholecystectomy from July 2022 to March 2023. Participants were randomized to receive either routine exsufflation or LRM at pneumoperitoneum release. The postoperative shoulder pain and abdominal pain were assessed at 1, 4, 6, 12, and 24 h after surgery using a numeric rating scale. Analgesic consumption and postoperative nausea or vomiting (PONV) were evaluated during the first 24 h after surgery. The incidence of shoulder pain during the first 24 h after surgery was significantly lower in the LRM group compared to the control group (26.9 vs. 59.3

Abstract Background Dizziness and vertigo rank among the top 10 reasons for emergency and clinical referrals to neurologists. Chronic dizziness and imbalance not only reduce quality of life, but also increase mortality. While the Mediterranean diet has long been considered beneficial for human and planetary health, its effects on chronic dizziness or imbalance are understudied. We investigated the associations of adherence to the Mediterranean diet with chronic dizziness and imbalance. Methods This study used data from the Korea National Health and Nutrition Examination Survey 2019–2021 and included 4,183 adults aged 40 years and older with complete information from diet, dizziness, and neurotology questionnaires. The alternate Mediterranean diet score (aMed) for nine food groups was calculated from 24-hour dietary recall data. Based on questionnaire responses, chronic dizziness was categorized as either isolated or chronic dizziness with imbalance, characterized by a cluster of difficulties maintaining a standing position, walking, or falling. Results In a multivariable-adjusted model, the prevalence of chronic imbalance was lower in the top aMed tertile than in the bottom tertile (OR 0.37; 95% CI, 0.18–0.74; p-trend = 0.01). Among the individual aMed components, the intake of whole grains and nuts exhibited an inverse relationship with chronic imbalance (OR 0.50; 95% CI, 0.27–0.93 for whole grains; OR 0.55; 95% CI, 0.31–1.01 for nuts). The aMed score was not associated with isolated chronic dizziness. Conclusions Greater adherence to the Mediterranean diet may reduce chronic imbalance, particularly with an adequate intake of whole grains and nuts.

Objectives: The aim of this study is to categorize headaches associated with definite Menière’s disease (MD) according to diagnostic criteria, to determine their prevalence, and to investigate the preferred medication across participating centers.Methods: Patients diagnosed with definite MD at 17 university hospitals in otolaryngology or neurology departments in Korea between January 1, 2021 to December 31, 2021 were retrospectively included. Data on the presence of accompanying vestibular migraine (VM), migraine or non-migraine headaches, and clinical information were collected. A survey was conducted to assess preferences for treatment drugs for vertigo and headache control in MD patients with headache.Results: A total of 435 definite MD patients were included, with a mean age of 57.0±14.9 years. Among them, 135 (31.0%) had accompanying headaches, of whom 48 (11.0% of all definite MD patients) could be diagnosed with VM. The prevalence of comorbid VM (definite and probable) was significantly higher in females (41 of 288, 14.2%) than in males (7 of 147, 4.8%) (p<0.05). There was no significant difference in the prevalence of comorbid VM between unilateral and bilateral MD patients (10.8% and 13.6%, respectively) (p > 0.05). Benzodiazepines, antihistamines, and antiemetics were mainly preferred for acute vertigo control, while nonsteroidal anti-inflammatory drugs, acetaminophen, and triptans were preferred for acute headache control, and topiramate, propranolol, and calcium channel blockers were mainly preferred for headache prevention.Conclusions: VM is not uncommon in patients with definite MD in Korea. Further research is needed to understand the differences in headache prevalence and preferred medications across different centers.

OBJECTIVE:To elucidate the association between phase angle (PA) and a composite adverse outcome in patients requiring off-pump coronary artery bypass grafting (OPCAB). DESIGN:A prospective observational study. SETTING:High-volume single center. PARTICIPANTS:A total of 229 adult patients who underwent OPCAB from May 2019 to October 2020. INTERVENTIONS:Each patient underwent bioelectrical impedance analysis, including PA assessment before surgery (PApre), immediately postoperatively (PApost), and 1 day postoperatively (PAPOD1), using an Inbody S10. Frailty index and nutritional assessments also were obtained before surgery. MEASUREMENTS AND MAIN RESULTS:Patient outcomes were assessed using a composite adverse outcome comprising death, myocardial infarction, revascularization, new-onset atrial fibrillation, acute kidney injury, stroke, postoperative pulmonary complications, wound complications, sepsis, reoperation, and/or delirium occurring during hospitalization and over the following year. Patients for whom composite adverse outcomes were reported had lower PApre than those without complications (5.4 ± 0.9 v 6.0 ± 0.9, p < 0.001). The PA was significantly associated with in-hospital and 1-year composite postoperative outcomes. The odds ratios (OR, [95% confidence interval]) for PApre by time were in-hospital complications (0.435 [0.314, 0.604], p < 0.001; 1-year complications: 0.459 [0.330, 0.638], p < 0.001) and PAPOD1 (OR, in-hospital complications: 0.400 [0.277, 0.576], 1-year complications: 0.429 [0.298, 0.619], p < 0.001). The PApre was significantly associated with days alive and out of hospital until 1 year. The cut-off value of PApre for optimal prediction of in-hospital complications was 6.0 (area under the curve: 0.691 [0.623-0.758], p < 0.001). CONCLUSION:Low PA as an indicator of frailty is associated with adverse postoperative outcomes after OPCAB. Low PA may be employed as a noninvasive and practical tool for the prediction of prognosis in patients with coronary artery disease.

Study objective: The emergence profiles in patients undergoing total intravenous anesthesia with either propofol or remimazolam with flumazenil reversal were compared.Design: A prospective, double-blind, randomized trial. Setting: An operating room and a post-anesthesia care unit (PACU).Patients: Adult patients (n = 100) having American Society of Anesthesiologists (ASA) physical status of I-III undergoing general anesthesia were enrolled and randomly assigned to the propofol or the remimazolam group.Interventions: The propofol group received target-controlled infusion of propofol, and the remimazolam group received continuous infusion of remimazolam. Continuous infusion of remifentanil was used in both groups. For emergence, flumazenil was used in increments of 0.2 mg in the remimazolam group.Measurements: The primary outcome was the time required for the patient to obey verbal commands. The sec-ondary outcomes included the time to bispectral index (BIS) over 80, the time to laryngeal mask airway (LMA) removal, the Richmond Agitation-Sedation Scale (RASS) scores in the PACU, and adverse events throughout the study period.Main results: The time taken to obey verbal commands was significantly longer in the propofol group than the remimazolam group (14 [9, 19]) vs. 5 [3, 7]) minutes, P < 0.001; median difference-9, 95% confidence interval-11 to-6). The times to BIS over 80 and to LMA removal were also significantly longer in the propofol group. In addition, the RASS score upon arrival to the PACU differed significantly between the two groups (P = 0.006). Re -sedation in the PACU was observed in 11 (22%) of the patients in the remimazolam group.Conclusions: Remimazolam-based total intravenous anesthesia with flumazenil reversal may be effective in reducing emergence time, but a significant incidence of re-sedation was observed in the PACU. Further studies are needed to determine adequate dose and timing of routine flumazenil use and minimize the risk of re-sedation.

Study objective: Dynamic arterial elastance (Eadyn) has been suggested as a functional measure of arterial load. We aimed to evaluate whether pre-induction Eadyn can predict post-induction hypotension.Design: Prospective observational study. Patients: Adult patients undergoing general anesthesia with invasive and non-invasive arterial pressure moni-toring systems.Measurements: We collected invasive and non-invasive Eadyns (n = 38 in each), respectively. In both invasive and non-invasive Eadyns, pre-induction Eadyns were obtained during one-minute tidal and deep breathing in each patient before anesthetic induction. Post-induction hypotension was defined as a decrease of >30% in mean blood pressure from the baseline value or any absolute mean blood pressure value of <65 mmHg for 10 min after anesthetic induction. The predictabilities of Eadyns for the development of post-induction hypotension were tested using receiver-operating characteristic curve analysis.Main results: Invasive Eadyn during deep breathing showed significant predictability with an area under the curve (AUC) of 0.78 (95% Confidence interval [CI], 0.61-0.90, P = 0.001). But non-invasive Eadyn during tidal breathing (AUC = 0.66, 95% CI, 0.49-0.81, P = 0.096) and deep breathing (AUC = 0.53, 95% CI, 0.36-0.70, P = 0.75), and invasive Eadyn during tidal breathing (AUC = 0.66, 95% CI, 0.41-0.74, P = 0.095) failed to predict post-induction hypotension. Conclusion: In our study, invasive pre-induction Eadyn during deep breathing-could predict post-induction hy-potension. Despite its invasiveness, future studies will be needed to evaluate the usefulness of Eadyn as a pre-dictor of post-induction hypotension because it is an adjustable parameter.

Weight gain is associated with imbalance in older people. In contrast, overweightness or mild obesity is less common in patients with chronic dizziness. This paradox may be, at least in part, related to differences in the body composition indices adopted in the previous studies. This study aimed to determine any association between the predicted body composition and chronic dizziness or imbalance of unknown causes. We measured the lean body mass, body fat mass, and appendicular skeletal mass in 9243 people who participated in the Korean National Health and Nutrition Examination Survey 2019–2021. Sarcopenia was defined according to the Asian Working Group for Sarcopenia’s guidelines. Obesity was defined as a body fat percentage of ≥ 25

Abstract Background and Objectives Vestibular syncope is a condition in which vertigo‐induced hemodynamic changes cause syncope. This study investigated the clinical and laboratory findings of vestibular syncope and tried to refine our knowledge of the mechanism underlying this newly recognized entity. Methods This study retrospectively analyzed 53 patients (33 women, median age = 63 years [interquartile range = 54–71 years]) with vestibular syncope from January 2017 to December 2021. To explain the mechanism of vestibular syncope, we incorporated a velocity‐storage model into the dual reflex pathways comprising the vestibulo‐sympathetic reflex and baroreflex and predicted the cardiovascular responses. Results Twenty (37.7%) patients had multiple episodes of vestibular syncope, and seven (13.2%) had potentially life‐threatening injuries. Meniere's disease (20.8%) and benign paroxysmal positional vertigo (9.4%) were the most common underlying vestibular disorders. Abnormal vestibular function tests included impaired cervical vestibular‐evoked myogenic potentials (57.5%) and positive head impulse tests (31.0%). Orthostatic hypotension was found in 19.5% of patients. Dyslipidemia (30.2%) and hypertension (28.3%) were common medical comorbidities. The dual reflex pathways incorporating the function of the velocity‐storage circuit in the brainstem and cerebellum suggest that vestibular syncope is a neurally mediated reflex syncope associated with a sudden hemodynamic change during vertigo. This change can be arterial hypertension triggered by a false downward inertial cue, as suggested previously, or hypotension driven by a false upward inertial cue. Conclusions Vestibular syncope is associated with various vestibular disorders and requires careful evaluation and intervention to prevent recurrent falls and significant injuries.

IntroductionIn this cross-sectional study, we investigated the 1-year prevalence and related factors in the general population with an experience of chronic dizziness.MethodsThis study analyzed persons (n = 5,163) who respond to dizziness and nutrition questionnaire from participant of Korean National Health and Nutrition Examination Survey (KNHANES, 2019-2020).ResultsOf individuals over 40 years, 25.3% of the general population (61.6% females) reported either dizziness or imbalance for the past year. Moreover, 4.8% of the patients reported they suffered from chronic dizziness or imbalance for more than 3 months. In multiple regression analysis, patients with chronic dizziness were older, females, had lower body mass index (BMI), had stress awareness, and had a history of tinnitus within 1 year (>5 min per episode). Relative to normal body weight, both overweight and mild obesity (obesity stages 1 and 2) were associated with a significantly lower risk of chronic dizziness. Overweight, obesity stage 1, and obesity stage 2 had odds ratios of 0.549 [95% confidence interval (CI), 0.332–0.910], 0.445 (95% CI, 0.273–0.727), and 0.234 (95% CI, 0.070–0.779), respectively.ConclusionsIn this study, the prevalence of chronic dizziness in the general population was 4.8%. Our study demonstrated that overweight and mild obesity were independently associated with a lower risk of chronic dizziness in adults for the past year. Therefore, the optimal BMI for patients with dizziness should be defined and managed according to an integrated care pathway.

This study aimed to evaluate vestibular perception in patients with unilateral vestibulopathy. We recruited 14 patients (9 women, mean age = 59.3 ± 14.3) with unilateral vestibulopathy during the subacute or chronic stage (disease duration = 6 days to 25 years). For the evaluation of position perception, the patients had to estimate the position after whole-body rotation in the yaw plane. The velocity/acceleration perception was evaluated by acquiring decisions of patients regarding which direction would be the faster rotation after a pair of ipsi- and contra-lesional rotations at various velocity/acceleration settings. The duration perception was assessed by collecting decisions of patients for longer rotation directions at each pair of ipsi- and contra-lesional rotations with various velocities and amplitudes. Patients with unilateral vestibulopathy showed position estimates and velocity/acceleration discriminations comparable to healthy controls. However, in duration discrimination, patients had a contralesional bias such that they had a longer perception period for the healthy side during the equal duration and same amplitude rotations. For the complex duration task, where a longer duration was assigned to a smaller rotation amplitude, the precision was significantly lower in the patient group than in the control group. These results indicate persistent impairments of duration perception in unilateral vestibulopathy and favor the intrinsic and distributed timing mechanism of the vestibular system. Complex perceptual tasks may be helpful to disclose hidden perceptual disturbances in unilateral vestibular hypofunction.