The authors describe a 16-year-old patient with recurrent episodes of epileptic linear self-motion perception and occasional body tilts. Intracranial seizure monitoring located the seizure onset, caused by a circumscribed ependymoma, in the right paramedian precuneus. Electrical cortical stimulation of this area could reproduce the same vestibular sensations, which ceased after lesionectomy. The findings implicate the paramedian area of the precuneus in the processing of static and dynamic vestibular, probably otolithic, information.

To describe the unique case of a patient with panic attacks and bilateral selective amygdala lesions due to Urbach-Wiethe disease.

To determine age-related changes, the initial linear vestibulo-ocular reflex (LVOR) of eight older subjects of mean age 65+/-7 years (mean +/- SD, range 56-75 years) was compared with that of nine younger subjects of mean age 24+/-5 years (range 18-31 years) in response to random transients of whole-body heave (interaural) translation at peak acceleration of 0.5 g delivered by a pneumatic actuator. Binocular eye rotations were measured with magnetic search coils, while linear head position and acceleration were measured with a potentiometer and piezoelectric accelerometer. Subjects viewed targets 200 cm, 50 cm, or 15 cm distant immediately before the unpredictable onset of randomly directed translation in darkness (LVOR) and in light (LVVOR). All subjects maintained ideal vergence of 1.5-2 degrees for the 200-cm target, 6-8 degrees for the 50-cm target, and 21-26 degrees for the 15-cm target, with actual vergences depending on individual interpupillary distances. Search coil recording of angular position of the upper teeth showed head rotation to be negligible (less than 0.5 degrees ) for the first 250 ms after onset of head translation, excluding a role for the angular VOR in the responses studied. The LVOR response to heave translation was an oppositely directed eye rotation occurring after a mean latency of 62+/-3 ms for older and 42+/-3 ms (mean +/- SD) for younger subjects ( P<0.0001). The peak of the latency distribution was 60-100 ms for older and 20-60 ms for younger subjects. During the early interval, 70-80 ms from head motion onset prior to a pursuit contribution or saccades, all subjects had significantly enhanced LVOR with decreasing target distance. In this interval, the LVOR position amplitude of younger subjects was 0.17+/-0.01 degrees, 0.40+/-0.01 degrees, 0.57+/-0.01 degrees (mean +/- SE), respectively, in descending order of target distance. Early sensitivities were significantly reduced for older subjects to 0.07+/-0.01 degrees, 0.23+/-0.01 degrees, 0.40+/-0.01 degrees ( P<0.0001). There was no significant effect of target visibility in either group during the first 110 ms ( P>0.05). Visual-otolith interaction was mainly reflected not by the vestibular slow phase, but by vestibular catch-up saccades (VCUS) in the compensatory direction. The effect of aging on the initial human LVOR is thus to: prolong latency, reduce early sensitivity, and reduce occurrence of vestibular catch-up saccades.

The objective of the study was to examine migrainous vertigo prospectively by means of a diary. We included 146 patients with at least one migraine attack per month. All patients underwent a semistructured interview, completed questionnaires on depression, anxiety and quality of sleep and kept a diary covering detailed information on headache, vertigo and dizziness over a period of 30 days. A completed diary was returned by 116 patients (79.5%). Based on the diary migrainous vertigo (MV) was diagnosed in 18 patients (15.5%) and non-migrainous vertigo or dizziness (non-MV) in 35 patients (30.2%). MV was present on 65 of 3477 patient days (1.9%) and non-MV on 145 days (4.2%). MV occurred more often on days with headache (P < 0.001). Its median duration was 3 h and it lasted longer on days with headache than on days without headache (P < 0.001). The most prominent specific feature of MV was head motion intolerance. Patients with MV showed anxiety more often (P < 0.001) and tended to have worse quality of sleep and higher depression scores. In conclusion, vertigo and dizziness are frequent symptoms in migraineurs. The 1-month prevalence of MV is 16% and that of non-MV 30% in patients with at least one migraine attack per month. Frequency of MV is higher and duration longer on days with headache. MV is a risk factor for co-morbid anxiety.

The linear vestibulo-ocular reflex (LVOR) was studied in eight normal human subjects of average age 24+/-5 years. Subjects underwent a sudden heave (mediolateral) translation delivered by a pneumatic servo-driven chair with a peak acceleration of 0.5 g while viewing earth-fixed targets at 15, 25, 50, and 200 cm. Stimuli were provided both with targets continuously visible or extinguished just prior to motion. Cancellation was tested using chair-fixed targets at each viewing distance. Eye movements were recorded using binocular magnetic search coils. Head translation was measured using a linear accelerometer attached to the upper teeth, to which also was attached a magnetic search coil verifying absence of head rotation. Vergence angles achieved by all subjects were appropriate to interpupillary distance and target distance. Heave translations evoked horizontal ocular rotations in the opposite direction following a brief latency. Latency of the LVOR was determined by automated algorithms based on identification of times when eye position and head acceleration exceeded three standard deviations (SDs) of baseline noise, and was corrected for differing transducer delays. Mean LVOR latency was 30+/-16 ms (mean +/- SD), range 12-53 ms. Slow phase LVOR amplitude was greater for near and less for more distant targets, although all observed responses were suboptimal. Measured 100 ms after head translation onset, mean response was 20% of ideal for the target at 15 cm, 22% at 25 cm, 31% at 50 cm, and 53% at 200 cm. Mean latency was significantly longer than the previously reported values for both the human angular VOR and the monkey LVOR, and had significant inverse correlation with response magnitude. The relatively longer latency of the human LVOR than angular VOR may be tailored to match human head movement dynamics.