Abstract
Even though dizziness is a common symptom of heat illness, comprehensive evaluation of the vestibular function has not been available in this potentially life-threatening disorder. Three patients developed vertigo about a week after heat exposure. Evaluation showed bilateral impairments of the vestibulo-ocular reflex during head impulses and the signs of vestibulocerebellar dysfunction that included spontaneous downbeat nystagmus, gaze-evoked nystagmus, and positional downbeat nystagmus. Exposure to excessive heat may give rise to delayed vestibulopathy by damaging the vestibulocerebellum.
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Acknowledgments
This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).
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All experiments followed the tenets of the Declaration of Helsinki and this study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (B-B-1603-338-701).
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No conflicting relationship exists for the authors.
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Drs. Jung, Choi, and H Kim report no disclosure. Dr. Ji-Soo Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Korean Society of Clinical Neurophysiology, Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, and Medicine.
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I. Jung and S.-Y. Choi equally contributed to this study.
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Supplementary material 1 Video 1 Ocular motor findings and ataxia in patient 1. Video shows spontaneous downbeat nystagmus and direction-changing horizontal gaze-evoked nystagmus with a side-pocket-like appearance during lateral gazes. HITs show corrective catch-up saccades during stimulation of horizontal and posterior semicircular canals on both sides with a perverted downward component when stimulating the horizontal canals. Truncal and limb ataxia are also evident (WMV 69513 kb)
Supplementary material 2 Video 2 Horizontal and vertical head impulse tests in patient 2. Video shows horizontal gaze-evoked nystagmus and corrective catch-up saccades during head impulse stimulation of the horizontal and posterior semicircular canals on both sides. Downward corrective saccades are prominent during stimulation of the horizontal canals (WMV 45950 kb)
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Jung, I., Choi, SY., Kim, HJ. et al. Delayed vestibulopathy after heat exposure. J Neurol 264, 49–53 (2017). https://doi.org/10.1007/s00415-016-8322-x
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DOI: https://doi.org/10.1007/s00415-016-8322-x