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The aim of the present study was to evaluate the characteristics of brain injury and to assess the relationship between them and treatment outcomes in patients with traumatic benign paroxysmal positional vertigo (t-BPPV). Sixty-three consecutive patients who were diagnosed with BPPV within 2 weeks after head trauma were included. Cerebral concussion, intracranial hemorrhages (ICH), skull fracture without ICH, and hemorrhagic contusion were observed in 68%, 24%, 5%, and 3% of t-BPPV patients, respectively. BPPV with single canal involvement was observed in 52 (83%) patients and that with multiple canal involvement was observed in 11 (17%) patients. The number of treatment sessions was not significantly different according to the cause of head trauma (p = 0.252), type of brain injury (p = 0.308) or location of head trauma (p = 0.287). The number of recurrences was not significantly different according to the cause of head trauma (p = 0.308), type of brain injury (p = 0.536) or location of head trauma (p = 0.138). The present study demonstrated that there were no significant differences in treatment sessions until resolution and the mean number of recurrences according to the type of brain injury. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the therapeutic efficacy of the forced prolonged position (FPP) in patients with horizontal semicircular canal (HSCC) cupulolithiasis in whom the cupulolith repositioning maneuver (CuRM) failed. Methods: Fifty-four consecutive patients with HSCC cupulolithiasis were included, and immediate treatment efficacy of CuRM and short-term treatment efficacy of FPP were investigated. Results: We performed the CuRM in HSCC cupulolithiasis, and, if the CuRM did not show immediate success, instructed the patients to perform the FPP or the sham position (by random allocation) at home. The immediate therapeutic success of the CuRM was assessed by the absence of nystagmus and vertigo on positional testing after 30 minutes of the maneuver, which was 14.8% on the first visit day. And the resolution rate of HSCC cupulolithiasis was higher in the FPP group than in the sham position group at the second (78.3% vs 55.6%), third (75.0% vs 42.9%), and fourth visits (100% vs 25.0%). Conclusion: Although the CuRM has been considered to be a good therapeutic option for HSCC cupulolithiasis because it theoretically aims to detach otoconial particles attached both on the utricle and canal sides of the cupula, the immediate success rate was only 14.8% at the first visit. The FPP can be additionally recommended to improve the resolution rate in HSCC cupulolithiasis patients in whom the CuRM fails. [ABSTRACT FROM AUTHOR]

Macroautophagy/autophagy, a lysosome-dependent self-degradative process, is a critical mechanism for the clearance of misfolded proteins and dysfunctional organelles in neurons. In the peripheral nervous system, autophagic stress is associated with the development of peripheral neuropathy. However, the molecular mechanism of axonal neuropathy induced by autophagic stress due to dysfunction of autophagy in peripheral neurons in vivo is still unclear. We found that dorsal root ganglion (DRG) neuron-specific atg7 (autophagy related 7) knockout (atg7-cKO) mice employing two different Cre recombinase systems exhibited sensory neuropathy approximately 2 months after birth. In electron microscopy analysis, axon degeneration was clearly observed in the myelinated fibers of the sciatic nerve before the appearance of neuronal cell death. Dystrophic axons filled with abnormal vesicular accumulations and amorphous inclusions were specifically localized in the myelinated axons within the DRG in atg7-cKO mice, indicating the presence of autophagic stress in proximal axons. In line with the EM findings, the mutant mice showed preferential induction of axonal injury-associated genes, including ATF3 (activating transcription factor 3), in large-size DRG neurons that constitute myelinated fibers without axotomy. SARM1 (sterile alpha and HEAT/Armadillo motif containing 1), the central executioner of Wallerian degeneration, was activated in the sciatic nerves of atg7-cKO mice, and axonal degeneration and sensory neuropathy in atg7-cKO mice were prevented via expression of a dominant-negative Sarm1 transgene. Our findings demonstrate the importance of SARM1-dependent axon degeneration in the development of peripheral sensory neuropathy induced by impairment of autophagy. AAV: adeno-associated virus; ATF3: activating transcription factor 3; ATG7: autophagy related 7; AVIL: advillin; cADPR: cyclic ADP ribose; CALC: calcitonin/calcitonin-related polypeptide; CMT: Charcot-Marie-Tooth disease; cKO: conditional knockout; DEG: differentially expressed gene; DRG: dorsal root ganglion; FE-SEM: field emission scanning electron microscopy; IF: immunofluorescence; NCV: nerve conduction velocity; PVALB: parvalbumin; RAG: regeneration-associated gene; ROS: reactive oxygen species; SARM1: sterile alpha and HEAT/Armadillo motif containing 1; SYN1: synapsin I [ABSTRACT FROM AUTHOR]

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Axon regeneration is essential for successful recovery after peripheral nerve injury. Although growth cone reformation and axonal extension are crucial steps in axonal regeneration, the regulatory mechanisms underlying these dynamic processes are poorly understood. Here, we identify βPix (Arhgef7), the guanine nucleotide exchange factor for Rac1 GTPase, as a regulator of axonal regeneration. After sciatic nerve injury in mice, the expression levels of βPix increase significantly in nerve segments containing regenerating axons. In regrowing axons, βPix is localized in the peripheral domain of the growth cone. Using βPix neuronal isoform knockout (NIKO) mice in which the neuronal isoforms of βPix are specifically removed, we demonstrate that βPix promotes neurite outgrowth in cultured dorsal root ganglion neurons and in vivo axon regeneration after sciatic nerve crush injury. Activation of cJun and STAT3 in the cell bodies is not affected in βPix NIKO mice, supporting the local action of βPix in regenerating axons. Finally, inhibiting Src, a kinase previously identified as an activator of the βPix neuronal isoform, causes axon outgrowth defects in vitro, like those found in the βPix NIKO neurons. Altogether, these data indicate that βPix plays an important role in axonal regrowth during peripheral nerve regeneration. [ABSTRACT FROM AUTHOR]

Objective: To investigate the characteristics of positional nystagmus in posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (BPPV) patients with longer durations, and to discuss the possible underlying mechanism of this nystagmus. Methods: We conducted a retrospective review, and enrolled 118 consecutive patients with unilateral PSCC BPPV. The duration of nystagmus during a Dix‐Hallpike test was classified into short (<1 min) and long (≥1 min) durations. For the identification of a neutral point in PSCC BPPV patients with long durations, the patient's head was turned 45° to the lesioned side to set the affected PSCC on the sagittal plane, and the disappearance of positional nystagmus was investigated in a pitch plane. Results: Among 118 patients with PSCC BPPV, positional nystagmus during a Dix‐Hallpike test showed short durations (<1 min) in 112 patients and long durations (≥1 min) in 6 patients. Of 6 PSCC BPPV patients with a long duration, a neutral point was identified in 5 patients whose nystagmus lasted for longer than 2 min; interestingly, a neutral point was observed when the patient's head was slightly tilted backward in all 5 patients. Conclusion: Considering that a neutral position was identified when the patient's head was slightly tilted backward while keeping the head turned 45° to the right or left, we assume that the light cupula condition of the ipsilateral PSCC or the contralateral anterior semicircular canal, and not PSCC BPPV cupulolithiasis, could be responsible for the occurrence of persistent torsional‐upbeating nystagmus in a Dix‐Hallpike test. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the incidence of spontaneous nystagmus (SN) in posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (BPPV) and its effect on treatment outcomes. Study Design: Retrospective case series. Setting: Tertiary referral center. Methods: This study included 50 patients with idiopathic unilateral PSCC BPPV between July 2021 and May 2022. The presence of SN was investigated, and the results of the bithermal caloric test and video head impulse test (vHIT) were compared. Results: SN was observed in 13 (26%) of the 50 patients presenting PSCC BPPV. The direction of SN was mainly unidirectional and horizontal in 12 of the 13 patients with a slow‐phase velocity ranging from 2 to 4°/s. One patient presented an upbeating torsional SN at the initial evaluation. The mean vHIT gain of the PSCC on the affected side was significantly lower in patients with SN than those without SN (p =.004, Mann‐Whitney U test). The proportion of patients who recovered within 2 sessions of the repositioning maneuver was significantly higher in those without SN than that in those with SN (p <.001, Fisher's exact test). Conclusion: This study demonstrated that the treatment outcomes of PSCC BPPV were significantly worse in patients with SN than those without SN. Examining the presence of SN in patients with PSCC BPPV may be helpful in counseling the patients on prognosis, and it is expected that more sessions of canalith repositioning maneuver may be required to treat PSCC BPPV in patients with SN than those without SN. [ABSTRACT FROM AUTHOR]