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It is generally known that cerebral infarction commonly occurs in elderly people. Rarely, cerebral infarction may occur in young adults due to complications such as collagen disease, heart disease, and dissecting aneurysm. We recently encountered a 32-year-old man who had occasionally complained of occipital pain after drinking alcohol since April 1999. As he also experienced sudden onset of vertigo with occipital pain, he went to the Department of Otolaryngology, Takarazuka City Hospital on April 14, 1999. Left-ward horizontal-rotatory spontaneous nystagmus was presented as shown in vestibular dysfunction. There were not any cerebellar signs, but left trigeminal hypesthesia suggested a central nervous system disorder. Moreoever, we found disturbances of touch, temperature, and pain sensations on the right upper and lower extremities.MRI showed an infarction in the left lateral medulla oblongata. Vertebral angiography showed an aneurysm in the distal and proximal segments of the left posterior inferior cerebellar artery. These findings indicated that medullary infarction was caused by dissecting aneurysm of the vertebral artery.In the present case, it was suggested that the intima of the vertebral artery rapidly deteriorated due to the dehydration resulting from excessive alcohol intake, and that neurological examination should be performed even in juvenile vertiginous cases.

The oral glycerol test is useful to diagnose endolymphatic hydrops. The test is known to indicate positive results in almost 50% of the patients with Meniere's disease. However, it prohibits food intake before the test, requires a long examination time, and is associated with side effects such as headache, nausea and vomiting. The intravenous glycerol test is known to have no such disadvantages. We examined here, the usefulness of the intravenous test.The intravenous glycerol test was performed in 30 ears of 30 cases of Meniere's disease. Audiometry was carried out before the administration. A total amount of 100 ml Glyceol (10% glycerol) was intravenously injected over 30 min. Audiometry was also performed immediately after, and then 1 hour and 3 hours after the injection. Before the examination, food intake was not prohibited. A positive result was defined as a threshold improvement of the audiogram of 10 dB or more in at least 2 frequencies.Positive results were observed in 11 of 30 ears (36.7%) immediately after the injection, in 15 of 30 ears (50.0%) 1 hour later, and in 10 of 20 ears (50%) 3 hours later. The positive ratio 1 hour later was almost the same as that of the oral glycerol test, which was previously described. Thus, the injection test can evaluate the disease 1 hour after the administration without prohibition of food intake before the test. No side effects such as headache, nausea or vomiting were observed in any case.The intravenous glycerol test has the following advantages compared to the oral test: it does not prohibit food intake before the test, the examination time is shortened, and it is not associated with side effects.

Magnetic resonance angiography (MRA) can image the blood vessels without invasion. Using MRA, we studied the vascular morphology of the vertebral artery in patients with positional nystagmus and vertigo. Fifteen patients without vestibular disorder such as benign positional vertigo were examined. Six cases underwent conventional vertebral angiograpy, including digital subtraction angiography (DSA) for comparison with MRA.In all cases, we observed the vertebral artery from the bifurcation to the basilar artery with MRA. In 12 cases, abnormal findings of elongation, bending, narrowing or obstruction of the vertebral artery were found. In five cases, arterial compression and elongation increased in association with head rotation. A difference in the vessel diameter on each side was observed in 4 cases. Accordingly, some abnormal vessels were found in 14 of 15 cases in our study. This rate was very close to previous resolts obtained with conventional angiography.In two cases, MRA findings differed from conventional angiography due to peculiar artifacts of MRA. Therefore, MRA may be the first choice for the patients with vertigo, followed by conventional angiography, if necessary.

A study of tympanoplasties using allograft tympanic membrane with or without ossicles for 33 patients with conductive deafness during the period of 1980. 10 through 1984. 8 is presented with respect to primary take rate, type of allograft used and postoperative hearing changes. Out of 33 cases, 5 fell into necrosis and 6 perforation, allograft take rate being 84% (completely 67%). But those 5 cases of necrosis are included among initial 17 cases and no more necrosis occurred among another 16 cases, in which combination use of temporal fascia or pedicled epi-thelial flap were used. For 29 cases tympanoplasty using allograft ear drum attached with or without ossicles have been done and for another 4 cases only transplantation of ear drum attached with malleus have been done as first step of staged operation. Type of allograft trans-plantations grouped into 3 according to the number of ossicles attached to the tympanic membrane;Group A: Tympanic membrane only. Group B: Tympanic membrane attached with malleus. Group C: Tympanic membrane attached with malleus and incus. In group A (4 cases), small ossicles or PORP were placed between allograft drum and recipients stapes.In group B of 17 cases, various management for ossicular continuity were made. i. e. con-nection between allograft malleus and (i) stapes footplate of a recipients with tragal cartilage (2 cases). (ii) head of the stapes with notched incus (9 cases). In one case allograft drum necrotized and two cases provided successful results in rest of 6. (iii) recipient's retracted malleus in 3 cases, two of which resulted in necrosis. (iv) recipient's deformed incus or stapes (2 cases). Both cases were congenital aural atresi and provided good hearing gain of 27dB and 42dB respectively.In group C (8 cases), 2 cases necrotized and one perforated. Final results provided 6 successful hearing results.