Hyperventilation-induced nystagmus and vertigo after stereotactic radiotherapy for vestibular schwannoma

Joseph P. Bradley, Timothy Hullar, J. Gail Neely, Joel A. Goebel

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE: To describe the phenomenon of hyperventilation-induced nystagmus (HVN) after stereotactic radiotherapy for vestibular schwannoma. PATIENTS: We present 2 patients with vestibular schwannoma and no pretreatment vestibular symptoms who both received stereotactic radiotherapy. Within 2 months of completing treatment, both patients developed intense vertigo while exerting themselves. Video-oculography demonstrated an intense nystagmus with the fast phase directed toward the side of the schwannoma in both patients. INTERVENTION: Diagnostic. RESULTS: Patients who have undergone surgical resection of their vestibular schwannoma, or have a large tumor, will often demonstrate HVN with the fast phase directed away from the side of the tumor. This is distinct from patients with smaller lesions who have a fast-phase nystagmus toward the tumor's side. This second type of nystagmus is thought to originate from changes in the extracellular calcium concentration secondary to hyperventilation-induced alkalosis. CONCLUSION: We hypothesize that stereotactic radiotherapy induced greater demyelination of the vestibular nerve leading to the observable sign of HVN. These patients represent the first reported cases of HVN after stereotactic radiation and illustrate the pathophysiology of HVN, which may lead to a greater understanding of the effects of stereotactic radiotherapy.

Original languageEnglish (US)
Pages (from-to)1336-1338
Number of pages3
JournalOtology and Neurotology
Volume32
Issue number8
DOIs
StatePublished - Oct 2011
Externally publishedYes

Fingerprint

Acoustic Neuroma
Hyperventilation
Vertigo
Radiotherapy
Vestibular Nerve
Alkalosis
Neoplasms
Neurilemmoma
Demyelinating Diseases
Radiation
Calcium

Keywords

  • Acoustic neuroma
  • Case report
  • Gamma knife
  • Hyperventilation-induced nystagmus
  • Nystagmus
  • Stereotactic radiation
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Sensory Systems
  • Medicine(all)

Cite this

Hyperventilation-induced nystagmus and vertigo after stereotactic radiotherapy for vestibular schwannoma. / Bradley, Joseph P.; Hullar, Timothy; Neely, J. Gail; Goebel, Joel A.

In: Otology and Neurotology, Vol. 32, No. 8, 10.2011, p. 1336-1338.

Research output: Contribution to journalArticle

Bradley, Joseph P. ; Hullar, Timothy ; Neely, J. Gail ; Goebel, Joel A. / Hyperventilation-induced nystagmus and vertigo after stereotactic radiotherapy for vestibular schwannoma. In: Otology and Neurotology. 2011 ; Vol. 32, No. 8. pp. 1336-1338.
@article{aa77f18280014b259f7ae08049aa5143,
title = "Hyperventilation-induced nystagmus and vertigo after stereotactic radiotherapy for vestibular schwannoma",
abstract = "OBJECTIVE: To describe the phenomenon of hyperventilation-induced nystagmus (HVN) after stereotactic radiotherapy for vestibular schwannoma. PATIENTS: We present 2 patients with vestibular schwannoma and no pretreatment vestibular symptoms who both received stereotactic radiotherapy. Within 2 months of completing treatment, both patients developed intense vertigo while exerting themselves. Video-oculography demonstrated an intense nystagmus with the fast phase directed toward the side of the schwannoma in both patients. INTERVENTION: Diagnostic. RESULTS: Patients who have undergone surgical resection of their vestibular schwannoma, or have a large tumor, will often demonstrate HVN with the fast phase directed away from the side of the tumor. This is distinct from patients with smaller lesions who have a fast-phase nystagmus toward the tumor's side. This second type of nystagmus is thought to originate from changes in the extracellular calcium concentration secondary to hyperventilation-induced alkalosis. CONCLUSION: We hypothesize that stereotactic radiotherapy induced greater demyelination of the vestibular nerve leading to the observable sign of HVN. These patients represent the first reported cases of HVN after stereotactic radiation and illustrate the pathophysiology of HVN, which may lead to a greater understanding of the effects of stereotactic radiotherapy.",
keywords = "Acoustic neuroma, Case report, Gamma knife, Hyperventilation-induced nystagmus, Nystagmus, Stereotactic radiation, Vestibular schwannoma",
author = "Bradley, {Joseph P.} and Timothy Hullar and Neely, {J. Gail} and Goebel, {Joel A.}",
year = "2011",
month = "10",
doi = "10.1097/MAO.0b013e31822e8666",
language = "English (US)",
volume = "32",
pages = "1336--1338",
journal = "Otology and Neurotology",
issn = "1531-7129",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Hyperventilation-induced nystagmus and vertigo after stereotactic radiotherapy for vestibular schwannoma

AU - Bradley, Joseph P.

AU - Hullar, Timothy

AU - Neely, J. Gail

AU - Goebel, Joel A.

PY - 2011/10

Y1 - 2011/10

N2 - OBJECTIVE: To describe the phenomenon of hyperventilation-induced nystagmus (HVN) after stereotactic radiotherapy for vestibular schwannoma. PATIENTS: We present 2 patients with vestibular schwannoma and no pretreatment vestibular symptoms who both received stereotactic radiotherapy. Within 2 months of completing treatment, both patients developed intense vertigo while exerting themselves. Video-oculography demonstrated an intense nystagmus with the fast phase directed toward the side of the schwannoma in both patients. INTERVENTION: Diagnostic. RESULTS: Patients who have undergone surgical resection of their vestibular schwannoma, or have a large tumor, will often demonstrate HVN with the fast phase directed away from the side of the tumor. This is distinct from patients with smaller lesions who have a fast-phase nystagmus toward the tumor's side. This second type of nystagmus is thought to originate from changes in the extracellular calcium concentration secondary to hyperventilation-induced alkalosis. CONCLUSION: We hypothesize that stereotactic radiotherapy induced greater demyelination of the vestibular nerve leading to the observable sign of HVN. These patients represent the first reported cases of HVN after stereotactic radiation and illustrate the pathophysiology of HVN, which may lead to a greater understanding of the effects of stereotactic radiotherapy.

AB - OBJECTIVE: To describe the phenomenon of hyperventilation-induced nystagmus (HVN) after stereotactic radiotherapy for vestibular schwannoma. PATIENTS: We present 2 patients with vestibular schwannoma and no pretreatment vestibular symptoms who both received stereotactic radiotherapy. Within 2 months of completing treatment, both patients developed intense vertigo while exerting themselves. Video-oculography demonstrated an intense nystagmus with the fast phase directed toward the side of the schwannoma in both patients. INTERVENTION: Diagnostic. RESULTS: Patients who have undergone surgical resection of their vestibular schwannoma, or have a large tumor, will often demonstrate HVN with the fast phase directed away from the side of the tumor. This is distinct from patients with smaller lesions who have a fast-phase nystagmus toward the tumor's side. This second type of nystagmus is thought to originate from changes in the extracellular calcium concentration secondary to hyperventilation-induced alkalosis. CONCLUSION: We hypothesize that stereotactic radiotherapy induced greater demyelination of the vestibular nerve leading to the observable sign of HVN. These patients represent the first reported cases of HVN after stereotactic radiation and illustrate the pathophysiology of HVN, which may lead to a greater understanding of the effects of stereotactic radiotherapy.

KW - Acoustic neuroma

KW - Case report

KW - Gamma knife

KW - Hyperventilation-induced nystagmus

KW - Nystagmus

KW - Stereotactic radiation

KW - Vestibular schwannoma

UR - http://www.scopus.com/inward/record.url?scp=80052967045&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052967045&partnerID=8YFLogxK

U2 - 10.1097/MAO.0b013e31822e8666

DO - 10.1097/MAO.0b013e31822e8666

M3 - Article

VL - 32

SP - 1336

EP - 1338

JO - Otology and Neurotology

JF - Otology and Neurotology

SN - 1531-7129

IS - 8

ER -