The damped pendular rotation test in central vestibular disorders.

Nystagmic rhythm in the damped pendular rotation test (DPRT) was analysed electronystagmographically both in healthy subjects (control) and patients with peripheral and central vestibular lesions. The patients were tested in a semi-dark room with eyes open and, in addition, a serial subtraction task was performed to maintain the state of alertness throughout the rotation. In the controls 49 years of age and under dysrhythmia was found in 11%, while in persons 50 years of age and over the abnormal rate was 29%. In patients with acoustic tumors, who had undergone surgery in which the translabyrinthine and middle fossa approach had been utilized, dysrhthmia was present post-operatively in only a few cases. In patients 49 years of age and under, operated on through the suboccipital approach, dysrhythmia was found post-operatively, or was at least more remarkable than pre-operatively in most cases. Nystagmic rhythm was, on the other hand, regular with cerebellar degenerative process or atrophy. Pre-operative dysrhythmia in patients with cerebellar and cerebral tumors was in some cases post-operatively converted to regular rhythmic nystagmus in pendular stimulations. Therefore, in cerebellar and cerebral tumors, dysrhythmia was thought to be due to secondary effects in brainstem, as these tumors can cause intracranial hypertension and circulatory disturbances in surrounding brain tissues. In Menière's disease and sudden deafness, dysrhythmia and salvos in DPRT were found in the age groups, 49 years of age and under and 50 years and over, as frequently as in the healthy and control group. In one case with Menière's disease which showed dysrhythmia, labyrinthectomy was done. This surgical manipulation of the labyrinth did not eliminate dysrhythmia, though a temporary improvement was obtained. This result indicates that the dysrhythmia may be of central origin. These findings also suggest that nystagmic rhythm in DPRT with mental arithmetic is significant in assessing brainstem dysfunctions, when the age and state of alertness of the patient are taken into consideration, or when comparing the pre- and post-operative findings in intracranial lesions.