3.電気眼振図(ENG)の検査法と診断的意義について
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1 Equilibrium Res Vol. (6) ENG Diagnostic significance and test methods of electronystagmography (ENG) Akinori Itoh Department of Neuro-Otology, Faculty of Medicine, Saitama Medical University Electronystagmography (ENG) is an equilibrium function test that records eye movements. Its objectives are to detect asymmetry in peripheral vestibular function and to detect central nervous system disorders. The merits of ENG are as follows: 1) various types of eye movements, including nystagmus, can be recorded; 2) nystagmus can be quantitatively analyzed; and 3) eye movement with the eyes closed and with the eyes open in darkness can be recorded. A weakness of ENG is that while it can record eye movement in the horizontal and vertical directions, it is not capable of recording rotatory eye movements. In clinical practice, ENG is used to detect the following: 1) spontaneous ocular motility in bright light and in the absence of fixation (with the eyes closed and with the eyes open in darkness); 2) gaze nystagmus; 3) positional nystagmus; 4) positioning nystagmus; 5) smooth pursuit; 6) optokinetic nystagmus; 7) saccade; 8) rotatory nystagmus; 9) caloric nystagmus; and 10) visual suppression. ENG can be performed with either binocular or monocular leads, and the latter is used particularly for recording of dysconjugate ocular motility, which occurs with supranuclear ocular motility disorders such as MLF syndrome. Although ENG is being used for diagnosis of dizziness and disequilibrium, we must not place too trust on the results of ENG tests. ENG is only a test of eye movement, and the causal relationship between ENG results and lesions must be determined by the users themselves. Recently, the use of videooculography (VOG) using an infrared CCD camera that also enables recording of rotatory eye movements has gradually spread, while the use ofengisindecline. Key words: electronystagmography (ENG) nystagmus, ocular motility Electronystagmograph Electronystagmography ENG Electrooculography EOG Henriksson ENG ( 401 )
2 Equilibrium Res Vol. (6) ENG ENG ENG ENG corneo-retinal potential ENG 100 μv 1 ch 2ch 3ch 4ch AC DC AC DC ENG ENG spontaneous nystagmus jerky nystagmuspendular nystagmus velocity storage mechanism VSM VSM VSM VSM positive feedback VSM VSM tonic-unbalance VSM positive feedback VSM ( 402 )
3 Equilibrium Res Vol. (6) positive feedback VSM 3type congenital nystagmus acquired pendular nystagmus C /sec/c 10 mm /sec/d 20 /sec ENG ENG 20 C /sec /c 10 /sec e/d 20 ( 403 )
4 Equilibrium Res Vol. (6) downbeat nystagmus ENG downbeat nystagmus upbeat nystagmus ENG upbeat nystagmus downbeat nystagmus Arnold-Chiari malformation spinocerebellar degeneration SCD downbeat nystagmus upbeat nystagmus upbeat nystagmus Wernicke ( 404 )
5 Equilibrium Res Vol. (6) ENG ENG 6 7Hz 3 4Hz downbeat nystagmus VSM positive feedback upbeat nystagmus ( 405 )
6 Equilibrium Res Vol. (6) ENG rebound nystagmus ENG rebound nystagmus ENG ETT OKN OKN OKN OKN null region gaze nystagmus VSM ( 406 )
7 Equilibrium Res Vol. (6) MLF ENG DC a b MLF acquired pendular nystagmus ENG VSM VSM 6 7 Hz3 4Hz Bruns VSM rebound nystagmus ( 407 )
8 Equilibrium Res Vol. (6) square wave jerks ENG 5 8 intersaccadic interval macro-square wave jerks rebound nystagmus RN RN RN VSM positive feedback RN ENG RN RN RN RN medial longitudinal fasciculus MLF internuclear ophthalmoplegia INO INO ENG DC ENG DC INO ENG MLF acquired pendular nystagmus APN myoclonus palato-ocular myoclonus Guillain- Mollaret s triangle ENG APN APN square wave jerks intersaccadic interval square wave jerks SWJ macro-square wave jerks ( 408 )
9 Equilibrium Res Vol. (6) opsoclonus flutter like oscillation ENG opsoclonus ENG flutter like oscillation SWJ oscillation SWJ opsoclonus ocular flutter intersaccadic interval opsoclonus ocular flutter OF ENG opsoclonus opsoclonus ENG OF opsoclonus OF opsoclonus OF opsoclonus OF ( 409 )
10 Equilibrium Res Vol. (6) opsoclonus ocular flutter ocular dysmetria ENG ENG ENG hum ENG ENG ENG ENG ENG videooculography ENG ENG Henriksson NG: An electrical method for registration and analysis of the movements of the eyes in nystagmus. Acta Otolaryngol 45: 25 41, 1955 ENG Electronystagmograph ENG ENG Robinson DA: Eye movement control in primate. Science 161: , 1968 Cannon SC, Robinson DA: Loss of the neural integrator of the oculomotor system from brain stem lesions in monkey. J Neurophysiol 57: , 1987 Zee DS, Leigh RJ, Mathieu-Millaire F: Cerebellar control of ocular gaze stability. Ann Neurol 7: 37 40, 1980 Leigh RJ, Zee DS: Abnormalities of the Neural Integrator:Gaze-evoked nystagmus. The neurology of the eye movements. fourth edition. pp , Oxford University Press, New York, 2006 Leigh RJ, Zee DS: The nature and visual consequences of abnormal eye movemnts that prevent steady fixation. pp 476, Oxford University Press, New York, 2006 Aschoff JC, Conrad B, Kornhuber HH: Acquired pendular nystagmus with oscillopsia in multiple sclerosis: a sign of cerebellar nuclei disease. J Neurosurg Psychiatr 37: , 1974 Zee DS, Yee RD, Robinson DA, et al.: Oculomotor abnormalities in hereditary cerebellar ataxia. Brain 99: , 1976 Baloh RW, Spooner JW: Downbeat nystagmus.: A type of central vestibular nystagmus. Neurology 31: , 1981 Benjamin EE, Zimmermann CF, Troost BT: Lateropulsion and upbeat nystagmus on manifestation of central vestibular dysfunc- ( 410 )
11 Equilibrium Res Vol. (6) tion. Arch Neurol 43: , 1986 Ranalli PJ, Sharpe JA: Upbeat nystagmus and the ventral tegmental pathway of the upward vestibulo-ocular reflex. Neurology 38: , 1988 Keane JR, Itabashi HH: Upbeat nystagmus: clinicopathological study of two patients. Neurology 37: , 1987 Leigh RJ, Zee DS: Infantile nystagmus syndrome or congenital nystagmus. The Neurology of eye movemnts fourth edition. pp , Oxford University Press, New York, 2006 Halmagyi GM, Gresty MA, Leech J : Reversed optokinetic nystagmus (OKN): mechanism and clinical significance. Ann Neurol 7: , 1980 Dell Osso LF: Evaluation of smooth pursuit in the presence of congenital nystagmus. Neuro -ophthalmol 6: , 1986 Opticam LM, Zee DS: A hypothetical explanation of congenital nystagmus. Biol Cybern 50: , 1984 Hood JD, Kayan A, Leech J: Rebound nystagmus. Brain 96: , 1973 Selhorst JB, Stark L, Ochs AL: Disorders in cerebellar ocular motor control. Macrosaccadic oscillation : An Oculographic control system and clinicoanatomical analyssis. Brain 99: , 1976 Optican LM, Robinson DA: Cerebellar dependent adaptive control of primate saccadic system. J Neurophysiol 44: , 1980 Zee DS, Robinson DA: A hypothetical explanation of saccadic oscillations. Ann Neurol 5: , 1978 ( 411 )
1) Bender MB, Gorman WF : Vertical nystag mus on direct forward gaze with vertical oscillopsia. Am J Ophthalmol 32 : 967-972, 1949 2) Hozawa J, Fujiwara F, Saito H, et al : The value of "trapezoid rotation
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