Central Vestibular Dysfunction in an Otorhinolaryngological Vestibular Unit: Incidence and Diagnostic Strategy

Abstract

Introduction Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit. Methods This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required. Results There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years). Provisional videonystagmography (VNG) results were: 40% benign paroxysmal positional vertigo (BPPV), 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41) had magnetic resonance imaging (MRI) and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23%) were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus). Conclusions Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions.

Multiple sclerosis and primary vascular dysregulation (Flammer syndrome)

“…Our MS patients suffer more often from dizziness than controls. Indeed, dizziness in MS has already been reported in the literature [ 22 ]. In addition, about 60 % of the MS patients have been reported to suffer from disequilibrium [ 23 ].…”

Vestibular migraine in low- and lower-middle-income countries: A scoping review

“…Most of the articles originated from India (n = 17, 65.4%) ( Anshul et al., 2020 ; Ashish et al., 2017 ; Bansal, 2016 ; Das et al., 2017 ; Dash et al., 2008 ; Haripriya et al., 2021 ; Lepcha et al., 2014 ; Mamindla et al., 2020 ; Prakash et al., 2008 , 2021 ; Prakash and Shah, 2009 ; Sen et al., 2016 ; Sunitha et al., 2019 ; Swain et al., 2018 , 2020 ; Syed et al., 2020 ; Udagatti and Dinesh Kumar, 2017 ), followed by Egypt (n = 3, 11.5%) ( El-Badry et al., 2017 ; ElSherif et al., 2020 ; Mostafa et al., 2014 ), Nigeria (n = 3, 11.5%) ( Adegbiji et al., 2014 ; Ogah, 2017 ; Olusesi and Abubakar, 2016 ), Iran (n = 1, 3.8%) ( Taghdiri et al., 2014 ), Tunisia (n = 1, 3.8%) ( Mouelhi et al., 2020 ), and Vietnam (n = 1, 3.8%) ( Ky et al., 2021 ) as represented by the heat map ( Fig. 2 ).…”

“…Five studies used the term “migraine” and described vertigo and/or dizziness in its clinical presentation (n = 5, 19.2%) ( Anshul et al., 2020 ; Ky et al., 2021 ; Mouelhi et al., 2020 ; Ogah, 2017 ; Prakash et al., 2021 ). “Migraine vestibulopathy” was utilized in one study (n = 1, 3.7%) ( Mostafa et al., 2014 ). Two studies simultaneously used more than one of the aforementioned terms (n = 2, 7.4%) ( Bansal, 2016 ; Sen et al., 2016 ).…”

“…Prevalence of VM was reported in 13 studies (50%), ranging from 0.3% to 33.3% ( Adegbiji et al., 2014 ; Bansal, 2016 ; Das et al., 2017 ; Haripriya et al., 2021 ; Mamindla et al., 2020 ; Mostafa et al., 2014 ; Ogah, 2017 ; Olusesi and Abubakar, 2016 ; Sen et al., 2016 ; Sunitha et al., 2019 ; Swain et al., 2018 , 2020 ; Syed et al., 2020 ). Five of the studies were conducted specifically in vertigo or dizziness clinics ( Bansal, 2016 ; Mostafa et al., 2014 ; Sen et al., 2016 ; Swain et al., 2018 ; Udagatti and Dinesh Kumar, 2017 ), whereas five others were conducted at otolaryngology clinics ( Adegbiji et al., 2014 ; Das et al., 2017 ; Haripriya et al., 2021 ; Sunitha et al., 2019 ; Syed et al., 2020 ), another at a headache clinic ( Taghdiri et al., 2014 ), and one which did not specify ( Mamindla et al., 2020 ).…”

“…VM was present among 26.4% of elderly adults (above the age of 60) at a vertigo clinic ( Swain et al., 2018 ). Among adults only, the prevalence of VM was more variable and ranged from 0.3% to 15.4% ( Bansal, 2016 ; Mostafa et al., 2014 ; Olusesi and Abubakar, 2016 ; Sen et al., 2016 ; Sunitha et al., 2019 ). In studies of both adults and children, the prevalence ranged from 2% to 6.7% ( Adegbiji et al., 2014 ; Das et al., 2017 ; Ogah, 2017 ).…”