7-Tesla MRI demonstrates absence of structural lesions in patients with vestibular paroxysmia

Rommer, Paulus S.; Wiest, Gerald; Kronnerwetter, Claudia; Zach, Heidemarie; Loader, Benjamin; Elwischger, K.; Trattnig, Siegfried

doi:10.3389/fnana.2015.00081

Cited by 16 publications

(17 citation statements)

References 22 publications

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“…A 7-Tesla MRI in six patients with VP did not exhibit any structural abnormalities. This finding supports the view that high-field MRI does not help differentiate between symptomatic and asymptomatic neurovascular cross-compression in VP [ 18 ].…”

Section: Imaging Neurovascular Cross-compression Of the Eighth Nervesupporting

confidence: 87%

Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome

2016

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The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute and occur in a series of up to 30 or more per day. VP may manifest when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. The symptoms are usually triggered by direct pulsatile compression with ephaptic discharges, less often by conduction blocks. MR imaging reveals the neurovascular compression of the eighth nerve (3D constructive interference in steady state and 3D time-of-flight sequences) in more than 95 % of cases. A loop of the anterior inferior cerebellar artery seems to be most often involved, less so the posterior inferior cerebellar artery, the vertebral artery, or a vein. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages (200–600 mg/d or 300–900 mg/d, respectively), which have been shown to also be effective in children. Alternative drugs to try are lamotrigine, phenytoin, gabapentin, topiramate or baclofen or other non-antiepileptic drugs used in trigeminal neuralgia. The results of ongoing randomized placebo-controlled treatment studies, however, are not yet available. Surgical microvascular decompression of the eighth nerve is the “ultima ratio” for medically intractable cases or in exceptional cases of non-vascular compression of the eighth nerve by a tumor or cyst. The International Barany Society for Neuro-Otology is currently working on a consensus document on the clinical criteria for establishing a diagnosis of VP as a clinical entity.

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Section: Imaging Neurovascular Cross-compression Of the Eighth Nervesupporting

confidence: 87%

Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome

2016

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“…30% gesunder Probanden ebenfalls nachweisbar [60], in Fallserien häufiger auch beidseits [61]. Eine kleine Untersuchung mittels hochauflösendem 7 T MRT konnte bei keinem von 6 Patienten mit Vestibularisparoxysmie strukturelle Veränderungen am Gleichgewichtsnerven detektieren, sodass auch diese Methode zur Differenzierung symptomatischer und asymptomatischer Gefäß-Nerven-Kontakte nicht hilfreich zu sein scheint [63]. Diese Ergebnisse stützen die Hypothese, dass die Symptome der Vestibularisparoxysmie durch exzitatorische [60] und nicht makroskopisch sichtbare hypofunktionelle Phänomene verursacht werden [63].…”

Section: Visuelle Höhenintoleranz/akrophobieunclassified

“…Eine kleine Untersuchung mittels hochauflösendem 7 T MRT konnte bei keinem von 6 Patienten mit Vestibularisparoxysmie strukturelle Veränderungen am Gleichgewichtsnerven detektieren, sodass auch diese Methode zur Differenzierung symptomatischer und asymptomatischer Gefäß-Nerven-Kontakte nicht hilfreich zu sein scheint [63]. Diese Ergebnisse stützen die Hypothese, dass die Symptome der Vestibularisparoxysmie durch exzitatorische [60] und nicht makroskopisch sichtbare hypofunktionelle Phänomene verursacht werden [63]. Eine cMRT sollte aber trotzdem, v. a. in klinisch atypischen Fällen, durchgeführt werden, um andere Erkrankungen mit therapeutischer Konsequenz auszuschließen.…”

Section: Visuelle Höhenintoleranz/akrophobieunclassified

Seltenere, aber klinisch relevante episodische Schwindelsyndrome

Becker‐Bense

Huppert

2021

Fortschr Neurol Psychiatr

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ZusammenfassungDie Differentialdiagnostik der selteneren, episodischen Schwindelsyndrome kann im klinischen Alltag eine Herausforderung darstellen, insbesondere wenn sie keine im Intervall messbaren Befunde in der neuro-ophthalmologischen oder -otologischen Routinediagnostik hinterlassen. Ursächlich für diese episodischen Schwindelsyndrome können physiologische Reaktionen aufgrund intersensorischer Inkongruenzen oder angeborene bzw. erworbene neuroanatomische/neurophysiologische Varianten sein, die zu vestibulären Reizsyndromen führen. In dieser Übersicht fokussieren wir auf die folgenden, aus unserer Sicht wichtigen vestibulären Syndrome: Bewegungskrankheit, Mal de Debarquement Syndrom, Visuelle Höhenintoleranz, Vestibularisparoxysmie, Zervikaler Schwindel, Episodische Ataxie Typ II und Syndrome eines dritten mobilen Fensters wie das Syndrom der Dehiszenz des superioren Kanals. Die Ausprägung reicht von milden Symptomen mit geringer Belastung bis hin zu schweren Krankheitsbildern mit relevanter Alltagseinschränkung. Sie können vom Kindes- oder Jugendalter bis ins Senium auftreten, teilweise mit abweichender Symptomatik. Durch gezielte Anamnese und ggf. erweiterte vestibuläre Diagnostik in einem spezialisierten Zentrum lassen sich diese Syndrome oft klar herausarbeiten und einer erfolgreichen Therapie zuführen.

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“…The vessels are mainly arteries, most often the anterior inferior cerebellar artery (AICA) [ 1 , 8 ]. No structural lesions of the vestibular nerve were identified in 7 T MRI despite the presence of NVCC [ 11 ]. Audiovestibular testing has shown heterogeneous results ranging from normal results to unilateral deficits and coinstantaneous signs of reduced and increased function within the same nerve [ 1 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

A randomized double-blind, placebo-controlled, cross-over trial (Vestparoxy) of the treatment of vestibular paroxysmia with oxcarbazepine

et al. 2017

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ObjectiveVestibular paroxysmia (VP) is characterized by short, often oligosymptomatic attacks of vertigo which occur spontaneously or are sometimes provoked by turning the head. Despite the description of the disease almost 40 years ago (first termed “disabling positional vertigo”), no controlled treatment trial has been published to date. The Vestparoxy trial was designed as a randomized, placebo-controlled, double-blind cross-over trial to examine the therapeutic effect of oxcarbazepine (OXA) in patients with definite or probable VP.MethodsPatients were recruited from August 2005 to December 2011 in the outpatient Dizziness Unit of the Department of Neurology of the Munich University Hospital, and randomized to receive OXA (first week: 300 mg once per day, second week: 300 mg b.i.d., third week: 300 mg t.i.d. until the end of the third month), followed by placebo or vice versa with a 1-month wash-out period in between. The primary endpoint was the number of days with one or more attacks. Secondary endpoints were the number of attacks during the observed days, and the median (for each day) duration of attacks. All these endpoints were assessed using standardized diaries collected at the end of each treatment phase.ResultsForty-three patients were randomized, 18 patients provided usable data (2525 patient days) for at least one treatment phase and were included in the main (intention-to-treat) analysis. The most common reasons for discontinuation documented were adverse events. The risk of experiencing a day with at least one attack was 0.41 under OXA, and 0.62 under placebo treatment, yielding a relative risk of 0.67 (95% CI 0.47–0.95, p = 0.025). The number of attacks during the observed days ratio was 0.53 (95% CI 0.42–0.68, p < 0.001) under OXA compared to placebo. Median attack duration was 4 s (Q25: 2 s, Q75: 120 s) under OXA, and 3 s (Q25: 2 s, Q75: 60 s) under placebo treatment. When days with no attacks, i.e., duration = 0, were included in the analysis, these figures changed to 0 (Q25: 0, Q75: 3 s), and 2 (Q25: 0, Q75: 6 s). No serious adverse events or new safety findings were identified during the trial.ConclusionsThe Vestparoxy trial showed a significant reduction of VP attacks under OXA compared to placebo treatment, confirming the known and revealing no new side effects.

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7-Tesla MRI demonstrates absence of structural lesions in patients with vestibular paroxysmia

Cited by 16 publications

References 22 publications

Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome

Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome

Seltenere, aber klinisch relevante episodische Schwindelsyndrome

A randomized double-blind, placebo-controlled, cross-over trial (Vestparoxy) of the treatment of vestibular paroxysmia with oxcarbazepine

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