The spectrum of acute vestibular neuropathy through modern vestibular testing: A descriptive analysis

Yacovino, Darío Andrés; Zanotti, Estefanía; Cherchi, Marcello

doi:10.1016/j.cnp.2021.02.008

Cited by 14 publications

(10 citation statements)

References 60 publications

(72 reference statements)

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“…While the former is composed of the lateral and anterior ampullary nerves and the utricular nerve, the inferior vestibular nerve is composed of the singular nerve (or posterior ampullary nerve) and the saccular nerve ( 21 ) ( Figure 4A ). IVN is considered a rare entity, with a possible prevalence of 1.3–18% among overall VN cases, depending on different inclusion criteria and available instrumental battery ( 3 , 7 , 8 , 22 – 25 ). Diagnosis is often challenging due to spontaneous vertical nystagmus and lack of corrective saccades on horizontal HIT, which is supposed to guide toward an acute CNS disorder ( 5 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Posterior semicircular canal ossification following acute vestibular loss mimicking inferior vestibular neuritis: A case report

Comacchio

Castellucci

2022

Front. Neurol.

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Vestibular neuritis (VN) mostly involves the superior vestibular nerve. Isolated inferior vestibular neuritis (IVN) has been more rarely described. The diagnosis of IVN is based on an abnormal head impulse test (HIT) for the posterior semicircular canal (PSC), pathological cervical vestibular-evoked myogenic potentials (C-VEMPs), and spontaneous downbeat nystagmus consistent with acute functional loss of inner ear sensors lying within the inferior part of the labyrinth. HIT for both lateral and superior semicircular canals is normal, as are ocular VEMPs and bithermal caloric irrigations. The etiology of IVN is debated since peripheral acute vestibular loss with a similar lesion pattern can often be associated with ipsilesional sudden hearing loss (HL). Viral inflammation of vestibular nerves is considered the most likely cause, although reports suggest that VN usually spares the inferior division. On the other hand, an ischemic lesion involving the terminal branches of the common cochlear artery has been hypothesized in cases with concurrent HL. Debated is also the lesion site in the case of IVN without HL since different instrumental patterns have been documented. Either isolated posterior ampullary nerve involvement presenting with selective PSC functional loss on video-HIT, or only saccular lesion with isolated ipsilesional C-VEMPs impairment, or inferior vestibular nerve damage (including both saccular and posterior ampullary afferents) exhibiting an impairment of both C-VEMPs and PSC-HIT. We report an interesting case of a patient with an acute vestibular loss consistent with IVN without HL who developed a PSC ossification on follow-up, questioning the viral origin of the lesion and rather orienting toward an occlusion of the posterior vestibular artery. To the best of our knowledge, this is the first report of PSC ossification after a clinical picture consistent with IVN.

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Section: Discussionmentioning

confidence: 99%

Posterior semicircular canal ossification following acute vestibular loss mimicking inferior vestibular neuritis: A case report

Comacchio

Castellucci

2022

Front. Neurol.

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“…In addition, not only low gain but also presence of corrective saccades should count in the definition of a vHIT abnormality (20,29,30). A differential involvement of the cVEMP and oVEMP tests has also been reported in VN and MD (31)(32)(33)(34)(35)(36). In patients with VN, we found a higher abnormal rate (50%) in the oVEMP test compared to that (30%) in the cVEMP test, suggesting a higher incidence of utricular dysfunction than saccular dysfunction in VN (37), although this was not significant in this study.…”

Section: Discussionmentioning

confidence: 99%

Differential Involvement of Lateral Semicircular Canal and Otolith Organs in Common Vestibular Disorders

et al. 2022

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Semicircular canal and otolith functions came to be evaluated recently, but comprehensive and comparative analysis of canal and otolith dysfunction in common vestibular disorders is lacking. We aimed to analyze the abnormal rates of canal and otolith function in common vestibular disorders. We enrolled 302 patients who were managed for 2 months in a dizziness clinic. Results of caloric, video head impulse test (vHIT), and cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP) tests were analyzed and compared among various diagnoses. Vestibular disorders diagnosed included recurrent vestibulopathy (RV, 27%), vestibular migraine (VM, 21%), benign paroxysmal positional vertigo (BPPV, 17%), Meniere's disease (MD, 11%), vestibular neuritis (VN, 10%), orthostatic dizziness (7%), and central lesions (3%). Lateral canal dysfunction was found most in VN (100%) and less commonly in definite MD (75%), RV (46%) and definite VM (29%). Abnormal caloric results were more common than abnormal vHIT in all disorders. Otolith dysfunction was found more frequently than lateral canal dysfunction in most vestibular disorders except VN. An abnormal cVEMP was more frequent in definite MD than the other disorders. Isolated otolith dysfunction without lateral canal dysfunction was the most found in BPPV, followed by definite VM, RV, and definite MD in decreasing order. Various patterns of involvement in canal and otoliths were revealed in vestibular disorders, suggesting different pathogenesis.

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“…The most valid etiopathogenesis theory is the reactivation of a latent herpes simplex 1(HSV-1) inhabiting the vestibular ganglion. Superior branch involvement (affecting the horizontal semicircular canal and/or anterior semicircular canal and/or utricle) is the most frequent variant 57% [ 10 ]. Video head impulse test studies in humans [ 11 ] showed that the horizontal semicircular canal (SCC) is affected more frequently than the anterior SCC whereas deficits of the utricle are less common.…”

Section: Discussionmentioning

confidence: 99%

Recovery Nystagmus in Vestibular Neuritis with Minimal Canal Paresis. Clinical Observation and Interpretation

Gkoritsa¹

2022

Brain Sciences

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Recovery nystagmus in vestibular neuritis patients is a reversal of spontaneous nystagmus direction, beating towards the affected ear, observed along the time course of central compensation. It is rarely registered due either to its rarity as a phenomenon per se, or to the fact that it is missed between follow-up appointments. The aim of the manuscript is to describe in detail a case of recovery nystagmus found in an atypical case of vestibular neuritis and discuss pathophysiology and clinical considerations regarding this rare finding. A 26-year-old man was referred to our Otorhinolaryngology practice reporting “dizziness” sensation and nausea in the last 48 h. Clinical examination revealed left beating spontaneous nystagmus (average slow phase velocity aSPV 8.1°/s) with absence of fixation. The head impulse test (H.I.T.) was negative. Cervical vestibular evoked myogenic potentials (cVEMP) and Playtone audiometry (PTA) were normal. Romberg and Unterberger tests were not severely affected. A strong directional preponderance to the left was found in caloric vestibular test with minimal canal paresis (CP 13%) on the right. The first follow-up consultation took place on the 9th day after the onset of symptoms. Right beating weak (aSPV 2.4°/s) spontaneous nystagmus was observed with absence of fixation, whereas a strong right directional preponderance (DP) was found in caloric vestibular test. A brain MRI scan was ordered to exclude central causes of vertigo, which was normal. The patient was seen again completely free of symptoms 45 days later. He reported feeling dizzy during dynamic movements of the head and trunk for another 15 days after his second consultation. The unexpected observation of nystagmus direction reversal seven days after the first consultation is a typical sign of recovery nystagmus. Recovery nystagmus (RN) is centrally mediated and when found, it should always be carefully assessed in combination with the particularities of vestibular neuritis.

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The spectrum of acute vestibular neuropathy through modern vestibular testing: A descriptive analysis

Cited by 14 publications

References 60 publications

Posterior semicircular canal ossification following acute vestibular loss mimicking inferior vestibular neuritis: A case report

Posterior semicircular canal ossification following acute vestibular loss mimicking inferior vestibular neuritis: A case report

Differential Involvement of Lateral Semicircular Canal and Otolith Organs in Common Vestibular Disorders

Recovery Nystagmus in Vestibular Neuritis with Minimal Canal Paresis. Clinical Observation and Interpretation

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