A Classification of Recurrent Vestibulopathy

Abstract

Intermittent vertigo represents one of the most disabling symptoms encountered in otologic practice. The recurrent nature of this disability implies a reversible alteration in vestibular nerve physiology caused by changes in the neuron or its environment. Three of the most common clinical syndromes manifesting as recurrent vertigo are benign paroxysmal positional vertigo (BPV), Ménière's disease (MD) and vestibular neuronitis (VN). The morphologic evidence presented in previous chapters supported by molecular [1, 2], immunologic [3-6] and clinical observations [7][8][9][10][11][12][13][14][15][16][17][18][19] indicates that these common, and some less common, recurrent vestibulopathies are manifestations of reactivation of latent viral vestibular ganglionitis.The agents responsible for the ganglionitis are neurotropic (NT) viruses, likely herpes simplex (HSV) or zoster virus. Other NT viruses that may be included in this group are cytomegalovirus, Epstein-Barr and pseudorabies virus. The ubiquity of HSV accounts for the high exposure rates recorded in the world population. Elevated serum antibody titers to HSV-1 have been recorded in 70% of 25-year-olds, while at the age of 60 years the rate is over 90% [20]. After the NT virus has entered a sensory nerve, it may acquire a latent state in its ganglion cells. Reactivation of the virus from latency is reflected in clinical signs and symptoms.Because the clinical syndromes with recurrent vertigo are varied, it is useful to construct a classification system based on vestibular ganglionitis [21]. We propose a new classification system based on three bodies of information: (1) a review of temporal bone (TB) specimens, (2) case reports and (3) a clinical series.

Diagnosis of Vertigo and Dizziness Syndromes in a Neurological Outpatient Clinic

“…The etiology of BRV is not yet clear, and a few studies had shown that BRV could develop into a migraine, BPPV, or MD [36]. BRV accounted for 5.1% of our cases, and this finding was similar to that of a previous report in Canada [37, 38]. …”

Clinical characteristics and natural course of recurrent vestibulopathy: A long‐term follow‐up study

“…The cause of RV is uncertain, and it may be a provisional diagnosis before differentiation in cases of suspected peripheral vestibular disorder. In patients with recurrent vertigo, a diagnosis cannot be made easily, as RV has no definite or clear diagnostic criteria, and an initial temporary diagnosis of RV may be changed to benign paroxysmal positional vertigo, migraine, or Ménière's disease 4, 5…”

“…The etiology of RV remains unclear, but its pathophysiology has been proposed to include endolymphatic hydrops, abnormal vascular compression of the eighth cranial nerve, recurrent viral infection, and others, and RV can develop into migraine, benign paroxysmal positional vertigo, or Ménière's disease 4, 5. However, neither the natural course nor the clinical features of RV have been determined, and therefore, the aim of this study was to document its clinical characteristics and natural course by long‐term follow‐up.…”

Clinical features and outcomes of benign recurrent vertigo: A longitudinal study

“…2 Several terms have also been used for this condition: benign paroxysmal vertigo (BPV), recurrent vestibulopathy (RV), migrainous vertigo, and migraine-associated vertigo. [3][4][5][6][7] However, BRV is currently underdiagnosed because its pathophysiological mechanism is not well-understood. Previous studies have reported that there is a significant link between BRV and migraine, and that the incidence of migraine in BRV patients and their families is higher than that in the general population.…”

“…In 1979, Slater first described benign recurrent vertigo (BRV) in adult patients who presented with recurrent vertigo that lasted from several minutes to hours without neurologic or any auditory symptoms . Several terms have also been used for this condition: benign paroxysmal vertigo (BPV), recurrent vestibulopathy (RV), migrainous vertigo, and migraine‐associated vertigo …”