Bilateral loss of vestibular function: clinical findings in 53 patients

Rinne, Tuula; Bronstein, Adolfo M.; Rudge, Peter; Gresty, M. A.; Luxon, Linda M.

doi:10.1007/s004150050225

Cited by 156 publications

(143 citation statements)

References 40 publications

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“…They also usually have oscillopsia and/or vertigo, neither of which was present in our patient. 7 Review of the patient's medical records revealed that her anemia was long-standing. She confirmed that she had no history of chemotherapy, radiation therapy, or unusual exposure to chemicals.…”

Section: Which Onementioning

confidence: 99%

38-Year-Old Woman With Increasing Fatigue and Dyspnea

Khambatta

Nguyen

Wittich

2010

Mayo Clinic Proceedings

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A 38-year-old woman presented to the emergency department because of increasing fatigue and shortness of breath, worsening during the past 2 months. At the time of presentation, even minimal exertion caused her to become short of breath. She denied chest pain, cough, expectoration, orthopnea, paroxysmal nocturnal dyspnea, recent fevers, or chills. Her medical history was remarkable for a Roux-en-Y gastric bypass procedure 16 years earlier for morbid obesity. Her weight before surgery was approximately 100 kg (220 pounds), but she had lost considerable weight after surgery, with her recent weight being stable at around 57 kg (125 pounds). She had a history of frequent upper respiratory tract infections, urinary tract infections, and yeast infections since her obesity surgery.Physical examination revealed a pale woman who appeared malnourished and in mild distress. She was afebrile. The patient's vital signs were as follows: pulse rate, 110 beats/min; respiration rate, 16 breaths/min; and blood pressure, 110/70 mm Hg. Her pulse oximetry revealed normal oxygen saturation while breathing room air. A grade 2/6 systolic ejection murmur was heard over the left sternal border. Her chest was clear to auscultation bilaterally. Examination or her ear, nose, and throat was remarkable for cheilitis and glossitis.A complete blood cell count yielded the following results (reference ranges shown parenthetically): hemoglobin, 6.1 g/dL (12.0-15.5 g/dL); hematocrit, 18.1% (34.9%-44.5%); mean corpuscular volume, 104 fL (81.6-98.3 fL); white blood cell count, 1.1 × 10 9 /L (3.5-10.5 × 10 9 /L); and platelet count, 254 × 10 9 /L (150-450 × 10 9 /L). She had a blood urea nitrogen level of 17 mg/dL (6-21 mg/dL), a creatinine level of 0.7 mg/dL (0.6-0.9 mg/dL), and a reticulocyte count of 2.11% (0.60%-1.83%). A differential white blood cell count revealed 66% lymphocytes (16%-52%), 19% monocytes (1%-11%), and 11% neutrophils (42%-75%). A peripheral smear revealed mostly macrocytes, few hypochromic microcytes, and dacrocytes, with no schistocytes or spherocytes.

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Section: Which Onementioning

confidence: 99%

38-Year-Old Woman With Increasing Fatigue and Dyspnea

Khambatta

Nguyen

Wittich

2010

Mayo Clinic Proceedings

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“…Bilateral vestibular loss causes ataxia and oscillopsia, not vertigo, 27 and in the absence of any significant and relevant hearing loss it can cause diagnostic difficulties because an aural cause might not be considered in the differential diagnosis of imbalance. The patient will be able to walk perfectly well heel to toe and the only easily demonstrable abnormality will be an inability to stand, with the eyes closed, but only when trying to do so on a soft, yielding surface such as a mattress or two pillows -a sort of Romberg's test.…”

Section: Bilateral Vestibulopathymentioning

confidence: 99%

Diagnosis and management of vertigo

Halmagyi

2005

Clinical Medicine

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-Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Menière's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short. KEY WORDS What vertigo is and is notVertigo is an illusion of rotation caused by asymmetry of neural activity between the left and right vestibular nuclei. This can be induced in anyone• by simply spinning them at constant speed for about 20 seconds and then suddenly stopping them• by heating or cooling one labyrinth, as happens in the caloric test• by otoconial particles (calcium-containing debris: literally 'earstones') moving along semicircular canal duct, as happens in benign paroxysmal positional vertigo (BPPV). It can also be produced by sudden unilateral destruction of a normal vestibular end-organ, nerve or nucleus or vestibulo-cerebellum, a structure that normally inhibits the ipsilateral vestibular nucleus. (Bilateral simultaneous vestibular destruction does not produce vertigo -in fact, a patient with bilateral vestibular loss will never again experience vertigo from unilateral or asymmetrical vestibular stimulation.)Vertigo is always temporary. Even after the vestibular nerve on one side has been surgically severed, the resulting vertigo (and nystagmus) will abate within a few days. This is not because the vestibular nerve has re-anastomosed but because profound neurochemical changes occuring in the brainstem during the process of vestibular compensation restore symmetrical vestibular nucleus activity. Vertigo is always made worse by head movement; thus patients who are 'dizzy all the time' and are happy to move around whilst dizzy do not have vertigo.Patients with aural vertigo should not lose consciousness but some patients cannot give confident and convincing answers to such simple questions as 'Did it feel as if you were losing balance or as if you were losing consciousness? Did you feel as if you were going to pass out or fall over?' Patients with vertigo might lose consciousness if they have been vomiting a lot, or if they incurred a head injury when they fell.Witness descriptions are not much help in identifying vertigo, but can be helpful in identifying other paroxysmal disorders such as seizure and syncope. Whereas panic attacks, especially with hyperventilation, co...

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“…However, those with bilateral vestibular deficiency (BVD) due to ototoxic drug exposure, Ménière's disease, meningitis, genetic defects, or other insults to the inner ear often suffer from degraded visual acuity during head movements, in addition to postural instability and chronic disequilibrium (Minor 1998;Rinne et al 1998;Black et al 2001Black et al , 2004Mamoto et al 2002). For these individuals, an implantable neuroelectronic prosthesis that measures three-dimensional (3D) head rotation and stimulates the vestibular nerve accordingly could significantly improve quality of life.…”

Section: Introductionmentioning

confidence: 99%

Multichannel Vestibular Prosthesis Employing Modulation of Pulse Rate and Current with Alignment Precompensation Elicits Improved VOR Performance in Monkeys

Davidovics

Rahman

Dai

et al. 2013

JARO

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An implantable prosthesis that stimulates vestibular nerve branches to restore the sensation of head rotation and the three-dimensional (3D) vestibular ocular reflex (VOR) could benefit individuals disabled by bilateral loss of vestibular sensation. Our group has developed a vestibular prosthesis that partly restores normal function in animals by delivering biphasic current pulses via electrodes implanted in semicircular canals. Despite otherwise promising results, this approach has been limited by insufficient velocity of VOR response to head movements that should inhibit the implanted labyrinth and by misalignment between direction of head motion and prosthetically elicited VOR. We report that significantly larger VOR eye velocities in the inhibitory direction can be elicited by adapting a monkey to elevated baseline stimulation rate and current prior to stimulus modulation and then concurrently modulating ("co-modulating") both rate and current below baseline levels to encode inhibitory angular head velocity. Comodulation of pulse rate and current amplitude above baseline can also elicit larger VOR eye responses in the excitatory direction than do either pulse rate modulation or current modulation alone. Combining these stimulation strategies with a precompensatory 3D coordinate transformation improves alignment and magnitude of evoked VOR eye responses. By demonstrating that a combination of co-modulation and precompensatory transformation strategies achieves a robust VOR response in all directions with significantly improved alignment in an animal model that closely resembles humans with vestibular loss, these findings provide a solid preclinical foundation for application of vestibular stimulation in humans.

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Bilateral loss of vestibular function: clinical findings in 53 patients

Cited by 156 publications

References 40 publications

38-Year-Old Woman With Increasing Fatigue and Dyspnea

38-Year-Old Woman With Increasing Fatigue and Dyspnea

Diagnosis and management of vertigo

Multichannel Vestibular Prosthesis Employing Modulation of Pulse Rate and Current with Alignment Precompensation Elicits Improved VOR Performance in Monkeys

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