Combined peripheral and central vestibulopathy

Abstract

Diagnosis of central vestibulopathy remains a challenge when it is associated with peripheral vestibular dysfunction because neurotological findings from peripheral vestibulopathy may overshadow those from central vestibular involvements. To define the characteristics of disorders involving both peripheral and central vestibular structures, we classified the combined vestibulopathies into four types according to their vestibular manifestations, and describe a typical case in each subtype. Infarction involving the territory of anterior inferior cerebellar artery is the most common cause of acute unilateral cases, whereas tumors involving the cerebellopontine angle should be of prime suspicion in patients with chronic unilateral ones. Wernicke encephalopathy was most common in patients with acute bilateral combined vestibulopathy while degenerative disorders should be considered in chronic bilateral ones. Since the head impulse test (HIT) is mostly positive in combined vestibulopathy, signs of central vestibular dysfunction other than negative HIT should be sought carefully even in patients with obvious clinical or laboratory features of peripheral vestibulopathy.

Approach to dizziness in the emergency department

“…In contrast, initial diffusion-weighted MRI was false negative in 12% of these patients, especially within 48 hours of symptom onset [ 29 ]. However, HINTS may not be sufficiently robust to detect infarctions involving the AICA territory since HIT is mostly positive due to concurrent labyrinthine infarction [ 15 , 53 , 54 ]. Indeed, HINTS failed to detect central lesions in five of 18 patients with AICA infarctions [ 53 ].…”

Current diagnostic procedures for diagnosing vertigo and dizziness

“…Acute vertigo without nystagmus is rare but it has been described in the acute phase of cerebellar infarction [ 125 ]. Acute, combined peripheral and central disorders have been published as single case descriptions [[ 126 ]. In single cases, even cerebral infarction may be present with a positive head impulse test [ 127 ], [ 128 ].…”

Moderne Schwindeldiagnostik

“…Akuter "Schwindel" ohne Nystagmus ist selten, jedoch in der Akutphase bei Kleinhirninfarkten beschrieben [125]. Akute, kombiniert auftretende periphere und zentrale Störungen sind als Einzelfälle publiziert [126]. Auch bei einem positiven Kopfimpulstest kann in Einzelfällen ein Hirninfarkt vorliegen [127,128].…”