Electrophysiological and inner ear MRI findings in patients with bilateral vestibulopathy

Eliezer, Michaël; Hautefort, Charlotte; Nechel, Christian Van; Duquesne, Ulla; Guichard, Jean‐Pierre; Herman, Philippe; Kania, Romain; Houdart, Emmanuel; Attyé, Arnaud; Toupet, Michel

doi:10.1007/s00405-020-05829-8

Cited by 11 publications

(4 citation statements)

References 37 publications

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“…Fittingly and further underlying its pathophysiological relevance, varying degrees of ELH are also nearly universally present in post-mortem human temporal bone [ 78 , 79 ] and iMRI studies on subjects with a history of MD [ 16 , 18 , 19 , 32 ]. However, in-vivo iMRI studies also showed a relatively high prevalence in the healthy population (via iMRI [ 80 ], as well as in post-mortem studies [ 81 ]) and in patients with other vestibular disorders such as vestibular migraine [ 18 , 19 ], vestibular schwannoma [ 82 ], or bilateral vestibulopathy [ 83 ]. Consequently, ELH is being re-evaluated as a non-pathognomonic phenomenon that should not directly indicate MD [ 84 ].…”

Section: Discussionmentioning

confidence: 99%

Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression

et al. 2022

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Combining magnetic resonance imaging (MRI) sequences that permit the determination of vestibular nerve angulation (NA = change of nerve caliber or direction), structural nerve integrity via diffusion tensor imaging (DTI), and exclusion of endolymphatic hydrops (ELH) via delayed gadolinium-enhanced MRI of the inner ear (iMRI) could increase the diagnostic accuracy in patients with vestibular paroxysmia (VP). Thirty-six participants were examined, 18 with VP (52.6 ± 18.1 years) and 18 age-matched with normal vestibulocochlear testing (NP 50.3 ± 16.5 years). This study investigated whether (i) NA, (ii) DTI changes, or (iii) ELH occur in VP, and (iv) to what extent said parameters relate. Methods included vestibulocochlear testing and MRI data analyses for neurovascular compression (NVC) and NA verification, DTI and ELS quantification. As a result, (i) NA increased NVC specificity. (ii) DTI structural integrity was reduced on the side affected by VP (p < 0.05). (iii) 61.1% VP showed mild ELH and higher asymmetry indices than NP (p > 0.05). (iv) “Disease duration” and “total number of attacks” correlated with the decreased structural integrity of the affected nerve in DTI (p < 0.001). NVC distance within the nerve’s root-entry zone correlated with nerve function (Roh = 0.72, p < 0.001), nerve integrity loss (Roh = − 0.638, p < 0.001), and ELS volume (Roh = − 0.604, p < 0.001) in VP. In conclusion, this study is the first to link eighth cranial nerve function, microstructure, and ELS changes in VP to clinical features and increased vulnerability of NVC in the root-entry zone. Combined MRI with NVC or NA verification, DTI and ELS quantification increased the diagnostic accuracy at group-level but did not suffice to diagnose VP on a single-subject level due to individual variability and lack of diagnostic specificity.

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Section: Discussionmentioning

confidence: 99%

Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression

et al. 2022

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“…Imaging is essential in the etiological assessment [10]. On the MRI, the FLAIR and particularly delayed 3D-FLAIR sequence allows an analysis of the brain parenchyma and the inner ear [10][11][12]. In addition, functional MRI (fMRI) would be very useful for the diagnosis of BVA by showing increased brain responsivity to galvanic vestibular stimulation [11].…”

Section: Discussionmentioning

confidence: 99%

An exceptional case of bilateral vestibular areflexia complicating acute otitis media

Halwani¹,

Zribi²,

Bouomrani³

2020

Heighpubs Otolaryngol Rhinol

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“…Fittingly, varying degrees of ELH were nearly universally present in subjects with a history of MD, with 97–100% in post-mortem human temporal bones studies [ 5 , 6 ] and 80% in i MRI studies [ 7 – 10 ]. ELH was further consistently detected in other pathologies presenting with episodic vertigo, such as in 36–60% in intralabyrinthine schwannoma [ 11 – 14 ], 60% in bilateral vestibulopathy [ 15 ], 59% in otosclerosis [ 16 ], 8–30% in vestibular migraine [ 8 , 17 , 18 ], and also in idiopathic intracranial hypertension [ 19 ], spontaneous intracranial hypotension [ 20 , 21 ], or cerebrospinal venous insufficiency [ 22 ]. Consequently, ELH's specificity to MD is being revalued, while its pathophysiological relevance within the pathologies mentioned remains unclear to varying degrees.…”

Section: Introductionmentioning

confidence: 99%

Endolymphatic space is age-dependent

et al. 2022

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Knowledge of the physiological endolymphatic space (ELS) is necessary to estimate endolymphatic hydrops (ELH) in patients with vestibulocochlear syndromes. Therefore, the current study investigated age-dependent changes in the ELS of participants with normal vestibulocochlear testing. Sixty-four ears of 32 participants with normal vestibulocochlear testing aged between 21 and 75 years (45.8 ± 17.2 years, 20 females, 30 right-handed, two left-handed) were examined by intravenous delayed gadolinium-enhanced magnetic resonance imaging of the inner ear (iMRI). Clinical diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, and head-impulse test. iMRI data analysis provided semi-quantitative visual grading and automatic algorithmic quantitative segmentation of ELS volume (3D, mm3) using a deep learning-based segmentation of the inner ear’s total fluid space (TFS) and volumetric local thresholding, as described earlier. As a result, following a 4-point ordinal scale, a mild ELH (grade 1) was found in 21/64 (32.8%) ears uni- or bilaterally in either cochlear, vestibulum, or both. Age and ELS were found to be positively correlated for the inner ear (r(64) = 0.33, p < 0.01), and vestibulum (r(64) = 0.25, p < 0.05). For the cochlea, the values correlated positively without reaching significance (r(64) = 0.21). In conclusion, age-dependent increases of the ELS should be considered when evaluating potential ELH in single subjects and statistical group comparisons.

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Electrophysiological and inner ear MRI findings in patients with bilateral vestibulopathy

Cited by 11 publications

References 37 publications

Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression

Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression

An exceptional case of bilateral vestibular areflexia complicating acute otitis media

Endolymphatic space is age-dependent

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