Inferior peduncle lesion presenting with bilaterally impaired vestibular responses to horizontal and posterior head impulses

Abstract

Differentiating central from peripheral origins of vestibulo-ocular reflex (VOR) lesions can be challenging. A 36-year old man presented with a 1-year history of progressive unsteadiness. The video-Head Impulse Test revealed a significantly reduced VOR gain in both horizontal and posterior canals (0.49 ± 0.05 and 0.38 ± 0.06) but normal VOR responses in both anterior canals (0.89 ± 0.08 and 1.04 ± 0.15). No plausible combination of end-organ lesion should be responsible for these observations. A brain magnetic resonance imaging disclosed a left inferior cerebellar peduncle lesion suggestive of a glioma.

Video Head Impulse Test and central nervous system diseases: a integrative review

“…In the first selection phase, the titles and abstracts of the identified studies were evaluated, and only 21 of them addressed the study theme of this literature review. These publications were read in full and, after application of the eligibility criteria, 18 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) were selected to compose the final sample of this study. Figure 1 shows the detailed selection process of these publications.…”

“…From the information extracted from the 18 selected articles (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) , a chart was created including data on disease, vestibular symptoms, and results of the vHIT and oculomotor tests (Chart 1).…”

“…All studies included in this literature review were published between 2014 and 2019. Regarding study design, there were seven case reports (8,9,14,18,22,23,25) , four case series (13,19,21,24) , six case controls (10)(11)(12)15,16,20) , and one cross-sectional study (17) .…”

“…The sample size ranged from 1 to 63, with age or mean age of participants between 25 and 77 years. The strength of scientific evidence was classified as level 5 for 11 articles (8,9,13,14,18,19,(21)(22)(23)(24)(25) and level 4 for seven articles (10)(11)(12)(15)(16)(17)20) . This was since most studies were case reports, followed by case controls, which are designs with a low grade of recommendation because they are more likely to be biased.…”

“…As for Chart 1, the following CNS disorders were studied: cerebellar stroke (8,12,17,23) , multiple sclerosis (MS) (9,10,20) , cerebellar ataxia with neuropathy, and vestibular areflexia syndrome (CANVAS) (19,22,24) , superficial siderosis of the CNS (14,21) , Wernicke encephalopathy (18) , left inferior cerebellar peduncle glioma (25) , progressive supranuclear palsy (PSP) (11) , mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS syndrome) (13) , Parkinson's disease (PD) (16) , spinocerebellar ataxia types 1 (SA1), 2 (SA2) and 3 (SA3) and Friedreich's ataxia (FA) (15) .…”