Inferior vestibular neuritis: 3 cases with clinical features of acute vestibular neuritis, normal calorics but indications of saccular failure

Monstad, Per; Økstad, Siri; Mygland, Åse

doi:10.1186/1471-2377-6-45

Cited by 41 publications

(38 citation statements)

References 19 publications

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“…Ochi and Ohashi [14] observed in a patient with VN the absence of VEMP in the acute phase of the disease and its full recovery after 15 months. Monstad [5] described three patients, affected by VN, with the complete absence of VEMP and caloric test reflectivity.…”

Section: Discussionmentioning

confidence: 99%

“…Although past experiences highlight the importance of performing the VEMP together with the caloric test in the diagnosis of VN [2,5], some experiences show contrasting results: Murofushi et al [6] observed that VEMP is independent of the caloric stimulation results in 34% of patients with acute phase of VN; Halmagyi et al [7] described two cases of VN with normal response on caloric stimulation, but with no evocable VEMP.…”

Section: Introductionmentioning

confidence: 95%

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Vestibular evoked myogenic potential in vestibular neuritis

Nola¹,

Guastini

Crippa

et al. 2011

Eur Arch Otorhinolaryngol

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This study wants to show the diagnostic value of vestibular evoked myogenic potential (VEMP) in the diagnosis of vestibular neuritis (VN), independently of the caloric test results. Twenty patients were enrolled with acute vertigo caused by VN. VEMP was tested with the binaural simultaneous stimulation method. Surface electromyographic activity was recorded in the supine patients from symmetrical sites over the upper half of each sternocleidomastoid muscle, with a reference electrode on the lateral end of the upper sternum. During the acute attack, 8 days, 1 month and 3 months after the beginning of the acute attack, all the patients underwent the following examinations: Dix-Hallpike manoeuvre, Pagnini-McClure manoeuvre, head shaking test, pure-tone audiometry, tympanometry, caloric labyrinth stimulation according to the Fitzgerald-Hallpike method and VEMP. At the last visit, the 11 patients diagnosed with superior branch vestibular neuritis did not show any improvement at the caloric labyrinth stimulation and presented VEMP on both sides with normal amplitude and latency; in the 9 cases diagnosed with inferior branch vestibular neuritis, there was an improvement of the VEMP reflex and normal caloric test. Our experience highlights that VEMP recording is applicable for patients with VN as a screening test.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Vestibular evoked myogenic potential in vestibular neuritis

Nola¹,

Guastini

Crippa

et al. 2011

Eur Arch Otorhinolaryngol

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“…Nach den bisherigen wenigen Berichten dominieren solche Schwindelempfindungen wie unbestimmtes Unwohlsein und Schwankschwindel [5,6,7,10]. Der für eine periphere vestibuläre Störung richtungsweisende Drehschwindel fehlt.…”

Section: Diagnosestellungunclassified

“…Die wichtigsten funktionsdiagnostischen Kriterien für eine Neuritis des N. vestibularis inferior sind somit die Konstellation einseitig fehlender ACcVEMP, erhaltene oVEMP, eine normale thermische Erregbarkeit und ein regelrechter Kopfimpulstest für den horizontalen VOR [4,6,10].…”

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Neuritis des N. vestibularis inferior

Walther

Repik

2011

HNO

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Vestibular evoked myogenic potentials (VEMP) are a new method to establish the functional status of the otolith organs. The sacculocollic reflex of the cervical VEMP to air conduction (AC) reflects predominantly saccular function due to saccular afferents to the inferior vestibular nerve. We describe a case of inferior vestibular neuritis as a rare differential diagnosis of vestibular neuritis. Clinical signs were a normal caloric response, unilaterally absent AC cVEMPs and bilaterally preserved ocular VEMPs (AC oVEMPs).

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“…The frequently occurring ocular tilt reaction [22] toward the affected side which can be observed directly through fundoscopy or be inferred from testing the subjective visual vertical (SVV) [24] is indicative of an utricular hypofunction as is an asymmetry ratio (AR) in ocular vestibular evoked myogenic potentials (oVEMPs). The saccular afferents from the vestibular organ as tested through cervical VEMPs frequently remain unaffected [14], but can also be dysfunctional [30,45]. The frequent sparing of the sacculus previously led to the conclusion that vestibular neuritis chiefly affects the superior vestibular nerve whilst sparing its inferior half in most cases [14].…”

Section: Introductionmentioning

confidence: 99%