Acute Vestibular Syndrome

2020 ◽  
Vol 40 (01) ◽  
pp. 059-066
Author(s):  
Kevin A. Kerber
Keyword(s):  
Vestibular Neuritis ◽  
Vestibular Disorders ◽  
Acute Vestibular Syndrome ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy ◽  
New Onset

AbstractThe acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy due to vestibular neuritis. Stroke is also a serious concern in patients with AVS. Most other peripheral vestibular disorders present as episodic or chronic syndromes. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed.

scholarly journals Acute vestibular syndrome: is skew deviation a central sign?

2021 ◽  
Author(s):  
Athanasia Korda ◽  
Ewa Zamaro ◽  
Franca Wagner ◽  
Miranda Morrison ◽  
Marco Domenico Caversaccio ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Head Impulse Test ◽  
Clinical Test ◽  
Stroke Patients ◽  
Acute Vestibular Syndrome ◽  
Low Sensitivity ◽  
A Prospective Study ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy ◽  
Skew Deviation

Abstract Objective Skew deviation results from a dysfunction of the graviceptive pathways in patients with an acute vestibular syndrome (AVS) leading to vertical diplopia due to vertical ocular misalignment. It is considered as a central sign, however, the prevalence of skew and the accuracy of its test is not well known . Methods We performed a prospective study from February 2015 until September 2020 of all patients presenting at our emergency department (ED) with signs of AVS. All patients underwent clinical HINTS and video test of skew (vTS) followed by a delayed MRI, which served as a gold standard for vestibular stroke confirmation. Results We assessed 58 healthy subjects, 53 acute unilateral vestibulopathy patients (AUVP) and 24 stroke patients. Skew deviation prevalence was 24% in AUVP and 29% in strokes. For a positive clinical test of skew, the cut-off of vertical misalignment was 3 deg with a very low sensitivity of 15% and specificity of 98.2%. The sensitivity of vTS was 29.2% with a specificity of 75.5%. Conclusions Contrary to prior knowledge, skew deviation proved to be more prevalent in patients with AVS and occurred in every forth patient with AUVP. Large skew deviations (> 3.3 deg), were pointing toward a central lesion. Clinical and video test of skew offered little additional diagnostic value compared to other diagnostic tests such as the head impulse test and nystagmus test. Video test of skew could aid to quantify skew in the ED setting in which neurotological expertise is not always readily available.

scholarly journals Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

2020 ◽  
Vol 267 (S1) ◽  
pp. 118-125
Author(s):  
Klaus Jahn ◽  
Antoanela Kreuzpointner ◽  
Thomas Pfefferkorn ◽  
Andreas Zwergal ◽  
Thomas Brandt ◽  
...  
Keyword(s):  
Working Hours ◽  
Distribution Patterns ◽  
Vestibular Neuritis ◽  
Viral Origin ◽  
Reduced Physical Activity ◽  
One Year ◽  
Ischemic Attack ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy ◽  
Paroxysmal Positional Vertigo

AbstractDistinguishing between serious (e.g., stroke) and benign (e.g., benign paroxysmal positional vertigo, BPPV) disorders remains challenging in emergency consultations for vertigo and dizziness (VD). A number of clues from patient history and clinical examination, including several diagnostic index tests have been reported recently. The objective of the present study was to analyze frequency and distribution patterns of specific vestibular and non-vestibular diagnoses in an interdisciplinary university emergency room (ER), including data on daytime and season of presentation. A retrospective chart analysis of all patients seen in a one-year period was performed. In the ER 4.23% of all patients presented with VD (818 out of 19,345). The most frequent-specific diagnoses were BPPV (19.9%), stroke/transient ischemic attack (12.5%), acute unilateral vestibulopathy/vestibular neuritis (UVH; 8.3%), and functional VD (8.3%). Irrespective of the diagnosis, the majority of patients presented to the ER between 8 a.m. and 4 p.m. There are, however, seasonal differences. BPPV was most prevalent in December/January and rare in September. UVH was most often seen in October/November; absolute and relative numbers were lowest in August. Finally, functional/psychogenic VD was common in summer and autumn with highest numbers in September/October and lowest numbers in March. In summary, daytime of presentation did not distinguish between diagnoses as most patients presented during normal working hours. Seasonal presentation revealed interesting fluctuations. The UVH peak in autumn supports the viral origin of the condition (vestibular neuritis). The BPPV peak in winter might be related to reduced physical activity and low vitamin D. However, it is likely that multiple factors contribute to the fluctuations that have to be disentangled in further studies.

scholarly journals A new ocular motor sign in acute vestibular syndrome: Is HINTS plus enough?

2021 ◽  
Vol 26 (4) ◽  
pp. 853-857
Author(s):  
Vishal Pawar ◽  
Aishwarya Anand ◽  
Prasanna Kulkarni ◽  
Ji Soo Kim
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Head Impulse Test ◽  
Medial Branch ◽  
Radio Imaging ◽  
Acute Vestibular Syndrome ◽  
Cerebellar Artery ◽  
Ct Brain ◽  
The Right ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy

A 66-year-old hypertensive and diabetic male presented with acute vestibular syndrome for three days. HINTS plus examination was performed. The horizontal head impulse test was positive on the left side. Video oculography showed centripetal nystagmus on gaze testing in the dark and test of skew was negative. There was no new hearing loss on the finger rub test. On neurological examination, he had severe postural instability and saccadic smooth pursuit. Radio-imaging studies were conducted to rule out the possibility of stroke. CT brain showed infarction in the territory of the medial branch of the right posterior inferior cerebellar artery. MRI brain confirmed the diagnosis. Thus, posterior circulation stroke can present with acute vestibular syndrome mimicking acute unilateral vestibulopathy. However, the presence of associated neurological symptoms like gait ataxia, centripetal nystagmus and vascular risk factors pointed towards a central cause. Clinical evaluation suggesting a peripheral lesion should never be taken in isolation and needs to be correlated with other associated signs. We describe centripetal nystagmus without fixation as a new oculomotor sign in acute vestibular syndrome.

The Interrelations Between Different Causes of Dizziness: A Conceptual Framework for Understanding Vestibular Disorders

2019 ◽  
Vol 128 (9) ◽  
pp. 869-878 ◽  
Author(s):  
Richard T. Zhu ◽  
Vincent Van Rompaey ◽  
Bryan K. Ward ◽  
Raymond Van de Berg ◽  
Paul Van de Heyning ◽  
...  
Keyword(s):  
Conceptual Framework ◽  
Meniere’S Disease ◽  
Vestibular Migraine ◽  
Menière’S Disease ◽  
Vestibular Neuritis ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Vestibular Disorders ◽  
Menière's Disease ◽  
Ménière's Disease

Background:According to population-based studies that estimate disease prevalence, the majority of patients evaluated at dizziness clinics receive a single vestibular diagnosis. However, accumulating literature supports the notion that different vestibular disorders are interrelated and often underdiagnosed.Objective:Given the complexity and richness of these interrelations, we propose that a more inclusive conceptual framework to vestibular diagnostics that explicitly acknowledges this web of association will better inform vestibular differential diagnosis.Methods:A narrative review was performed using PubMed database. Articles were included if they defined a cohort of patients, who were given specific vestibular diagnosis. The interrelations among vestibular disorders were analyzed and placed within a conceptual framework.Results:The frequency of patients currently receiving multiple vestibular diagnoses in dizziness clinic is approximately 3.7% (1263/33 968 patients). The most common vestibular diagnoses encountered in the dizziness clinic include benign paroxysmal positional vertigo (BPPV), vestibular migraine, vestibular neuritis, and Ménière’s disease.Conclusions:A review of the literature demonstrates an intricate web of interconnections among different vestibular disorders such as BPPV, vestibular migraine, Ménière’s disease, vestibular neuritis, bilateral vestibulopathy, superior canal dehiscence syndrome, persistent postural perceptual dizziness, anxiety, head trauma, and aging, among others.

scholarly journals 084 Separating stroke from vestibular neuritis by vestibular function test parameters

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.1-A27
Author(s):  
Zeljka Calic ◽  
Benjamin Nham ◽  
Rachel Taylor ◽  
Allison Young ◽  
Craig Anderson ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Vestibular Function ◽  
Vestibular Neuritis ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Saccade Amplitude ◽  
Vestibular Tests ◽  
Acute Vestibular Syndrome ◽  
Significant Difference ◽  
Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

Relevance of Otopathological Findings in the Treatment of Dizzy Patients

1984 ◽  
Vol 93 (4_suppl) ◽  
pp. 12-16 ◽  
Author(s):  
Pierre B. Montandon ◽  
Rudolf Häusler
Keyword(s):  
Retrospective Study ◽  
Endolymphatic Hydrops ◽  
Vestibular Neuritis ◽  
Common Symptom ◽  
Vestibular Disorders ◽  
Histopathological Changes ◽  
The Brain

Dizziness is a common symptom in disorders of the brain and the ear. In a retrospective study of 1,000 cases, dizziness is attributed to a peripheral disorder in 25%, to a CNS disorder in 46%, and to undetermined causes in 29% of the cases. Peripheral disorders can be defined in terms of histopathological changes; the most frequent is cupulolithiasis, followed by endolymphatic hydrops and vestibular neuritis. These vestibular disorders are reviewed and discussed in connection with accepted facts and current hypotheses.

scholarly journals Glucocorticoids improve acute dizziness symptoms following acute unilateral vestibulopathy

2015 ◽  
Vol 262 (11) ◽  
pp. 2578-2582 ◽  
Author(s):  
Angel Batuecas-Caletrío ◽  
Raquel Yañez-Gonzalez ◽  
Carmen Sanchez-Blanco ◽  
Pedro Blanco Pérez ◽  
Enrique González-Sanchez ◽  
...  
Keyword(s):  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy

Vestibular vertigo in emergency neurology

2021 ◽  
Vol 26 (4) ◽  
pp. 50-59
Author(s):  
A. A. Kulesh ◽  
D. A. Dyomin ◽  
A. L. Guseva ◽  
O. I. Vinogradov ◽  
V. A. Parfyonov
Keyword(s):  
Clinical Signs ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Vertebrobasilar System ◽  
Acute Vestibular Syndrome ◽  
Vestibular Vertigo ◽  
Vestibular Neuronitis ◽  
Emergency Neurology

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

P 61 Glial activation accelerates behavioural compensation of acute unilateral vestibulopathy

2017 ◽  
Vol 128 (10) ◽  
pp. e358
Author(s):  
A. Zwergal ◽  
L. Günther ◽  
M. Brendel ◽  
R. Beck ◽  
S. Lindner ◽  
...  
Keyword(s):  
Glial Activation ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy
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