Combined peripheral and central vestibulopathy

Issue title: The Vestibular System: A Clinical and Scientific Update in Siena. In honor of Professor Daniele Nuti, Siena, Italy, April 5–6, 2013

Guest editors: Marco Mandalàx, Stefano Ramaty and David S. Zee

Article type: Research Article

Authors: Choi, Seo-Young^a; | Kee, Hyun-Ju^b; | Park, Jae-Han^c | Kim, Hyo-Jung^d | Kim, Ji-Soo^{e; *}

Affiliations: [a] Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea | [b] School of Medicine, Keimyung University, Daegu, Korea | [c] Department of Neurology, Soon Chun Hyang University Gumi~Hospital, Gumi-si, Korea | [d] Department of Biomedical Laboratory Science, Kyungdong University, Goseong-gun, Gangwon-do, Korea | [e] Department of Neurology, College Medicine, Seoul National University Bundang Hospital, Seoul, Korea | [x] Otological and Skull Base Surgery Department, S.M. delle Scotte Hospital, Siena, Italy | [y] Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

Correspondence: [*] Corresponding author: Ji-Soo Kim, Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea. Tel.: +82 31 787 7463; Fax: +82 31 719 6828; E-mail: jisookim@snu.ac.kr

Note: [1] Both authors contributed equally to this study

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.

Keywords: Vertigo, vestibular disorders, infarction, tumor, Wernicke encephalopathy

DOI: 10.3233/VES-140524

Journal: Journal of Vestibular Research, vol. 24, no. 5-6, pp. 443-451, 2014