Combined peripheral and central vestibulopathy

Area of Science:

• Neurology
• Otolaryngology
• Neuroscience

Background:

• Central vestibulopathy diagnosis is complicated by co-existing peripheral vestibular dysfunction, which can mask central signs.
• Understanding combined peripheral and central vestibular disorders is crucial for accurate diagnosis and management.

Observation:

• This study classified combined vestibulopathies into four types based on vestibular manifestations.
• Typical cases were described for each subtype to illustrate clinical characteristics.

Findings:

• Acute unilateral combined vestibulopathy is often caused by anterior inferior cerebellar artery infarction.
• Chronic unilateral cases frequently involve cerebellopontine angle tumors.
• Wernicke encephalopathy is a common cause of acute bilateral combined vestibulopathy, while degenerative disorders are typical in chronic bilateral cases.

Implications:

• The head impulse test (HIT) is often positive in combined vestibulopathy, necessitating careful search for other central signs.
• Clinicians must remain vigilant for central vestibular dysfunction even when peripheral signs are prominent.
• This classification aids in differentiating causes and guiding diagnostic strategies for complex vestibular presentations.