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Acute Bilateral Superior Branch Vestibular Neuropathy
Dario A Yacovino1,2, John B Finlay1,3, Valentina N Urbina Jaimes4
1Department of Neurology, Cesar Milstein Hospital, Buenos Aires, Argentina.
Frontiers in Neurology
|June 6, 2018
Summary
Acute bilateral vestibular neuritis (BVN) can cause sudden bilateral vestibular hypofunction (BVH), even without ototoxicity. This case highlights the importance of assessing all vestibular organs for diagnosis.
Area of Science:
- Neurology
- Otolaryngology
- Vestibular System
Background:
- Bilateral vestibular hypofunction (BVH) is typically linked to ototoxicity or is idiopathic.
- Sequential bilateral vestibular neuritis (VN) is a known cause of BVH, but simultaneous, acute bilateral VN has lacked clinical evidence.
Observation:
- A patient presented with acute, severe gait ataxia and oscillopsia, indicative of BVH.
- Initial vestibular function tests revealed impairment in bilateral superior semicircular canals and utricles, suggesting damage to both superior vestibular nerve branches.
- Hearing remained unaffected throughout the observation period.
Findings:
- This case provides the first clinical evidence for acute bilateral vestibular neuritis (BVN) as a cause of acute bilateral vestibular hypofunction (BVH).
- Vestibular function testing demonstrated bilateral superior semicircular canal and bilateral utricle deficits, sparing hearing.
- Limited recovery was observed after vestibular rehabilitation, with only unilateral utricular function improving over one year.
Implications:
- The findings suggest that acute BVN should be considered in the differential diagnosis of acute BVH, particularly when ototoxicity is absent.
- Comprehensive assessment of all ten vestibular end organs is crucial for diagnosing rare presentations of vestibular dysfunction.
- This case expands the understanding of VN's potential impact on vestibular function and its clinical manifestations.
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