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Bilateral vestibulopathy presaging clinically probable multisystem atrophy.

Uma Ravishankar1, Rithvik Ramesh2, Shankar Venkatasubramanian1

  • 1Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.

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Bilateral vestibulopathy can precede multisystem atrophy (MSA) diagnosis by over a year. Early re-evaluation for parkinsonism and cerebellar signs is crucial in idiopathic cases.

Keywords:
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Area of Science:

  • Neurology
  • Neuroscience
  • Otolaryngology

Background:

  • Bilateral vestibulopathy is a condition affecting balance, often diagnosed through investigations.
  • Its causes are diverse, including neurodegenerative diseases, but many cases remain idiopathic.
  • Early symptoms can be subtle and lack clear lateralizing signs.

Observation:

  • A case study of an elderly male with progressive bilateral vestibulopathy is presented.
  • The patient was diagnosed with clinically probable multisystem atrophy (MSA) 1.5 years after initial vestibulopathy symptoms.
  • This highlights a potential early presentation of MSA.

Findings:

  • Bilateral vestibulopathy may serve as an early indicator of underlying neurodegeneration.
  • The study suggests a potential link between idiopathic bilateral vestibulopathy and the early stages of MSA.
  • Lack of lateralizing signs can mask the underlying neurological condition.

Implications:

  • Clinicians should consider serial re-evaluation for parkinsonism and cerebellar signs in patients with idiopathic bilateral vestibulopathy.
  • Bilateral vestibulopathy could be an early premonitory syndrome for MSA, akin to anosmia or constipation.
  • This understanding may improve early diagnosis and management of MSA.