Selective otolithic dysfunction in patients presenting with acute spontaneous vertigo: consideration based on MRI.
Keun-Tae Kim1, Sangeun Park2, Sun-Uk Lee1,3
1Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea.
Frontiers in Neurology
|January 8, 2025
Summary
Selective otolithic dysfunction can cause acute vestibular syndrome (AVS), mimicking other conditions. Advanced neurotologic tests and inner ear MRI are crucial for accurate diagnosis and expanding the AVS clinical spectrum.
Area of Science:
- Neurology
- Otolaryngology
- Neuroimaging
Background:
- Acute unilateral peripheral vestibulopathy (AUPV/VN) is characterized by sudden vertigo and vestibular hypofunction.
- Diagnosis typically relies on video-head impulse tests (video-HITs) and caloric tests.
Purpose of the Study:
- To report cases of acute vestibular syndrome (AVS) with selective otolithic dysfunction.
- To highlight the diagnostic utility of advanced neurotologic evaluations and MRI in such cases.
Main Methods:
- Retrospective review of AVS patients (Sept 2019-April 2024) at a tertiary referral hospital.
- Comprehensive neurotologic assessment including VEMPs, subjective visual vertical, and video-oculography.
- Dedicated inner ear MRI with gadolinium contrast and delayed imaging.
Main Results:
- Four patients presented with AVS and selective otolithic dysfunction.
- Caloric tests and video-HITs were normal in most patients.
- Abnormalities in oVEMP, cVEMP, subjective visual vertical, and vestibular enhancement on MRI were observed.
Conclusions:
- Selective otolithic dysfunction is a potential cause of AVS that may be overlooked.
- Thorough neurotologic evaluation and specialized MRI are essential for diagnosing selective otolithic dysfunction.
- This expands the recognized clinical spectrum of AVS.
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