Vestibular dysfunction and infratentorial MRI abnormalities in multiple sclerosis

To determine the prevalence of vestibular symptoms in people with multiple sclerosis (pwMS) and to examine associations with infratentorial MRI abnormalities.

We conducted a cross-sectional study of pwMS attending a university hospital, using a self-report questionnaire to assess vestibular symptoms. MRI brain scans were analysed for (i) active T2 lesions, (ii) middle cerebellar peduncle (MCP) lesion count, and (iii) total infratento-rial lesion count. Associations with symptoms were tested using Chi-squared analysis.

Eighty pwMS participated with a mean age 46.1 ± 13.9 years, 64 female (80%), and 64 (80%) had relapsing remitting MS. Vestibular symptoms were identified in 74 participants (92.5%), including imbalance, vertigo, and dizziness most frequently reported. No associations were observed between symptoms and active lesions or MCP lesion counts. However, infratento-rial lesion burden was significantly associated with head motion intolerance (p = 0.007).

Vestibular symptoms are common in pwMS yet frequently under-recognised. Our findings highlight the clinical relevance of infratentorial lesion counts, a routinely available MRI metric, in identifying patients at risk of vestibular dysfunction. Early referral to vestibular rehabilitation in patients with high infratentorial lesion burden may help reduce falls and improve quality of life.