Selective Otolithic Dysfunction in Patients Presenting with Acute Spontaneous Vertigo: Consideration Based on MRI

Overview

Journal Front Neurol

Date 2025 Jan 8

PMID 39777315

Authors

Keun-Tae Kim

Sangeun Park

Sun-Uk Lee

Euyhyun Park

Byungjun Kim

Ji-Soo Kim

Affiliations

Soon will be listed here.

Abstract

Objective: Acute unilateral peripheral vestibulopathy or vestibular neuritis (AUPV/VN) manifests as acute onset vertigo, often accompanied by nausea, vomiting, and moderate gait instability. It is suspected when vestibular hypofunction is documented on video-head impulse (video-HITs) and caloric tests in the presence of contralesionally beating horizontal-torsional nystagmus. Herein, we report patients presenting with acute vestibular syndrome (AVS) showing selective otolithic dysfunction in the presence of normal caloric and video-HITs and abnormal enhancement of the peripheral vestibular structures on MRI.

Methods: We retrospectively reviewed the medical records of patients presenting with AVS between September 2019 and April 2024 at a tertiary referral hospital in South Korea. All patients underwent extensive neurotologic evaluation, including cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP, respectively), subjective visual vertical, video-oculography, video-HITs, caloric tests, and audiometry. Patients also underwent MRI according to a standard protocol for the inner ear and internal acoustic canal with an additional 3D-fluid attenuated inversion recovery sequence acquired 4 h after intravenous gadolinium injection.

Results: We identified four patients with selective otolith dysfunction. Video-HITs and caloric test results were normal in all patients, except one with a canal paresis on the opposite side of otolithic dysfunction. Patients usually showed abnormal oVEMP ( = 3) and cVEMP ( = 2) or subjective visual vertical ( = 3). Gadolinium enhancements were found in the vestibule ( = 3), inferior ( = 2) or superior ( = 1) vestibular nerves on dedicated inner ear MRI.

Discussion: Selective otolithic dysfunction can present with AVS, which can be easily overlooked. A thorough neurotologic evaluation and MRI dedicated to the inner ear can help detect selective otolithic dysfunction, expanding the clinical spectrum of AVS.

References

Halmagyi G, Weber K, Curthoys I . Vestibular function after acute vestibular neuritis. Restor Neurol Neurosci. 2010; 28(1):37-46. DOI: 10.3233/RNN-2010-0533. View

Kassner S, Schottler S, Bonaterra G, Stern-Straeter J, Hormann K, Kinscherf R . Proinflammatory activation of peripheral blood mononuclear cells in patients with vestibular neuritis. Audiol Neurootol. 2010; 16(4):242-7. DOI: 10.1159/000320839. View

Goto F, Meng H, Bai R, Sato H, Imagawa M, Sasaki M . Eye movements evoked by selective saccular nerve stimulation in cats. Auris Nasus Larynx. 2004; 31(3):220-5. DOI: 10.1016/j.anl.2004.03.002. View

Park K, Shin K, Ha S, Park J, Kim S . A Case of Acute Vestibular Neuritis Visualized by Three-Dimensional FLAIR-VISTA Magnetic Resonance Imaging. Neuroophthalmology. 2016; 38(2):60-61. PMC: 5123162. DOI: 10.3109/01658107.2013.874454. View

Curthoys I . Vestibular compensation and substitution. Curr Opin Neurol. 2000; 13(1):27-30. DOI: 10.1097/00019052-200002000-00006. View

Strupp M, Jager L, Muller-Lisse U, Arbusow V, Reiser M, Brandt T . High resolution Gd-DTPA MR imaging of the inner ear in 60 patients with idiopathic vestibular neuritis: no evidence for contrast enhancement of the labyrinth or vestibular nerve. J Vestib Res. 1998; 8(6):427-33. View

Celebisoy N . Acute vestibular syndrome: clinical head impulse test versus video head impulse test. J Neurol. 2018; 265(Suppl 1):44-47. DOI: 10.1007/s00415-018-8804-0. View

Murofushi T, Komiyama S, Hayashi Y, Yoshimura E . Frequency preference in cervical vestibular evoked myogenic potential of idiopathic otolithic vertigo patients. Does it reflect otolithic endolymphatic hydrops?. Acta Otolaryngol. 2015; 135(10):995-9. DOI: 10.3109/00016489.2015.1022834. View

Manzari L, Koch G, Tramontano M . Selective Asymmetry of Ocular Vestibular-Evoked Myogenic Potential in Patients with Acute Utricular Macula Loss. J Int Adv Otol. 2021; 17(1):58-63. PMC: 7901419. DOI: 10.5152/iao.2020.18012020. View

10.

Fujimoto C, Suzuki S, Kinoshita M, Egami N, Sugasawa K, Iwasaki S . Clinical features of otolith organ-specific vestibular dysfunction. Clin Neurophysiol. 2017; 129(1):238-245. DOI: 10.1016/j.clinph.2017.11.006. View

11.

Kim K, Park E, Lee S, Kim B, Kim B, Kim J . Clinical Features and Neurotologic Findings in Patients With Acute Unilateral Peripheral Vestibulopathy Associated With Antiganglioside Antibody. Neurology. 2023; 101(19):e1913-e1921. PMC: 10663017. DOI: 10.1212/WNL.0000000000207814. View

12.

Mantokoudis G, Saber Tehrani A, Wozniak A, Eibenberger K, Kattah J, Guede C . VOR gain by head impulse video-oculography differentiates acute vestibular neuritis from stroke. Otol Neurotol. 2014; 36(3):457-65. DOI: 10.1097/MAO.0000000000000638. View

13.

PERLMAN H, Kimura R, Fernandez C . Experiments on temporary obstruction of the internal auditory artery. Laryngoscope. 1959; 69(6):591-613. DOI: 10.1288/00005537-195906000-00001. View

14.

Manzari L, Burgess A, Curthoys I . Does unilateral utricular dysfunction cause horizontal spontaneous nystagmus?. Eur Arch Otorhinolaryngol. 2012; 269(11):2441-5. DOI: 10.1007/s00405-012-2127-z. View

15.

Curthoys I, Burgess A, Manzari L . The Evidence for Selective Loss of Otolithic Function. Semin Neurol. 2019; 40(1):33-39. DOI: 10.1055/s-0039-3402064. View

16.

FLUUR E, Siegborn J . The otolith organs and the nystagmus problem. Acta Otolaryngol. 1973; 76(6):438-42. DOI: 10.3109/00016487309121533. View

17.

Guler A, Akarca F, Eraslan C, Tarhan C, Bilgen C, Kirazli T . Clinical and video head impulse test in the diagnosis of posterior circulation stroke presenting as acute vestibular syndrome in the emergency department. J Vestib Res. 2017; 27(4):233-242. DOI: 10.3233/VES-170620. View

18.

Brandt T . Otolithic vertigo. Adv Otorhinolaryngol. 2002; 58:34-47. DOI: 10.1159/000059110. View

19.

Eliezer M, Maquet C, Horion J, Gillibert A, Toupet M, Bolognini B . Detection of intralabyrinthine abnormalities using post-contrast delayed 3D-FLAIR MRI sequences in patients with acute vestibular syndrome. Eur Radiol. 2018; 29(6):2760-2769. DOI: 10.1007/s00330-018-5825-0. View

20.

Perez N, Rama-Lopez J . Head-impulse and caloric tests in patients with dizziness. Otol Neurotol. 2003; 24(6):913-7. DOI: 10.1097/00129492-200311000-00016. View