Chasing dizzy chimera: Diagnosis of combined peripheral and central vestibulopathy

Abstract

Background and objectives: Diagnosis of combined peripheral and central vestibulopathy remains a challenge since the findings from peripheral vestibular involvements may overshadow those from central vestibulopathies or vice versa. The aim of this study was to enhance the detection of these intriguing disorders by characterizing the clinical features and underlying etiologies.Methods: We had recruited 55 patients with combined peripheral and central vestibulopathy at the Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2013. Peripheral vestibular involvement was determined by decreased caloric responses in one or both ears, and central vestibulopathy was diagnosed with obvious central vestibular signs or the lesions documented on MRIs to involve the central vestibular structures.Results: Combined peripheral and central vestibulopathy could be classified into four types according to the patterns of vestibular presentation. Infarctions in the territory of anterior inferior cerebellar artery were the most common cause of acute unilateral cases while cerebellopontine angle tumors were mostly found in chronic unilateral ones. Wernicke encephalopathy and degenerative disorders were common in acute and chronic bilateral disorders. HINTS may not detect central lesions in combined vestibulopathy. The dissociation in the abnormalities between the caloric and head impulse tests may suggest a combined peripheral and central vestibulopathy.Conclusions: Peripheral vestibular signs may overshadow the central ones in combined peripheral and central vestibulopathy. Given the requirements for urgent treatments and potentially grave prognosis of combined vestibulopathy, central signs should be sought carefully even in patients with obvious clinical or laboratory features of peripheral vestibulopathy. Background and objectives: Diagnosis of combined peripheral and central vestibulopathy remains a challenge since the findings from peripheral vestibular involvements may overshadow those from central vestibulopathies or vice versa. The aim of this study was to enhance the detection of these intriguing disorders by characterizing the clinical features and underlying etiologies. Methods: We had recruited 55 patients with combined peripheral and central vestibulopathy at the Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2013. Peripheral vestibular involvement was determined by decreased caloric responses in one or both ears, and central vestibulopathy was diagnosed with obvious central vestibular signs or the lesions documented on MRIs to involve the central vestibular structures. Results: Combined peripheral and central vestibulopathy could be classified into four types according to the patterns of vestibular presentation. Infarctions in the territory of anterior inferior cerebellar artery were the most common cause of acute unilateral cases while cerebellopontine angle tumors were mostly found in chronic unilateral ones. Wernicke encephalopathy and degenerative disorders were common in acute and chronic bilateral disorders. HINTS may not detect central lesions in combined vestibulopathy. The dissociation in the abnormalities between the caloric and head impulse tests may suggest a combined peripheral and central vestibulopathy. Conclusions: Peripheral vestibular signs may overshadow the central ones in combined peripheral and central vestibulopathy. Given the requirements for urgent treatments and potentially grave prognosis of combined vestibulopathy, central signs should be sought carefully even in patients with obvious clinical or laboratory features of peripheral vestibulopathy.