Do patients who experience episodic tilting or translational sensations in the pitch plane have abnormal sacculo-collic reflexes?

Abstract

The otolith-collic and otolith-ocular reflexes of patients who experienced episodic tilting or translational sensations in the pitch plane without any other vestibular symptoms were assessed using cervical vestibular evoked myogenic potentials (cVEMP) and ocular vestibular evoked myogenic potentials (oVEMP). Eleven patients (4 men and 7 women, mean age=40.4) were enrolled. All of the patients complained of episodic tilting or translational sensations in the pitch plane. Patients with a medical history of rotatory vertigo, loss of consciousness, head trauma, or symptoms of central nervous dysfunction or proprioceptive dysfunction and those who had been definitely diagnosed with a disease that causes disequilibrium were excluded. All 11 patients underwent cVEMP and caloric tests. Ten patients participated in the oVEMP tests. Seven of the 11 patients exhibited unilateral cVEMP absences, two displayed bilateral cVEMP absences, one demonstrated unilaterally decreased cVEMP, and one displayed normal cVEMP. Concerning oVEMP, 2 of the 10 patients showed unilateral oVEMP absences, 2 displayed bilateral oVEMP absences, 2 exhibited unilaterally decreased oVEMP, and 4 displayed normal oVEMP. All patients exhibited normal bilateral caloric responses. These findings were distinct from the results obtained for patients who experienced episodic lateral tilting sensations in previous studies. While most of the latter patients exhibited abnormal oVEMP, the patients in the present study tended to display abnormal cVEMP. These results suggest that patients with episodic tilting or translational sensations in the pitch plane suffer from saccular dysfunction. We propose “idiopathic otolithic vertigo” as a clinical entity and suggest that it is caused by idiopathic saccular dysfunction and/or utricular dysfunction.