Jumbling Phenomenon in a Case of Unilateral Peripheral Vestibular Disease

Abstract

One kind of oscillopsia of vestibular origin consists of disorders in visual perception when a patient with loss of vestibular function moves rapidly. It is called “jumbling” and may be induced by insufficiency of compensatory vestibular eye movement.Usually “jumbling phenomenon” appears in cases of loss of bilateral vestibular function, since an intact unilateral labyrinth may completely cover the absence of unilateral vestibular function. However, it appeared in our three patients with unilateral vestibular disease: vestibular neuritis or unilateral labyrinthine disease due to meningitis. All three complained of difficulty in walking in dim light and sensed apparent move ments of a still target when they moved their head towards the side of the diseased ear either actively or passively.They had normal clear vision during movement of the head to the side of the intact ear. This may be called “unilateral jumbling” as opposed to “bilateral jumbling”, which is oscillopsia caused by moving the head to either. Unilateral jumbling, which seems to be provoked by strong DP (directional preponderance of nystagmus) due to acute vestibular asymmetry, may disappear as soon as vestibular symmetry disappears. However, unilateral jumbling in older patients or in those with unilateral vestibular disease combined with some central nervous system disorder may persist for a long time.