Nystagmus during an acute Ménière’s attack: from prodrome to recovery

John Fitzgerald,Jacob L Newman,Stephen J Cox,John S Phillips

doi:10.1080/14992027.2020.1799252

Abstract

Objective We are currently undertaking a clinical investigation to evaluate the diagnostic capability of a system for detecting periods of pathological dizziness. This article presents an analysis of the data captured during an acute attack of Ménière’s disease. Design The Continuous Ambulatory Vestibular Assessment (CAVA) device is worn by patients in the community, and continuously records eye and head movement data (vestibular telemetry). Study sample A 53-year-old lady with a fifteen-year history of left-sided unilateral Ménière’s disease. Results The patient wore the device nearly continuously for thirty days. The data revealed a three-hour long attack of vertigo consisting of four separate phases of nystagmus. The duration, beat-direction and slow phase velocity of the nystagmus evolved through time. The first phase contained isolated nystagmus beats which preceded the patient’s record of the vertigo attack onset but coincided with anticipation of an impending vertigo attack. Conclusions CAVA provides a unique insight into the physiological parameters present during episodes of dizziness. Here, it has provided the first full example of an acute Ménière’s attack, including a period of prodrome. These findings have implications for the prediction of vertigo attack onset, for the diagnosis of Ménière’s disease and other diseases resulting in dizziness.

Highlights

Meniere’s disease is a chronic idiopathic condition affecting the inner ear that results in repeated episodes of vertigo
The device data showed clear evidence of nystagmus during the period indicated by the patient—see Figure 2
We observed eight separate episodes of nystagmus occurring within a three-hour period (Figures 2 and 3, and Table 1)

Summary

Introduction

Meniere’s disease is a chronic idiopathic condition affecting the inner ear that results in repeated episodes of vertigo (van et al 2006). Little is known regarding the processes taking place within the vestibular system during a Meniere’s attack. There are anecdotal reports of patients being asked to use a mobile phone to record their eye movements during an attack of dizziness. Such an approach is useful for confirming the presence of nystagmus but relies on patients to correctly identify attack onset and to operate their phone during an attack

Methods

Results

Conclusion