Vertigo Attacks Research Articles

A Case of Neurovascular Compression Syndrome Confirmed by the Finding of Nystagmus During a Vertigo Attack

A Case of Neurovascular Compression Syndrome Confirmed by the Finding of Nystagmus During a Vertigo Attack

Diferencijalna dijagnoza vertiga - prikazi slučajeva

Introduction: Vertigo represents illusion or hallucination of movement caused by disturbance of perception of own movements or movements of observed object. It is caused by dysfunction of the inner ear vestibular apparatus (peripheral vertigo) or parts of central nervous system (central vertigo). Making distinction between these two types is very important for the making of rational decision by emergency medicine physician. Case report I: Female, 69 years of age is referred to neurologist in Emergency Center for attacks of acute onset rotatory vertigo, horizontal nystagmus and severe autonomic disturbances provoked by movement. Anamnesis, clinical, neuroultrasound examinations and CT scan showed no signs of acute neurologic disease. Treatment of peripheral type vertigo with vasodilators was indicated and further continued with otolaryngologist follow up. Case report II: Male, 72 years of age was treated on Clinic of Neurology for infarction of left cerebellar hemisphere. Symptoms at onset were vertigo, headache, diplopia, nausea and vomiting. Neurological examination revealed right sided horizontalrotatory nystagmus with fine vertical nystagmus, astasia/abasia and right sided hemiparesis. Treatment included thrombolytic, antithrombotic and anticoagulant therapy, as well as established vascular risk treatment. Conclusion: Role of emergency physician in establishing of etiology of vertigo at the place of onset is very important. Detailed anamnesis about onset of symptoms and their duration, clinical examination, diagnostic (ABCD2) score, and therapeutic repositioning (Epley) maneuver ensure fast triage and shorter transport delays if necessary.

Longitudinal variation of endolymphatic hydrops in patients with Ménière's disease.

The relationships of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) with Ménière's disease (MD) remains unclear. This study aimed to describe the dynamic variation of EH and PE for MD patients over 2 hospitalizations by applying magnetic resonance imaging (MRI) to further clarify the relationships of EH and PE with MD. A total of 77 MD patients who underwent inner ear MRI after intravenous administration of gadolinium and pure-tone average (PTA) testing during a first and second hospitalization were included. The degree of EH and PE were evaluated via MRI, and the duration and frequency of vertigo attacks and PTA were collected and recorded. The PTA, EH, and PE for the 2 hospitalizations were compared, and the relationships of EH and cochlear PE with the MD stage were investigated. There was no difference between the 2 hospitalizations for duration of vertigo attacks or frequency of vertigo attacks. However, there were significant differences in PTA (Z=-3.02, P=0.003). Additionally, the cochlear and vestibular EH in the asymptomatic ear at the second hospitalization was significantly worse than that of the first hospitalization (Z=-2.33 and -2.49, P=0.020 and 0.013, respectively), while there were no differences in EH and PE in the affected ear (all P>0.05). Moreover, the degree of cochlear and vestibular EH was correlated with MD stage (both P<0.01). Although EH and PE in the affected ear were unchanged over 2 hospitalizations, an underlying EH in the asymptomatic ear and hearing loss in the affected ear for MD patients developed longitudinally with the duration of disease, and EH varied with the natural course of MD whereas PE did not. Therefore, EH instead of PE is necessary but insufficient to cause the clinical symptoms of MD.

The use of brandt daroff for Vertigo among elderly

Introduction: Vertigo is a disturbance in the orientation or balance of the body towards a room that makes the patient feel moving or spinning and feel pain. Vertigo attacks if not treated immediately will cause bad effects, namely life. Vertigo can also be a serious cause of early symptoms of a brain tumor. many vertigo sufferers are less concerned about vertigo, the only action taken is taking medication when the vertigo recurs, and just lying down or resting at home, not being taken to the nearest health service and there is no effort to prevent vertigo symptoms. Efforts to reduce vertigo symptoms non-pharmacologically include therapy Brandt Daroff which has the advantage of being able to accelerate the recovery of vertigo and prevent recurrence without having to take drugs. Objective: This study aims to apply therapy Brandt Daroff to reduce vertigo symptoms in the elderly in the family. Methods: The method used in this research is a case study, with a purposive sampling technique. The sample taken was an elderly patient aged 49 years who experienced vertigo with a pain scale of 4. The research data was taken by participatory observation method. Interview and documentation method. Results: the results of this study found that physical therapy brandt daroff can reduce vertigo symptoms in the form of pain from a scale of 4 to a scale of 2 within 6 visits for 2 weeks. Conclusion: therapy Brandt Daroff can reduce the scale of pain that can be done at home, in contrast to other methods that must be done with a doctor's supervision.

Meniere's Disease Patients with Distinct Sac Pathoanatomic Findings React Differently to Endolymphatic Duct Blockage.

To explore the possible difference in response to endolymphatic duct blockage (EDB) treatment in patients with Meniere's disease (MD) with distinct pathoanatomic characteristics of the sac. In a total of 24 patients with MD receiving EDB treatment, the dynamics of the vertigo attack, hearing, vestibular function, and endolymph hydrops (EH) before surgery and 40 months following surgery in patients with normoplastic extraosseous portion of endolymphatic sac (eES) were compared with that in patients with atrophic eES. A higher prevalence of complete vertigo control, better cochlear and vestibular function, and lower endolymph to vestibule-volume ratio were found in patients with normoplastic eES than in those with atrophic eES. Moreover, the reversal of EH was found in a total of six patients in normoplastic eES group, but no reversal of EH was detected in the atrophic eES group after surgery. A difference in response to EDB treatment was shown in the MD patients with normoplastic eES and those with atrophic eES; the reversal of EH was found in the normoplastic eES group, but not in the atrophic eES group after surgery, suggesting two distinct pathologies in the eESs may underlie the pathogenesis of EH in two subgroups of MD patients. 4 Laryngoscope, 133:2761-2769, 2023.

The peripheral blood inflammatory markers in Ménière's disease patients with and without migraine

Objective: To investigate the peripheral blood inflammatory markers including white blood cell count (WBC), monocytes, neutrophils, lymphocytes, platelets, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), high-density lipoprotein(HDL-C), low-density lipoprotein and fibrinogen (FIB) in Ménière's disease (MD) patients with and without migraine, and to explore the relationship between the inflammatory response with MD and migraine. Methods: The general physical condition, clinical manifestations, pure-tone audiometry, and peripheral blood inflammatory markers of 92 unilateral MD patients who were hospitalized in Peking University People's Hospital for surgical treatment from January 2017 to January 2021 were continuously collected. Meanwhile, 50 healthy controls matched with age and sex were included, and their general physical conditions and peripheral blood inflammatory markers were also collected. This study consisted of two parts. First, the differences in epidemical characteristics and peripheral blood inflammatory markers between MD patients and healthy controls were compared by univariate analysis. Second, all 92 MD patients were divided into two subgroups according to whether they were accompanied by migraine. The clinical characteristics and peripheral blood inflammatory markers of MD patients with and without migraine were compared by univariate analysis. Thereafter, binary Logistic regression was used to analyze the related factors of whether MD patients were accompanied with migraine. Results: Compared with the healthy control group, the peripheral blood WBC, neutrophils and FIB of MD patients were significantly increased (all P<0.05). Compared with MD patients without migraine, MD patients with migraine had higher female prevalence, longer disease history, lower low-frequency hearing threshold, higher frequency of vertigo attacks and higher HDL-C levels (all P<0.05), meanwhile, female, frequency of vestibular attacks and HDL-C were independent related factors of whether MD patients were accompanied with migraine. Conclusion: The occurrence of MD and migraine may be related to the inflammatory response. The level of anti-inflammatory factors in the blood of MD patients with migraine are higher, suggesting that the inflammatory response status of MD patients with and without migraine is different.

Co-Occurrence of Sj/ITPR1 and NMDA Antibodies: A Case Report

Objective To highlight a case of concurrent anti-SJ/ITPR1 and anti-NMDA encephalitis. Background The anti-Sj/inositol 1,4,5-trisphosphate receptor (ITPR1) has been associated with autoimmune cerebellar ataxia and malignancy. Reports of patients with anti-Sj/ITPR1 describe isolated cerebellar ataxia as well as various manifestations throughout the central and peripheral nervous system. Anti-NMDA encephalitis presents with subacute decline, seizures, movement disorder, alterations in behavior and cognition, autonomic dysfunction, and central hypoventilation but is rarely associated with cerebellar ataxia in adults. Design/Methods NA. Results A 28-year-old female with no relevant medical history presented to an outside hospital with acute onset headache, diplopia, nystagmus, and vertigo. MRI and MRV were unremarkable. CSF analysis showed a lymphocytic pleocytosis. She was empirically treated with acyclovir, although viral serologies were negative. On initial assessment in our clinic, neurologic exam showed square wave jerks, ataxic eye movements, resting tremor, appendicular and gait ataxia. She progressively declined with gait instability, autonomic dysfunction, neuropsychiatric symptoms, and significant weight gain from compulsive hyperphagia. Her course was complicated by respiratory failure and tracheostomy was placed for mechanical ventilation. Malignancy screening with mammogram, CT, and full body PET was negative. Transvaginal ultrasound was nondiagnostic. Serum paraneoplastic autoantibody panel was negative. EEG showed severe generalized slowing. Repeat CSF studies were positive for anti-SJ/ITPR1 and anti-NMDA. She was treated with high-dose IV methylprednisolone, plasmapheresis, and rituximab. She has residual moderate/severe ataxia, but is now conversant, without trach dependence, and ambulates with assistance. Conclusions There is no definite current evidence for the pathogenicity of the ITPR1 antibody. Given the rarity of cerebellar ataxia in anti-NMDA encephalitis in adults, one could argue for a pathogenic role of ITPR1 in our case. No underlying malignancy was identified in our patient. We will continue surveillance since the clinical syndrome may precede tumor identification by several years.

Long-term efficacy of dexamethasone treatment via tympanic antrum catheterization for intractable Meniere's disease.

To explore the long-term efficacy and safety of dexamethasone treatment via tympanic antrum catheterization (TAC) in intractable Meniere's disease (MD). In this retrospective analysis, 60 unilateral intractable MD patients treated with TAC in our hospital from January 2020 to August 2020 were followed for 2 years. Fifty patients who underwent endolymphatic sac decompression (ESD) and 50 patients who accepted intratympanic steroids (ITS) were established as the control groups. Vertigo control, hearing level, tinnitus, aural fullness and functional level were assessed during the study. The effective vertigo control rate of intractable MD patients with TAC treatment was 76.7% (46/60) after 2 years follow-up, with a complete control rate of 58.3% (35/60) and a substantial control rate of 18.3% (11/60). The vertigo control rate of TAC was comparable to that of ESD (χ 2 = 0.313, p > 0.05), and significantly higher than that of ITS (χ 2 = 4.380, p < 0.05). The hearing loss rate of these patients was 10.8% (4/37), which was not significantly different from the control groups (χ 2 = 2.452, p > 0.05). The tinnitus improvement rate of patients with TAC was 56.7% (34/60), which was significantly higher than that of patients with ESD (χ 2 =11.962, p < 0.001) and ITS (χ 2 =15.278, p < 0.001). The aural fullness improvement rate in the TAC group was 56.7% (34/60), which was significantly higher than that in the ESD (χ 2 = 11.962, p < 0.001) and ITS groups (χ 2 = 5.635, p < 0.05). The functional level improvement rate in the TAC group was 71.7% (43/60), which was much higher than that in the ITS group (χ 2 = 17.256, p < 0.001), but there was no significant difference between TAC and ESD (χ 2 = 0.410, p > 0.05). No patients had complications or adverse reactions following TAC treatment. Dexamethasone treatment via TAC can effectively control vertigo attacks and improve related symptoms of intractable MD patients, providing valuable new insights into the treatment of MD.

Assessment of inner ear morphology and function in response to local positive pressure for Ménière’s disease: a nonrandomized controlled trial

Ménière’s disease (MD) is an inner ear disorder in which the main pathological feature is endolymphatic hydrops (EH). Positive pressure therapy (PPT) using a portable device is now a second-line therapy for intractable MD when initial medical treatment fails. However, it remains unknown whether PPT causes the morphological and functional changes of inner ear in patients with active MD in accordance with reduction of vertigo attacks. In this nonrandomized controlled trial of 52 patients with MD, the volume of EH significantly decreased with reduction of vertigo attacks during 8 months of PPT combined with medications while the volume of that significantly increased with medications alone. There was no difference between Control group (n = 26) and PPT group (n = 26) regarding the vertigo control, however, PPT group achieved a significant functional improvement of vertical semicircular canals. The effect of volume reduction by PPT has been firstly demonstrated and the functional changes of all semicircular canals during PPT have been firstly examined. Morphological and functional changes in the inner ear by administrating local positive pressure are quite different from those caused by medications alone.Clinical trial registration: UMIN-CTR UMIN000041164 (registered on July 20, 2020).

Correlation Between Quantitative Value of Endolymphatic Hydrops and Hearing Threshold Using Magnetic Resonance Imaging.

This study investigated the relationship between quantitative value of endolymphatic hydrops in the affected ear and the hearing threshold in patients with unilateral Meniere's disease. Prospective study. Forty patients with unilateral definite Meniere's disease were diagnosed in outpatient clinic. We recorded their clinical symptoms (duration of vertigo and tinnitus and duration of vertigo attacks), and obtained the hearing thresholds of high, middle, and low by pure tone audiometry. A 3D-FLAIR MRI revealed endolymphatic hydrops and assessed quantitative values of cochlear and vestibular endolymphatic hydrops. We assessed the correlation between hearing thresholds and quantitative values of endolymphatic hydrops. All patients showed varying degrees of endolymphatic hydrops in the affected ear. With the duration of vertigo, tinnitus and vertigo attacks as control variables, partial correlation analysis showed that the correlation coefficients between quantitative value of cochlear hydrops and hearing thresholds of low, middle, and high tone in the affected ear were 0.581, 0.610, and 0.125, respectively. The correlation coefficients between quantitative value of vestibular hydrops and hearing thresholds of low, middle, and high tone in the affected ear were 0.727, 0.569, and 0.201, respectively. The degree of endolymphatic hydrops in Meniere's disease can be revealed and assessed by 3D-FLAIR MRI after intravenous administration of double doses of gadoterate meglumine. Clinical evaluation of endolymphatic hydrops in Meniere's disease can be assisted by low- and middle-tone hearing thresholds, thereby providing anatomical support for the clinical symptoms of Meniere's disease.

Letter to the Editor in Reference to “New Onset Vertigo After COVID-19 Infection” – COVID-19-related Vestibular Neuritis: Case Series and Review of the Literature

Letter to the Editor in Reference to “New Onset Vertigo After COVID-19 Infection” – COVID-19-related Vestibular Neuritis: Case Series and Review of the Literature

Lateral Medullary Syndrome Presenting as Babinski–Nageotte Syndrome with Ipsilateral Upper Motor Neuron Facial Palsy

Babinski–Nageotte syndrome is one of the variants of lateral medullary syndrome (LMS) with contralateral hemiparesis along with classical LMS findings. The simultaneous occurrence of ipsilateral central facial nerve palsy and contralateral hemiparesis is an extremely rare occurrence in LMS. We report the case of a 46-year-old male who presented with complaints of acute onset of vertigo, right-sided (ipsilateral) Horner syndrome, facial sensory loss, upper motor neuron facial nerve palsy, ataxia, and left hemiparesis (contralateral). Magnetic resonance imaging brain suggested acute infarct of the right dorsal medulla and medial aspect of the right cerebellar tonsil with attenuation of the distal segment of the right vertebral artery and right posterior inferior cerebellar artery.

Videonystagmography (VNG) and video head impulse test (vHIT) analysis of patients with migraine who had first episode of vertigo

Objective This study reviews the pattern of vestibular disturbance by videonystagmography (VNG) and video head impulse (vHIT) tests in patients with migraine during first attack of vertigo. Method Thirty-four patients with migraine (21 female, 13 male) were recruited. The main outcome measure is to analyze the spontaneous nystagmus, VNG findings, and the pattern of vHIT abnormality. Patients were grouped as those with (Group-I, 24 patients) or without (Group-II, 10 patients) spontaneous nystagmus. One-way analysis of variance (ANOVA test) was used to analyze the groups. Results Normal vHIT responses without refixation saccades but with lower gain were detected in 10 patients (29.4%). Fourteen patients (41%) showed abnormal vHIT results either in the form of normal or low VOR gain with refixation saccades. Six patients (42%) demonstrated dysfunction of both vestibular nerves. Of the 8 patients with unilateral refixation saccades, 2 patients (25%) had involvement of both vestibular nerve divisions, 2 patients had (25%), the superior vestibular nerve, and 4 patients (50%) had inferior vestibular nerve involvement. Conclusion Results suggest that the peripheral vestibular system is likely affected during migraine-associated vertigo. Re-fixation saccades were detected by vHIT in nearly half of the patients (42%). However, no specific pattern has been found. Inferior vestibular nerve involvement was more frequent.

A Drosophila model for Meniere's disease: Dystrobrevin is required for support cell function in hearing and proprioception.

Meniere's disease (MD) is an inner ear disorder characterised by recurrent vertigo attacks associated with sensorineural hearing loss and tinnitus. Evidence from epidemiology and Whole Exome Sequencing (WES) suggests a genetic susceptibility involving multiple genes, including α-Dystrobrevin (DTNA). Here we investigate a Drosophila model. We show that mutation, or knockdown, of the DTNA orthologue in Drosophila, Dystrobrevin (Dyb), results in defective proprioception and impaired function of Johnston's Organ (JO), the fly's equivalent of the inner ear. Dyb and another component of the dystrophin-glycoprotein complex (DGC), Dystrophin (Dys), are expressed in support cells within JO. Their specific locations suggest that they form part of support cell contacts, thereby helping to maintain the integrity of the hemolymph-neuron diffusion barrier, which is equivalent to a blood-brain barrier. These results have important implications for the human condition, and notably, we note that DTNA is expressed in equivalent cells of the mammalian inner ear.

Recurrent Vestibulopathy: Comparison of Vestibular Test Results with Ménière’s Disease and Vestibular Migraine

Introduction: Recurrent and episodic vestibular symptoms not fulfilling criteria for known episodic vestibular syndromes are named as recurrent vestibulopathy (RV). We aimed to compare the vestibular test results of RV patients with vestibular migraine (VM) and Ménière’s disease (MD). Methods: Twenty patients with MD, 20 patients with VM, 18 patients with RV, and 20 healthy volunteers (HC) were evaluated. Pure-tone hearing thresholds (PTHTs), video head impulse test (vHIT), functional head impulse test (fHIT), and cervical vestibular evoked myogenic potentials (cVEMPs) were studied. Results: PTHT of the MD-affected ears were significantly high, and cVEMP-corrected amplitudes were low when compared with the VM, RV, and HC (p < 0.001 for all). Amplitude asymmetry ratio was significantly high in MD-affected ears when compared with the HC (p = 0.014), VM (p = 0.038), and RV (p = 0.045). VEMP latencies and lateral canal vHIT gain were not different between groups (p > 0.05). The percentage of correctly identified optotypes on fHIT of the MD (p > 0.001), VM (p = 0.004), and RV (p = 0.001) patients were low in comparison with the HC. Conclusion: Apart from hearing loss, low cVEMP amplitudes on the affected side were the main feature in MD differentiating it from VM and RV. Vestibular test results of patients with RV and VM were similar. Low fHIT results in all groups indicate a functional deficit in gaze stabilization. Disabling vertigo attacks disturbing attention may be the cause of this functional impairment. MD, VM, and RV may be parts of a broad-spectrum disorder, RV patients representing milder forms not associated with cochlear or migrainous features.

Surgical Fixation of Jugular Bulb Abnormalities Associated With Phelebectasia in Patients With Vascular Tinnitus.

Internal jugular phlebectasia is a rare entity in which there is a fusiform dilatation of the internal jugular vein (IJV), usually presenting as a neck mass or tinnitus. The jugular bulb (JB) is an enlarged confluence connecting the sigmoid sinus and the IJV. It has been suggested that JB abnormality might also cause vertigo and pulsatile tinnitus. This prospective interventional study involved 15 patients with pulsatile tinnitus associated with internal jugular phlebectasia. Four patients presented with recurrent vertigo attacks. IJV diameter at rest ranged from 11 to 18 mm. Eight patients have had inner ear bone dehiscence, and 40% had high JB. All cases were treated by surgical fixation using a ringed polytetrafluoroethylene graft extending from the costoclavicular joint to the sigmoid sinus under fluoroscopic guidance. Tinnitus disappeared immediately postoperatively in all cases, followed by the disappearance of vertigo on the fourth day. Two cases reported thrombosis of the graft in the sixth and seventh months but maintained symptomatic improvement. Recurrence was reported in 2 cases while the grafts were patent. Surgical fixation by replacing the jugular vein and bulb with a synthetic graft may offer an excellent surgical option for relieving vascular tinnitus, especially in these young patients in whom endovascular therapy may not be a durable treatment.

Episodic ataxias in children and adolescents: Clinical findings and suggested diagnostic criteria.

The main clinical presentation of episodic ataxias (EAs) consists of vertigo and dizziness attacks lasting for minutes to hours with widely varying accompanying symptoms. The differentiation of EA and episodic vertigo/dizziness syndromes in childhood and adolescence such as vestibular migraine (VM) and recurrent vertigo of childhood (RVC) can be challenging. Furthermore, only few prospective studies of children/adolescents with EA are available. This study aims to characterize clinical and instrument-based findings in EA patients under 18 years of age, to delineate the clinical and therapeutic course in EA, and to present potentially new genetic mutations. Furthermore, the study aims to differentiate distinct characteristics between EA, VM, and RVC patients. We prospectively collected clinical and instrument-based data of patients younger than 18 years, who presented at the German Center for Vertigo and Balance Disorders (DSGZ) at the LMU University Hospital in Munich with EA, VM, or RVC between January 2016 and December 2021. All patients underwent a comprehensive evaluation of neurological, ocular-motor, vestibular and cochlear function, including video-oculography with caloric testing, video head impulse test, vestibular evoked myogenic potentials, posturography, and gait analysis. Ten patients with EA, 15 with VM, and 15 with RVC were included. In EA the main symptoms were vertigo/dizziness attacks lasting between 5 min and 12 h. Common accompanying symptoms included walking difficulties, paleness, and speech difficulties. Six EA patients had a previously unknown gene mutation. In the interictal interval all EA patients showed distinct ocular-motor deficits. Significant differences between EA, VM, and RVC were found for accompanying symptoms such as speech disturbances and paleness, and for the trigger factor "physical activity". Furthermore, in the interictal interval significant group differences were observed for different pathological nystagmus types, a saccadic smooth pursuit, and disturbed fixation suppression. By combining clinical and ocular-motor characteristics we propose diagnostic criteria that can help to diagnose EA among children/adolescents and identify patients with EA even without distinct genetic findings. Nevertheless, broad genetic testing (e.g., next generation sequencing) in patients fulfilling the diagnostic criteria should be conducted to identify even rare or unknown genetic mutations for EA.

Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria.

This paper describes the diagnostic criteria for Acute Unilateral Vestibulopathy (AUVP), a synonym for vestibular neuritis, as defined by the Committee for the Classification of Vestibular Disorders of the Bárány Society. AUVP manifests as an acute vestibular syndrome due to an acute unilateral loss of peripheral vestibular function without evidence for acute central or acute audiological symptoms or signs. This implies that the diagnosis of AUVP is based on the patient history, bedside examination, and, if necessary, laboratory evaluation. The leading symptom is an acute or rarely subacute onset of spinning or non-spinning vertigo with unsteadiness, nausea/vomiting and/or oscillopsia. A leading clinical sign is a spontaneous peripheral vestibular nystagmus, which is direction-fixed and enhanced by removal of visual fixation with a trajectory appropriate to the semicircular canal afferents involved (generally horizontal-torsional). The diagnostic criteria were classified by the committee for four categories: 1. "Acute Unilateral Vestibulopathy", 2. "Acute Unilateral Vestibulopathy in Evolution", 3. "Probable Acute Unilateral Vestibulopathy" and 4. "History of Acute Unilateral Vestibulopathy". The specific diagnostic criteria for these are as follows:"Acute Unilateral Vestibulopathy": A) Acute or subacute onset of sustained spinning or non-spinning vertigo (i.e., an acute vestibular syndrome) of moderate to severe intensity with symptoms lasting for at least 24 hours. B) Spontaneous peripheral vestibular nystagmus with a trajectory appropriate to the semicircular canal afferents involved, generally horizontal-torsional, direction-fixed, and enhanced by removal of visual fixation. C) Unambiguous evidence of reduced VOR function on the side opposite the direction of the fast phase of the spontaneous nystagmus. D) No evidence for acute central neurological, otological or audiological symptoms. E) No acute central neurological signs, namely no central ocular motor or central vestibular signs, in particular no pronounced skew deviation, no gaze-evoked nystagmus, and no acute audiologic or otological signs. F) Not better accounted for by another disease or disorder."Acute Unilateral Vestibulopathy in Evolution": A) Acute or subacute onset of sustained spinning or non-spinning vertigo with continuous symptoms for more than 3 hours, but not yet lasting for at least 24 h hours, when patient is seen; B) - F) as above. This category is useful for diagnostic reasons to differentiate from acute central vestibular syndromes, to initiate specific treatments, and for research to include patients in clinical studies."Probable Acute Unilateral Vestibulopathy": Identical to AUVP except that the unilateral VOR deficit is not clearly observed or documented."History of acute unilateral vestibulopathy": A) History of acute or subacute onset of vertigo lasting at least 24 hours and slowly decreasing in intensity. B) No history of simultaneous acute audiological or central neurological symptoms. C) Unambiguous evidence of unilaterally reduced VOR function. D) No history of simultaneous acute central neurological signs, namely no central ocular motor or central vestibular signs and no acute audiological or otological signs. E) Not better accounted for by another disease or disorder. This category allows a diagnosis in patients presenting with a unilateral peripheral vestibular deficit and a history of an acute vestibular syndrome who are examined well after the acute phase.It is important to note that there is no definite test for AUVP. Therefore, its diagnosis requires the exclusion of central lesions as well as a variety of other peripheral vestibular disorders. Finally, this consensus paper will discuss other aspects of AUVP such as etiology, pathophysiology and laboratory examinations if they are directly relevant to the classification criteria.

Transmyringeal ventilation tube insertion for unilateral Menière’s disease: a protocol for a prospective, sham-controlled, double-blinded, randomized, clinical trial

BackgroundMenière’s disease is an idiopathic disorder characterized by recurrent episodes of vertigo lasting more than 20 min, unilateral sensorineural hearing loss, and tinnitus. If vertigo attacks occur frequently, the patient is usually severely incapacitated. Currently, there is no consensus on the treatment of Menière’s disease. The evidence regarding most treatment options is sparse due to a lack of randomized trials together with an often-spontaneous relief over time and a considerable placebo effect. Insertion of a transmyringeal tube is a simple and relatively safe, minimally invasive procedure and previous open-label trials have shown promising results.Study designThis is a prospective, sham-controlled, double-blinded, randomized, clinical trial.AimThis trial aims to assess the effects of inserting a ventilation tube into the tympanic membrane compared with sham treatment for definite or probable unilateral Menière’s disease according to the criteria formulated by the Classification Committee of the Bàràny Society.OutcomesThe primary outcome will be the number of spontaneous vertigo attacks lasting more than 20 min and time to treatment failure. In addition to the primary outcome, we will assess various secondary outcomes related to hearing, ear fullness, dizziness, and serious adverse events.Sample sizeAn estimated 104 participants in total or 52 participants in each group will be necessary.The primary analysis will be according to the intention-to-treat principle. The trial will be initiated in 2021 and is expected to end in 2025.Trial statusClinicalTrials.gov: NCT04835688. Registered on April 8, 2021.Protocol version: 1.8, 26-09-2022. Date of first enrollment: October 1st, 2021. End of study: anticipated January 2025.

Intravenous gadolinium-enhanced inner ear MRI of a patient with Ménière's disease during a vertigo attack

梅尼埃病发作期的内耳磁共振钆造影鲜有报道，本文报道1例梅尼埃病患者在间歇期和发作期内耳影像的动态变化。该男性老年梅尼埃病患者在间歇期完成静脉给药的内耳磁共振钆造影，次日在发作期完成影像复查。结果显示，梅尼埃病发作期患耳内淋巴积水的程度较发作前减轻，且未见明显膜迷路破裂、内外淋巴交混的证据。该患者梅尼埃病发作期影像不支持膜迷路破裂学说，在短时间内发生的内淋巴的体积变化可能与其眩晕发作相关。.