Peripheral Vertigo Research Articles

Case Report : Wanita 60 Tahun dengan Vertigo Perifer di Rumah Sakit Cut Meutia Aceh Utara

Vertigo is a phenomenon that is often encountered. Vertigo is a symptom or feeling where someone or objects around them seem to be moving or spinning, which is usually accompanied by nausea or loss of balance. . Cases of peripheral vertigo are more common with a percentage of 75% compared to cases of central vertigo. A 60 year old woman came to the emergency room at Cut Meutia Hospital with complaints of dizziness for 3 days before entering the hospital accompanied by nausea. The results of the romber test examination showed that the patient failed to maintain balance and the dix-hallpike showed lateral nystagmus +/+. Based on the history, physical examination and supporting examinations, the patient was diagnosed with peripheral vertigo ec Benign Paroxysmal Positional Vertigo (BPPV). Medical therapy was carried out in the form of Inf. Asering, Inj. Ondancetron/12h, Betahistine 6mg 3x1, Omeprazole 20mg 2x1 and Paracetamol 500mg 3x1.

Benign paroxysmal positional vertigo

Abstract Benign paroxysmal positional vertigo (BPPV) is the leading etiology of peripheral vertigo. It manifests with transient, recurring bouts of vertigo brought on by movements of the head. BPPV happens when particles known as otoliths, which can either float freely (canalithiasis) or become attached to the cupula (cupulolithiasis), stimulate semicircular canals abnormally. The clinical symptoms of the BPPV are triggered when the head changes position so that the involved semicircular canal aligns vertically with gravity. During the Dix–Hallpike maneuver (used to diagnose posterior canal BPPV) and the supine roll test (used to diagnose horizontal canal BPPV), patients typically experience a brief delay followed by acute vertigo and nystagmus. Reversing the head position often causes the nystagmus to change direction. The location of otolith debris and the semicircular canal that is affected determine the severity, frequency, and length of symptoms in BPPV. There may be a spontaneous recovery of the BPPV with the help of conservative treatments. However, an important treatment option such as the canalith repositioning maneuver is helpful for giving an immediate resolution of the symptoms by clearing otolithic debris from the semicircular canal into the vestibule. This review article will discuss the prevalence, etiopathology, clinical features, differential diagnosis, and management of different types of BPPV including medical and surgical treatment and rehabilitation for BPPV.

Effect of Transcranial Direct Current Stimulation and Brandt-Daroff Exercises in Benign Paroxysmal Positional Vertigo: A Study Protocol

Abstract Background: Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of peripheral vertigo that constitutes more than half of all occurrences of vestibular disorders. Objective: The objective of this study was to find out the effectiveness of transcranial direct current stimulation (tDCS) along with vestibular rehabilitation therapy (VRT) on dizziness, anxiety, and various cardiovascular parameters. Methods: The present study will be a parallel-group single-blinded randomized controlled trial with concealed allocation. The participants will be randomized into three groups: Group A (VRT group), Group B (tDCS group), and Group C (tDCS + VRT group). The outcome variables will be the Dizziness Handicap Inventory Scale, Beck Anxiety Inventory Scale, and cardiovascular parameters. The outcome variables will be assessed at the baseline, at week 4, and a follow-up at week 6. Results: The result will be presented in the form of mean, standard deviation, median, and P value. Conclusions: The application of cerebellar tDCS along with Brandt-Daroff exercises can be seen as a potent approach to improve the symptoms of BPPV.

Effect of betahistine on pro-inflammatory cytokine expression in autoimmune inner ear disease and Meniere's disease patients.

Betahistine is a partial H1 receptor agonist and a potent H3 receptor antagonist commonly used for the treatment of MD and peripheral vertigo. The aim of this study was to investigate the impact of betahistine on the salt induced cytokine expression profiles of AIED and MD patients. Peripheral blood mononuclear cells (PBMCs) were obtained from 24 patients with autoimmune inner ear disease (AIED) or Meniere's disease (MD) during an acute exacerbation of hearing loss. These PBMCs were cultured with 80 mM NaCl or a combination of 80 mM NaCl and betahistine and IL-1β and IL-6 expression were measured by real time PCR and ELISA. In most patients, IL-1β expression in response to NaCl exceeded the unstimulated condition and this expression was abrogated by the addition of betahistine, which was statistically significant at p = .004. mRNA expression of IL-1β was not reduced when samples were treated with both salt and betahistine compared to samples treated with salt alone, inferring the mechanism of betahistine-mediated IL-1β suppression is post-translational. Similarly, IL-6 cellular release was augmented with salt exposure and reduced with co-culture of betahistine. Unlike IL-1 however, betahistine appeared to reduce IL-6 mRNA expression. We observe that betahistine abrogates salt-induced IL-1β expression, suggesting an additional treatment option for AIED and MD patients with inflammatory mediated disease. Level 4.

Clinical and Therapeutic Features of Herpes Zoster Oticus: A Case Report

Ear shingles, also called herpes zoster oticus or Sicard syndrome, are a viral infection of the outer, middle and/or inner ear due to varicella zoster virus (VZV). Patients with ear involvement associated with facial palsy are clinically diagnosed with Ramsay-Hunt´s syndrome. We here report the case of a 22-year-old patient with herpes zoster oticus associated with peripheral facial palsy, Associated with other signs such as tinnitus, peripheral rotational vertigo, and hypoacusis. The objective of this study is to report our experience in the treatment of sicard syndrome and investigate the various clinical, para-clinical and evolutionary features of herpes zoster oticus and the therapeutic approaches.

Comparing the efficacy of repositioning manoeuvres over medications in the treatment of posterior and lateral canal benign paroxysmal positional vertigo: a prospective, randomized and comparative study

Background: Benign paroxysmal positional vertigo (BPPV) is a benign peripheral disorder of vestibular system and is the most common cause of peripheral vertigo. The aim of our study was to compare and assess the efficacy of Epley’s and Barbeque roll over manoeuvres with labyrinthine sedatives in the management of Benign Paroxysmal Positional Vertigo (BPPV) over a period of one month and to know the prevalence of BPPV in different age and gender groups among the two semicircular canals(posterior and lateral). Methods-This prospective randomized comparative clinical trial included 60 patients with clinically diagnosed BPPV in a tertiary care centre and were investigated for a period on one year. The clinical diagnosis of specific canal type of BPPV was assessed based on the diagnostic tests, Dix Hallpike test and McClure test. In manoeuvre group, posterior canal BPPV, Epley’s manoeuvre was performed and for lateral canal BPPV, Barbeque roll over manoeuvre was performed as treatment. In pharmacological group, labyrinthine sedatives i.e. either cinnarizine 25mg twice a day or betahistine 16 mg twice a day were administered for one month as treatment. Results: Results were assessed at the end of 48 hours (immediate time period) and at four weeks’ time period after the treatment, under three different outcome categories namely disappeared, improving and unchanged. Treatment of Benign Paroxysmal Positional Vertigo with repositioning manoeuvre had higher success percentage of 83.3% than the medical treatment. Conclusion: The treatment of BPPV with repostioning manoeuvres had a better outcome than the medical treatment.

The Hidden "Ear-Way": A Cohort Analysis of Otologic Manifestations in Aspirin Exacerbated Respiratory Disease.

This study aims to report otologic manifestations in a cohort of patients with aspirin exacerbated respiratory disease (AERD) to determine if severity of sinonasal inflammation is associated with presence of otologic sequalae (OS). All AERD patients treated at a tertiary care center between 2009 and 2016 were included in analysis. Demographics, history of hearing loss, Lund-Mackay (LMK) scores, number of previous sinus procedures, CT findings, and pure tone averages (PTA) were compared between patients with and without OS using chi-square test, Fisher's exact test, and Wilcoxon rank sum test. Of 255 AERD patients, 58.4% were female with a mean age of 48.9 (SD: 13.4) years. The majority (52.2%) had otologic manifestations, most commonly: otitis media requiring antibiotics (n = 89, 34.9%), peripheral vertigo (n = 59, 23.1%), and middle ear effusion (n = 44, 17.3%). A total of 74 patients (29.0%) had hearing loss. PTA ranged from 13.3 to 61.7 dB for the cohort, with no significant difference between those with and without OS. There was no significant difference in LMK in both groups. Patients with OS had a significantly greater number of sinus procedures than those without OS (median = 2.4 and 1.8 respectively; P = .01). Otologic manifestations are common in patients with AERD. While there was an increased number of sinonasal surgeries performed in the patients with OS, there was no correlation between sinonasal inflammation, and the presence of OS as measured by LMK score or PTA. Otologic signs and symptoms should be considered in patients with AERD to help mitigate patient morbidity. III.

Lasting Deficiencies in Vergence Eye Movements in Patients with Peripheral or Central Vertigo: Improvements After Four Sessions of REMOBI Neurotraining and Associated Functional Benefits.

The vestibular function is in synergism with the oculomotor vergence. Vertigo may be related to vergence disorders and conversely, vestibular pathologies may affect vergence. To consolidate this hypothesis, we conducted a study at the vestibular orthoptic clinic of the Bastogne Hospital. Fourteen patients with vertigo history appearing 2 weeks to 8 years ago, aged 30 to 65 years were studied; at the moment of the eye movement study, no patient had acute attack of vertigo. The origin of vertigo varied (Meniere's disease, organic pathology, sensitivity to visual movement). An assessment with objective measurement of vergence (single-step protocol) was carried out with the REMOBI technology coupled with binocular video-oculography in sitting and standing positions. Four neuro-rehabilitation sessions of vergence eye movements were performed with the double-step in-depth protocol, alternating sitting and standing positions to involve different postural and vestibular functions. An assessment of vergence was done again 1 to 2 months later. The initial assessment revealed problems of magnitude and/or speed or variability of vergence for 11 of the patients relative to controls (published by the group in previous studies). After neuro-rehabilitation, an improvement was observed in eight patients. Patients reported a clear improvement of their self confidence in moving in the space. Posture measures done before rehabilitation comparing eyes fixating or closed or while making near-far vergence eye movements indicated lower medio-lateral acceleration when doing vergence eye movements in patients with vertigo history of functional origin. The results are in favor of the hypothesis of a symbiosis between vergence and vestibular function and the interest of diagnosis and rehabilitation of the vergence disorder in patients with vertigo history in the absence of acute vertigo attack.

EFFECTIVENESS OF EPLEY MANEUVER AND GANS REPOSITIONING MANEUVER ON DIZZINESS, BALANCE AND KINESIOPHOBIA IN PATIENTS WITH POSTERIOR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO

Background: Benign paroxysmal positional vertigo (BPPV) is the most prevalent type of peripheral vestibular vertigo, typically affecting the posterior semi-circular canal. Objective: The objective of study was to compare the effectiveness of Epley maneuver and Gans repositioning maneuver on dizziness, balance and kinesiophobia in patients with posterior canal BPPV. Methods: 30 BPPV patients were selected and assigned into two groups based on the selection criteria. Group-A (N=15), received Epley maneuver and 15 were assigned to Group-B, undergone Gans repositioning maneuver, for 20 minutes per session, 3 session (alternate days) per week for 3 weeks. Cawthorne and Cooksey Exercises were given to both the group as common intervention. Dizziness, balance and kinesiophobia were assessed both before and after the 3-week intervention program using Dizziness Handicap Inventory (DHI) scale, Timed-Up and Go (TUG) test and Tampa Scale of Kinesiophobia (TSK), respectively. The collected data were subsequently tabulated and analyzed using appropriate statistical tools. Results: The unpaired ‘t’ test analysis of dizziness and balance revealed statistically significant scores in DHI(t=2.2259) and TUG(t=2.2547), respectively, at a 95% confidence interval. Consequently, Group A demonstrated significant reduction in dizziness and balance improvement in patients with posterior canal BPPV. The scores of Kinesiophobia for both the groups were (A, Mean=31.6; B, Mean= 32.2), which showed no significant difference(t=1.074), that means the group showed the improvement from baseline. Conclusion: The study concluded that a 3-week intervention combining the Epley maneuver with Cawthorne-Cooksey exercises was effective in treating dizziness, balance and kinesiophobia in patients with posterior canal BPPV. Implication: The Epley and Gans maneuvers effectively reduce dizziness and improve balance in patients with posterior canal BPPV. They also may alleviate kinesiophobia, enhancing patient confidence in movement. These interventions highlight the importance of targeted therapy in managing vestibular disorders, promoting functional recovery and quality of life.

Photodynamic therapy-induced precise attenuation of light-targeted semicircular canals for treating intractable vertigo.

Vertigo is a common symptom of various diseases that affects a large number of people worldwide. Current leading treatments for intractable peripheral vertigo are to intratympanically inject ototoxic drugs such as gentamicin to attenuate the semicircular canal function but inevitably cause hearing injury. Photodynamic therapy (PDT) is a noninvasive therapeutic approach by precisely targeting the diseased tissue. Here, we developed a PDT-based method for treating intractable peripheral vertigo in a mouse model using a polymer-coated photosensitizer chlorin e6 excited by red light. We found that a high dose of PDT attenuated the function of both semicircular canals and otolith organs and damaged their hair cells. Conversely, the PDT exerted no effect on hearing function or cochlear hair-cell viability. These results suggest the therapeutic potential of PDT for treating intractable peripheral vertigo without hurting hearing. Besides, the attenuation level and affected area can be precisely controlled by adjusting the light exposure time. Furthermore, we demonstrated the potential of this therapeutic approach to be minimally invasive with light irradiation through bone results. Thus, our PDT-based approach for attenuating the function of the semicircular canals offers a basis for developing a less-invasive and targeted therapeutic option for treating vertigo.

Sickness and peripheral dizziness: A review

In this lecture, some aspects of vestibular pathology propedeutics are highlighted. The necessity of careful vestibulosensory reactions analysis by different physicians (ENT specialist, neurologist, internist, general practitioner) is emphasized. Main patients’ complaints (vertigo and unsteadiness) are distinguished between. Special attention is paid to the classification of these vestibulosensory reactions on their duration and periodicity. The terms (sickness itself and balance disorders that may be concomitant symptoms of kinetosis) are clearly defined. Theories and clinical manifestations of sickness syndromes and motion sickness are described in details. Clinical variants of peripheral and central vestibular dysfunction are analyzed. The importance of computerized technics of vestibulometry (electrooculography, video oculography and computer dynamic posturography) in order to make a topic diagnosis of vestibular dysfunction and to assess visual-vestibular interaction in sickness is emphasized.

R-cVR, a two-step bedside algorithm for the differential diagnosis of acute dizziness and vertigo

BackgroundThe ability to quickly and accurately differentiate between peripheral and central dizziness or vertigo is vital. We developed the R-cVR algorithm for the early identification of central-type dizziness or vertigo. MethodsIn this single-center, retrospective cohort study, we assessed patients with isolated dizziness or vertigo between December 10, 2023, and February 28, 2024. Classification into central or peripheral types was based on magnetic resonance imaging (MRI)-diffusion-weighted imaging (DWI) results. We reevaluated the diagnostic value of the Romberg test for acute dizziness or vertigo by quantifying the duration of standing and created the R-cVR algorithm. The algorithm's accuracy was subsequently validated against the MRI-DWI results. ResultsAfter screening, 109 patients were recruited and divided into central (n = 25) and peripheral (n = 84) groups. The central group had a high incidence of cerebral infarction (88.0 %), whereas the peripheral group included patients with vestibular neuronitis, benign paroxysmal positional vertigo, and Meniere's disease (96.4 %). Significant disparities in the incidence of balance disorders were noted between the groups (92.0 % vs. 15.5 %, p < 0.001). Multivariate logistic regression revealed an odds ratio of 61.82 for balance disorders (p < 0.001). The R-cVR algorithm, which integrates the Romberg test and the V-shaped stance with closed-eyes protocol, was tested against MRI-DWI and yielded high diagnostic agreement (kappa = 0.80), with a sensitivity and specificity of 88.0 % and 94.0 %, respectively. There was no significant difference in the diagnostic efficacy of this algorithm for acute dizziness or vertigo with or without nystagmus. ConclusionThe R-cVR algorithm effectively identifies central-type dizziness or vertigo and is simple for general practitioners to use without specialized equipment, which may be valuable in various clinical settings.

Causal association between blood metabolites and vertigo: A Mendelian randomization study.

Metabolic disorders have been identified as an important factor causing nervous system diseases. However, due to the interference of confounding factors, the causal relationship between them has not been clearly elucidated, so it is necessary to study the causal relationship between them. To explore the causal relationship between blood metabolites and vertigo by Mendelian randomization. To assess causality, the inverse variance weighting method was employed as the primary analytical approach, complemented by additional sensitivity analyses. Metabolic pathway enrichment analysis and genetic correlation analysis were employed to further assess the metabolites. All statistical analyses were conducted using the R software. The study employed metabolite Genome Wide Association Study and vertigo diseases summary data sets to examine the causal relationship between 486 blood metabolites and 3 types of vertigo. A total of 55 potential metabolites associated with the 3 types of vertigo were identified, with 22, 16, and 13 candidate metabolites showing relatively reliable MR Evidence for Vestibular Dysfunction, Peripheral Vertigo, and Central Vertigo, respectively. Enrichment analysis was conducted to investigate the biological significance of these candidate metabolites, resulting in the identification of 7 key metabolic pathways across the 3 diseases, the metabolic pathway known as "Valine, leucine, and isoleucine biosynthesis" was found to be associated with all 3 types of vertigo, suggesting its potential influence on the vestibular system. Genetic correlation analysis revealed a genetic correlation between X-10510 and dodecanedioate with Vestibular Dysfunction. This study offers novel perspectives on the causal impact of blood metabolites on vertigo through the integration of genomics and metabolomics. Identifying metabolites that contribute to vertigo could serve as potential biomarkers and contribute to a better understanding of the underlying biological mechanisms associated with vertigo.

Diagnostic Value of Neutrophil/Lymphocyte Ratio in Distinguishing Peripheral and Central Vertigo in Patients with Dizziness

Objective: Neutrophil/lymphocyte ratio (NLR) is an inexpensive parameter that gives an idea about systemic inflammatory response and cellular immune response. This study aims to investigate the value of NLR in distinguishing peripheral and central vertigo. Materials and Methods: Patients presenting with acute vertigo at the emergency clinic were included between January 2017 and December 2018. Hemogram, brain computerized tomography, and diffusion magnetic resonance imaging data were reviewed to categorize patients into peripheral and central vertigo groups. Laboratory parameters were compared between these groups. Results: Neutrophil, lymphocyte, and C-reactive protein levels were higher in patients with central vertigo than those with peripheral vertigo (p=0.003, p=0.003, p=0.022, respectively). Moreover, the NLR value was significantly elevated in central vertigo cases (median: 3.99) in contrast to peripheral vertigo cases (median: 2.32) (p

Is the Epley maneuver the most effective technique for improving symptoms in benign paroxysmal peripheral vertigo?

Is the Epley maneuver the most effective technique for improving symptoms in benign paroxysmal peripheral vertigo?

Clinical efficacy of vestibular assessment and rehabilitation training in peripheral vestibular vertigo.

To evaluate the clinical efficacy of vestibular assessment and rehabilitation training in patients with peripheral vestibular vertigo. This was a retrospective study. A total of 169 patients diagnosed with peripheral vestibular vertigo, admitted to Cangzhou People's Hospital between January 2020 and January 2023 were divided into control group (83 cases) and observation group (86 cases). The control group received medication-based treatment, while the observation group was provided with combined treatment of medication and vestibular rehabilitation training. Assessment of recovery included the Dizziness Handicap Inventory (DHI), Vestibular Symptom Index (VSI), and Activities-specific Balance Confidence (ABC) scale before and at two, four, and eight weeks post-treatment. Psychological status, sleep quality, and life quality were evaluated. Both groups underwent the Fukuda stepping test and timed balance test. At two, four, and eight weeks post-treatment, both groups exhibited significantly lower DHI-P, DHI-F, DHI-E, VSI, and ABC scores compared to pre-treatment (p<0.05). The observation group showed significantly lower DHI-P, DHI-F, DHI-E, VSI, and ABC scores than the control group at two and four weeks post-treatment (p<0.05). After treatment, both groups demonstrated reduced body deviation angles and increased time without falling in the Fukuda stepping test (p<0.05). Notably, the observation group had significantly better outcomes (p<0.05). In comparison to medication-based treatment alone, a combined approach involving medication treatment and vestibular rehabilitation training may demonstrate early improvements in vertigo symptoms, enhance balance capabilities, and ameliorate psychological well-being, sleep quality, and overall quality of life for patients.

Acupuncture for Residual Dizziness After Successful Repositioning Maneuvers in Patients with Benign Paroxysmal Positional Vertigo: Study Protocol for a Randomized Noninferiority Trial.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo among adults. Successful treatment often requires an appropriate canalith repositioning procedure (CRP), which has proven effective in the treatment of BPPV. However, some patients experience residual dizziness (RD) after CRP, affecting their daily activities and quality of life. Although oral betahistine is a common clinical treatment for RD, some patients may discontinue this medication due to adverse effects. Conversely, acupuncture has demonstrated efficacy in treating dizziness with minimal adverse effects. However, to date, no trials have directly compared the efficacy of acupuncture and betahistine in treating RD. Our goal was to assess the noninferiority of acupuncture in treating RD compared with the commonly used oral betahistine treatment. A randomized, controlled, non-inferiority trial was conducted to compare the effectiveness of acupuncture and betahistine in patients with BPPV who experience RD after a successful CRP. Eighty-four participants were randomly assigned to two treatment groups, each receiving either acupuncture or betahistine. The assessors and statisticians were blinded to treatment allocation. The primary outcomes were the response rate and change in vertigo level, and secondary outcomes included Visual Analog Scores and the presence and change in depressive symptoms among patients. Scale measures were recorded at baseline, 2, 4, and 12 weeks after randomization. This trial aims to provide causal evidence supporting the non-inferiority of acupuncture therapy relative to oral betahistine, offering an alternative treatment avenue for patients intolerant to betahistine. Ethics approval was obtained from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, with permission number 2023-095-KY. Written informed consent was obtained from the enrolled patients.

Risk Factors for Peripheral Vertigo

Background: Several risk factors influence the occurrence of peripheral vertigo, including advanced age, gender, and chronic metabolic diseases. This disease is not widely recorded in primary care due to the need for detection with simple examinations. Research on the association of several risk factors has yet to be reported. Objectives: To examine the relationship between age, gender, type 2 diabetes mellitus (DM2), and hypertension as risk factors for peripheral vertigo. Methods: This study is a case-control study that used consecutive sampling. The study sample consisted of 39 people: 19 in the case group and 20 in the control group. Data were obtained from 2 health centers and Diponegoro National Hospital, Semarang City. The data were obtained from history taking and physical examinations such as the Gans Sensory Organization Performance Test (SOP), past pointing test, and dysdiadokokinesia test. DM2 disease and hypertension were gathered from medical records. Data analysis used univariate analysis, bivariate analysis with chi-square, and logistic regression multivariate analysis. Results: Statistical test results concluded that hypertension is a risk factor for peripheral vertigo (p = 0.008; OR = 6.964; 95%CI = 1.657 - 29.263). Whereas age, gender, and DM2 were not risk factors, with p-values of 0.187, 0.378, and 0.417, respectively. Conclusion: The significant risk factor associated with the occurrence of peripheral vertigo was hypertension by 6.964 times.

Accuracy of the Bedside Examination in Patients With Suspected Acute Unilateral Peripheral Vestibulopathy.

Acute unilateral peripheral vestibulopathy (AUPVP) is a frequent form of peripheral vestibular vertigo characterized by unilateral vestibular organ dysfunction. Diagnostic challenges in anamnesis and bedside examination can lead to potential misdiagnoses. This study investigated the sensitivity of bedside examinations in diagnosing AUPVP. This retrospective analysis examined 136 AUPVP inpatients at a level 3 university hospital between 2017 and 2019. Demographic data and bedside test results were collected. Instrumental otoneurological tests included caloric testing and video head impulse test (HIT). The sensitivity of each bedside parameter was computed based on the instrumental diagnostics, and statistical analyses were performed. The study included 76 men and 60 women, with a mean age of 59.2 years. Spontaneous nystagmus exhibited a sensitivity of 92%, whereas the absence of skew deviation was identified with a sensitivity of 98%. Abnormal bedside HIT showed a sensitivity of 87%. The combined HINTS (HIT, nystagmus, and test of skew) had a sensitivity of 83%. The Romberg test and Fukuda test demonstrated sensitivities of 26% and 48%, respectively. The sensitivity of bedside tests varied from 26% to 98%. This aligns with previous literature, highlighting the challenge of differentiating AUPVP from vestibular pseudoneuritis solely through bedside examination. Although the tests excel in excluding central causes, they are insufficient for diagnosing AUPVP with certainty. In addition, the bedside examination sensitivities vary widely, and early radiological imaging can be misleading. Therefore, this study underlines the necessity of prompt otoneurological testing for accurate exclusion of vestibular pseudoneuritis and thus improve patient outcomes.

Altered thalamus functional connectivity in patients with acute unilateral vestibulopathy: a resting-state fMRI study.

Acute unilateral vestibulopathy (AUVP) is the second leading cause of peripheral vestibular vertigo. Full recovery of AUVP is related to sufficient central vestibular compensation. It has been confirmed that the vestibular nucleus and vestibular cortex are involved in the process of vestibular compensatory in AUVP patients. However, few studies have focused on the functional compensation of thalamus in patients with AUVP. This study aimed to explore the alterations of resting-state functional connectivity (FC) focused on thalamus using functional magnetic resonance imaging (fMRI) in AUVP patients. Data of 3D-T1 and resting-state fMRI were collected from 40 AUVP patients and 35 healthy controls (HC). Seeds-based (bilateral thalamus) FC was analyzed to investigate the changes in FC between the two groups. Furthermore, we evaluated the associations between altered thalamus FC and clinical features in AUVP patients using Pearson's partial correlation. Compared with HC, AUVP patients showed decreased FC between bilateral thalamus and left insula. We also observed decreased FC between right thalamus and left supramarginal gyrus. Additionally, we found increased FC between left thalamus and right postcentral gyrus (PCG), as well as increased FC between right thalamus and regions of bilateral PCG, right middle frontal gyrus and right middle occipital gyrus in AUVP patients. Furthermore, the FC between left thalamus and left insula was negatively correlated with values of canal paresis in patients with AUVP (p = 0.010, r = -0.434). Our results provided first evidence for the decreased thalamo-vestibular cortex pathway, as well as increased thalamo-somatosensory and thalamo-visual cortex pathway in AUVP patients. These findings help us better understand the underlying mechanisms of central dynamic compensatory following an acute unilateral peripheral vestibular damage.