Int Arch Otorhinolaryngol 2014; 18(03): 235-238
DOI: 10.1055/s-0034-1370884
Original Research
Thieme Publicações Ltda Rio de Janeiro, Brazil

Central Vestibular Dysfunction in an Otorhinolaryngological Vestibular Unit: Incidence and Diagnostic Strategy

Badr E. Mostafa
1  Department of ENT-HNS, Ain-Shams University, Cairo, Egypt
,
Ayman O. El Kahky
1  Department of ENT-HNS, Ain-Shams University, Cairo, Egypt
,
Hisham M. Abdel Kader
1  Department of ENT-HNS, Ain-Shams University, Cairo, Egypt
,
Michael Rizk
1  Department of ENT-HNS, Ain-Shams University, Cairo, Egypt
› Author Affiliations
Further Information

Publication History

18 December 2013

21 January 2014

Publication Date:
21 March 2014 (online)

  

Abstract

Introduction Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis.

Objective The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit.

Methods This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required.

Results There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years). Provisional videonystagmography (VNG) results were: 40% benign paroxysmal positional vertigo (BPPV), 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41) had magnetic resonance imaging (MRI) and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23%) were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus).

Conclusions Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions.