PMID- 23392781
OWN - NLM
STAT- MEDLINE
DCOM- 20140115
LR  - 20211021
IS  - 1432-1459 (Electronic)
IS  - 0340-5354 (Linking)
VI  - 260
IP  - 6
DP  - 2013 Jun
TI  - Multiple sclerosis as a cause of the acute vestibular syndrome.
PG  - 1649-54
LID - 10.1007/s00415-013-6850-1 [doi]
AB  - Multiple sclerosis (MS) causes dizziness and vertigo. Reports suggest responsible 
      lesions are often in the intra-pontine 8th nerve fascicle. We sought to determine 
      frequency and clinical features of demyelinating acute vestibular syndrome (AVS). 
      This is a prospective observational study (1999-2011). Consecutive AVS patients 
      (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) 
      with a risk for central localization underwent structured bedside examination and 
      neuroimaging. When applicable, we identified MS based on clinical, imaging, and 
      laboratory features. Of 170 AVS presentations, 4% (n = 7) were due to 
      demyelinating disease. Five had an acute MS plaque likely responsible for the 
      clinical syndrome. Lesion location varied-1 medulla; 1 inferior cerebellar 
      peduncle; 1 middle cerebellar peduncle; 1 posterior pontine tegmentum; 1 in the 
      intrapontine 8th nerve fascicle; 1 superior cerebellar peduncle; 1 midbrain. Only 
      two had a lesion in or near the intra-pontine 8th nerve fascicle. Three were 
      first presentations (i.e., clinically isolated demyelinating syndrome), while the 
      others were known MS. All had central oculomotor signs. In two patients, the only 
      central sign was a normal horizontal head impulse test (h-HIT) of vestibular 
      function. All patients improved with steroid therapy. Demyelinating disease was 
      an uncommon cause of AVS in our series. Symptomatic lesions were not restricted 
      to the 8th nerve fascicle. Five patients had relatively obvious oculomotor signs, 
      making differentiation from vestibular neuritis straightforward. Two patients had 
      unidirectional, horizontal nystagmus that followed Alexander's law and was 
      suppressed with fixation (true pseudoneuritis). The presence of a normal h-HIT in 
      these suggested central localization.
FAU - Pula, J H
AU  - Pula JH
AD  - Department of Neurology, University of Illinois College of Medicine at Peoria, 
      Peoria, 530 NE Glen Oak Avenue, 6th Floor, Peoria, IL 61637, USA. 
      jpula12004@yahoo.com
FAU - Newman-Toker, D E
AU  - Newman-Toker DE
FAU - Kattah, J C
AU  - Kattah JC
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20130208
PL  - Germany
TA  - J Neurol
JT  - Journal of neurology
JID - 0423161
SB  - IM
MH  - Adult
MH  - Brain/*pathology
MH  - Dizziness/etiology/pathology
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Multiple Sclerosis/*complications/pathology
MH  - Nystagmus, Pathologic/etiology/pathology
MH  - Prospective Studies
MH  - Syndrome
MH  - Vertigo/etiology/pathology
MH  - Vestibular Diseases/*etiology/pathology
MH  - Vestibulocochlear Nerve Diseases/etiology/pathology
MH  - Young Adult
EDAT- 2013/02/09 06:00
MHDA- 2014/01/16 06:00
CRDT- 2013/02/09 06:00
PHST- 2012/11/25 00:00 [received]
PHST- 2013/01/19 00:00 [accepted]
PHST- 2013/01/17 00:00 [revised]
PHST- 2013/02/09 06:00 [entrez]
PHST- 2013/02/09 06:00 [pubmed]
PHST- 2014/01/16 06:00 [medline]
AID - 10.1007/s00415-013-6850-1 [doi]
PST - ppublish
SO  - J Neurol. 2013 Jun;260(6):1649-54. doi: 10.1007/s00415-013-6850-1. Epub 2013 Feb 
      8.