Delayed vestibular evoked responses to the eyes and neck in a patient with an isolated brainstem lesion.
OBJECTIVE
Two recently described tests of the vestibular system, vestibular evoked myogenic potentials (VEMPs) and ocular vestibular evoked myogenic potentials (OVEMPs), test the descending and ascending vestibular brainstem pathways, respectively. We describe a case of a patient in whom these investigations localised the lesion and suggested its nature.


METHODS
VEMPs (to clicks and short duration galvanic stimulation) and OVEMPs (to clicks) were recorded.


RESULTS
Click- and galvanic-evoked VEMPs were delayed on the left side (by approximately 5-6 ms), and click-evoked OVEMPs were similarly delayed (by approximately 4 ms) following left-sided stimulation. Repeat testing 21 months later showed partial resolution.


CONCLUSIONS
The observed delays in evoked potentials suggested a demyelinating lesion. Furthermore, the similarity in delayed responses to neck and extraocular muscles was suggestive of a lesion at the root entry zone of the vestibulocochlear nerve.


CONCLUSIONS
VEMPs and OVEMPS may thus provide information about the location and nature of lesions affecting central vestibular pathways.
Rosengren
Sally M
SM
UNSW Clinical School and Prince of Wales Medical Research Institute, Institute of Neurological Sciences, High Street, Randwick, Sydney, NSW 2031, Australia.
Nogajski
Joseph H
JH
Cremer
Phillip D
PD
Colebatch
James G
JG
D001933:Brain Stem / Q000503:physiopathology*; D003711:Demyelinating Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D004558:Electric Stimulation; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009334:Neck Muscles / Q000503:physiopathology*; D009801:Oculomotor Muscles / Q000503:physiopathology*; D011930:Reaction Time; D014722:Vestibule, Labyrinth / Q000503:physiopathology*; D000159:Vestibulocochlear Nerve / Q000503:physiopathology