title: Multiple sclerosis as a cause of the acute vestibular syndrome.
abstract: 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.
authors: 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
authors: J H
authors: JH
authors: Pula
authors: D E
authors: DE
authors: Newman-Toker
authors: J C
authors: JC
authors: Kattah
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D004244:Dizziness / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000473:pathology; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D013577:Syndrome; D014717:Vertigo / Q000209:etiology / Q000473:pathology; D015837:Vestibular Diseases / Q000209:etiology* / Q000473:pathology; D000160:Vestibulocochlear Nerve Diseases / Q000209:etiology / Q000473:pathology; D055815:Young Adult
references: Arch Otolaryngol. 1967 May;85(5):537-8
references: 6023711
references: ORL J Otorhinolaryngol Relat Spec. 1994;56(1):55-9
references: 8121687
references: Stroke. 2009 Nov;40(11):3504-10
references: 19762709
references: Am J Otol. 1997 Sep;18(5):590-5
references: 9303155
references: CMAJ. 2011 Jun 14;183(9):E571-92
references: 21576300
references: Cell Biochem Biophys. 2011 Mar;59(2):109-12
references: 20976571
references: J Neurol Neurosurg Psychiatry. 2006 Jun;77(6):790-2
references: 16705203
references: Mult Scler. 1999 Jun;5(3):179-83
references: 10408718
references: Arch Iran Med. 2010 May;13(3):188-92
references: 20433222
references: Neurology. 2008 Jun 10;70(24 Pt 2):2378-85
references: 18541870
references: J Neurol Neurosurg Psychiatry. 1997 Nov;63(5):682-5
references: 9408116
references: Neurol Res. 2010 Nov;32(9):986-91
references: 20426898
references: J Neurol Sci. 2008 Mar 15;266(1-2):187-9
references: 17942120
references: Otol Neurotol. 2001 Nov;22(6):808-12
references: 11698800
references: Neurol Sci. 2001 Nov;22 Suppl 2:S74-8
references: 11794483
references: Neurology. 2009 May 19;72(20):e101-2
references: 19451525
references: Neurology. 2000 Nov 28;55(10):1566-9
references: 11094117
references: J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):458-60
references: 18344397
references: J Laryngol Otol. 1995 Jun;109(6):545-8
references: 7642999
references: Semin Neurol. 2009 Nov;29(5):509-19
references: 19834862