Document Detail

Spontaneous plugging of the horizontal semicircular canal with reversible canal dysfunction and recovery of vestibular evoked myogenic potentials.
MedLine Citation:
PMID:  23632787     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the clinical pathophysiology of oculomotor changes in a patient presenting with a spontaneous semicircular horizontal canal plug.
PATIENT: A 42-year-old man with acute spontaneous vertigo with spinning and persistent left-horizontal nystagmus, intensity but not direction dependent on head orientation with respect to gravity, indicating a benign paroxysmal positional vertigo due to otoconia causing a plug in the horizontal semicircular canal.
INTERVENTION: Electrophysiological and video-oculographic testing; vestibular rehabilitation.
MAIN OUTCOME MEASURES: Cervical and ocular vestibular evoked myogenic potentials (VEMPs); video head impulse testing.
RESULTS: The video head-impulse test revealed an eye velocity cutoff at 80°/s in the time interval from 40 to 90 ms after initiation of head impulses to the right. This normalized within 2 days after liberatory maneuvers, documenting for the first time a reversible deficiency of the cupular-endolymph high-frequency system dynamics. Cervical and ocular vestibular myogenic potentials were absent during stimulation of the affected side before the liberatory maneuvers but normalized within 30 to 80 days.
CONCLUSION: This case is special in 4 respects: 1) nystagmus intensity, but not direction, was dependent on head orientation with respect to gravity, indicating a horizontal canal plug; 2) VEMPs were asymmetrical before liberatory maneuvers; 3) VEMPs recovered after Day 30; and 4) video head-impulse test asymmetry recovered. These observations challenge the common belief that VEMPs are evoked by otolith stimulation only. Instead, the assumption of a reversible canal dysfunction by a plug offers a more plausible explanation for all effects.
Leonel Luis; João Costa; Fernando Vaz Garcia; Josep Valls-Solé; Thomas Brandt; Erich Schneider
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  34     ISSN:  1537-4505     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-14     Completed Date:  2013-12-30     Revised Date:  2014-03-04    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  743-7     Citation Subset:  IM    
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MeSH Terms
Nystagmus, Pathologic / physiopathology*
Semicircular Canals / physiopathology*
Vertigo / physiopathology*
Vestibular Evoked Myogenic Potentials / physiology*
Vestibular Function Tests
Comment In:
Otol Neurotol. 2014 Feb;35(2):377-9   [PMID:  24448299 ]
Otol Neurotol. 2014 Feb;35(2):379-83   [PMID:  24448300 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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