Subjective Visual Vertical and Horizontal Abnormalities in a Patient with Lateral Medullary Syndrome-A Case Report

Document Type : Case Report

Authors

AVC Department, Christian Medical College,Vellore,India.

Abstract

Introduction:
Evaluation of persistent vertigo in post infarct patients is very important as the management depends on whether the cause is purely of central origin or due to associated vestibular affliction.
 
Case Report:
A patient with left sided dorsolateral medullary syndrome and persistent vestibular symptoms was evaluated. Vestibular test battery showed abnormal smooth pursuit, bilateral hyperactive caloric responses, and abnormal dynamic subjective visual vertical and dynamic subjective visual horizontal tests.
 
Conclusion: 
Dorsolateral medullary infarctions (Wallenberg’s syndrome) typically cause a central vestibular tonus imbalance in the roll plane with ipsilateral deviations of perceived vertical orientation. The SVV and SVH tests may have a role in localizing the pathology in a patient with lateral medullary syndrome.

Keywords

Main Subjects

References

1. Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg’s lateral medullary syndrome: Clinical-magnetic resonance imaging correlations. Arch Neurol 1993;50(6):609–14.
2. Cipparrone L, Fratiglioni L, Siracusa G, Amato MP, Amaducci L, Pagnini P, et al. Electronysta- gmography in the diagnosis of multiple sclerosis. Acta Neurol Scand 1989;80(3):193–200.
3. Funabashi M, Santos-Pontelli TEG, Colafemina JF, Pavan TZ, Carneiro AAO, Takayanagui OM. A new method to analyze the subjective visual vertical in patients with bilateral vestibular dysfunction. Clinics 2012 ;67(10):1127–31.
4. Schubert MC, Minor LB. Vestibulo-ocular Physiology Underlying Vestibular Hypofunction. Phys Ther 2004 ;84(4):373–85.
5. Akin FW, Murnane OD, Pearson A, Byrd S, Kelly KJ. Normative data for the subjective visual vertical test during centrifugation. J Am Acad Audiol.2011;22(7):460–8.
6. Pavan TZ, Funabashi M, Carneiro JAO, Pontelli TEG dos S, Tedeschi W, Colafêmina JF, et al. Software for subjective visual vertical assessment: an observational cross-sectional study. Braz J Otorhinolaryngol 2012;78(5):51–8.
7. Barnett HJM, Mohr JP, Stein BM, Yatsu FM. New York: Churchill Livingstone; 1998.
8. Cass SP. Vestibular Disorders: A Case-study Approach. Oxford University Press; 2003. 440 p.
9. Kato I, Ogino S, Okada T, Koizuka I, Kanayama R, Nakamura T. Wallenberg’s syndrome: neurotological classification. Auris Nasus Larynx. 2003; Suppl:       S13–18.
10. Brandt T, Bronstein AM. Cervical vertigo. J Neurol Neurosurg Psychiatry 2001;71(1):8–12.
11. CURRIER RD, GILES CL, DEJONG RN. Some comments on Wallenberg’s lateral medullary syndrome. Neurology 1961;11:778–91.
12. Kim JS. Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain J Neurol 2003;126       (8):1864–72.
13. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke J Cereb Circ 2006;37(10):2484–7.
14. Lee H, Yi HA, Cho YW, Sohn CH, Whitman GT, Ying S, et al. Nodulus infarction mimicking acute peripheral vestibulopathy. Neurology. 2003;60(10):1700–2.
15. Lee H, Cho Y-W. A case of isolated nodulus infarction presenting as a vestibular neuritis. J Neurol Sci 2004;221(1-2):117–9.
16. Koenigsberg RA, McCormick D, Thomas C, Yee M, Williams N. Vertigo secondary to isolated PICA insufficiency: successful treatment with balloon angioplasty. Surg Neurol 2003;60(4): 306–10.
17. Kim JS. Pure lateral medullary infarction: clinical–radiological correlation of 130 acute, consecutive patients. Brain 2003;126(8):1864–72.
18. Amarenco P, Roullet E, Hommel M, Chaine P, Marteau R. Infarction in the territory of the medial branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 1990;53(9):731–5.
19. Lee H, Sohn S-I, Cho Y-W, Lee S-R, Ahn B-H, Park B-R, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006; 67(7): 1178–83.
20. Coats AC. Directional preponderance and unilateral weakness as observed in the electronystagmographic examination. Ann Otol Rhinol Laryngol 1965;74(3):655–68.
21. Torok N. The hyperactive vestibular response. Acta Otolaryngol (Stockh) 1970;70(3):153–62.
22.Tomaz A, Borges FN, Ganança CF, Campos CAH de, Tilbery CP. [Signs and symptoms associated to otoneurologic alterations diagnosed on computerized vestibular exam of patients with multiple sclerosis]. Arq Neuropsiquiatr 2005; 63(3B):837–42.
23. Funabashi M, Santos-Pontelli TEG, Colafêmina JF, Pavan TZ, Carneiro AAO, Takayanagui OM. A new method to analyze the subjective visual vertical in patients with bilateral vestibular dysfunction. Clin São Paulo Braz 2012; 67(10): 1127–31.
24. Tribukait A, Eiken O. Changes in the perceived head transversal plane and the subjective visual horizontal induced by Coriolis stimulation during gondola centrifugation. J Vestib Res Equilib Orientat 2006;16(3):105–16.
 25. Akin FW, Murnane OD, Pearson A, Byrd S, Kelly KJ. Normative data for the subjective visual vertical test during centrifugation. J Am Acad Audiol 2011;22(7):460–8.
 26. Dieterich M, Brandt T. Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs. Ann Neurol 1993;33(3):292–9.
 27. Faralli M, Ricci G, Molini E, Longari F, Altissimi G, Frenguelli A. Determining subjective visual vertical: dynamic versus static testing. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 2007;28(8):1069–71.
Iranian Journal of Otorhinolaryngology
Volume 27, Issue 1 - Serial Number 1
January and February 2015
Pages 75-80

Files

Share

How to cite

Statistics