New Type of Vertigo Defined That May Be Treatable
Neurologists have defined a new type of vertigo with no known cause (Neurology. 2018:published online May 23). The authors have differentiated this type of vertigo from serious causes of vertigo (eg, brain or cranial nerve tumors) and from other forms of benign recurrent vertigo (BRV) including Meniere’s disease, vestibular neuritis, vestibular migraine, and episodic ataxia.
The authors had noted the presence of recurrent spontaneous vertigo (RSV) with headshaking nystagmus (HSN), which is caused by shaking the head in the horizontal plan at 2 Hz to 3 Hz for 10 to 20 seconds, in patients who did not have auditory symptoms, migraine, or unilateral peripheral vestibulopathy. They identified 338 patients who had vertigo with no known cause, 35 of whom had HSN. Another 35 patients with BRV of unknown etiology and no HSN were examined as a control group.
Patients had comprehensive evaluations of audiovestibular function and a full neurologic examination as well as brain MRI as needed. All patients answered the Motion Sickness Susceptibility Questionnaire (MSSQ) as well. All patients were evaluated between attacks.
Patients with RSV with HSN had nystagmus with a primary phase of 12 seconds compared to controls who had a primary phase of 5 to 6 seconds (P = .001). Patients with RSV with HSN were more likely to have severe motion sickness than those with other types of vertigo (P = .015).
A total of 20 patients with RSV with HSN who had frequent attacks and severe symptoms were given preventive medication; over a 12-year period, 6 reported that they had fewer attacks then before taking medication and 1 reported having no futher attacks.
“These conditions can be difficult to diagnose and quite debilitating for people, so it’s exciting to be able to discover this new diagnosis of a condition that may respond to treatment,” said study author Ji-Soo Kim, MD, PhD, of Seoul National University in Seongnam, South Korea.