ABSTRACT
Based on two cases and a review of the recent literature, we would like to draw attention to the fact that a cerebellar infarction, localised to the territory of the PICA, can present with just a single clinical feature-acute rotary vertigo. Cerebellar vascular accidents remain a little known cause of acute vertigo, often masquerading as a peripheral vestibular disturbance. The main differential diagnosis is vestibular neuronitis. The prognosis is usually good, but the risk of a late recurrence or of a further cerebro-vascular episode is difficult to predict. This uncommon aetiology should not be ignored because of the risk of progression towards a sort of pseudo-tumoral infarct, in which the risk of a fatal outcome remains ever present. In most cases, however, sequelae are few or absent.
Subject(s)
Cerebellum/blood supply , Ischemia/complications , Vertigo/etiology , Acute Disease , Adult , Aged , Arteries , Female , Humans , MaleABSTRACT
We sought to determine whether the rotatory impulsional test was capable of exploring the canalar function with sufficient precision to replace the caloric test, as it has been recently affirmed. We first compared the observed preponderance from this test with that measured during a sinusoidal (20 and 4 s) test. We observed that, in the case of a significant preponderance for a given test, there was complete redondance with the preponderance observed with any other test. The rotatory impulsional test does not present any specific advantage compared to other kinetic test as far as the observation of the preponderance phenomenon. We then compared the preponderance with the results of the caloric tests and came to the following conclusions i) the absence of preponderance does not allow us to predict the absence of vestibular deficit, due to the fact that 37% of the deficits were compensated for including acoustic neuroma; ii) the presence of a preponderance does not allow a priori to say whether it is of vestibular, cervical, or central origin and systematic caloric tests shows that almost one fourth of preponderance observed is not associated with unilateral weakness iii) supposing that a clinical argument allow us to conclude as to the probable vestibular origin of a vestibular preponderance, the direction of this preponderance does not allow us to determine which side is involved. In fact, if the undercompensated deficits are 3 times more frequent than overcompensated deficits, the proportion of preponderance not linked to a significant deficit indicates that the probability of encountering a preponderance related to a specific undercompensated deficit is approximately 50%. We thus did not find in the rotatory impulsional test any specific advantage allowing us to predict the laterality of a vestibular lesion.
Subject(s)
Caloric Tests , Nystagmus, Physiologic , Vestibular Diseases/diagnosis , Humans , Rotation , Vestibular Diseases/physiopathologyABSTRACT
We present a group of 50 patients with retrocochlear pathology, divided on 41 (82 per 100) non tumoral and 9 (18 per 100) tumoral: 8 cerebello-pontine angle meningiomas and 1 intracranial cholesteatoma. The retrocochlear diagnosis of the pathology is assessed by the results of the audiovestibular explorations, specially the electrophysiology (early auditory evoked response, electrocochleography). The neuroradiologic explorations (TAC, MNR) define the tumoral or non tumoral nature of the pathology. We review some technical aspects of the common electrocochleographic practice, as actually is realised by the Bordeaux group; also, the different parameters of a retrocochlear pathologic response. In this group, the electrocochleography was necessary on 64 per 100 of the cases to obtain an electrophysiologic retrocochlear diagnostic.
Subject(s)
Audiometry, Evoked Response , Cranial Nerve Diseases/diagnosis , Labyrinth Diseases/diagnosis , Acoustic Impedance Tests , Adult , Audiometry , Cerebellar Neoplasms/complications , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/physiopathology , Cerebellopontine Angle , Cholesteatoma/complications , Cholesteatoma/diagnosis , Cholesteatoma/physiopathology , Cranial Nerve Diseases/etiology , Cranial Nerve Diseases/physiopathology , Electrodiagnosis/methods , Female , Humans , Labyrinth Diseases/etiology , Labyrinth Diseases/physiopathology , Male , Meningioma/complications , Meningioma/diagnosis , Meningioma/physiopathology , Middle AgedABSTRACT
The authors study the different parameters of the stapedius reflex on a 55 patients group with retrocochlear and non tumoral diagnostic is assess by electrophysiologic (BERA, Electrocochleography) and neuroradiologic explorations (TAC), Meato-cisternography, NMR). We realise an comparative study between the results of this group and the results of 2 other groups (98 acoustic neuromas and 104 endocochlear diseases). The test has a moderate sensibility and none specificity in this kind of pathology, because the high percent of false negative (30%), and the positivity on 95% of acoustic neuromas and on 74% of endocochlear diseases.
