ABSTRACT
Bilateral vestibulopathy is a relatively widespread and at the same time rarely diagnosed cause of chronic postural instability. Numerous toxic factors, dysmetabolic, autoimmune and neurodegenerative processes can lead to this condition. The main clinical manifestations of bilateral vestibulopathy are balance disorders and visual disturbances (oscillopsia), which can significantly increase the risks of falls in such patients. In addition, cognitive and affective disorders, which also reduce the quality of life in patients with bilateral vestibulopathy, have been described and actively studied in recent years. The diagnosis of bilateral vestibulopathy is based on the results of a clinical neurovestibular study, including a dynamic visual acuity test and a Halmagyi test. A video head impulse test, a bithermal caloric test and a sinusoidal rotation test are used as instrumental methods confirming the dysfunction of the peripheral vestibular system. However, they are still not widespread in neurological practice. Treatment of bilateral vestibulopathy is reduced to vestibular rehabilitation. Encouraging results have been obtained in a number of studies using galvanic vestibular stimulation and the use of vestibular implants. In addition, cognitive rehabilitation methods are currently being developed, which presumably can also improve compensation for bilateral vestibular loss.
Subject(s)
Bilateral Vestibulopathy , Vestibular Diseases , Humans , Bilateral Vestibulopathy/diagnosis , Bilateral Vestibulopathy/complications , Quality of Life , Vestibular Function Tests/adverse effects , Caloric Tests/adverse effects , Head Impulse Test , Vision Disorders , Vestibular Diseases/diagnosisABSTRACT
Cerebrovascular diseases and, in particular, ischemic stroke, are an important medical and social problem, remaining not only one of the leading causes of mortality, but also often leading to severe and irreversible disability. Cerebrovascular diseases, in addition to obvious focal neurological symptoms, are manifested by cognitive disorders of varying modality and severity, among which visual-spatial disorders remain almost the least studied. Many areas of the brain are responsible for providing visual-spatial functions, some of which also take part in maintaining balance. In addition, in recent years, data have appeared on the role of damage to the vestibular system in the development of visual-spatial disorders. That is, an important condition for ensuring visual-spatial functions is probably the preservation of vestibular afferent pathways. The mechanisms of the development of visual-spatial disorders with damage to vestibular structures and their relationship with the function of maintaining balance remain almost unexplored. Disorders of visual-spatial functions in patients with cerebrovascular diseases, apparently, can make a significant contribution to the development of balance disorders and make it difficult to carry out full-fledged therapeutic and rehabilitation measures in this category of patients. Currently, the diagnosis of visual-spatial disorders is insufficiently developed. There are no universal approaches to the correction of this type of vascular (including post-stroke) cognitive disorders, as well as balance disorders that have arisen as a result of visual-spatial dysfunction. Thus, further research in this area is needed to clarify the mechanisms of formation of visual-spatial disorders, their relationship with the function of maintaining balance in cerebrovascular diseases and to develop optimal ways to correct them.
