Transient vertigo preceding vestibular neuritis.

Abstract

BACKGROUND: Transient vertigo preceding vestibular neuritis (VN) has been reported from Korea, exclusively as a single episode in the previous week. Such attacks have parallels with TIA, raising the possibility of a vascular mechanism for VN. We aimed to compare VN patients with and without transient premonitory vertigo to determine whether there was an age difference or VOR gain reduction difference between the two groups. METHODS: Consecutive patients with acute vestibular syndrome with onset in the previous 48 hours were enrolled. Following a detailed history and examination ICS impulse video oculography (GN Otometrics) was performed daily during the admission. RESULTS: Amongst 30 patients with acute vestibular syndrome there were only three who had transient vertigo preceding the main attack. One two episodes lasting a few minutes in the preceding 30 days, and two more brief attacks on the day of presentation. Another had a single episode lasting 30 minutes four days prior to presentation. One had two attacks up to 10 seconds duration, one riding a bicycle 4 days before the onset of VN. All three were men, aged 33-68, mean 46, v mean age 62.4 (NS) (range 33-88) in the remainder. None had vascular risk factors. The mean VOR gain on the affected side was 0.52 v 0.65 (NS) in those without transient premonitory symptoms. CONCLUSION: Transient premonitory vertigo may precede an attack of presumed vestibular neuritis by several days or more. More than one attack can occur. Our numbers are small and the difference are not statistically significant, but these patients are younger and have significant VOR gain reductions unlike some much older patients with subtle acute vestibulopathy and a small VOR gain reductions. Transient premonitory vertigo may have the opposite significance to TIA, and may support a viral rather than a vascular mechanism for the acute vestibular syndrome.