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BackgroundVestibular migraine (VM) is one of the most common causes of recurrent vertigo and presents with a history of spontaneous or positional vertigo with a history of migraine headaches. While research has identified a high prevalence of migraine headaches and vestibular deficits among fragile X premutation carriers, there has been no discussion about VM within this population.ObjectiveThis case series and review seeks to describe the clinical characteristics and pathophysiology of VM among individuals with the fragile X premutation. We also seek to discuss treatment and future steps in addressing VM in this population.MethodsA review of the literature regarding vestibular migraine and presentation of migraine headaches and vestibular deficits among premutation carriers was performed. A detailed clinical history of migraine headaches and vertigo was obtained from three patients with the fragile X premutation seen by the senior author (RJH).ResultsAll three cases first developed symptoms of migraine headaches earlier in life, with the development of VM near menopause. Two of the three cases developed progressive balance issues following the development of VM. All three cases found that their VM episodes were improved or resolved with pharmacological and/or lifestyle interventions.ConclusionsIt is important to recognize VM among premutation carriers because beneficial treatments are available. Future studies are needed regarding the prevalence of VM and the relationship to subsequent FXTAS. The pathophysiology of VM remains uncertain but possibilities include mitochondrial abnormalities, cranial nerve VIII toxicity secondary to neurotoxic protein accumulation, and calcitonin gene-related peptide (CGRP) signaling dysfunction due to altered levels of fragile X messenger ribonucleoprotein (FMRP).

Purpose: This study introduces and evaluates the sitting lateral canal maneuver (SLCM), a novel seated repositioning technique for treating geotropic lateral canal benign paroxysmal positional vertigo (BPPV). Methods: We conducted a retrospective chart review at the Hospital of Salerno, focusing on 26 patients diagnosed with geotropic LC-BPPV between 2021 and 2022. The SLCM was applied, and its efficacy was assessed based on the resolution of nystagmus and vertigo symptoms. A 95% confidence interval was calculated to estimate the success rate. Results: The SLCM demonstrated a high success rate, with 22 out of 26 patients (approximately 85%, 22/26 patients) showing positive outcomes. The 95% confidence interval for the success rate ranged from approximately 65.02–100%. These findings suggest that SLCM is a potentially effective intervention for LC-BPPV, especially beneficial for patients who find traditional supine or lateral maneuvers uncomfortable. Conclusion: The SLCM represents a promising alternative to traditional BPPV maneuvers, especially for patients requiring a seated approach. While the initial results are encouraging, further research with larger sample sizes and longer follow-up periods is needed to validate its efficacy and explore its full potential in the management of LC-BPPV. Level of evidence: This study represents a Level IV source of evidence, as defined by the evidence-based practice guidelines. It is a retrospective chart review that involves a moderate cohort of patients diagnosed with geotropic horizontal positional nystagmus consistent with lateral canal benign paroxysmal positional vertigo (LC-BPPV). While the study provides valuable insights into the efficacy of the sitting lateral canal maneuver (SLCM) and contributes to the existing literature on BPPV management, it is important to note the inherent limitations associated with this level of evidence. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the hearing outcomes in patients with sudden sensorineural hearing loss without vertigo (SSNHLwoV). Methods: Patients with SSNHLwoV managed from December 2016 to March 2020 were prospectively enrolled in an academic tertiary referral center. Fifty-one patients with SSNHLwoV who completed high-dose steroid treatment. The hearing prognosis was analyzed using a multivariate Cox regression model. Results: The rates of complete, partial, and no hearing recovery were 52.9%, 17.6%, and 29.4% in patients with SSNHLwoV, respectively. The video head impulse test (vHIT) of the posterior semicircular canal (PSC), high-tone hearing loss (4–8 kHz) ≥ 30 dB, and average hearing threshold (0.5–1–2–4 kHz) were significantly associated with incomplete recovery of hearing after treatment. In multivariate analysis, the vHIT of the PSC (hazard ratio [HR], 14.502; 95% confidence interval [CI], 1.371–153.355) and high-tone hearing loss ≥ 30 dB (HR, 9.170; 95% CI, 2.283–36.830) remained robust. Conclusions: Abnormal vestibular function tests were performed in 80.4% of the patients with SSNHLwoV. Abnormal vHIT of the PSC and high-tone hearing loss ≥ 30 dB were independent factors resulting in incomplete recovery of hearing in patients with SSNHLwoV. In the SSNHLwoV cohort, the caloric test was not significantly associated with hearing prognosis, and vHIT was a feasible predictor of treatment outcome. [ABSTRACT FROM AUTHOR]

Introduction: Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society's International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV. Methodology: This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria. Results: Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis. Conclusion: The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility. [ABSTRACT FROM AUTHOR]

Martin Luther (1483–1546) reported attacks of headache and of vertigo in his letters and in his lectures. The symptomatology of his headache attacks fulfilled, at least in part, the diagnostic semiological criteria of migraine. However, because we cannot be sure about the time pattern and the exclusion of other disorders that might explain the headache, the diagnosis of migraine is not final. The vertigo attacks sometimes fulfilled the criteria of Ménière's disease. Vertigo also occurred together with headache attacks fulfilling the International Classification of Headache Disorders, 3rd edition criteria for vestibular migraine; however, we do not know exactly the pattern of attack frequency and duration. In summary, it is possible that Martin Luther suffered from attacks of vestibular migraine and had in addition a comorbidity of migraine and Ménière's disease. [ABSTRACT FROM AUTHOR]

Vestibular compensation is a physiological response of the vestibular organs within the inner ear. This adaptation manifests during consistent exposure to acceleration or deceleration, with the vestibular organs incrementally adjusting to such changes. The molecular underpinnings of vestibular compensation remain to be fully elucidated, yet emerging studies implicate associations with neuroplasticity and signal transduction pathways. Throughout the compensation process, the vestibular sensory neurons maintain signal transmission to the central equilibrium system, facilitating adaptability through alterations in synaptic transmission and neuronal excitability. Notable molecular candidates implicated in this process include variations in ion channels and neurotransmitter profiles, as well as neuronal and synaptic plasticity, metabolic processes, and electrophysiological modifications. This study consolidates the current understanding of the molecular events in vestibular compensation, augments the existing research landscape, and evaluates contemporary therapeutic strategies. Furthermore, this review posits potential avenues for future research that could enhance our comprehension of vestibular compensation mechanisms. [ABSTRACT FROM AUTHOR]

Vertigo, difficulty walking, and loss of balance/coordination are among the symptoms of stroke in 50% of stroke cases. Vertigo due to cerebrovascular disease is generally associated with other neurological signs such as cranial nerve abnormalities, hemiparesis, facial weakness, diplopia, hyperesthesia, and Horner's syndrome. A 42-year-old woman came to the emergency department with complaints of dizziness, nausea, and frequent vomiting for the previous 4 hours. The symptoms are also accompanied by a feeling of tingling on the left side of the face, and the left eyelid cannot open optimally. The patient has a history of uncontrolled hypertension. The HINTS test revealed central vertigo, and the patient also found dysdiadochokinesis, ataxia, and dysmethria. A non-contrast head CT scan showed ICH in the left cerebellum with a volume of 6.9 cc. Based on the results of these examinations, the patient was diagnosed with cerebellar hemorrhage. The blood supply to the brainstem, cerebellum, and inner ear comes from the vertebrobasilar vascular system. Blockage or rupture of blood vessels in one of the main branches of this system can cause symptoms of vertigo. Symptoms of vertebrobasilar stroke vary widely and depend on which of the three main circumferential branches is affected; posterior inferior cerebellar artery, anterior inferior cerebellar artery, or superior cerebellar artery. Vertigo in patients who have risk factors for stroke accompanied by other neurological symptoms should be considered for a thorough neurological examination to evaluate the possibility of cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Phally polymorphism in snails offers an excellent opportunity to study the evolutionary basis of sexual polymorphism in animals. Phally polymorphism occurs when two or three sexual morphs co-occur in populations of hermaphroditic organisms. Euphallics have a fully developed and functional penis, hemiphallics have a reduced and non-functional penis, while aphallics have no penis. All morphs can self-fertilize, but only euphallics can donate sperm during copulation. In this study, we investigated the geographical pattern of phally polymorphism in minute Vertigo species by testing snails from Polish and Swedish populations. Considering the principle of resource allocation, we checked whether sexual morph reflects the size of the shell. Although the Swedish Vertigo snails tend to be smaller than the Polish ones, our results show no clear geographical pattern of sexual morph balance in the studied populations. Aphallics of V. angustior were bigger than the euphallics; conversely to V. substriata , where euphallics were bigger than aphallics. Such a result suggests a species-specific resource allocation towards the given sexual function. Since hemiphallics of V. antivertigo were smaller than euphallics, we discuss the possible trade-off when faced with resource depletion and the failure of attaining sexual maturity of euphallics. [ABSTRACT FROM AUTHOR]

Background Clinical studies suggest that vestibular migraine patients have psychiatric comorbidities and low life quality. However, the absence of a multidisciplinary approach to vestibular migraine patients, including otorhinolaryngologists and psychiatrists, is concerning. We aimed to investigate these patients comprehensively and to compare the results of three questionnaires—the Hospital Anxiety and Depression Scale (HADS), Dizziness Handicap Inventory (DHI), and Short Form Health Survey (SF-36)—between patients with definite vestibular migraine (dVM), migraine without vertigo (MO), and healthy controls (HCs). Methods: A total of 104 participants were divided into 3 groups: dVM patients (19 participants), MO patients (22 participants), and HCs (63 participants). The scores of the three questionnaires across the three groups were compared using analysis of variance, and linear regression was used to examine the associations between the questionnaire scores within each group. Results: Compared to MO patients and HCs, dVM patients had significantly higher total scores on the HADS (p < 0.0001) and DHI (p < 0.0001) scales, and lower scores for all nine components of the SF-36, indicating poorer health. In the vestibular migraine group, the DHI score was strongly negatively correlated with the Physical Functioning subscale of the SF-36. Conclusions: Anxiety and depression are more prevalent in patients with definite vestibular migraine compared to patients with migraine without vertigo and healthy controls. The physical functioning of patients with definite vestibular migraine is highly affected by their dizziness, resulting in a lower quality of life. Timely screening for psychiatric comorbidity in vestibular migraine patients is essential to prevent psychiatric consequences. [ABSTRACT FROM AUTHOR]

Paroxysmal positional nystagmus frequently occurs in lesions involving the cerebellum, and has been ascribed to disinhibition and enhanced canal signals during positioning due to cerebellar dysfunction. This study aims to elucidate the mechanism of central positional nystagmus (CPN) by determining the effects of baclofen on the intensity of paroxysmal positional downbeat nystagmus due to central lesions. Fifteen patients with paroxysmal downbeat CPN were subjected to manual straight head-hanging before administration of baclofen, while taking baclofen 30 mg per day for at least one week, and two weeks after discontinuation of baclofen. The maximum slow phase velocity (SPV) and time constant (TC) of the induced paroxysmal downbeat CPN were analyzed. The positional vertigo was evaluated using an 11-point numerical rating scale (0 to 10) in 9 patients. After treatment with baclofen, the median of the maximum SPV of paroxysmal downbeat CPN decreased from 30.1°/s [interquartile range (IQR) = 19.6—39.0°/s] to 15.2°/s (IQR = 11.2—22.0°/s, Wilcoxon signed rank test, p < 0.001) with the median decrement ratio at 40.2% (IQR = 28.2—50.6%). After discontinuation of baclofen, the maximum SPV re-increased to 24.6°/s (IQR = 13.1—34.4°/s, Wilcoxon signed rank test, p = 0.001) with the median increment ratio at 23.5% (IQR = 5.2—87.9%). In contrast, the TCs of paroxysmal downbeat CPN remained unchanged at approximately 3.0 s throughout the evaluation. The positional vertigo also decreased with the medication (Wilcoxon signed rank test, p = 0.020), and remained unchanged even after discontinuation of medication (Wilcoxon signed rank test, p = 0.737). The results of this study support the prior presumption that paroxysmal CPN is caused by enhanced responses of the semicircular canals during positioning due to cerebellar disinhibition. Baclofen may be tried in symptomatic patients with paroxysmal CPN. [ABSTRACT FROM AUTHOR]

Cerebral cavernous malformation (CM) is a rare benign vascular lesion of the brain, accounting for only 0.3–0.5% incidence in the population. Among them, only a small portion of the patients have multiple lesions (3–33%). While most lesions are asymptomatic, some patients present with seizures and hemorrhagic events. We present an atypical case of multiple cerebral CM in a patient who presented with vertigo. He did not have apparent neurological signs and symptoms until it was detected through imaging studies. His MRI showed multiple CM, with the largest lesion located in the cerebellopontine angle. A neurological consult was obtained and the patient opted for conservative treatment. He was discharged well on medications and was under active monitoring by both the neurosurgery and otorhinolaryngology teams. Intracranial cavernoma can present as vertigo without classic neurological manifestations. Any atypical presentations should alert the physician to perform further imaging to rule out sinister causes in the brain. To date, there is no reported case of intracranial cavernoma presenting as vertigo in the literature. Main Points: Cerebral cavernous Malformation (cavernoma) is a rare benign vascular lesion of the brain, accounting for only 0.3–0.5% incidence in the population. To date There is no reported case of intracranial cavernoma presenting as vertigo in the literature. Intracranial cavernoma can rarely present as vertigo without classic neurological manifestations. Any atypical presentations Should alert the physician to perform further imaging to rule out sinister causes in the brain. [ABSTRACT FROM AUTHOR]

Aim: To estimate the Single-sided deafness (SSD) among sensorineural hearing loss (SNHL) in Tertiary Care Rehabilitation Centre. To determine the audiological characteristics, associated and medical problems, and rehabilitative approaches among SSD. Method: A retrospective study was conducted to report on demographic details, audiological evaluation, and hearing aid management among SSD clients. A total of 11,534 cases of SNHL were reported to the Audiology department at the tertiary care rehabilitative center at Mysuru between January 2014 and December 2017. Results: A total of 225 were diagnosed as having SSD, accounting for approximately two cases of SSD in a cohort of 100 SNHL cases (225/11,534*100). In addition, males are affected more than females. SSD is found to have more in the right ear than the left ear. Their major complaints were tinnitus and vertigo, apart from reduced hearing sensitivity from the affected ear. In the side of the ear with profound hearing loss among SSD clients showed normal middle ear status with absent acoustic reflexes, otoacoustic emissions, and auditory brainstem response. Only 54 individuals (24%) out of 225 SSD clients underwent a hearing aid trial. Twenty-one (9%) SSD clients purchased a hearing aid, and a minuscule seven (3%) of 225 SSD clients are using a hearing aid. The preference for hearing aid uptake was low because of the experience of vibratory sensation and having near-normal hearing in one ear. Conclusion: Two cases of SSD were observed among SNHL and they are less likely to get benefits from the hearing aid. [ABSTRACT FROM AUTHOR]