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      Síntomas y signos de la hipofunción vestibular unilateral y bilateral Translated title: Symptoms and signs of unilateral and bilateral vestibular hypofunction

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          Abstract

          RESUMEN Introducción y objetivos: La disfunción vestibular periférica implica a los órganos vestibulares o a los nervios vestibulares, produciendo una gran variedad de síntomas y signos clínicos. Material y métodos: Revisión narrativa. Resultados: El otoneurólogo es el encargado de realizar una evaluación exhaustiva para llegar a identificar el trastorno que presenta el paciente que acude con vértigo o desequilibrio. La clave diagnóstica es la anamnesis profunda completada con un cuidadoso examen otoneurológico. Además, las nuevas tecnologías de estudio que han surgido en este campo permiten un cambio en la definición, caracterización y tratamiento de estas patologías. Conclusiones: En la presente revisión narrativa se describirán los dos grandes grupos de deficiencia vestibular periférica: la vestibulopatía unilateral y bilateral.

          Translated abstract

          ABSTRACT Introduction: Peripheral vestibular dysfunction involve the vestibular organs or the vestibular nerve producing a wide variety of symptoms and clinical signs. Material and methods: Narrative revision. Results: The otoneurologist is responsible for conducting an exhaustive evaluation to identify the pathology presented by the patient who has vertigo or imbalance. The key to the diagnosis is the deep history completed with a careful otoneurological examination. Conclusions: In the present narrative review, the two large groups of peripheral vestibular deficiency will be described: unilateral and bilateral vestibulopathy.

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          Classification of vestibular symptoms: towards an international classification of vestibular disorders.

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            Beyond Dizziness: Virtual Navigation, Spatial Anxiety and Hippocampal Volume in Bilateral Vestibulopathy

            Bilateral vestibulopathy (BVP) is defined as the impairment or loss of function of either the labyrinths or the eighth nerves. Patients with total BVP due to bilateral vestibular nerve section exhibit difficulties in spatial memory and navigation and show a loss of hippocampal volume. In clinical practice, most patients do not have a complete loss of function but rather an asymmetrical residual functioning of the vestibular system. The purpose of the current study was to investigate navigational ability and hippocampal atrophy in BVP patients with residual vestibular function. Fifteen patients with BVP and a group of age- and gender- matched healthy controls were examined. Self-reported questionnaires on spatial anxiety and wayfinding were used to assess the applied strategy of wayfinding and quality of life. Spatial memory and navigation were tested directly using a virtual Morris Water Maze Task. The hippocampal volume of these two groups was evaluated by voxel-based morphometry. In the patients, the questionnaire showed a higher spatial anxiety and the Morris Water Maze Task a delayed spatial learning performance. MRI revealed a significant decrease in the gray matter mid-hippocampal volume (Left: p = 0.006, Z = 4.58, Right: p < 0.001, Z = 3.63) and posterior parahippocampal volume (Right: p = 0.005, Z = 4.65, Left: p < 0.001, Z = 3.87) compared to those of healthy controls. In addition, a decrease in hippocampal formation volume correlated with a more dominant route-finding strategy. Our current findings demonstrate that even partial bilateral vestibular loss leads to anatomical and functional changes in the hippocampal formation and objective and subjective behavioral deficits.
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              Causative factors and epidemiology of bilateral vestibulopathy in 255 patients.

              To determine the causative factors and epidemiology of bilateral vestibulopathy (BV). This is a retrospective review of 255 patients (mean age, 62 +/- 16 years) with BV diagnosed in our dizziness unit between 1988 and 2005. All patients had undergone a standardized neurophthalmological and neurootological examination, electronystagmography with caloric irrigation, cranial magnetic resonance imaging or computed tomography (n = 214), and laboratory tests. Sixty-two percent of the study population were male subjects. Previous vertigo attacks had occurred in 36%, indicating a sequential manifestation. The definite cause of BV was determined in 24% and the probable cause in 25%: The most common causes were ototoxic aminoglycosides (13%), Menière's disease (7%), and meningitis (5%). Strikingly, 25% exhibited cerebellar signs. Cerebellar dysfunction was associated with peripheral polyneuropathy in 32% compared with 18% in BV patients without cerebellar signs. Hypoacusis occurred bilaterally in 25% and unilaterally in 6% of all patients. It appeared most often in patients with BV caused by Cogan's syndrome, meningitis, or Menière's disease. The cause of BV remains unclear in about half of all patients despite intensive examinations. A large subgroup of these patients have associated cerebellar dysfunction and peripheral polyneuropathy. This suggests a new syndrome that may be caused by neurodegenerative or autoimmune processes.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                March 2020
                : 11
                : 1
                : 7-17
                Affiliations
                [1] Zamora orgnameSacyl orgdiv1Complejo Asistencial de Zamora orgdiv2Servicio de Otorrinolaringología España
                [2] Salamanca orgnameSacyl. Complejo Asistencial Universitario de Salamanca orgdiv1Complejo Asistencial Universitario de Salamanca orgdiv2Servicio de Otorrinolaringología y PCF España
                Article
                S2444-79862020000100002 S2444-7986(20)01100100002
                10.14201/orl.21625
                df72d136-498d-494b-9d99-6e04abf5d668

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 25 November 2019
                : 22 October 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 11
                Product

                SciELO Spain

                Categories
                Artículo de revisión

                bilateral vestibulopathy,vestibulopatía bilateral,disfunción,unilateral vestibulopathy,vestibulopatía unilateral,dysfunction,peripheral,hypofunction,hipofunción,periférico

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