Cavernous Hemangioma With Right Vestibulopathy: A Case Report Illustrating Multidisciplinary Clinical Decision-Making in Vestibular Diagnostics

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Abstract

This paper describes a case study of a 56-year-old male patient with a small cavernous hemangioma and concurrent peripheral vestibular symptoms, initially thought to warrant neurosurgical intervention. A structured, multidisciplinary approach involving audiology, ear, nose and throat, and physiotherapy revealed that peripheral vestibular dysfunction, rather than the central lesion, was the primary cause of symptoms. The report illustrates the diagnostic utility of video head impulse testing (vHIT), caloric testing, and vestibular evoked myogenic potentials (VEMPs) in differentiating central and peripheral vestibular dysfunction, leading to a nonsurgical treatment plan. The case underscores the importance of multidisciplinary collaboration in preventing unnecessary interventions and highlights an effective clinical decision-making framework for similar cases.

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Most cited references 23

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The Video Head Impulse Test (vHIT) of Semicircular Canal Function – Age-Dependent Normative Values of VOR Gain in Healthy Subjects

Leigh A. McGarvie, Hamish G. MacDougall, G. Michael Halmagyi … (2015)

Background/hypothesis The video Head Impulse Test (vHIT) is now widely used to test the function of each of the six semicircular canals individually by measuring the eye rotation response to an abrupt head rotation in the plane of the canal. The main measure of canal adequacy is the ratio of the eye movement response to the head movement stimulus, i.e., the gain of the vestibulo-ocular reflex (VOR). However, there is a need for normative data about how VOR gain is affected by age and also by head velocity, to allow the response of any particular patient to be compared to the responses of healthy subjects in their age range. In this study, we determined for all six semicircular canals, normative values of VOR gain, for each canal across a range of head velocities, for healthy subjects in each decade of life. Study design The VOR gain was measured for all canals across a range of head velocities for at least 10 healthy subjects in decade age bands: 10–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89. Methods The compensatory eye movement response to a small, unpredictable, abrupt head rotation (head impulse) was measured by the ICS impulse prototype system. The same operator delivered every impulse to every subject. Results Vestibulo-ocular reflex gain decreased at high head velocities, but was largely unaffected by age into the 80- to 89-year age group. There were some small but systematic differences between the two directions of head rotation, which appear to be largely due to the fact that in this study only the right eye was measured. The results are considered in relation to recent evidence about the effect of age on VOR performance. Conclusion These normative values allow the results of any particular patient to be compared to the values of healthy people in their age range and so allow, for example, detection of whether a patient has a bilateral vestibular loss. VOR gain, as measured directly by the eye movement response to head rotation, seems largely unaffected by aging.

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The epidemiology of dizziness and vertigo.

H Neuhauser (2016)

This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.

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Epidemiology of vertigo.

H Neuhauser (2007)

Epidemiological findings on the distribution, determinants and outcome of vertigo can be used for clinical decision making and can help understand the underlying causes of vestibular diseases. This article gives an overview of the epidemiology of the vestibular symptom vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, migrainous vertigo, Menière's disease and vestibular neuritis. Based on a neurotologic survey of the general population, 1-year prevalence estimates for vertigo were 4.9%, for migrainous vertigo 0.89% and for benign paroxysmal positional vertigo 1.6%. Diagnostic positional manoeuvres and treatments for benign paroxysmal positional vertigo, however, are still not being done by most doctors. The female preponderance among patients with benign paroxysmal positional vertigo and migrainous vertigo may be linked to migraine but is not fully understood. A recently reported prevalence of Menière's disease of 0.51% is much higher than previous estimates. Follow-up studies have shown benign paroxysmal positional vertigo recurrence rates of 50% at 5 years and a persistence of dizziness related to anxiety in almost a third of patients 1 year after vestibular neuritis. The epidemiology of vertigo and vestibular disorders is still an underdeveloped field. Recent studies have underscored the impact of vertigo at the population level, but its determinants and outcome are not well known yet.

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Author and article information

Journal

Journal ID (nlm-ta): J Clin Med Res

Journal ID (iso-abbrev): J Clin Med Res

Journal ID (publisher-id): Elmer Press

Title: Journal of Clinical Medicine Research

Publisher: Elmer Press

ISSN (Print): 1918-3003

ISSN (Electronic): 1918-3011

Publication date (Print): December 2024

Publication date (Electronic): 30 November 2024

Volume: 16

Issue: 11

Pages: 564-570

Affiliations

[a ]Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa

[b ]Cintocare Multidisciplinary Dizziness, Vertigo and Imbalance Clinic, Pretoria, South Africa

[c ]Department of Audiology, University of the Witwatersrand, Johannesburg, South Africa

Author notes

[d ]Corresponding Author: Amisha Kanji, Department of Audiology, University of the Witwatersrand, Johannesburg, South Africa. Email: amisha.kanji@ 123456wits.ac.za

Author information

Alida Naude https://orcid.org/0000-0002-3618-6551

Lisa Brown https://orcid.org/0000-0003-2750-9889

Amisha Kanji https://orcid.org/0000-0002-9577-4935

Article

DOI: 10.14740/jocmr6089

PMC ID: 11614406

PubMed ID: 39635333

SO-VID: fc9be8a3-5578-44fc-808a-6a250beeaa75

License:

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 4 October 2024

Date accepted : 20 November 2024

Funding

The authors have no funding to disclose.

Cavernous Hemangioma With Right Vestibulopathy: A Case Report Illustrating Multidisciplinary Clinical Decision-Making in Vestibular Diagnostics

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