Normal Caloric Responses during Acute Phase of Vestibular Neuritis
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Background and PurposezzWe report a novel fnding of caloric conversion from normal responses into unilateral paresis during the acute phase of vestibular neuritis (VN). MethodszzWe recruited 893 patients with a diagnosis of VN at Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014 afer excluding 28 patients with isolated inferior divisional VN (n=14) and those without follow-up tests despite normal caloric responses initially (n=14). We retrospectively analyzed the neurotological fndings in four (0.5%) of the patients who showed a conversion from initially normal caloric responses into unilateral paresis during the acute phase. ResultszzIn those four patients, the initial caloric tests were performed within 2 days of symptom onset, and conversion into unilateral caloric paresis was documented 1–4 days later. Te clinical and laboratory fndings during the initial evaluation were consistent with VN in all four patients except for normal fndings in bedside head impulse tests in one of them. ConclusionszzNormal fndings in caloric tests should be interpreted with caution during the acute phase of suspected VN. Follow-up evaluation should be considered when the fndings of the initial caloric test are normal, but VN remains the most plausible diagnosis.
Abstract
Background and PurposezzWe report a novel fnding of caloric conversion from normal responses into unilateral paresis during the acute phase of vestibular neuritis (VN). MethodszzWe recruited 893 patients with a diagnosis of VN at Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014 afer excluding 28 patients with isolated inferior divisional VN (n=14) and those without follow-up tests despite normal caloric responses initially (n=14). We retrospectively analyzed the neurotological fndings in four (0.5%) of the patients who showed a conversion from initially normal caloric responses into unilateral paresis during the acute phase. ResultszzIn those four patients, the initial caloric tests were performed within 2 days of symptom onset, and conversion into unilateral caloric paresis was documented 1–4 days later. Te clinical and laboratory fndings during the initial evaluation were consistent with VN in all four patients except for normal fndings in bedside head impulse tests in one of them. ConclusionszzNormal fndings in caloric tests should be interpreted with caution during the acute phase of suspected VN. Follow-up evaluation should be considered when the fndings of the initial caloric test are normal, but VN remains the most plausible diagnosis.
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