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J Vestib Res. 2017;27(4):177-189. doi: 10.3233/VES-170619.

Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society.

Author information

1
Department of Neurology and German Center for Vertigo, Hospital of the LMU Munich, Germany.
2
Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
3
Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital Kawasaki, Japan.
4
Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland.
5
Department of Neurology and Neurobiology, University of California, Los Angeles, USA.
6
Department of Neurology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia.
7
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, USA.
8
Department of Otolaryngology, Maastricht, The Netherlands/Department of Medical Physics, Tomsk Research State University, Russian Federation.

Abstract

This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on the patient history, bedside examination and laboratory evaluation. Bilateral vestibulopathy is a chronic vestibular syndrome which is characterized by unsteadiness when walking or standing, which worsen in darkness and/or on uneven ground, or during head motion. Additionally, patients may describe head or body movement-induced blurred vision or oscillopsia. There are typically no symptoms while sitting or lying down under static conditions.The diagnosis of BVP requires bilaterally significantly impaired or absent function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the angular VOR by the head impulse test (HIT), the video-HIT (vHIT) and the scleral coil technique and for the low frequency range by caloric testing. The moderate range can be examined by the sinusoidal or step profile rotational chair test.For the diagnosis of BVP, the horizontal angular VOR gain on both sides should be <0.6 (angular velocity 150-300°/s) and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side <6°/s and/or the horizontal angular VOR gain <0.1 upon sinusoidal stimulation on a rotatory chair (0.1 Hz, Vmax = 50°/sec) and/or a phase lead >68 degrees (time constant of <5 seconds). For the diagnosis of probable BVP the above mentioned symptoms and a bilaterally pathological bedside HIT are required.Complementary tests that may be used but are currently not included in the definition are: a) dynamic visual acuity (a decrease of ≥0.2 logMAR is considered pathological); b) Romberg (indicating a sensory deficit of the vestibular or somatosensory system and therefore not specific); and c) abnormal cervical and ocular vestibular-evoked myogenic potentials for otolith function.At present the scientific basis for further subdivisions into subtypes of BVP is not sufficient to put forward reliable or clinically meaningful definitions. Depending on the affected anatomical structure and frequency range, different subtypes may be better identified in the future: impaired canal function in the low- or high-frequency VOR range only and/or impaired otolith function only; the latter is evidently very rare.Bilateral vestibulopathy is a clinical syndrome and, if known, the etiology (e.g., due to ototoxicity, bilateral Menière's disease, bilateral vestibular schwannoma) should be added to the diagnosis. Synonyms include bilateral vestibular failure, deficiency, areflexia, hypofunction and loss.

KEYWORDS:

Bilateral vestibulopathy; Bárány Society; diagnostic criteria; disequilibrium; dizziness; vertigo; vestibular

PMID:
29081426
DOI:
10.3233/VES-170619
[Indexed for MEDLINE]

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