Highlights
- •Intracranial hypotension frequently induces audiovestibular impairments.
- •Oculographic analyses documented spontaneous and/or positional nystagmus.
- •Audiometry showed unilateral or bilateral sensorineural hearing loss.
- •Compensatory endolymphatic hydrops for CSF hypovolemia may cause otologic symptoms.
- •Compression of brainstem/cerebellum by CSF buoyancy loss can also be the mechanism.
Abstract
Objective
To investigate the patterns and mechanisms of audiovestibular impairments associated
with intracranial hypotension.
Methods
We had consecutively recruited 16 patients with intracranial hypotension at the Neurology
Center of Pusan National University Hospital for two years. Spontaneous, gaze-evoked,
and positional nystagmus were recorded using 3D video-oculography in all patients,
and the majority of them also had pure tone audiometry and bithermal caloric tests.
Results
Of the 16 patients, five (31.3%) reported neuro-otological symptoms along with the
orthostatic headache while laboratory evaluation demonstrated audiovestibular impairments
in ten (62.5%). Oculographic analyses documented spontaneous and/or positional nystagmus
in six patients (37.5%) including weak spontaneous vertical nystagmus with positional
modulation (n = 4) and pure positional nystagmus (n = 2). One patient presented with recurrent spontaneous vertigo and tinnitus mimicking
Meniere's disease, and showed unidirectional horizontal and torsional nystagmus with
normal head impulse tests during the attacks. Bithermal caloric tests were normal
in all nine patients tested. Audiometry showed unilateral (n = 6) or bilateral (n = 1) sensorineural hearing loss in seven (53.8%) of the 13 patients tested.
Conclusions
Intracranial hypotension frequently induces audiovestibular impairments. In addition
to endolymphatic hydrops and irritation of the vestibulocochlear nerve, compression
or traction of the brainstem or cerebellum due to loss of CSF buoyancy may be considered
as a mechanism of frequent spontaneous or positional vertical nystagmus in patients
with intracranial hypotension.
Keywords
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Article info
Publication history
Published online: July 03, 2015
Accepted:
July 1,
2015
Received in revised form:
June 4,
2015
Received:
December 28,
2014
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
