Mediterr J Otol 2006:2(2):58-62

Vestibular Abnormalities in Pseudotumor Cerebri

Hossam Abdelghaffar

Audiology Unit Faculty of Medicine, Cairo University, Cairo, Egypt.

OBJECTIVE: To identify the vestibular function in patients diagnosed with pseudotumor cerebri and determine whether pseudotumor cerebri is accompanied by vestibular system malfunction.

METHODS: Fifteen patients (12 women and 3 men; age range, 23-36 years [mean, 31.5 years]) with benign intracranial hypertension and true vertiginous attacks were referred to the vertigo clinic of Cairo University in Egypt for further evaluation and management. A complete neuro-otological history was taken from all subjects, with special emphasis on vertigo history. Subjects with a known history of peripheral or central vestibular system involvement and those with present predisposing factors for vestibular system involvement were excluded from this study. All patients underwent basic audiologic evaluation, and vestibular system testing by videonystagmography.

RESULTS: The entire study group had normal hearing threshold levels with pure tone average 20 dB and normal middle ear function, evidenced by type A tympanogram with preserved acoustic reflexes. Four subjects (26.6%) had normal videonystagmography test battery. Saccadic tracking was normal in the whole study group. No spontaneous or gaze-evoked nystagmus were detected in the 15 subjects. Three subjects (20%) showed reduced pursuit and optokinetic gain with normal symmetry. The same 3 subjects showed normal caloric responses with abnormal fixation index. Dix-Hallpike tests elicited robust positioning nystagmus in 2 subjects (13.4%). Unilateral canal weakness and directional preponderance were found in 5 subjects (33.4%) and 1 subject had bilateral canal weakness (6.6%).

CONCLUSIONS: These findings confirm that vestibular abnormalities are common in patients with pseudotumor cerebri.