Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2021
Bilateral Vestibulopathy in Neuroborreliosis.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Malara Pasquale, Martellucci Salvatore, Castellucci Andrea, Belvisi Valeria, Del Torso Aleardo
Аннотация
OBJECTIVE: To describe a unique case of definite neuroborreliosis presenting with bilateral vestibulopathy (BV) due to simultaneous involvement of both vestibular systems highlighted by a complete assessment for all five vestibular receptors.
PATIENT: A 72-year-old woman presented with disabling disequilibrium arisen about 4 weeks earlier and history of erythema migrans developing about 45 days before.
INTERVENTIONS: Assessing all five vestibular receptors with the video-head impulse test (vHIT), the suppression head impulse paradigm (SHIMP) and vestibular evoked myogenic potentials (VEMPs), a severe bilateral vestibulopathy was diagnosed. IgG and IgM Borrelia-specific antibodies on patient serum and cerebrospinal fluid analysis confirmed the diagnosis of neuroborreliosis. Following diagnosis, a course of doxycycline was started and the patients received an individualized vestibular rehabilitation program.
RESULTS: The patient exhibited slowly progressive improvements for disabling symptoms and the improving function of all five vestibular receptors was monitored with vHIT, SHIMP, and VEMPs over time.
CONCLUSIONS: This is the first case report of bilateral vestibulopathy likely caused by neuroborreliosis. Although neurotologic involvement is an uncommon complication in this condition, clinicians should consider a vestibular testing battery when addressed by patient's history and bedside vestibular findings.
PATIENT: A 72-year-old woman presented with disabling disequilibrium arisen about 4 weeks earlier and history of erythema migrans developing about 45 days before.
INTERVENTIONS: Assessing all five vestibular receptors with the video-head impulse test (vHIT), the suppression head impulse paradigm (SHIMP) and vestibular evoked myogenic potentials (VEMPs), a severe bilateral vestibulopathy was diagnosed. IgG and IgM Borrelia-specific antibodies on patient serum and cerebrospinal fluid analysis confirmed the diagnosis of neuroborreliosis. Following diagnosis, a course of doxycycline was started and the patients received an individualized vestibular rehabilitation program.
RESULTS: The patient exhibited slowly progressive improvements for disabling symptoms and the improving function of all five vestibular receptors was monitored with vHIT, SHIMP, and VEMPs over time.
CONCLUSIONS: This is the first case report of bilateral vestibulopathy likely caused by neuroborreliosis. Although neurotologic involvement is an uncommon complication in this condition, clinicians should consider a vestibular testing battery when addressed by patient's history and bedside vestibular findings.