A Puzzle of Vestibular Physiology in a Meniere’s Disease Acute Attack

Figure 1

Vestibular examinations performed before the attack suffered by the patient. The vestibular myogenic evoked potentials for otolithic function, ocular (oVEMP) and cervical (cVEMP), are registered after bone vibration (500 Hz) with Bruel & Kjaer minishaker at the hairline (Fz); the response is abnormal on the left side/ear. The first component of the oVEMP (n10) is registered in the contralesional (right) eye that is very small or absent, whereas the n10 beneath the ipsilesional (left) eye is of normal amplitude. The sacculocollic cervical vestibular-evoked myogenic potential (cVEMP) is an uncrossed and predominantly sacculocollic response. The study of the vestibuloocular reflex with the video head-impulse test is normal except for the presence of reduced gain and overt saccades after left lateral semicircular canal stimulation.