In otorhinolaryngological patients suffering from acute and chronic vestibular symptoms, beside peripheral vestibular disorders, central vestibular origins should also be considered possible. Downbeatnystagm is often displayed as a central vestibular lesion.
We report on two patients with downbeatnystagm. A 15year old female (case 1) suffering from daily, intermitting rotary dizziness since one year. A 82year old female (case 2) with permanent rotary dizziness and ataxia since three months. Both with unremarkable clinical ORL exams, further vestibular diagnostics showed no sign of peripheral vestibular lesion. Patient 1 showed no neurological abnormabilities, whereas patient 2 showed a small-step ataxia. While cerebral MRI was without pathology in case 1, there was a SAE-like brain stem lesion in the pons in case 2. Following our consulting neurological recommendation, we started a offlabel therapy with Fampridin, a potassium channel inhibitor and physical therapy. The younger patient was offered an appointment in a neurological clinic by January 2020. In this case we decided against an offlabel therapy.
Remarkable was the highly diverging clinic and the different MRI results. An offlabel therapy with Fampyra has been dicussed positively in current literature. Unfortunately, since Patient 2 did not showed up on a follow appointment, we are not able to present a definite long-term result. In case 1, the upcoming appointment will most likely give further insights.
Central vestibular lesions are important differential diagnoses in otorhinolaryngology. A profound knowledge of clinical-neurological examination is essential to differentiate between central and common peripheral lesions with the goal of admitting the adequate therapy in time.
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