Vascular loop in the cerebellopontine angle: Clinical-radiological correlation.

BACKGROUND: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. OBJECTIVES: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. MATERIALS AND METHODS: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. RESULTS: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. CONCLUSIONS AND SIGNIFICANCE: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.

Correlación clínico-radiológica del asa vascular del ángulo pontocerebeloso / Vascular loop in the cerebellopontine angle: clinical-radiological correlation

Antecedentes: El tronco encefálico, situado en la fosa posterior, conecta el cerebro con la médula espinal. Debido a su ubicación, sus componentes nerviosos guardan una estrecha relación con estructuras vasculares. Objetivos: Describir una relación clínico-radiológica del asa vascular del ángulo pontocerebeloso en pacientes con síntomas indicativos de afectación vestibulococlear mediante evaluación por neuroimagen. Materiales y métodos: Se realizó un estudio retrospectivo y descriptivo. Se incluyeron todos los pacientes evaluados entre 2011 y 2017 con indicios de asa vascular del ángulo pontocerebeloso e historial clínico y estudios de diagnóstico por imagen disponibles. Resultados: 102 pacientes (63 mujeres y 39 hombres) presentaban afectación vestibulococlear. La indicación clínica más frecuente fue mareos (41,18%). Se halló asa vascular unilateral en 43 pacientes (derecho: 21,57%, izquierdo: 20,59%) y bilateral en 59 pacientes (57,84%). El tipo de asa vascular más frecuente fue el tipo II (derecho: 69,14%; izquierdo: 58,75%). El origen más frecuente fue la arteria cerebelosa anteroinferior (ACAI) (derecha: 66,67%, izquierda: 65,00%). No se observó ninguna asociación entre asas vasculares y pérdida de audición neurosensitiva, nistagmo o vértigo. Se halló una asociación con acúfenos. Conclusiones y significación: La presencia de asas vasculares no se asocia a la mayoría de los síntomas auditivos. No obstante, deben notificarse todos los hallazgos de los estudios por imagen. La interpretación de los hallazgos de los estudios por imagen debe correlacionarse con los síntomas clínicos después de excluir otras causas más frecuentes que puedan explicar la sintomatología.(AU)

Background: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. Objectives: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. Materials and methods: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. Results: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. Conclusions and significance: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.(AU)

Vascular loop in the cerebellopontine angle: clinical-radiological correlation. / Correlación clínico-radiológica del asa vascular del ángulo pontocerebeloso.

BACKGROUND: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. OBJECTIVES: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. MATERIALS AND METHODS: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. RESULTS: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. CONCLUSIONS AND SIGNIFICANCE: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.

Normative values of vestibulo-ocular reflex gain obtained through Video Head Impulse Test: an integrative literature review / Valores normativos para la ganancia del reflejo vestíbulo ocular obtenidos a través de test de impulso cefálico asistido por video: una revisión integrativa de la literatura

ABSTRACT Purpose: to identify and analyze the available evidence on the reference values of the vestibulo-ocular reflex gain obtained with the video head impulse test. Methods: an integrative review based on the PRISMA protocol, searching the ProQuest, EBSCO, PubMed, ScienceDirect, Cochrane Library, LILACS, and SciELO databases with keywords. The studies included were original research articles, systematic reviews, and meta-analyses published since 2009, involving humans, written in English, Spanish and/or Portuguese. Results: 10,250 studies related to the keywords were found. Of these, 10 articles met the inclusion criteria and were analyzed following the CADE protocol. On the horizontal plane, the values ranged from 0.80 to 1.06, while on the right anterior/left posterior and on the left anterior/right posterior planes, the values ranged from 0.80 to 1.03. Other relevant data for obtaining the gain were analyzed, such as the number of impulses, the assessor's experience, the patient-object distance, and the percentage of asymmetry. Conclusion: little research on the theme, recently developed and published, mostly in European countries, was found. This shows the need for a greater number of studies to strengthen the scientific evidence.

RESUMEN Objetivo: identificar y analizar la evidencia disponible sobre los valores de referencia para la ganancia del reflejo vestíbulo ocular, obtenido a través del test de impulso cefálico asistido por video. Método: se realizó una revisión integrativa guiada por protocolo PRISMA en las bases de datos Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library, LILACS y Scielo de acuerdo a términos claves. Fueron incluídos artículos originales de investigación, revisiones sistemáticas y metaanálisis, publicados desde el año 2009, realizados en humanos y en idiomas inglés, español y portugués. Resultados: se encontraron 10.250 estudios relacionados con los términos claves utilizados. 10 artículos cumplieron con los criterios de inclusión y fueron analizados según protocolo CADE. Para plano horizontal los valores varían entre 0.80 y 1.06; mientras que para los planos DerechoAnterior/IzquierdoPosterior e IzquierdoAnterior/DerechoPosterior, los valores oscilan entre 0.80 y 1.03. Se analizaron también otros datos relevantes para la obtención de la ganancia, como la cantidad de impulsos, experiencia del evaluador, distancia paciente-objetivo y porcentaje de asimetría. Conclusión: la investigación en torno al tema es escasa, ha sido desarrollada y publicada de manera reciente en países principalmente europeos; demostrando la necesidad de contar con un mayor número de estudios para fortalecer la evidencia científica.

Paroxismia vestibular: reporte de un caso / Vestibular paroxysmia: case report

Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

[High-grade glioma after stereotactic radiosurgery for vestibular schwannoma]. / Glioma radioinducido secundario a tratamiento radioquirúrgico de un schwannoma del nervio vestibular.

Stereotactic radiosurgery undoubtedly represents an important therapeutic procedure for various intracranial pathologies, especially tumours, although they are not entirely complication-free. Radiosurgery have been considered a good management strategy for the majority of small-to-medium size vestibular schwannomas. The authors describe a case of high-grade glioma associated with a previous radiosurgery treatment for a vestibular schwannoma in a 69 year-old woman. A detailed description of these cases is provided, as well as a summary of the related literature.

Schwannoma del nervio vestibular / Vestibular nerve Schwannoma

Se hace una revisión bibliográfica del Schwannoma del nervio vestibular, analizando fundamentalmente los aspectos epidemiológicos, etiológico, anatomopatológico y clínico. Se esboza detalladamente la clasificación de House–Brackmann para la valoración de la función del nervio facial, así como llegar al diagnóstico de dicha patología. Se hace énfasis en el diagnóstico diferencial. Finalmente se concluye con el tratamiento, el cuál depende de la clasificación de KOOS basada en el tamaño del tumor. El pronóstico depende de la extensión de la enfermedad, la cual puede provocar varias complicaciones (AU)

There has been done a bibliographic revision of the vestibular nerve schwannoma, analysing mainly its epidemiological, ethiological and clinical aspects. It´s outlined in details House-Brackmann´s classification to the valuation of facial nerve´s function, as well as to arrive to the diagnosis of this pathology. There has been emphasized the differential diagnosis. Finally it´s concluded by the treatment, which depends on Koos´s classification based on the tumor´s size. The prognosis depends on the illness´s extension which can cause various complications (AU)