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Possible Participation of Irregularly Surfaced Carotid Plaques in the Genesis of Idiopathic Transient Vestibulopathy

Objective: In our specialist vertigo center, patients with vertigo of sudden onset and rapid recovery (within 24 hour), which we call “idiopathic transient vestibulopathy’ (ITV), are not uncommon. The present study aimed to clarify the underlying mechanism(s) of ITV.

Methods: Consecutive ITV patients (n=39) who attended the Vertigo Center of Toho University Sakura Hospital were enrolled with a control group of 64 consecutive patients with vestibular neuritis (VN). At their visit, a caloric test and carotid ultrasonography (CUS) were performed.

Results: By caloric test, most of the ITV patients had no vestibular dysfunction whereas the majority of the VN patients had severe vestibular dysfunction. By CUS, atherosclerosis was more advanced in the ITV patients. 39% of ITV and 18% (p=0.003 vs. ITV) of VN patients had irregularly surfaced plaques. Conclusion: Irregularly surfaced carotid plaque, which often indicates the presence of thrombogenic ulcer, fissure or previous disruption, was frequent in ITV patients, suggesting its participation in transient ischemic vestibular nerve dysfunction and consequent vertigo in at least one-third of ITV patients.

Author(s): Tomoe Yoshida,Masahiko Yamamoto, Mitsuya Suzuki and Takeshi Sasak