Nystagmus during an acute Ménière’s attack: from prodrome to recovery

Abstract

Objective

We are currently undertaking a clinical investigation to evaluate the diagnostic capability of a system for detecting periods of pathological dizziness. This article presents an analysis of the data captured during an acute attack of Ménière’s disease.

Design

The Continuous Ambulatory Vestibular Assessment (CAVA) device is worn by patients in the community, and continuously records eye and head movement data (vestibular telemetry).

Study sample

A 53-year-old lady with a fifteen-year history of left-sided unilateral Ménière’s disease.

Results

The patient wore the device nearly continuously for thirty days. The data revealed a three-hour long attack of vertigo consisting of four separate phases of nystagmus. The duration, beat-direction and slow phase velocity of the nystagmus evolved through time. The first phase contained isolated nystagmus beats which preceded the patient’s record of the vertigo attack onset but coincided with anticipation of an impending vertigo attack.

Conclusions

CAVA provides a unique insight into the physiological parameters present during episodes of dizziness. Here, it has provided the first full example of an acute Ménière’s attack, including a period of prodrome. These findings have implications for the prediction of vertigo attack onset, for the diagnosis of Ménière’s disease and other diseases resulting in dizziness.

Keywords:

• Ménière’s disease
• vertigo
• nystagmus
• dizziness
• vestibular diseases

Acknowledgements

We would like to thank Dr Art Mallinson and Dr Neil Longridge for their constructive input on these findings.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data presented here is available upon reasonable request.

Additional information

Funding

John Phillips takes full responsibility for the integrity of the content of this manuscript. This work was supported by the UK Medical Research Council under Grant MR/P026265/1.