Neurological and vestibular findings in three cases of Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams.

Figure 1. Video Head Impulse Test recordings after head impulses in the plane of each semicircular canal in both ears of cases 1 (A), 2 (B) and 3 (C). In blue and pink is the speed of the head corresponding to the left and right sides, respectively. In green is the speed of the eye equivalent to each impulse of the head. In the central hexagonal graph is the gain value of the answers: in red, altered results, and in green, normal results. In red, the occurrence of compensatory saccades is noted.

Figura 1. Registros do exame Video Head Impulse Test. O após impulsos cefálicos no plano de cada canal semicircular em ambas as orelhas dos casos 1 (A), 2 (B) e 3 (C). Em azul e rosa está a velocidade da cabeça correspondente aos lados esquerdo e direito, respectivamente. Em verde está a velocidade do olho equivalente a cada impulso da cabeça. No gráfico hexagonal central encontra-se o valor de ganho das respostas: em vermelho, resultados alterados, e em verde, resultados normais. Em vermelho, observa-se a ocorrência de sacadas compensatórias.