前庭表现作为多发性硬化症的首发表现：病例系列

文献信息

中文摘要

背景： 多发性硬化症（MS）是一种中枢神经系统的慢性脱髓鞘疾病，最初可表现为多种神经系统症状。前庭功能障碍可能是早期表现，并可模仿常见的外周前庭疾病，造成诊断挑战。
目的： 描述以最初表现为前庭功能障碍的MS患者的前庭症状和临床体征。
材料和方法： 这项回顾性观察性病例系列纳入了2019年至2024年间评估的10例患者，其MS的首发临床表现是前庭功能障碍。进行了临床和神经耳科评估、vHIT和VNG，并在怀疑中枢前庭受累时进行了脑MRI。
结果： 确定了四种主要表现：急性前庭综合征（n=2）、不平衡（n=4）、复发性眩晕（n=2）和位置性眩晕（n=2）。10例患者中有9例至少有一项提示中枢前庭受累的发现，而1例患者前庭检查正常。脑MRI显示所有10例患者均有符合MS放射学标准的病变。
结论： 在出现前庭症状的年轻成人中，中枢前庭体征应引起对潜在中枢病变和可能MS的怀疑。识别这些体征，并在临床指征时进行适当的神经影像学检查，可能有助于在临床孤立综合征阶段更早诊断。

英文摘要

BACKGROUND: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that can initially present with diverse neurological symptoms. Vestibular dysfunction may be an early manifestation, and can mimic common peripheral vestibular disorders, creating a diagnostic challenge.
OBJECTIVES: To characterize vestibular symptoms and clinical signs in patients with MS presenting initially with vestibular dysfunction.
MATERIALS AND METHODS: This retrospective observational case series included ten patients evaluated between 2019 and 2024 whose first clinical manifestation of MS was vestibular dysfunction. Clinical and neuro-otologic assessment, vHIT, and VNG were performed, and brain MRI was obtained when central vestibular involvement was suspected.
RESULTS: Four main presentations were identified: acute vestibular syndrome (n = 2), imbalance (n = 4), recurrent vertigo (n = 2), and positional vertigo (n = 2). Nine of ten patients had at least one finding suggestive of central vestibular involvement, whereas one patient had a normal vestibular examination. Brain MRI demonstrated lesions fulfilling the radiological criteria for MS in all ten patients.
CONCLUSIONS: Central vestibular signs in young adults presenting with vestibular symptoms should raise suspicion of an underlying central lesion and possible MS. Recognition of these signs, together with appropriate neuroimaging when clinically indicated, may facilitate earlier diagnosis during the clinically isolated syndrome stage.