cVEMP & oVEMP recovery in Susac syndrome (Suman et al., 2022)

Purpose: Susac syndrome (SS) is a rare autoimmune disorder that affects the brain and the retina and causes unilateral or bilateral sensorineural hearing loss. Although vestibular dysfunction is reported in SS, limited information is available underlying the vestibular pathophysiology.

Method: The diagnosis of SS was established based on symptoms and diagnostic tools such as magnetic resonance imaging and fundus fluorescein angiography. The audiovestibular evaluation was done on the seventh day of admission (Session 1) into the emergency unit, whereas the second and third evaluations were done at 3-month (Session 2) and 8-month (Session 3) follow-ups after discharge, respectively. The audiovestibular test battery consisted of routine audiological tests, auditory brainstem response, and vestibular evoked myogenic potentials (VEMPs; both cervical and ocular).

Results: We found unilateral sensorineural hearing loss and absent cervical VEMPs (cVEMPs) when testing the left ear during Session 1. In the following sessions, the unilateral hearing loss did not recover; however, cVEMPs were present bilaterally. The ocular VEMPs showed an increase in amplitude during Sessions 2 and 3.

Conclusions: SS can selectively disrupt auditory and vestibular structures. It may present with unique findings of audiovestibular tests. A detailed audiovestibular evaluation may be essential in patients with SS.

Supplemental Material S1. Cervical vestibular evoked myogenic potential (cVEMP) tracings for right and left ear for Sessions 1, 2, and 3.

Supplemental Material S2. Ocular vestibular evoked myogenic potential (oVEMP) tracings for Sessions 1, 2, and 3.

Supplemental Material S3. Audiogram depicting pure-tone thresholds.

Suman, N. S., Poovaiah, P. P., Rangarajan, A., Tiwari, R., Nashi, S., Yuvraj, P., & Rajasekaran, A. K. (2022). Cervical and ocular vestibular evoked myogenic potential recovery in Susac syndrome: A case report. American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2022_AJA-22-00012