I would like to ask if someone had seen specific pattern in caloric vestibular examination: 12-years old boy with walking instability, on ENG OKN hyporeflexia, caloric exam 4-times within 1,5 year, always strong DP to left, ie. reaction practically only in CR and WL tests, but changing intensity - twice greater on the left side, once greater on the right side. Once was caloric normal with all four reactions. Clinical symptoms dint change during this whole time.
I wonder, if you have ever seen similar fluctuation in caloric reactivity? Thanks
It is an gain asymetry pattern also knwn as isolated directional preponderance.
I've seen it sometimes in Meniere's Disease patients, but without such fluctuation you comment.
It's also described in migraine patients:
Does the patient has any migraine or migraine-equivalent symptom, ?
Thanks for your answer.
This patient doesnot have any migraine sign.
In fact, we have suspected factitive disorder. For this, we have repeated the claoric test with ENG registration and using Frenzel goggoles for direct response observation. Caloric gain was low, but better then withour Frenzel. It is my opinion, that there is labyrinthine abnromality proved by calorics. But the fluctuation is strange. Also, there is no sign for Meniere - no cochlear pathology at all.
with best regards
Hearing loss? If so, Menière's disease; if not, vestibular migraine. Perhaps my suggestions are unyielding but I think they are the most probable diseases you could suspect. Migraine in relatives?