A case of autoimmune mediated acute vestibular syndrome with neurological sequelae

Abstract

  Acute vestibular syndrome (AVS) is a condition characterized by sudden-onset dizziness, nausea, vomiting, nystagmus, and postural instability. Reported cases of AVS in children are rare. A 9-year-old girl was admitted to our hospital with dizziness, double vision, vomiting, and difficulty in walking after tonsillitis. Because apparent truncal ataxia and muscle weakness with a decline in deep tendon reflex were observed, suggesting Fisher syndrome, this case was followed up without treatment. Her symptoms of dizziness, nausea, vomiting, and nystagmus gradually improved, but muscle weakness and truncal ataxia remained. Spinal fluid examination revealed an increased number of mononuclear-dominated cells, and contrast enhanced magnetic resonance imaging (MRI) scan of the head showed abnormal contrast effects on the bilateral eighth cranial nerves at the cerebellopontine angle. An anti-ganglioside antibody test was negative for anti-GQ1b IgG and positive for anti-GM1 IgG and anti-GM2 IgG. We diagnosed her with autoimmune-mediated AVS. In autoimmune-mediated AVS, the involvement of multiple antibodies has been reported and, depending on the course of the disease, acute treatment such as Intravenous Immunoglobulin should be considered.