Central vertigo tx and prognosis

[Alyson Huber]

Hello,
What is the best treatment for a central cause of vertigo – all causes of central but particularly CVA/ischemia? Do you have any resources on the prognosis? I feel like the CPG is in reference to peripheral hypofunction only, correct?

[Chrissy Durrough Lugge]

Hi Alyson,
You are correct that the vestibular hypofunction CPG is related to peripheral vestibular dysfunction. Here is a great recent article discussing vestibular rehab for central vestibular dysfunction: https://www.tandfonline.com/doi/full/10.1080/14737175.2022.2106129

This is part of the authors’ commentary on cerebellar strokes:
“Rehabilitation during the acute phase of cerebral infarction can effectively improve the quality of life. Therefore it is crucial that appropriate rehabilitation strategy should be used for patients with cerebellar infarction in the acute phase [154,155]. Some scholars found that balance exercises can improve the motor coordination by remodeling nerve synapses and activating astrocytes to improve the patient’s balance. However, early post-stroke multisensorial training, under visual deprivation with somatosensorial and vestibular stimulation, could be more effective than a traditional approach based on neurodevelopmental concepts [156,157]”

These authors recommend VOR suppression/cancellation exercises, VOR memory/imaginary targets, anti-saccades, and memory saccades (all described in the article). Additionally, I have found postural control training, gait training, and VOR exercises to be important and effective in managing central vestibular dysfunction.

The prognosis for central vestibular dysfunction tends to be poorer than for peripheral disorders, with slower and less complete recoveries.

Chrissy

[Alyson Huber]

Thank you so much!

[Author]

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