{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:29Z","timestamp":1756339589726,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,5,23]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>Bilateral vestibulopathy is a clinical diagnosis backed by investigative confirmation, which can be masked by the lack of lateralising signs. It has a broad aetiological spectrum including neurodegenerative conditions, though many such cases also have unknown aetiology. We present the case of an elderly gentleman who presented with progressive bilateral vestibulopathy nearly 1.5 years prior to his eventual diagnosis of clinically probable multisystem atrophy. This case highlights the need to serially re-evaluate for parkinsonism and cerebellar signs in idiopathic bilateral vestibulopathy and raises a possibility that bilateral vestibulopathy, similar to constipation or anosmia, could be an early syndrome presaging the onset of overt extrapyramidal or cerebellar symptoms in patients with multisystem atrophy.<\/jats:p>","DOI":"10.1136\/bcr-2022-254472","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T11:00:31Z","timestamp":1686567631000},"page":"e254472","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral vestibulopathy presaging clinically probable multisystem atrophy"],"prefix":"10.1136","volume":"16","author":[{"given":"Uma","family":"Ravishankar","sequence":"first","affiliation":[{"name":"Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4142-637X","authenticated-orcid":false,"given":"Rithvik","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7873-603X","authenticated-orcid":false,"given":"Shankar","family":"Venkatasubramanian","sequence":"additional","affiliation":[{"name":"Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sundar","family":"Shanmugam","sequence":"additional","affiliation":[{"name":"Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"key":"2025082711263218000_16.6.e254472.1","doi-asserted-by":"crossref","first-page":"177","DOI":"10.3233\/VES-170619","article-title":"Bilateral Vestibulopathy: diagnostic criteria consensus document of the classification committee of the B\u00e1r\u00e1ny society","volume":"27","author":"Strupp","year":"2017","journal-title":"J Vestib Res"},{"key":"2025082711263218000_16.6.e254472.2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1212\/CON.0000000000000932","article-title":"Chronic dizziness","volume":"27","author":"Cha","year":"2021","journal-title":"CONTINUUM"},{"key":"2025082711263218000_16.6.e254472.3","doi-asserted-by":"publisher","DOI":"10.1002\/mds.29005"},{"key":"2025082711263218000_16.6.e254472.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3233\/VES-2009-0343","article-title":"Classification of vestibular symptoms: towards an international classification of vestibular disorders","volume":"19","author":"Bisdorff","year":"2009","journal-title":"J Vestib Res"},{"key":"2025082711263218000_16.6.e254472.5","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1988.00520310043015"},{"key":"2025082711263218000_16.6.e254472.6","doi-asserted-by":"crossref","unstructured":"Park JH , Kang SY . Dizziness in Parkinson\u2019s disease patients is associated with vestibular function. Sci Rep 2021;11. doi:10.1038\/s41598-021-98540-5","DOI":"10.1038\/s41598-021-98540-5"},{"key":"2025082711263218000_16.6.e254472.7","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2018.01085","article-title":"Vestibular functions and Parkinson\u2019s disease","volume":"9","author":"Smith","year":"2018","journal-title":"Front Neurol"},{"key":"2025082711263218000_16.6.e254472.8","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2017.00538","article-title":"Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation","volume":"8","author":"Cronin","year":"2017","journal-title":"Front Neurol"},{"key":"2025082711263218000_16.6.e254472.9","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1111\/ejn.13253","article-title":"Neurovestibular analysis and falls in Parkinson\u2019s disease and atypical parkinsonism","volume":"43","author":"Venhovens","year":"2016","journal-title":"Eur J Neurosci"},{"key":"2025082711263218000_16.6.e254472.10","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.parkreldis.2020.01.018","article-title":"A comparison of auditory and vestibular dysfunction in Parkinson's disease and multiple system atrophy","volume":"71","author":"Scarpa","year":"2020","journal-title":"Parkinsonism Relat Disord"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-254472","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:26:40Z","timestamp":1756319200000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-254472"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":10,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,12]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bcr-2022-254472"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-254472","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}