Disease Conditions — overview
Pattern recognition across the seven conditions covered in this atlas, with links to each detailed module.
The seven conditions
Third-window VEMP signature — lowered threshold, augmented amplitude.
Endolymphatic hydrops — reduced amplitudes and frequency-tuning shift.
Topographic diagnosis: superior vs inferior vs total neuritis.
VEMP in vestibular migraine — common but heterogeneous abnormalities.
Benign paroxysmal positional vertigo — utricular VEMP findings.
Sensitivity ~81%, specificity ~53% — adjunct to MRI work-up.
Central demyelination — latency prolongation, even with normal MRI.
Pattern recognition
Most clinical VEMP abnormalities fall into one of six broad patterns. Reading the pattern first — before reaching for a specific diagnosis — turns a long report into a short shortlist.
- Threshold lowered, amplitude augmentedSCDThird-window effect — pathognomonic for SCD when high-frequency oVEMP is preserved.
- Amplitude reduced, frequency tuning shiftedMénière'sEndolymphatic hydrops. Peak frequency shifts from 500 Hz toward 1 kHz.
- Absent on the affected side, contralateral side preservedVestibular neuritis · SchwannomaTopographic split: superior division → oVEMP affected; inferior → cVEMP affected.
- Latency prolonged with preserved amplitudeMultiple sclerosisCentral demyelination. Can be abnormal even with a normal MRI.
- Heterogeneous, often reduced amplitudes / increased IARVestibular migraineCommon but non-specific — supports but does not confirm the diagnosis.
- Utricular > saccular involvementBPPVoVEMP abnormalities more frequent than cVEMP; reflects utricular origin of displaced otoconia.