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https://www.readbyqxmd.com/read/29234822/-acute-vestibular-syndrome-clinical-examination-outperforms-mri-in-the-detection-of-central-lesions
#1
REVIEW
F Thömke
A significant number of patients who seek medical treatment in an emergency department because of vertigo or dizziness, suffer from acute vestibular syndrome. This is characterized by sustained vertigo, horizontal or horizontal rotatory jerk nystagmus, and unsteady stance and gait. In the acute situation it is crucial to differentiate patients with a peripheral vestibular disorder from those with a central disease. A number of recent studies have shown that a structured clinical examination enables a reliable differential diagnosis of central or peripheral disorders...
December 12, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/29208731/misleading-signs-in-acute-vertigo
#2
Sean Lance, Stuart Scott Mossman
The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma)...
December 5, 2017: Practical Neurology
https://www.readbyqxmd.com/read/29207275/clinical-features-of-otolith-organ-specific-vestibular-dysfunction
#3
Chisato Fujimoto, Sayaka Suzuki, Makoto Kinoshita, Naoya Egami, Keiko Sugasawa, Shinichi Iwasaki
OBJECTIVE: To elucidate the clinical features and vestibular symptoms of patients with otolith organ dysfunction in the presence of normal function of the semicircular canals. METHODS: We reviewed the clinical records of 277 consecutive new patients with balance disorders who underwent testing of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) as well as caloric testing and video head impulse testing (vHIT). RESULTS: We identified 76 patients who showed normal caloric responses and normal vHIT findings in each SCC plane, but abnormal responses in cVEMP and/or oVEMP testing...
November 21, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/29190293/morphological-correlation-between-caloric-tests-and-vestibular-hydrops-in-m%C3%A3-ni%C3%A3-re-s-disease-using-intravenous-gd-enhanced-inner-ear-mri
#4
Ji Eun Choi, Yi-Kyung Kim, Young Sang Cho, Kieun Lee, Hyun Woo Park, Sung Hoon Yoon, Hyung-Jin Kim, Won-Ho Chung
The purpose of this study was to prove the hypothesis that caloric response in Ménière's disease (MD) is reduced by hydropic expansion of the vestibular labyrinth, not by vestibular hypofunction, by evaluating the correlation morphologically using an intravenous Gadolinium (IV-Gd) inner ear MRI. In study I, the prevalence of abnormal video Head Impulse Test (vHIT) results among the patients with definite unilateral MD (n = 24) and vestibular neuritis (VN) (n = 22) were investigated. All patients showed abnormal canal paresis (CP) (> 26%) on caloric tests...
2017: PloS One
https://www.readbyqxmd.com/read/29189298/laboratory-examinations-for-the-vestibular-system
#5
Raymond van de Berg, Sally Rosengren, Herman Kingma
PURPOSE OF REVIEW: In the last decades, researchers suggested that clinical assessment of labyrinthine function in detail became easy thanks to video head impulse tests (VHITs), vestibular evoked myogenic potential test (VEMP) and video-oculography (VOG). It has been argued that they can replace electronystagmography, the caloric and rotatory chair tests. This review addresses the latest evaluations of these tests and the opportunities they offer, but also the limitations in clinical practice...
November 20, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29184530/the-video-head-impulse-test-to-assess-the-efficacy-of-vestibular-implants-in-humans
#6
Nils Guinand, Raymond Van de Berg, Samuel Cavuscens, Maurizio Ranieri, Erich Schneider, Floor Lucieer, Herman Kingma, Jean-Philippe Guyot, Angélica Pérez Fornos
The purpose of this study was to evaluate whether it is possible to restore the high-frequency angular vestibulo-ocular reflex (aVOR) in patients suffering from a severe bilateral vestibulopathy (BV) and implanted with a vestibular implant prototype. Three patients (S1-3) participated in the study. They received a prototype vestibular implant with one to three electrode branches implanted in the proximity of the ampullary branches of the vestibular nerve. Five electrodes were available for electrical stimulation: one implanted in proximity of the left posterior ampullary nerve in S1, one in the left lateral and another one in the superior ampullary nerves in S2, and one in the right lateral and another one in the superior ampullary nerves in S3...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29172124/material-mapping-strategy-to-improve-the-predicted-response-of-the-proximal-femur-to-a-sideways-fall-impact
#7
W S Enns-Bray, H Bahaloo, I Fleps, O Ariza, S Gilchrist, R Widmer, P Guy, H Pálsson, S J Ferguson, P A Cripton, B Helgason
Sideways falls are largely responsible for the highly prevalent osteoporotic hip fractures in today's society. These injuries are dynamic events, therefore dynamic FE models validated with dynamic ex vivo experiments provide a more realistic simulation than simple quasi-static analysis. Drop tower experiments using cadaveric specimens were used to identify the material mapping strategy that provided the most realistic mechanical response under impact loading. The present study tested the addition of compression-tension asymmetry, tensile bone damage, and cortical-specific strain rate dependency to the material mapping strategy of fifteen dynamic FE models of the proximal femur, and found improved correlations and reduced error for whole bone stiffness (R2 = 0...
October 27, 2017: Journal of the Mechanical Behavior of Biomedical Materials
https://www.readbyqxmd.com/read/29163350/differential-diagnosis-of-vertigo-in-the-emergency-department-a-prospective-validation-study-of-the-standing-algorithm
#8
Simone Vanni, Rudi Pecci, Jonathan A Edlow, Peiman Nazerian, Rossana Santimone, Giuseppe Pepe, Marco Moretti, Andrea Pavellini, Cosimo Caviglioli, Claudia Casula, Sofia Bigiarini, Paolo Vannucchi, Stefano Grifoni
Objective: We investigated the reliability and accuracy of a bedside diagnostic algorithm for patients presenting with vertigo/unsteadiness to the emergency department. Methods: We enrolled consecutive adult patients presenting with vertigo/unsteadiness at a tertiary hospital. STANDING, the acronym for the four-step algorithm we have previously described, based on nystagmus observation and well-known diagnostic maneuvers includes (1) the discrimination between SponTAneous and positional nystagmus, (2) the evaluation of the Nystagmus Direction, (3) the head Impulse test, and (4) the evaluation of equilibrium (staNdinG)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29142084/impaired-vestibular-responses-in-internuclear-ophthalmoplegia-association-and-dissociation
#9
Seo-Young Choi, Hyo-Jung Kim, Ji-Soo Kim
OBJECTIVE: To determine the role of the medial longitudinal fasciculus (MLF) in conveying vestibular signals. METHODS: In 10 patients with isolated acute unilateral internuclear ophthalmoplegia (INO) due to an acute stroke, we performed comprehensive vestibular evaluation using video-oculography, head impulse tests with a magnetic search coil technique, bithermal caloric tests, tests for the ocular tilt reaction, and measurements of subjective visual vertical and cervical and ocular vestibular evoked myogenic potentials (VEMPs)...
November 15, 2017: Neurology
https://www.readbyqxmd.com/read/29141478/utility-of-quick-oculomotor-tests-for-screening-the-vestibular-system-in-the-subacute-and-chronic-populations
#10
Helen S Cohen, Jasmine Stitz, Haleh Sangi-Haghpeykar, Susan P Williams, Ajitkumar P Mulavara, Brian T Peters, Jacob J Bloomberg
OBJECTIVE: The goal of this study was to determine the sensitivity and specificity of some widely used, easily administered clinical tests. BACKGROUND: Simple tests of oculomotor function have become widely used for clinical screening of patients suspected of having vestibular disorders despite a paucity of evidence showing good statistical support for their use in this highly variable population. METHODS: Healthy controls with no history of otologic or neurologic disorders (n = 291) were compared to patients with known vestibular disorders (n = 62)...
November 16, 2017: Acta Oto-laryngologica
https://www.readbyqxmd.com/read/29135873/the-effect-of-peripheral-vestibular-recovery-on-improvements-in-vestibulo-ocular-reflexes-and-balance-control-after-acute-unilateral-peripheral-vestibular-loss
#11
John H J Allum, Alja Scheltinga, Flurin Honegger
BACKGROUND: Patients with an acute unilateral peripheral vestibular deficit (aUPVD), presumed to be caused by vestibular neuritis, show asymmetrical vestibular ocular reflexes (VORs) that improve over time. Questions arise regarding how much of the VOR improvement is due to peripheral recovery or central compensation, and whether differences in peripheral recovery influence balance control outcomes. METHODS: Thirty patients were examined at aUPVD onset and 3, 6, and 13 weeks later with four different VOR tests: caloric tests; rotating (ROT) chair tests performed in yaw with angular accelerations of 5 and 20 degrees/s; and video head impulse tests (vHIT) in the yaw plane...
December 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/29129037/eye-movement-abnormalities-in-middle-cerebellar-peduncle-strokes
#12
Sung-Hee Kim, Ji-Soo Kim
The middle cerebellar peduncle (MCP) is a major conduit for cortico-ponto-cerebellar fibers that convey information related to eye movements. This study aims to elucidate eye movement abnormalities that arise from lesions confined to the MCP. In 23 patients with acute strokes restricted to unilateral MCPs, we investigated the clinical features and ocular motor findings including spontaneous nystagmus, saccades, smooth pursuit, ocular tilt reaction, and head impulse tests. Bithermal caloric tests and audiometry were also performed...
November 11, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/29110566/predicting-the-outcome-after-acute-unilateral-vestibulopathy-analysis-of-vestibulo-ocular-reflex-gain-and-catch-up-saccades
#13
Niccolò Cerchiai, Elena Navari, Stefano Sellari-Franceschini, Chiara Re, Augusto Pietro Casani
Objectives (1) To describe the relationships among the main instrumental features characterizing an acute unilateral vestibulopathy and (2) to clarify the role of the video head impulse test in predicting the development of chronic vestibular insufficiency. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Sixty patients suffering from acute unilateral vestibulopathy were retrospectively analyzed: 30 who recovered spontaneously (group 1) and 30 who needed a vestibular rehabilitation program (group 2)...
November 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29110135/the-effect-of-visual-contrast-on-human-vestibulo-ocular-reflex-adaptation
#14
M Muntaseer Mahfuz, Michael C Schubert, Christopher J Todd, William V C Figtree, Serajul I Khan, Americo A Migliaccio
The vestibulo-ocular reflex (VOR) is the main retinal image stabilising mechanism during rapid head movement. When the VOR does not stabilise the world or target image on the retina, retinal image slip occurs generating an error signal that drives the VOR response to increase or decrease until image slip is minimised, i.e. VOR adaptation occurs. Visual target contrast affects the human smooth pursuit and optokinetic reflex responses. We sought to determine if contrast also affected VOR adaptation. We tested 12 normal subjects, each over 16 separate sessions...
November 6, 2017: Journal of the Association for Research in Otolaryngology: JARO
https://www.readbyqxmd.com/read/29102239/comparison-of-the-video-head-impulse-test-with-the-caloric-test-in-patients-with-sub-acute-and-chronic-vestibular-disorders
#15
Anne Burston, Stuart Mossman, Benjamin Mossman, Mark Weatherall
The aim of this prospective register-based study was to compare video Head Impulse Tests (vHIT) with caloric tests on 173 patients assessed by a tertiary Neurology referral centre who had been referred for investigation of dizziness or vertigo and whose symptom duration was one month or longer. Abnormal vHIT was defined as angular velocity gain (peak eye velocity/peak head velocity) less than 0.79 at 80 ms and 0.75 at 60 ms, which was two standard deviations below our institutions' lower limit of normal; together with refixation saccades...
October 25, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29093698/the-role-of-predictability-in-saccadic-eye-responses-in-the-suppression-head-impulse-test-of-horizontal-semicircular-canal-function
#16
Jorge Rey-Martinez, Joaquin Yanes, Jonathan Esteban, Ricardo Sanz, Eduardo Martin-Sanz
Background: In the suppression head impulse paradigm (SHIMP) vHIT protocol, the participant is instructed to follow with his gaze a mobile target generated by a laser placed on the participant's head. Recent studies have reported that the refixation saccade latencies are in relation with the time evolution of the vestibular dysfunction in both (standard and SHIMP) procedures. We hypothesized that some central mechanisms like head impulse prediction could be one of the causes for the differences in the saccadic eye responses...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29092804/bilateral-vestibular-hypofunction-in-quantitative-head-impulse-test-clinical-characteristics-in-23-patients
#17
Hilla Levo, Heikki Aalto, Timo P Hirvonen
OBJECTIVE: To explore clinical features of patients with bilateral vestibular hypofunction (BVH) verified in motorized head impulse test (MHIT). MATERIALS AND METHODS: We examined clinical records of 23 adult patients (10 males and 13 females), whose gain of the vestibulo-ocular reflex in the MHIT was bilaterally lowered. Fifteen of 62 unilateral cochlear implant (CI) recipients routinely tested both pre- and postoperatively with the MHIT had BVH. Eight of 198 vestibular outpatients selected to the MHIT due to clinical causes had BVH...
November 2, 2017: Journal of International Advanced Otology
https://www.readbyqxmd.com/read/29089158/cerebellar-ataxia-with-neuropathy-and-vestibular-areflexia-syndrome-canvas
#18
Masakatsu Taki, Takashi Nakamura, Hiraku Matsuura, Tatsuhisa Hasegawa, Hirofumi Sakaguchi, Kanako Morita, Ryotaro Ishii, Ikuko Mizuta, Takashi Kasai, Toshiki Mizuno, Shigeru Hirano
Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a novel ataxic disorder consisting of the triad of cerebellar impairment, bilateral vestibular hypofunction, and a somatosensory deficit. We report the first Japanese case of CANVAS. The patient is a 68-year-old Japanese male. He was referred to our university for further evaluation of progressive gait disturbance and ataxia. He exhibited horizontal gaze-evoked nystagmus and sensory deficit. Nerve conduction studies showed sensory neuronopathy...
October 28, 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/29084063/central-vertigo
#19
Jeong-Yoon Choi, Seung-Han Lee, Ji-Soo Kim
PURPOSE OF REVIEW: This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. RECENT FINDINGS: Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome...
October 27, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29081427/clinical-and-video-head-impulse-test-in-the-diagnosis-of-posterior-circulation-stroke-presenting-as-acute-vestibular-syndrome-in%C3%A2-the-emergency-department
#20
Ayse Guler, Funda Karbek Akarca, Cenk Eraslan, Ceyda Tarhan, Cem Bilgen, Tayfun Kirazli, Nese Celebisoy
INTRODUCTION: Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS: Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow...
2017: Journal of Vestibular Research: Equilibrium & Orientation
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