Capturing acute vertigo

Abstract

ObjectiveTo facilitate the diagnosis of vestibular disorders by patient-initiated capture of ictal nystagmus.MethodsAdults from an Australian neurology outpatient clinic reporting recurrent vertigo were recruited prospectively and taught to self-record spontaneous and positional nystagmus at home while symptomatic, using miniature video-oculography goggles. Consenting patients with ictal videorecordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included.ResultsIctal eye videos of 117 patients were analyzed. Of 43 patients with MD, 40 showed high-velocity spontaneous horizontal nystagmus (median slow-phase velocity [SPV] 39.7°/s; 21 showed horizontal nystagmus reversing direction within 12 hours [24 on separate days]). In 44 of 67 patients with VM, spontaneous horizontal (n = 28, 4.9°/s), upbeating (n = 6, 15.5°/s), or downbeating nystagmus (n = 10, 5.1°/s) was observed; 16 showed positional nystagmus only, and 7 had no nystagmus. Spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD (95% confidence interval [CI] 0.84–0.99, 0.71–0.90). Nystagmus direction change within 12 hours was highly specific (95.7%) for MD (95% CI 0.85–0.99). Spontaneous vertical nystagmus was highly specific (93.0%) for VM (95% CI 0.81–0.99). In the 7 patients with BPPV, spontaneous nystagmus was absent or <3°/s. Lying affected-ear down, patients with BPPV demonstrated paroxysmal positional nystagmus. Median time for peak SPV to halve (T50) was 19.0 seconds. Patients with VM and patients with MD demonstrated persistent positional nystagmus (median T50; 93.1 seconds, 213.2 seconds). T50s <47.3 seconds had a sensitivity and specificity of 100% and 77.8% for BPPV (95% CI 0.54–1.00, 0.64–0.88).ConclusionPatient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.

Update on benign paroxysmal positional vertigo

“…By virtue of both recent developments in information (IT) and biology (BT) technology through programs available on mobile devices [46] and using artificial intelligence and a deep-learning model, interest has turned to whether this approach can be used to determine the underlying disorder(s) causing dizziness and vertigo, and with this the subtype of BPPV [47]. Furthermore, recording of nystagmus during the attacks of vertigo may also become feasible in near future using various portable devices [48]. These kinds of approaches adopting artificial intelligence, deeplearning, wearable devices, and mobile applications, will become more important in determining the cause of vertigo, especially when we have to rely more on telemedicine as is the case now given the COVID-19 pandemic.…”

Proof of Concept for an “eyePhone” App to Measure Video Head Impulses

“…Furthermore, the vHIT approach has the potential for even broader applications in the bedside assessment of patients with inner ear disease (e.g., vestibular neuritis, Ménière’s disease, and bilateral vestibulopathy), whether for diagnosis and management in the clinic, or for research. Finally, when paired with phone-based video recordings or nystagmography for intermittent vertigo with nystagmus [18], this approach has the potential to transform care for all patients with dizziness and vertigo, making in-home telediagnosis and treatment a real possibility. Because minority populations more often use smartphones as their primary tool for engaging in health-related activities [19], this is a way to place equity first in stroke and vestibular care.…”

Update on Nystagmus and Other Ocular Oscillations

“…Implementing home-based vestibular event monitoring by patient-initiated capture of ictal nystagmus could help in detecting nystagmus during vertiginous attacks and in the differential diagnosis of three of the most commonly encountered causes of episodic vertigo: vestibular migraine (VM), Meniere's disease, and benign paroxysmal positional vertigo (BPPV). 30 31 …”

“… 65 Patient-initiated monitoring of eye movements revealed spontaneous vertical nystagmus and persistent positional nystagmus, which are highly specific for VM during the attacks. 30 …”