Classification of vestibular signs and examination techniques: Nystagmus and nystagmus-like movements

Eggers, Scott D.Z.; Bisdorff, Alexandre; Brevern, Michael von; Zee, David S.; Kim, Ji Soo; Pérez-Fernández, Nicolas; Welgampola, Miriam S.; Santina, Charles C. Della; Newman‐Toker, David E.

doi:10.3233/ves-190658

Cited by 94 publications

(73 citation statements)

References 154 publications

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“…Episodic Ataxia (Type II) may be associated with interictal spontaneous down-beating nystagmus [15]. Spontaneous up-beating nystagmus is rare and has been described in Wernicke's encephalopathy [16] and lesions within the paramedian medulla [8]. Lying in the supine position may also provoke or enhance nystagmus generated by Chiari malformation or posterior fossa space occupying lesions [4,7,17,19,31,36].…”

Section: Discussionmentioning

confidence: 99%

Nystagmus characteristics of healthy controls

Young

Rosengren

D’Souza

et al. 2020

VES

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BACKGROUND: Healthy controls exhibit spontaneous and positional nystagmus which needs to be distinguished from pathological nystagmus. OBJECTIVE: Define nystagmus characteristics of healthy controls using portable video-oculography. METHODS: One-hundred and one asymptomatic community-dwelling adults were prospectively recruited. Participants answered questions regarding their audio-vestibular and headache history and were sub-categorized into migraine/non-migraine groups. Portable video-oculography was conducted in the upright, supine, left- and right-lateral positions, using miniature take-home video glasses. RESULTS: Upright position spontaneous nystagmus was found in 30.7% of subjects (slow-phase velocity (SPV), mean 1.1±2.2 degrees per second (°/s) (range 0.0 – 9.3). Upright position spontaneous nystagmus was horizontal, up-beating or down-beating in 16.7, 7.9 and 5.9% of subjects. Nystagmus in at least one lying position was found in 70.3% of subjects with 56.4% showing nystagmus while supine, and 63.4% in at least one lateral position. While supine, 20.8% of subjects showed up-beating nystagmus, 8.9% showed down-beating, and 26.7% had horizontal nystagmus. In the lateral positions combined, 37.1% displayed horizontal nystagmus on at least one side, while 6.4% showed up-beating, 6.4% showed down-beating. Mean nystagmus SPVs in the supine, right and left lateral positions were 2.2±2.8, 2.7±3.4, and 2.1±3.2°/s. No significant difference was found between migraine and non-migraine groups for nystagmus SPVs, prevalence, vertical vs horizontal fast-phase, or low- vs high-velocity nystagmus (<5 vs > 5°/s). CONCLUSIONS: Healthy controls without a history of spontaneous vertigo show low velocity spontaneous and positional nystagmus, highlighting the importance of interictal nystagmus measures when assessing the acutely symptomatic patient.

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Section: Discussionmentioning

confidence: 99%

Nystagmus characteristics of healthy controls

Young

Rosengren

D’Souza

et al. 2020

VES

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“…In fact, as each stimulus generating a cupular deflection results in the contraction of coupled ocular muscles, both excitatory and inhibitory stimuli for each SC ampullary receptor result in pathognomonic nystagmus patterns [1]. For example, Dix-Hallpike maneuver on the right side mainly assesses both right PSC and left ASC; therefore, positional nystagmus resulting from right PSC-canaloli- thiasis is upbeating with right-beating torsional components (i.e., with the top poles of the eyes beating toward the lowermost ear) [9]. Although specific positionings have been conceived for the diagnosis of each form of BPPV, positional nystagmus due to a specific BPPV subtype may also be evoked by maneuvers that are recommended for other SCs.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Jamming of Horizontal Semicircular Canal Combined with Canalolithiasis of Contralateral Posterior Semicircular Canal

Martellucci

Castellucci

Malara³

et al. 2022

J Audiol Otol

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Spontaneous canalith jam is an uncommon form of benign paroxysmal positional vertigo mimicking acute vestibular neuritis. We described for the first time a spontaneous horizontal semicircular canalith jam associated with a typical canalolithiasis involving contralateral posterior semicircular canal (PSC), illustrating how the latter condition modified direction-fixed nystagmus during head movements. An 81-year-old woman with persistent vertigo referred to our center. Video-Frenzel examination showed horizontal direction-fixed right-beating nystagmus in primary gaze position, inhibited by visual fixation. She exhibited corrective saccades after leftward head impulses. Chin-to-chest positioning at the head-pitch test did not modify spontaneous nystagmus, whereas slight torsional components with the top pole of the eye beating toward the right ear appeared in backward head-bending, resulting in mixed horizontal-torsional nystagmus. At supine positioning tests, direction-fixed nystagmus turned into direction-changing geotropic horizontal nystagmus, which was stronger on the left side, while overlapping upbeat nystagmus with torsional right-beating components appeared on the right. Primary clinical findings were consistent with a left horizontal semicircular canalith jam, inducing a persistent utriculofugal cupular displacement, combined with a typical right-sided PSC-canalolithiasis. Once canalith jam crumbled, resulting in a non-ampullary arm canalolithiasis of the horizontal semicircular canal, both involved canals were freed by debris with appropriate repositioning procedures.

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“…Horizontal SN was accompanied by a vertical and/or torsional component in seven patients, whereas only one patient presented with a purely torsional nystagmus. While horizontal SN does not allow a distinction between a peripheral and a central pathology, vertical and/or torsional SN is indicative of a central cause (41), further narrowing the differential diagnosis in the evaluation of such patients.…”

Section: Sn Patterns In Lateral Medullary Strokementioning

confidence: 99%

Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion

et al. 2020

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Background: Lateral medullary stroke (LMS) results in a characteristic pattern of brainstem signs including ocular motor and vestibular deficits. Thus, an impaired angular vestibulo-ocular reflex (aVOR) may be found if the vestibular nuclei are affected. Objective: We aimed to characterize the frequency and pattern of vestibular and ocular-motor deficits in patients with LMS. Methods: Patients with MR-confirmed acute/subacute unilateral LMS from a stroke registry were included and a bedside neuro-otological examination was performed. Video-oculography and video-based head-impulse testing (vHIT) was obtained and semicircular canal function was determined. The lesion location/extension as seen on MRI was rated and involvement of the vestibular nuclei was judged. Results: Seventeen patients with LMS (age = 59.4 ± 14.3 years) were included. All patients had positive H.I.N.T.S. vHIT showed mild-to-moderate aVOR impairments in three patients (ipsilesional = 1; ipsilesional and contralesional = 1; contralesional = 1). Spontaneous nystagmus (n = 10/15 patients) was more often beating contralesionally than ipsilesionally (6 vs. 3) and was accompanied by upbeat nystagmus in four patients. Head-shaking nystagmus was noted in seven subjects, ipsilesionally beating in six and down-beating in one. On brain MRI, damage of the most caudal parts of the medial and/or inferior vestibular nucleus was noted in 13 patients. Only those two patients with lesions affecting the rostral medulla oblongata demonstrated an ipsilaterally impaired aVOR. Conclusions: While subtle ocular motor signs pointed to damage of the central-vestibular pathways in all 17 patients, aVOR deficits were infrequent, restricted to those patients with rostral medullary lesions and, if present, mild to moderate only. This can be explained by lesions located too far caudally and too far ventrally to substantially affect the vestibular nuclei.

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Classification of vestibular signs and examination techniques: Nystagmus and nystagmus-like movements

Cited by 94 publications

References 154 publications

Nystagmus characteristics of healthy controls

Nystagmus characteristics of healthy controls

Spontaneous Jamming of Horizontal Semicircular Canal Combined with Canalolithiasis of Contralateral Posterior Semicircular Canal

Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion

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