Do central vestibular findings predict abnormal findings on magnetic resonance imaging?

Mankekar, Gauri; Jeha, George M.; Klumpp, Micah L.; Sevy, Alexander; Mehta, Rahul; Son, Leslie; Arriaga, Moisés A.

doi:10.1017/s002221511900104x

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…Furthermore, this study showed that oculomotor tests, regardless of rater, had only moderate sensitivity (50-70%) and specificity (40-70%) for predicting central lesions on MRI, in line with previous findings [14,15,19]. Interestingly, both raters showed low PPV but high NPV, suggesting the necessity of imaging studies if clinicians cannot confidently exclude central vestibular disorder.…”

Section: Discussionsupporting

confidence: 89%

Applicability of Oculomotor Tests for Predicting Central Vestibular Disorder Using Principal Component Analysis

Luo

Chen

et al. 2022

JPM

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The videonystagmography oculomotor test battery is considered useful method for diagnosing vertigo. However, its role in diagnosing central vestibular disorder has not been clarified due to variations in interpretation. Patients (n = 103) with vertigo or dizziness symptoms undergoing the oculomotor tests and brain MRI within 1 month were analyzed. Two otology specialists retrospectively interpreted the oculomotor tests, and three neurology and neuroradiology specialists determined whether central lesions were present on brain MRI. Multivariable logistic regression analysis was performed to determine the factors contributing to discordant interpretation between oculomotor tests and brain MRI. Oculomotor tests predicting central lesions were assessed using principal component analysis. The intra- and inter-rater reliability in oculomotor test interpretation was moderate to good. Age > 60 years and multiple comorbidities were significant predictors of a discordant interpretation between MRI and oculomotor tests. Positive neurological symptoms and a higher oculomotor index (according to saccade (vertical axis), smooth pursuit (horizontal axis), and gaze-evoked nystagmus (horizontal/vertical axes) tests) significantly predicted central vestibular disorder in vertigo patients. Caution is required when interpreting the results of the oculomotor test battery for diagnosis of central lesions in older patients, as well as in those with multiple comorbidities.

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Section: Discussionsupporting

confidence: 89%

Applicability of Oculomotor Tests for Predicting Central Vestibular Disorder Using Principal Component Analysis

Luo

Chen

et al. 2022

JPM

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“…This contrasts with Mankekar et al . 47 who reported a 50.9 per cent positive predictive value for abnormal MRI in patients with central vestibular pathology. Such discrepancy may be attributable to our small cohort of patients with central causes (20.8 per cent, n = 21) or our small numbers of patients referred for further imaging following their initial specialist clinic appointment (6.9 per cent, n = 7).…”

Section: Discussionmentioning

confidence: 99%

Balance testing: does it make a difference?

et al. 2022

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Objective This study aimed to analyse whether referral for specialist balance testing influences diagnosis and management of patients with dizziness. Method This was a retrospective study examining patients referred for vestibular function testing between 1 January 2018 and 30 June 2018. Results A total of 101 patients were referred, with 69 patients (68.3 per cent) receiving a preliminary ‘pre-vestibular function testing balance diagnosis’, which included benign paroxysmal positional vertigo (32.7 per cent), Ménière's disease (13.8 per cent) and migraine (14.9 per cent). Following vestibular function testing, revised diagnoses were achieved for 54 patients (53.5 per cent), including benign paroxysmal positional vertigo (14.9 per cent), Ménière's disease (3.0 per cent) and migraine (10.9 per cent). Pre-vestibular function testing balance diagnoses were confirmed for 32.4 per cent of patients. If no pre-vestibular function testing suspected diagnosis was provided, vestibular function testing was significantly more likely to be inconclusive. Following vestibular function testing, 38.6 per cent were discharged, 21.7 per cent were referred to another specialty and treatment was commenced for 17.8 per cent of patients. Conclusion Referral for vestibular function testing has a role when attempting to answer a clear clinical question. Diagnosing the underlying aetiology of complex imbalance is challenging, but diagnosis can be assisted by judicious use of vestibular function testing.

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Vestibular findings in patients with white matter disease

Hazzaa

Ahmed

El-Khair³

et al. 2022

Egypt J Otolaryngol

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Background Older people develop gait and balance dysfunction that is associated with the gradual onset of cerebral white matter disease. White matter disease is easily detected by neuroimaging, whereas small vessels are not; hence, the term small vessel disease is frequently used to describe the parenchyma lesions rather than the underlying small vessel alterations. This study was done to investigate the relationship between the presence and/or absence of white matter disease identified on magnetic resonance imaging with the vestibular findings in elderly patients with dizziness. The current study was conducted on a total number of 30 elderly patients complaining of dizziness and/or instability. The inclusion criteria are patients above 55 years old and a history of vertigo and/or instability. All the study groups were subjected to full neuro-otological history, hearing assessment, video-nystagmography test (VNG), assessment of the risk of fall by functional gait assessment test (FGA), and radiological assessment: magnetic resonance stroke protocol. Results FGA total scores were significantly lower in patients with white matter disease (0.047) specifically PVWM score 3 (0.04) and DWM score 3 (0.19). Abnormal VNG test results were significantly higher in patients with atherosclerotic changes (0.04). The most common VNG finding abnormality was positional nystagmus. Conclusions Normal VNG findings in elderly dizzy patients should be complemented with FGA test to assess the risk of falls. The presence of risk factors for white matter disease (WMD) as hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia, and migraine is an indication for requesting a further radiological assessment. The most frequent VNG abnormality in elderly patients with white matter disease is positional and positioning nystagmus, and a significant number of patients had positional nystagmus of the non-localizing criteria. FGA test scores are significantly related to the severity of white matter disease. The presence of atherosclerotic changes is significantly related to the presence of VNG test abnormality. It is important to ask the patient about the past history of migraine as it has an effect on VNG, FGA, and radiological findings.

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Do central vestibular findings predict abnormal findings on magnetic resonance imaging?

Cited by 4 publications

References 17 publications

Applicability of Oculomotor Tests for Predicting Central Vestibular Disorder Using Principal Component Analysis

Applicability of Oculomotor Tests for Predicting Central Vestibular Disorder Using Principal Component Analysis

Balance testing: does it make a difference?

Vestibular findings in patients with white matter disease

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