Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

Curthoys, Ian S.; Manzari, Leonardo; Rey-Martínez, Jorge; Dlugaiczyk, Julia; Burgess, Ann M.

doi:10.3389/fsurg.2021.666390

Cited by 8 publications

(7 citation statements)

References 46 publications

(55 reference statements)

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“…We also note that the backup saccade is distinctly different from the very early compensatory “saccade-like” response reported by Curthoys et al, in some MD patients with enhanced eye velocity ( 3 ). The latency of these “saccade-like” responses is very short and much shorter than ACQEMs and backup saccades, as well as being in the opposite direction to ACQEMs.…”

Section: Case Reportcontrasting

confidence: 72%

“…Why are backup saccades not more commonly seen in patients with enhanced eye velocity? It has been suggested that this could be due to the very different eye velocity trajectories during the increasing head velocity and decreasing head velocity phases of the head impulse [Curthoys et al ( 3 ); Figure 1 ]. It may be that the eye position error during the acceleration phase may be partially corrected by the eye position error during the deceleration phase, resulting in such a small final eye position error that it is not necessary for any correction.…”

Section: Case Reportmentioning

confidence: 99%

“…To avoid confusion we have used the term “backup saccade” to refer to this corrective saccade after enhanced eye velocity. Until now, when enhanced vestibular slow phase eye velocity during head impulses have been observed on vHIT testing, no corrective backup saccades have been described ( 3 ). In this case report we describe, for what we think is the first time, a patient with definite MD with enhanced eye velocity (and so enhanced VOR gain) during head impulse testing, who showed compensatory saccades (“backup saccades”).…”

Section: Introductionmentioning

confidence: 99%

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Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report

et al. 2021

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Reduced eye velocity and overt or covert compensatory saccades during horizontal head impulse testing are the signs of reduced vestibular function. However, here we report the unusual case of a patient who had enhanced eye velocity during horizontal head impulses followed by a corrective saccade. We term this saccade a “backup saccade” because it acts to compensate for the gaze position error caused by the enhanced velocity (and enhanced VOR gain) and acts to return gaze directly to the fixation target as shown by eye position records. We distinguish backup saccades from overt or covert compensatory saccades or the anticompensatory quick eye movement (ACQEM) of Heuberger et al. (1) ACQEMs are anticompensatory in that they are in the same direction as head velocity and so, act to take gaze off the target and thus require later compensatory (overt) saccades to return gaze to the target. Neither of these responses were found in this patient. The patient here was diagnosed with unilateral definite Meniere's disease (MD) on the right and had enhanced VOR (gain of 1.17) for rightward head impulses followed by backup saccades. For leftwards head impulses eye velocity and VOR gain were in the normal range (VOR gain of 0.89). As further confirmation, testing with 1.84 Hz horizontal sinusoidal head movements in the visual-vestibular (VVOR) paradigm also showed these backup saccades for rightwards head turns but normal slow phase eye velocity responses without backup saccades for leftwards had turns. This evidence shows that backup saccades can be observed in some MD patients who show enhanced eye velocity responses during vHIT and that these backup saccades act to correct for gaze position error caused by the enhanced eye velocity during the head impulse and so have a compensatory effect on gaze stabilization.

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Section: Case Reportcontrasting

confidence: 72%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report

et al. 2021

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“…Thirteen had vestibular migraine and five had Ménière's disease. We did not encounter any cases with VOR gains >1.29, a recently described cutoff value based on gains obtained from healthy subjects ( 8 ).…”

Section: Resultsmentioning

confidence: 95%

Caloric and video head impulse test dissociated results in dizzy patients

et al. 2022

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IntroductionWe are now able to detect abnormalities for any semicircular canal with the use of the video head impulse test (vHIT). Prior to the vHIT, the gold standard for unilateral canal paresis of the lateral canal was considered the caloric test. Clinical cases where the caloric test and vHIT are discordant are not uncommon.MethodsRetrospective study. All consecutive cases of dizziness seen from 11/2020 to 12/2021 for which the patient underwent both caloric and vHIT tests performed within 10 days, were reviewed. Patients with discordant results were included. We evaluated the caloric response, vHIT gains for all canals and saccades, with and without gain abnormalities.ResultsWe included 74 cases of dizziness with dissociated results. The most common finding was a normal caloric response with abnormal vHIT results (60.8%); the main abnormal finding on vHIT was the presence of saccades. In this group, 37.7% of patients had normal gains and refixation saccades. In addition, the most found low gain was for the posterior canal. The main diagnosis in this group was vestibular migraine. For the group with unilateral caloric paresis and normal vHIT gain in the lateral canal, the main diagnosis was Ménière's disease.DiscussionThe most common disorders with discordant results were Ménière's disease and vestibular migraine. The caloric test and vHIT are complementary and combining both tests provide greater clinical information. Further research is needed to understand refixation saccades with normal gains.

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“…An alternative explanation is the selective damage of type II vestibular hair cell population in MD and differential frequency stimulation of caloric test and vHIT ( Tsuji et al, 2000 ). Furthermore, MD patients may exhibit a variety of abnormal vHIT response, including enhanced gain ( Curthoys et al, 2021 ), saccades with normal gain ( Jerin et al, 2019 ), or fluctuating response ( Yacovino et al, 2017 ), etc.…”

Section: Discussionmentioning

confidence: 99%

Comparison between audio-vestibular findings and contrast-enhanced MRI of inner ear in patients with unilateral Ménière’s disease

Leng

Fan²,

Liu³

et al. 2023

Front. Neurosci.

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ObjectiveThe diagnosis of Ménière’s disease (MD), characterized by idiopathic endolymphatic hydrops (ELH), remains a clinical priority. Many ancillary methods, including the auditory and vestibular assessments, have been developed to identify ELH. The newly emerging delayed magnetic resonance imaging (MRI) of the inner ear after intratympanic gadolinium (Gd) has been used for identifying ELH in vivo. We aimed to investigate the concordance of audio-vestibular and radiological findings in patients with unilateral MD.MethodsIn this retrospective study, 70 patients with unilateral definite MD underwent three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences following intratympanic application of Gd. Audio-vestibular evaluations were performed, including pure tone audiometry, electrocochleogram (ECochG), glycerol test, caloric test, cervical and ocular vestibular evoked myogenic potentials (VEMPs), and video head impulse test (vHIT). The relationship between imaging signs of ELH and audio-vestibular results was investigated.ResultsThe incidence of radiological ELH was higher than that of neurotological results, including the glycerol test, caloric test, VEMPs, and vHIT. Poor or slight agreement was observed between audio-vestibular findings and radiological ELH in cochlear and/or vestibular (kappa values <0.4). However, the pure tone average (PTA) in the affected side significantly correlated with the extent of both cochlear (r = 0.26795, p = 0.0249) and vestibular (r = 0.2728, p = 0.0223) hydrops. Furthermore, the degree of vestibular hydrops was also positively correlated with course duration (r = 0.2592, p = 0.0303) and glycerol test results (r = 0.3944, p = 0.0061) in the affected side.ConclusionIn the diagnosis of MD, contrast-enhanced MRI of the inner ear is advantageous in detecting ELH over the conventional audio-vestibular evaluations, which estimates more than hydropic dilation of endolymphatic space.

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Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

Cited by 8 publications

References 46 publications

Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report

Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report

Caloric and video head impulse test dissociated results in dizzy patients

Comparison between audio-vestibular findings and contrast-enhanced MRI of inner ear in patients with unilateral Ménière’s disease

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