Head shaking nystagmus in the follow-up of patients with vestibular diseases

Abstract

We examined 420 patients with vestibular diseases of different origin; 273 with peripheral vestibular disease and 147 with both peripheral and central vestibular disease. Recurrent vestibulopathy like Menière's disease, or benign paroxysmal positional vertigo, were not included. Patients were evaluated initially and 6 months after pharmacological and/or rehabilitation therapy. At the initial assessment, the head-shaking test was specific for the side of the lesion in both groups, even if spontaneous nystagmus was no longer present. Thus, head-shaking nystagmus is a physical sign that can be easily evoked and gives useful information about the presence of vestibulo-ocular reflex asymmetry. At the follow-up at 6 months, many changes in the head-shaking nystagmus were noted: in some cases it appeared, in some others it changed direction and more often it disappeared. There is actually no acceptable explanation for the disappearance of the head-shaking nystagmus, despite some evidence that vestibular compensation could play a role. It is definitely proved that sensitivity of the head-shaking test is really poor, especially in the course of time and, therefore, it should not be used alone in the follow-up of patients with vestibular disease.

Vestibular Rehabilitation Exercises in Acute Vertigo

“…As for the PHSN test, abnormal results were present in a high number of patients belonging to both groups (93% for the SG and 95% for the CG) at the initial observation. This finding disagrees with that of Guidetti et al, 14 who found very few abnormal PHSN tests at the initial phases after vestibular lesions. In our study, the presence of spontaneous nystagmus and PHSN were documented by the observation of the principal investigator (with the patients wearing Frenzel lens), and it was not possible to characterize the type of response.…”

Nistagmo inducido por vibración en Otorrinolaringología

“…Una vibración aplicada sobre la mastoides o los músculos esternocleidomastoideos en pacientes con lesiones vestibulares unilaterales induce un nistagmo cuya fase lenta se dirige hacia el lado lesionado [5][6], esto se ha atribuido a la asimetría vestibular causada por un estímulo vibratorio aplicado en el cráneo [7][8], debido a que la estimulación craneal con vibraciones de baja frecuencia (<120 Hz) causa ondas de presión en el oído interno activando los receptores vestibulares [9]. El nistagmo espontáneo (NE) y el nistagmo tras agitación cefálica (NAC) son exámenes básicos que nos sirven para identificar una asimetría vestibular [10,11]. El NE refleja una asimetría vestibular durante la fase aguda, pero puede desaparecer o cambiar con los mecanismos de compensación central o con la recuperación de la función vestibular.…”

“…REALIZACIÓN DE LA PRUEBA El explorador se coloca delante (o detrás) del paciente y aplica el estímulo con el vibrador mastoideo en su mano dominante para conseguir una mayor reproducibilidad [8][9][10][11][12][13][14][15][16]. La exploración no se ve influenciada por la posición de la cabeza, así, se puede realizar con el paciente en decúbito [8].…”

Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury

“…Also in central pathology, post head shaking nystagmus will persist for a greater amount of time. Guidetti et al (2002) found that 74% of the subjects with peripheral disease had post head shaking nystagmus, with 80% of the subjects with both central and peripheral vestibular disorders demonstrating the same.…”