Negative Relationships between Responses from Head‐Shake and Caloric Tests

Spindler, John

doi:10.1111/j.1749-6632.1992.tb25286.x

Cited by 11 publications

(9 citation statements)

References 2 publications

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“…In some vestibular disorders, such as Ménière's disease, one may encounter an ''irritative state'' with nystagmus beating towards the lesion. In central nervous vestibular disorders the beat of nystagmus may be towards or away from the lesion (22). Head shake nystagmus may thus indicate asymmetric vestibular responses, but does not always specify the side of the relative hypofunction.…”

Section: Discussionmentioning

confidence: 99%

Observation of Vestibular Asymmetry in a Majority of Patients over 50 Years With Fall-Related Wrist Fractures

Kristinsdóttir¹,

Nordell²,

Jarnlo³

et al. 2001

Acta Oto-Laryngologica

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Previously [The abstract has been shortened somewhat, and the headings removed, in order to conform to journal style], we have observed vestibular asymmetry in about one-third of healthy senior citizens and in about two-thirds of subjects with previous hip fractures and no other significant ailments. Wrist fractures are considered a harbinger of hip fractures. If vestibular asymmetry is correlated with falls and fractures among the elderly then it should also be reflected among subjects with wrist fractures. Sixty-six consecutive patients (mean age 67.8 years) who had sustained a fall-related wrist fracture during a 10-month period were included in the study. The frequency of head shake nystagmus among the patients was compared to that found among 49 healthy senior citizens (mean age 74.9 years). Nystagmus after head shaking, indicating asymmetric vestibular function, was found in 50 participants (76%) (p <0.001). Thirty-eight of these were graded with distinct or prominent nystagmus responses. Sixty percent of the subjects with horizontal nystagmus had a wrist fracture coinciding with the slow phase of nystagmus. Twenty-three subjects reported 30 previous fall-related fractures during the previous 10 years. Subjects with nystagmus after head shaking sustained 26 of these fractures. The frequency of signs of vestibular asymmetry was significantly higher (p < 0.001) among the subjects than among healthy senior citizens. These findings suggest that an asymmetric vestibular function could be an epidemiologically important contributory factor to falls and wrist fractures among the elderly population.

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Section: Discussionmentioning

confidence: 99%

Observation of Vestibular Asymmetry in a Majority of Patients over 50 Years With Fall-Related Wrist Fractures

Kristinsdóttir¹,

Nordell²,

Jarnlo³

et al. 2001

Acta Oto-Laryngologica

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“…In two presurgery patients, head shake and hyperventilation elicited nystagmus in opposite directions, suggesting differing mechanisms of action. Head‐shake nystagmus is thought to represent asymmetric charging of the velocity storage mechanism, 5 although this is controversial 6 …”

Section: Discussionmentioning

confidence: 99%

Vestibular Disease Unmasked by Hyperventilation

et al. 1998

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Hyperventilation-induced dizziness is often thought to be psychogenic, but its effects in the presence of known vestibular disease have not been adequately examined. In this study hyperventilation was tested in two models of vestibular disease. These were, first, patients with profound unilateral vestibular deficit (prior translabyrinthine acoustic neuroma resection [postsurgery group]) and, second, patients with variable unilateral vestibular deficit (unoperated unilateral acoustic neuroma [presurgery group]). Patients were hyperventilated for 90 seconds. Using infrared videonystagmography, 100% of the 32 postsurgery patients and 82% of the 28 presurgery patients developed nystagmus with hyperventilation. Hyperventilation was more sensitive than head shake for eliciting nystagmus in these models. The false-positive rate for nystagmus in 29 normal volunteers was 3.5% for hyperventilation and 10% for head shake. Our results show that hyperventilation can unmask underlying vestibular disease.

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“…The finding of significant HSN in normal patient controls (24% in this study) and its negative relationship (i.e. reversed direction to that predicted) to a caloric reduction have often been cited as reasons for the poor sensitivity and specificity of this test in the assessment of patients with vestibular dysfunction (7)(8)(9)(10). Nevertheless, it is important to recognize that no single test of vestibular function exists to date that is 100% accurate in the diagnosis of patients with vestibular dysfunction, and that clinical correlation taking into account the physical and laboratory findings will always be necessary when assessing a dizzy patient (14).…”

Section: Discussionmentioning

confidence: 71%

“…Although much has been written concerning this subject, over the years there has been considerable controversy regarding its physiologic origin, clinical significance and sensitivity/specificity in the diagnosis of vestibular dysfunction (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…The presence of HSN during electronystagmography (ENG) testing in normal patient controls and in those patients with symmetric caloric responses has naturally resulted in the questioning of its significance (7)(8)(9)(10)(11). In particular, the controversy regarding HSN's significance persists on the subject of at what point the finding of HSN would be considered more reflective of a ''normal'' physiologic response (which would be expected if an inherited bias existed within the vestibular system) vs an ''abnormal'' response attributable to either peripheral or central vestibular pathology.…”

Section: Introductionmentioning

confidence: 99%

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Significance of Head-shaking Nystagmus in the Evaluation of the Dizzy Patient

Asawavichiangianda

Fujimoto²,

Mai³

et al. 1999

Acta Oto-Laryngologica

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Asawavichiangianda S, Fujimoto M, Mai M, Desroches H, Rutka J. Significance of head-shaking nystagmus in the e6aluation of the dizzy patient. Acta Otolaryngol (Stockh) 1999; Suppl 540: 27 -33.In a series of studies, the phenomenon of head-shaking nystagmus (HSN) was assessed in 50 control subjects and 1364 consecutive dizzy patients who underwent formal electronystagmography (ENG) at the Toronto Hospital Center for Advanced Hearing and Balance Testing. HSN was compared in a series of 30 patients who underwent conventional electro-oculography (EOG) vs magnetic (scleral) coil eye movement recordings. Clinical correlation of HSN to other parameters of the ENG test battery was performed in another sub-series of 300 patients with known diagnoses. HSN was identified in 31.7% of dizzy patients vs 24% of control subjects. No significant difference in its manifestation was noted between active vs passive head-shaking tests or on EOG vs magnetic (scleral) coil eye movement recordings. When compared to other aspects of the ENG test battery, HSN was neither specific nor sensitive for vestibular dysfunction. It nevertheless correlated well with the presence of a caloric reduction and with increasing R/L excitability differences on ENG testing. When present, HSN was characteristically monophasic in 76.8%, biphasic in 22.7% and triphasic in 0.5% of subjects. The initial direction of HSN generally obeyed Ewald's second law, but the reverse was noted in 27% with monophasic and 17.6% of patients with biphasic HSN. In the subseries of 300 patients with known diagnoses, the presence of HSN was statistically significant (pB 0.05) in patients with peripheral vestibular dysfunction vs psychogenic dizziness. Its presence was also significant in well-documented peripheral vestibular disorders such as Meniere's disease (pB 0.01), vestibular neuronitis (pB0.05) and acoustic neuroma (p B 0.05). Localization of the disease involvement based on the initial direction of HSN was especially unpredictable in patients with Meniere's disease. The significance and usefulness of the head-shake test in the otoneurological evaluation of the dizzy patient is further commented on. Acta Otolaryngol Downloaded from informahealthcare.com by Selcuk Universitesi on 02/06/15For personal use only.

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Negative Relationships between Responses from Head‐Shake and Caloric Tests

Cited by 11 publications

References 2 publications

Observation of Vestibular Asymmetry in a Majority of Patients over 50 Years With Fall-Related Wrist Fractures

Observation of Vestibular Asymmetry in a Majority of Patients over 50 Years With Fall-Related Wrist Fractures

Vestibular Disease Unmasked by Hyperventilation

Significance of Head-shaking Nystagmus in the Evaluation of the Dizzy Patient

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