Variations of Biphasic Head Shake Response: Physiology and Clinical Significance

Spindler, John; Schiff, Maurice

doi:10.1159/000416086

Cited by 10 publications

(3 citation statements)

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“…Furthermore, HSN has been shown to be present in vestibular paroxysmia ( 11 ). In the case of peripheral HSN, the direction of the nystagmus beats in most cases toward the side of the unaffected vestibular organ (monophasic HSN) but may change direction over time (biphasic HSN), or more rarely beats toward the affected side first (reversed biphasic HSN) ( 8 , 12 , 13 ). In central disorders, HSN occurs less frequently and may also manifest as perverted HSN (pHSN) ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Is There an “Acquired Idiopathic Head-Shaking Nystagmus”?—A Discussion of Mechanisms and Clinical Implications Based on a Case Report

Filippopulos¹,

Zwergal²,

Huppert³

2022

Front. Neurol.

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BackgroundHead-shaking nystagmus (HSN) occurs in both peripheral and central vestibular disorders. In most cases, HSN can be attributed to an asymmetric peripheral vestibular input or a structural lesion mostly in the cerebellum affecting the central velocity storage mechanism. An isolated HSN is very rare.Case PresentationWe report on a young female patient with the clinical picture of recurrent episodes of vertigo, which were induced by fast head movements and were accompanied by a severe right-beating HSN with a long time constant of 60 s. There was no other clinical and instrument-based evidence of peripheral vestibular dysfunction (including video head impulse test, caloric test, vestibular-evoked myogenic potentials) or indication of a structural lesion in the nodulus, uvula or pontomedullary brainstem on fine-slice magnetic resonance imaging. She had no previous history of migraine, hearing deficits, or other focal neurological symptoms. Diagnostic criteria for vestibular paroxysmia, vestibular migraine, benign peripheral paroxysmal vertigo, or any other known vestibular disorders were not fulfilled. Chart review in the database of the German Center for Vertigo and Balance Disorders indicated eight additional patients with a similar clinical phenotype between 2018 and 2022.ConclusionWe propose a clinical entity called acquired idiopathic head shaking nystagmus (aiHSN) as a rare cause of episodic vertigo induced by fast head movements. Nystagmus characteristics suggest a subtle functional pathology of the central velocity storage mechanism in the nodulus and uvula, which is exacerbated during symptomatic episodes.

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Section: Discussionmentioning

confidence: 99%

Is There an “Acquired Idiopathic Head-Shaking Nystagmus”?—A Discussion of Mechanisms and Clinical Implications Based on a Case Report

Filippopulos¹,

Zwergal²,

Huppert³

2022

Front. Neurol.

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“…Sometimes (2.9–22.7% of cases) it can be biphasic, which means that a reversal of the direction of nystagmus occurs during the course. 7,12 , 13,14 , 16,17 The duration of the second phase is generally longer than the first one, whereas nystagmus is less evident. Furthermore, the direction of the evoked nystagmus can rarely reverse again 4…”

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confidence: 99%

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

2002

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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.

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“…Approximately 27% of patients with monophasic and 17.6% with biphasic HSN had an initial direction of nystagmus opposite (i.e. in a reversed direction) to that (17).…”

Section: Discussionmentioning

confidence: 96%

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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Variations of Biphasic Head Shake Response: Physiology and Clinical Significance

Cited by 10 publications

References 0 publications

Is There an “Acquired Idiopathic Head-Shaking Nystagmus”?—A Discussion of Mechanisms and Clinical Implications Based on a Case Report

Is There an “Acquired Idiopathic Head-Shaking Nystagmus”?—A Discussion of Mechanisms and Clinical Implications Based on a Case Report

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

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

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