Vision and vertigo

Bronstein, Adolfo M.

doi:10.1007/s00415-004-0410-7

Cited by 148 publications

(43 citation statements)

References 42 publications

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“…In others, no history of a vestibular event can be obtained, but abnormalities are found on vestibular testing. It has been suggested that these subjects develop a compensation strategy for their vestibulo‐proprioceptive deficit and rely excessively on the visual input rendered thus “visually dependent” (Bronstein 2004, 2005). Lastly, in a proportion of VV patients, no vestibular lesion can be detected and their symptoms have been often considered to be of psychological origin (Schniepp et al.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance brain imaging in patients with visual vertigo

et al. 2015

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IntroductionPatients with visual vertigo (VV) report dizziness provoked by moving visual surroundings. It has been suggested that these subjects develop a compensation strategy for a vestibulo‐proprioceptive deficit and rely excessively on visual input. We have postulated that patients with VV might have brain abnormalities that interfere with appropriate processing of visual stimulation and performed a brain MRI study to verify this hypothesis.Materials and MethodsPatients with VV of more than 3 months duration were included. They were asked to complete the Situational Characteristic Questionnaire (SCQ) that scores for the symptoms of VV. Dizzy patients without VV served as controls. A brain MRI was performed with a Siemens 1.5 Tesla scanner in patients and controls.ResultsTwenty‐four patients with VV were included. Their mean SCQ score was 1.45 ± 0.9 (normal 0.16 ± 0.28). In 50% of patients, abnormalities in MRI imaging were found. Thirty‐three percent of 27 controls demonstrated an abnormal brain MRI. The two groups were similar in respect to the prevalence of a localized hemispheric or posterior fossa lesion (P = 0.13), but VV patients had more unspecific white matter brain changes than controls (P = 0.009). Patients and controls did not differ in age and gender distribution (P = 0.9) or the history of a neurotological event preceding their symptoms (P = 0.3).ConclusionsOur study suggests that multiple white matter lesions might contribute to occurrence of the phenomenon of VV. Future prospective large‐scale studies by specific MR techniques are indicated to validate our preliminary findings and elucidate the pathological mechanism of VV.

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Section: Introductionmentioning

confidence: 99%

Magnetic resonance brain imaging in patients with visual vertigo

et al. 2015

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“…[3, 4, 9] These symptoms have been defined as “visual vertigo”,[4, 27] and “space and motion discomfort”. [6, 10-12] Supermarkets, crowds, or even fence posts viewed within a person's peripheral vision can cause significant distress (increased dizziness, nausea, or even disorientation) in persons with complaints of visual vertigo.…”

Section: Introductionmentioning

confidence: 99%

“…[6, 10-12] Supermarkets, crowds, or even fence posts viewed within a person's peripheral vision can cause significant distress (increased dizziness, nausea, or even disorientation) in persons with complaints of visual vertigo. [4, 5, 19] Symptoms of visual vertigo have also been reported in persons without vestibular dysfunction. [9, 16]…”

Section: Introductionmentioning

confidence: 99%

“…[3, 4, 9, 19] Others have suggested that visual vertigo occurs in patients with vestibular disorders who are visually dependent and who have difficulty with vestibular-proprioceptive and visual cues that are conflicting. [9] Bronstein [5] has suggested that when pursuit-optokinetic eye movements and the vestibulo-ocular reflex (VOR) are in conflict, instead of working synergistically, visual input may suppress the VOR.…”

Section: Introductionmentioning

confidence: 99%

“…[7, 8, 17, 18, 21-23] Habituation exercises may be instrumental for reducing symptoms in visual vertigo that arise from sensory conflict. Bronstein[4] and Pavlou et al[19] have suggested that optic flow and visual/vestibular conflict exercises may enhance the rehabilitation of persons experiencing visual vertigo. Optokinetic stimulation has been shown to decrease symptoms in persons with vestibular dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Symptoms elicited in persons with vestibular dysfunction while performing gaze movements in optic flow environments1

Whitney

Sparto

Cook

et al. 2013

VES

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Introduction People with vestibular disorders often experience space and motion discomfort when exposed to moving or highly textured visual scenes. The purpose of this study was to measure the type and severity of symptoms in people with vestibular dysfunction during coordinated head and eye movements in optic flow environments. Methods Seven subjects with vestibular disorders and 25 controls viewed four different full-field optic flow environments on six different visits. The optic flow environments consisted of textures with various contrasts and spatial frequencies. Subjects performed 8 gaze movement tasks, including eye saccades, gaze saccades, and gaze stabilization tasks. Subjects reported symptoms using Subjective Units of Discomfort (SUD) and the Simulator Sickness Questionnaire (SSQ). Self-reported dizziness handicap and space and motion discomfort were also measured. Results/ Conclusion Subjects with vestibular disorders had greater discomfort and experienced greater oculomotor and disorientation symptoms. The magnitude of the symptoms increased during each visit, but did not depend on the optic flow condition. Subjects who reported greater dizziness handicap and space motion discomfort had greater severity of symptoms during the experiment. Symptoms of fatigue, difficulty focusing, and dizziness during the experiment were evident. Compared with controls, subjects with vestibular disorders had less head movement during the gaze saccade tasks. Overall, performance of gaze pursuit and gaze stabilization tasks in moving visual environments elicited greater symptoms in subjects with vestibular disorders compared with healthy subjects.

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Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

Grove

Whitney

Pyle

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCERegaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait.OBJECTIVES To investigate the use of an instrumented 2-minute walk test in adults with vestibular loss, to further characterize vestibulopathic gait, and to assess whether those with chronic vestibular loss have enduring gait deficits. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study, conducted between April 3, 2018, and June 27, 2019, recruited adults 20 to 79 years of age from an academic, tertiary, hospital-based, ambulatory care setting who were healthy or had confirmed unilateral or bilateral vestibular hypofunction. Of the 43 adults who were screened from convenience and referred samples, 2 declined, and 7 were excluded because of health conditions. EXPOSURES The main exposure was the instrumented 2-minute walk test, which was conducted with participants using wearable inertial measurement units while they walked a 10-m path at their self-selected speed and turned 180°in their self-selected direction at either end. MAIN OUTCOMES AND MEASURESThe primary measures were spatiotemporal gait metrics (eg, stride length [SL] and peak whole-body turning velocity). Multivariate analysis of variance was used to assess between-group differences. Validity was assessed using the area under the curve from receiver operator characteristic analyses.RESULTS Data from 17 healthy adults (mean [SD] age, 39.27 [11.20] years; 13 [76%] female) and 13 adults with vestibular loss (mean [SD] age, 60.50 [10.81] years; 6 [46%] female) were analyzed. Very large between-group differences were found for SL (left) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.47 [0.04] m vs 1.31 [0.04] m; Cohen d, 1.35; 95% CI, 0.18-2.52), SL (right) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.46 [0.04] m vs 1.29 [0.04] m; Cohen d, 1.44; 95% CI, 0.25-2.62), and peak turn velocity (estimated marginal mean [SE] for healthy vs vestibular groups, 240.17 [12.78]°/s vs 189.74 [14.70]°/s; Cohen d, 1.23; 95% CI, 0.07-2.40). The area under the curve was 0.79 (95% CI, 0.62-0.95) for SL (left), 0.81 (95% CI, 0.64-0.97) for SL (right), and 0.86 (95% CI, 0.72-0.99) for peak turn velocity. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, instrumented gait analysis had good discriminative validity and revealed persistent deficits in gait stability in those with chronic vestibular loss. The findings of this study suggest that these clinically and functionally meaningful deficits could be targets for vestibular rehabilitation.

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Vision and vertigo

Cited by 148 publications

References 42 publications

Magnetic resonance brain imaging in patients with visual vertigo

Magnetic resonance brain imaging in patients with visual vertigo

Symptoms elicited in persons with vestibular dysfunction while performing gaze movements in optic flow environments1

Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

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