What happens to spontaneous nystagmus during sleep in patients with acute unilateral vestibulopathy?

AbstractNystagmus is defined as rhythmic, most often involuntary eye movements. It normally consists of a slow (pathological) drift of the eyes, followed by a fast central compensatory movement back to the primary position (refixation saccade). The direction, however, is reported according to the fast phase. The cardinal symptoms are, on the one hand, blurred vision, jumping images (oscillopsia), reduced visual acuity and, sometimes, double vision; many of these symptoms depend on the eye position. On the other hand, depending on the etiology, patients may suffer from the following symptoms: 1. permanent dizziness, postural imbalance, and gait disorder (typical of downbeat and upbeat nystagmus); 2. if the onset of symptoms is acute, the patient may experience spinning vertigo with a tendency to fall to one side (due to ischemia in the area of the brainstem or cerebellum with central fixation nystagmus or as acute unilateral vestibulopathy with spontaneous peripheral vestibular nystagmus); or 3. positional vertigo. There are two major categories: the first is spontaneous nystagmus, i.e., nystagmus which occurs in the primary position as upbeat or downbeat nystagmus; and the second includes various types of nystagmus which are induced or modified by certain factors. Examples are gaze-evoked nystagmus, head-shaking nystagmus, positional nystagmus, and hyperventilation-induced nystagmus. In addition, there are disorders similar to nystagmus, such as ocular flutter or opsoclonus. The most common central types of spontaneous nystagmus are downbeat and upbeat, infantile, pure torsional, pendular fixation, periodic alternating, and seesaw nystagmus. Many types of nystagmus allow a precise neuroanatomical localization: for instance, downbeat nystagmus, which is most often caused by a bilateral floccular lesion or dysfunction, or upbeat nystagmus, which is caused by a lesion in the midbrain or medulla. Examples of drug treatment are the use of 4-aminopyridine for downbeat and upbeat nystagmus, memantine or gabapentin for pendular fixation nystagmus, or baclofen for periodic alternating nystagmus. In this article we are focusing on nystagmus. In a second article we will focus on central ocular motor disorders, such as saccade or gaze palsy, internuclear ophthalmoplegia, and gaze-holding deficits. Therefore, these types of eye movements will not be described here in detail.

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P 61 Glial activation accelerates behavioural compensation of acute unilateral vestibulopathy

Clinical Neurophysiology ◽

10.1016/j.clinph.2017.06.137 ◽

2017 ◽

Vol 128 (10) ◽

pp. e358

Author(s):

A. Zwergal ◽

L. Günther ◽

M. Brendel ◽

R. Beck ◽

S. Lindner ◽

...

Keyword(s):

Glial Activation ◽

Unilateral Vestibulopathy ◽

Acute Unilateral Vestibulopathy

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Neutrophil-mediated immune response as a possible mechanism of acute unilateral vestibulopathy

Journal of Vestibular Research ◽

10.3233/ves-200044 ◽

2020 ◽

Vol 30 (6) ◽

pp. 363-374

Author(s):

Eun Hye Oh ◽

Je-Keun Rhee ◽

Jin-Hong Shin ◽

Jae Wook Cho ◽

Dae-Seong Kim ◽

...

Keyword(s):

Mononuclear Cells ◽

Complete Blood Count ◽

Enrichment Analysis ◽

Functional Enrichment Analysis ◽

Functional Enrichment ◽

P Value ◽

Ppi Network ◽

Immune Pathway ◽

Unilateral Vestibulopathy ◽

Acute Unilateral Vestibulopathy

OBJECTIVE: This study aimed to investigate the underlying pathogenesis of acute unilateral vestibulopathy (AUV) using gene expression profiling combined with bioinformatics analysis. METHODS: Total RNA was extracted from the peripheral blood mononuclear cells of ten AUV patients in the acute phase and from ten controls. The differentially expressed genes (DEGs) between these two groups were screened using microarray analysis with the cut-off criteria (|fold changes| > 1.5 and p-value < 0.05). Functional enrichment analysis of DEGs was performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis, and the protein-protein interaction (PPI) network was constructed using the STRING (Search Tool for the Retrieval of Interacting Genes) database. RESULTS: There were 57 DEGs (50 up-regulated and 7 down-regulated) identified in the AUV group. Functional enrichment analysis showed that most of the up-regulated DEGs were significantly enriched in terms related to the neutrophil-mediated immune pathway. From the PPI network, the top ten hub genes were extracted by calculating four topological properties, and most of them were related to the innate immune system, inflammatory processes and vascular disorders. The complete blood count tests showed that the neutrophil-to-lymphocyte ratio was significantly higher in the 72 AUV patients than in the age-matched controls (2.93±2.25 vs 1.54±0.61, p < 0.001). CONCLUSIONS: This study showed that the neutrophil-mediated immune pathway may contribute to the development of AUV by mediating inflammatory and thrombotic changes in the vestibular organ.

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Prognosis after acute unilateral vestibulopathy: Usefulness of the suppression head impulse paradigm (SHIMP)

Journal of Vestibular Research ◽

10.3233/ves-210038 ◽

2021 ◽

pp. 1-10

Author(s):

Augusto Pietro Casani ◽

Rachele Canelli ◽

Francesco Lazzerini ◽

Elena Navari

Keyword(s):

Cross Sectional Study ◽

Head Impulse Test ◽

Cross Sectional ◽

Head Impulse ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex ◽

Group 2 ◽

Unilateral Vestibulopathy ◽

Vestibular Damage ◽

Acute Unilateral Vestibulopathy

OBJECTIVES: This cross-sectional study aims to describe the features of the suppression head impulse paradigm (SHIMP) in acute unilateral vestibulopathy (AUV) and to define its role in predicting the recovery of patients. METHODS: Thirty patients diagnosed with AUV were retrospectively analyzed. The dizziness handicap inventory score and video head impulse test parameters performed 4–8 weeks from the AUV onset constituted the main outcome measures. Patients with a worse recovery (Group 1) and patients who recovered spontaneously (Group 2) were compared. RESULTS: The SHIMP vestibulo-ocular reflex (VOR) gain was statistically significantly lower than the conventional head impulse paradigm (HIMP) VOR gain (P < 0.001). The SHIMP VOR gain was negatively correlated with the DHI (P < 0.001) and was positively correlated with the HIMP VOR gain (P < 0.001) and the SHIMP overt saccades (%) (P < 0.001). Patients with a worse recovery exhibited the following: higher DHI (P < 0.001), lower SHIMP and HIMP VOR gain (P < 0.001 and P = 0.007, respectively), and lower SHIMP and greater HIMP overt saccade prevalence values (P = 0.007 and P = 0.032, respectively). CONCLUSIONS: The SHIMP and HIMP help in improving our approach to AUV. SHIMP appears to better identify the extent of the vestibular damage in patient suffering from AUV than HIMP and could provide interesting information about the course of the disease. Particularly, the analysis of SHIMP VOR gain and overt saccade prevalence would provide useful information about the recovery of patients.

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May Video Head Impulse Test and Cervical Myogenic Potentials Contribute to Caloric Test in the Diagnosis of Acute Unilateral Vestibulopathy?

kulak burun boğaz ve baş boyun cerrahisi dergisi ◽

10.24179/kbbbbc.2020-79024 ◽

2021 ◽

Vol 29 (2) ◽

pp. 81-85

Author(s):

Gözde AKIN ◽

Osman H. ÇAM ◽

Pelin KOÇDOR ◽

Levent N. ÖZLÜOĞLU

Keyword(s):

Head Impulse Test ◽

Caloric Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Unilateral Vestibulopathy ◽

Acute Unilateral Vestibulopathy

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Acute vestibular syndrome: is skew deviation a central sign?

Journal of Neurology ◽

10.1007/s00415-021-10692-6 ◽

2021 ◽

Author(s):

Athanasia Korda ◽

Ewa Zamaro ◽

Franca Wagner ◽

Miranda Morrison ◽

Marco Domenico Caversaccio ◽

...

Keyword(s):

Diagnostic Value ◽

Head Impulse Test ◽

Clinical Test ◽

Stroke Patients ◽

Acute Vestibular Syndrome ◽

Low Sensitivity ◽

A Prospective Study ◽

Unilateral Vestibulopathy ◽

Acute Unilateral Vestibulopathy ◽

Skew Deviation

Abstract Objective Skew deviation results from a dysfunction of the graviceptive pathways in patients with an acute vestibular syndrome (AVS) leading to vertical diplopia due to vertical ocular misalignment. It is considered as a central sign, however, the prevalence of skew and the accuracy of its test is not well known . Methods We performed a prospective study from February 2015 until September 2020 of all patients presenting at our emergency department (ED) with signs of AVS. All patients underwent clinical HINTS and video test of skew (vTS) followed by a delayed MRI, which served as a gold standard for vestibular stroke confirmation. Results We assessed 58 healthy subjects, 53 acute unilateral vestibulopathy patients (AUVP) and 24 stroke patients. Skew deviation prevalence was 24% in AUVP and 29% in strokes. For a positive clinical test of skew, the cut-off of vertical misalignment was 3 deg with a very low sensitivity of 15% and specificity of 98.2%. The sensitivity of vTS was 29.2% with a specificity of 75.5%. Conclusions Contrary to prior knowledge, skew deviation proved to be more prevalent in patients with AVS and occurred in every forth patient with AUVP. Large skew deviations (> 3.3 deg), were pointing toward a central lesion. Clinical and video test of skew offered little additional diagnostic value compared to other diagnostic tests such as the head impulse test and nystagmus test. Video test of skew could aid to quantify skew in the ED setting in which neurotological expertise is not always readily available.

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Efficacy of a Non-invasive Vestibular System Masking for Improving Outcomes Following Acute Unilateral Vestibulopathy

Case Medical Research ◽

10.31525/ct1-nct04226976 ◽

2020 ◽

Author(s):

Keyword(s):

Vestibular System ◽

Non Invasive ◽

Unilateral Vestibulopathy ◽

Acute Unilateral Vestibulopathy

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Acute Vestibular Syndrome

Seminars in Neurology ◽

10.1055/s-0039-3402739 ◽

2020 ◽

Vol 40 (01) ◽

pp. 059-066

Author(s):

Kevin A. Kerber

Keyword(s):

Vestibular Neuritis ◽

Vestibular Disorders ◽

Acute Vestibular Syndrome ◽

Unilateral Vestibulopathy ◽

Acute Unilateral Vestibulopathy ◽

New Onset

AbstractThe acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy due to vestibular neuritis. Stroke is also a serious concern in patients with AVS. Most other peripheral vestibular disorders present as episodic or chronic syndromes. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed.

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