Predicting the Outcome after Acute Unilateral Vestibulopathy: Analysis of Vestibulo-ocular Reflex Gain and Catch-up Saccades

2017 ◽  
Vol 158 (3) ◽  
pp. 527-533 ◽  
Author(s):  
Niccolò Cerchiai ◽  
Elena Navari ◽  
Stefano Sellari-Franceschini ◽  
Chiara Re ◽  
Augusto Pietro Casani
Keyword(s):  
High Velocity ◽  
Case Series ◽  
Vestibular Rehabilitation ◽  
Rehabilitation Program ◽  
Head Impulse Test ◽  
Dizziness Handicap Inventory ◽  
Reflex Gain ◽  
Catch Up ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy

Objectives (1) To describe the relationships among the main instrumental features characterizing an acute unilateral vestibulopathy and (2) to clarify the role of the video head impulse test in predicting the development of chronic vestibular insufficiency. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Sixty patients suffering from acute unilateral vestibulopathy were retrospectively analyzed: 30 who recovered spontaneously (group 1) and 30 who needed a vestibular rehabilitation program (group 2). The main outcome measures included Dizziness Handicap Inventory score, canal paresis, high-velocity vestibulo-oculomotor reflex gain, and catch-up saccade parameters. The tests were all performed between 4 and 8 weeks from the onset of symptoms. Results The high-velocity vestibulo-oculomotor reflex gain correlated with the Dizziness Handicap Inventory score ( P = .004), with the amplitude of covert and overt saccades ( P < .001), and with the prevalence of overt saccades ( P < .001). Patients in need for vestibular rehabilitation programs had a significantly lower gain ( P < .001) and a higher prevalence and amplitude of overt saccades ( P = .002 and P = .008, respectively). Conversely, we found no differences in terms of response to the caloric test ( P = .359). Conclusions Lower values of high-velocity vestibulo-oculomotor reflex gain and a high prevalence of overt saccades are related to a worse prognosis after acute unilateral vestibulopathy. This is of great interest to clinicians in identifying which patients are less likely to recover and more likely to need a vestibular rehabilitation program.

scholarly journals Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation

2021 ◽  
Author(s):  
Morteza Hamidi Nahrani ◽  
Mehdi Akbari ◽  
Mohammad Maarefvand
Keyword(s):  
Vestibular Rehabilitation ◽  
Head Impulse Test ◽  
Dizziness Handicap Inventory ◽  
Strong Negative Correlation ◽  
Ocular Reflex ◽  
Vestibular Hypofunction ◽  
Before And After ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain

Background and Aim: Evaluating the effective­ness of vestibular rehabilitation (VR) in patients with vestibular lesions has always been a challe­nge. The questionnaires that are used for this pur­pose mostly show the degree of vestibular dis­ability rather than providing information about improvement of vestibular dysfunction. This study aimed to evaluate whether video head imp­ulse test (vHIT) that is used for the examination of vestibulo-ocular reflex (VOR), is a useful method for predicting the effectiveness of VR and has a correlation with dizziness handicap inventory (DHI) score. Methods: Participants were 42 patients with unilateral peripheral vestibular hypofunction (UPVH) undergoing VR. Patients were assessed before and after rehabilitation by the vHIT in all ipsilesional and contralesional semicircular can­als (SCCs) and the DHI. The changes in DHI score and VOR gain before and after rehabili­tation, were shown as ΔDHI and ΔVOR and their correlation was evaluated. Results: VOR gain from ipsilesional and contra­lesional SCCs was improved significantly after VR. There was a significant strong negative correlation between ΔVOR gain from ipsile­sional SCCs and ΔDHI score but no significant correlation was found between the ΔDHI score and ΔVOR gain from contralesional SCCs. Conclusion: vHIT test is a useful tool to evaluate the effectiveness of VR. VOR gain is correlated with the DHI score. Therefore, the improvement in vHIT results in all three SCCs after VR may be a good predictor of the degree of improvement in dizziness-related disability. Keywords: Vestibular rehabilitation; follow-up; unilateral vestibular hypofunction; video head impulse test; dizziness handicap inventory

scholarly journals Vestibulo-ocular reflex gain and compensatory saccades in three semicircular canals by video head impulse test

2019 ◽  
Author(s):  
Homa Zarrinkoob ◽  
Hadi Behzad ◽  
Seyed Mehdi Tabatabaee
Keyword(s):  
High Velocity ◽  
Semicircular Canals ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Low Velocity ◽  
Head Impulse ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain ◽  
The Right

Background and Aim: One of the tools for ass­essing the vestibulo-ocular reflex (VOR) is using video head impulse test (vHIT). In this test by placing the head at different angles and shaking the head, three semicircular canals of the vestibular system in each ear can be exami­ned separately. The purpose of this study was to investigate the relationship between the low and high velocities of the vHIT test with VOR and its compensatory saccades. Methods: The vHIT test was performed by an examiner in 49 normal individuals aged 23–39 at low and high velocities. All participants had normal hearing, visual, and vestibular systems. Results: Mean gains in the horizontal, anterior and posterior semicircular canals in the right ear respectively were 0.92, 1 and 0.90 and in the left ear 0.93, 0.99 and 0.95 for low velocity and 0.78, 0.92 and 0.79 in the right ear and 0.80, 0.85 and 0.86 in the left ear for high velocity. Also, the number of compensatory saccade at high velocity was higher than those at the low velocity and the latency of compensatory sacc­ade was lower at the higher velocity. Conclusion: In the vHIT test, VOR gain decreases at high velocity that is statistically significant. Also, compensatory saccades are more likely to occur at high velocity with sma­ller delay. Therefore, high-velocity vHIT test is not recommended for the purpose of examining the VOR gain and compensatory saccade.

scholarly journals Effects of a vestibular rehabilitation program on workers in the working environment: a pilot study

Revista CEFAC ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 304-312
Author(s):  
Isadora Altero Longo ◽  
Ariane Diane Morais Nunes ◽  
Clayton Henrique Rocha ◽  
Fabiana Mara Branco ◽  
Renata Rodrigues Moreira ◽  
...  
Keyword(s):  
Work Ability ◽  
Vestibular Rehabilitation ◽  
Rehabilitation Program ◽  
Working Environment ◽  
University Hospital ◽  
Dizziness Handicap Inventory ◽  
Work Ability Index ◽  
Chi Square ◽  
Ability Index ◽  
Nutrition And Dietetics

ABSTRACT Objective: to verify the effect of a vestibular rehabilitation program on workers with dizziness from the Division of Nutrition and Dietetics at a University Hospital. Methods: a total of 13 employees between 42 and 65 years of age participated, of whom, 1 was male, and 12, females. They were evaluated before and after the vestibular rehabilitation program using the Dizziness Handicap Inventory, Work Ability Index and Visual Analog Scale. The program was conducted in groups at the workplace. Statistical analysis was performed using the analysis of variance test for paired factors and the chi-square test. Results: in the pre- and post-vestibular rehabilitation comparison, significant differences were found in the Dizziness Handicap Inventory and Visual Analogue Scale scores. In the qualitative analysis of the Work Ability Index, an increase was observed in the number of workers who considered their ability to work to have improved. Conclusion: vestibular rehabilitation conducted in groups and in the working environment was effective in improving dizziness complaint in workers at the Division of Nutrition and Dietetics. It is believed that the positive experience of this program may be extended to other areas.

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

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.

scholarly journals Acute vestibular syndrome: is skew deviation a central sign?

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.

scholarly journals The Role of Functional Head Impulse Test With and Without Optokinetic Stimuli in Vestibular Migraine and Acute Unilateral Vestibulopathy: Discovering a Visual Dependence?

2021 ◽  
Author(s):  
Augusto-Pietro Casani ◽  
Francesco Lazzerini ◽  
Nicola Ducci ◽  
Ottavia Marconi ◽  
Nicola Vernassa
Keyword(s):  
Vestibular Migraine ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Functional Head ◽  
Significant Difference ◽  
The Difference ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy ◽  
Visual Dependence

Abstract Visually induced vertigo (i.e., vertigo provoked by moving visual scenes) could be considered as a noticeable feature of Vestibular Migraine (VM) and could be present in patients suffering from Acute Unilateral Vestibulophaty (AUV). The hypersensitivity to moving or conflicting visual stimulations is named Visual Dependence. The visuo-vestibular interactions were analyzed using functional Head Impulse Test (fHIT) with and without optokinetic stimulation (o-fHIT) in 25 patients with VM and 20 subjects affected by AUV. We calculated the percentage of correct answer (%CA) without and with the addition of confounding screen (CS). In VM groups the %CA at fHIT was 92,07% without CS and 73,66% with CS. A significant difference has been found between %CA on the deficit side and the normal side in AUV, both without CS and with CS). The results of fHIT in term of %CA with and without CS could be very useful to identify the presence of visual dependence especially in patients suffering from VM. The difference of %CA with and without CS could provide an instrumental support to correctly identify patients with VM. We propose the use of fHIT in clinical practice whenever there is a need to highlight a condition of visual dependence.

Assessment of Vestibulo-ocular Reflex Gain and Catch-up Saccades During Vestibular Rehabilitation

2018 ◽  
Vol 39 (10) ◽  
pp. e1111-e1117 ◽  
Author(s):  
Elena Navari ◽  
Niccolò Cerchiai ◽  
Augusto Pietro Casani
Keyword(s):  
Vestibular Rehabilitation ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain ◽  
Catch Up

scholarly journals A new ocular motor sign in acute vestibular syndrome: Is HINTS plus enough?

2021 ◽  
Vol 26 (4) ◽  
pp. 853-857
Author(s):  
Vishal Pawar ◽  
Aishwarya Anand ◽  
Prasanna Kulkarni ◽  
Ji Soo Kim
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Head Impulse Test ◽  
Medial Branch ◽  
Radio Imaging ◽  
Acute Vestibular Syndrome ◽  
Cerebellar Artery ◽  
Ct Brain ◽  
The Right ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy

A 66-year-old hypertensive and diabetic male presented with acute vestibular syndrome for three days. HINTS plus examination was performed. The horizontal head impulse test was positive on the left side. Video oculography showed centripetal nystagmus on gaze testing in the dark and test of skew was negative. There was no new hearing loss on the finger rub test. On neurological examination, he had severe postural instability and saccadic smooth pursuit. Radio-imaging studies were conducted to rule out the possibility of stroke. CT brain showed infarction in the territory of the medial branch of the right posterior inferior cerebellar artery. MRI brain confirmed the diagnosis. Thus, posterior circulation stroke can present with acute vestibular syndrome mimicking acute unilateral vestibulopathy. However, the presence of associated neurological symptoms like gait ataxia, centripetal nystagmus and vascular risk factors pointed towards a central cause. Clinical evaluation suggesting a peripheral lesion should never be taken in isolation and needs to be correlated with other associated signs. We describe centripetal nystagmus without fixation as a new oculomotor sign in acute vestibular syndrome.

scholarly journals The Role of the Functional Head Impulse Test with and without Optokinetic Stimuli in Vestibular Migraine and Acute Unilateral Vestibulopathy: Discovering a Dynamic Visual Dependence

2021 ◽  
Vol 10 (17) ◽  
pp. 3787
Author(s):  
Augusto Pietro Casani ◽  
Francesco Lazzerini ◽  
Ottavia Marconi ◽  
Nicola Vernassa
Keyword(s):  
Visual Stimulation ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Functional Head ◽  
Significant Difference ◽  
The Difference ◽  
Unilateral Vestibulopathy ◽  
Acute Unilateral Vestibulopathy ◽  
Visual Dependence

(1) Background: Visually induced vertigo (i.e., vertigo provoked by moving visual scenes) can be considered a noticeable feature of vestibular migraines (VM) and can be present in patients suffering from acute unilateral vestibulopathy (AUV). Hypersensitivity to moving or conflicting visual stimulation is named visual dependence. (2) Methods: Visuo-vestibular interactions were analyzed via the functional Head Impulse Test (fHIT) with and without optokinetic stimulation (o-fHIT) in 25 patients with VM, in 20 subjects affected by AUV, and in 20 healthy subjects. We calculated the percentage of correct answers (%CA) without and with the addition of the optokinetic background (OB). (3) In VM groups, the %CA on the fHIT was 92.07% without OB and 73.66% with OB. A significant difference was found between %CA on the deficit side and that on the normal side in AUV, both without OB and with OB. (4) Conclusions: The fHIT results in terms of %CA with and without OB could be useful to identify the presence of a dynamic visual dependence, especially in patients suffering from VM. The difference in %CA with and without OB could provide instrumental support to help correctly identify subjects suffering from VM. We propose the use of the fHIT in clinical practice whenever there is a need to highlight a condition of dynamic visual dependence.

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