Efficacy of the subjective visual vertical test performed using a mobile application to detect vestibular pathology

BACKGROUND: The subjective visual vertical (SVV) test is a sensitive test of vestibular dysfunction that allows the evaluation of otolithic organs; however, with the current method, there are technical and logistical limitations that make the application of this test difficult in the conventional clinic. OBJECTIVE: The objective of this study is to assess the effectiveness of detecting vestibular pathology using the SVV via a new screening method. METHODS: A consecutive sample of 62 patients with suspected vestibular pathology was included in the study. The patients were clinically diagnosed according to the Barany Society criteria. An exploratory system was designed using a mobile application in Android that detects accelerometer oscillations and involves placing the smartphone on a rotating disk anchored to the wall. All patients underwent a SVV examination using the bucket method and the study test. A cut-off point of the ROC curve was calculated for each test, and its sensitivity, specificity, diagnostic accuracy and probability ratios for detecting vestibular pathology were analysed. The SVV results were compared using the bucket test and the study test. RESULTS: We observed significant differences in sensitivity between the two tests: 86.95% for the study test versus 67.4% for the bucket test (p < 0.01). In the ROC curve, an area under the curve of 0.90 was observed for the study test, with a cut-off of 2.43 for a sensitivity of 86.95% and a specificity of 93.75%. CONCLUSIONS: SVV testing using a smartphone placed on a rotating disk anchored to the wall offers greater diagnostic accuracy than SVV using the bucket test. Both methods are inexpensive, harmless and easily accepted by patients.

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Evaluation of subjective vertical perception among stroke patients: a systematic review

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0584 ◽

2021 ◽

Vol 79 (11) ◽

pp. 1026-1034

Author(s):

Luana Ribeiro Ferreira ◽

Flávio José Pereira De Almeida Ferreira ◽

Fernanda Aparecida Campos ◽

Gustavo José Luvizutto ◽

Luciane Aparecida Pascucci Sande De Souza

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Web Of Science ◽

High Variability ◽

Cochrane Library ◽

Subjective Visual Vertical ◽

Stroke Patients ◽

Subjective Vertical ◽

Visual Vertical ◽

Crucial Information

Abstract Background: Verticality misperception is relatively common among patients after stroke, and it may be evaluated in terms of (a) subjective visual vertical (SVV), (b) subjective haptic vertical (SHV) and (c) subjective postural vertical (SPV). To better understand these assessment methods, we conducted a systematic review of the methodological characteristics of different protocols for evaluating SVV, SHV and SPV among individuals after stroke. Objective: To standardize the methodological characteristics of protocols for evaluating verticality perception after stroke. Methods: We searched the following databases: PUBMED, regional BVS portal (MEDLINE, LILACS, IBECS, CUBMED, Psychology Index and LIS), CINAHL, SCOPUS, Web of Science, Science Direct, Cochrane Library and PEDro. Two review authors independently used the QUADAS method (Quality Assessment of Diagnostic Accuracy Studies) and extracted data. Results: We included 21 studies in the review: most (80.9%) used SVV, eight (38.1%) used SPV and four (19.0%) used SHV. We observed high variability in assessments of verticality perception, due to patient positions, devices used, numbers of repetitions and angle of inclination for starting the tests. Conclusion: This systematic review was one of the first to explore all the methods of assessing verticality perception after stroke, and it provides crucial information on how to perform the tests, in order to guide future researchers/clinicians.

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Effects of galvanic vestibular stimulation on subjective visual vertical and static eye deviation

Electroencephalography and Clinical Neurophysiology ◽

10.1016/s0013-4694(97)88208-2 ◽

1997 ◽

Vol 103 (1) ◽

pp. 67

Author(s):

R Zink

Keyword(s):

Vestibular Stimulation ◽

Galvanic Vestibular Stimulation ◽

Subjective Visual Vertical ◽

Visual Vertical

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The Added Value of Inflow-Based Vascular-Space-Occupancy and Diffusion-Weighted Imaging in Preoperative Grading of Gliomas

Neurodegenerative Diseases ◽

10.1159/000512545 ◽

2021 ◽

pp. 1-8

Author(s):

Haimei Cao ◽

Xiang Xiao ◽

Jun Hua ◽

Guanglong Huang ◽

Wenle He ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Roc Curve ◽

Diffusion Weighted Imaging ◽

Low Grade ◽

High Grade ◽

Mr Images ◽

Vascular Space ◽

Diffusion Weighted ◽

High Grade Gliomas ◽

And Diffusion

Objectives: The present study aimed to study whether combined inflow-based vascular-space-occupancy (iVASO) MR imaging (MRI) and diffusion-weighted imaging (DWI) improve the diagnostic accuracy in the preoperative grading of gliomas. Methods: Fifty-one patients with histopathologically confirmed diffuse gliomas underwent preoperative structural MRI, iVASO, and DWI. We performed 2 qualitative consensus reviews: (1) structural MR images alone and (2) structural MR images with iVASO and DWI. Relative arteriolar cerebral blood volume (rCBVa) and minimum apparent diffusion coefficient (mADC) were compared between low-grade and high-grade gliomas. Receiver operating characteristic (ROC) curve analysis was performed to compare the tumor grading efficiency of rCBVa, mADC, and the combination of the two parameters. Results: Two observers diagnosed accurate tumor grade in 40 of 51 (78.4%) patients in the first review and in 46 of 51 (90.2%) in the second review. Both rCBVa and mADC showed significant differences between low-grade and high-grade gliomas. ROC analysis gave a threshold value of 1.52 for rCBVa and 0.85 × 10−3 mm2/s for mADC to provide a sensitivity and specificity of 88.0 and 81.2% and 100.0 and 68.7%, respectively. The area under the ROC curve (AUC) was 0.87 and 0.85 for rCBVa and mADC, respectively. The combination of rCBVa and mADC values increased the AUC to 0.92. Conclusion: The combined application of iVASO and DWI may improve the diagnostic accuracy of glioma grading.

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Topology of brainstem lesions associated with subjective visual vertical tilt

Neurology ◽

10.1212/wnl.0000000000000480 ◽

2014 ◽

Vol 82 (22) ◽

pp. 1968-1975 ◽

Cited By ~ 28

Author(s):

T.-H. Yang ◽

S.-Y. Oh ◽

K. Kwak ◽

J.-M. Lee ◽

B.-S. Shin ◽

...

Keyword(s):

Subjective Visual Vertical ◽

Brainstem Lesions ◽

Visual Vertical

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Subjective visual vertical in patients with neck pain

Clinical Chiropractic ◽

10.1016/j.clch.2012.06.011 ◽

2012 ◽

Vol 15 (2) ◽

pp. 88

Keyword(s):

Neck Pain ◽

Subjective Visual Vertical ◽

Visual Vertical

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Is There a Role for Prostate Tumour Overexpressed-1 in the Diagnosis of HGPIN and of Prostatic Adenocarcinoma? A Comparison with α-Methylacyl CoA Racemase

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463201202500109 ◽

2012 ◽

Vol 25 (1) ◽

pp. 67-74 ◽

Cited By ~ 6

Author(s):

M. Scarpelli ◽

R. Mazzucchelli ◽

F. Barbisan ◽

A. Santinelli ◽

A. Lopez-Beltran ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Differential Display ◽

Roc Curve ◽

Intraepithelial Neoplasia ◽

Prostatic Intraepithelial Neoplasia ◽

Curve Analysis ◽

High Grade ◽

Roc Curve Analysis ◽

Prostate Tumour

Prostate Tumour Overexpressed-1 (PTOV1) was recently identified as a novel gene and protein during a differential display screening for genes overexpressed in prostate cancer (PCa). α-Methyl-CoA racemose (AMACR) mRNA was identified as being overexpressed in PCa. PTOV1 and racemase were immunohistochemically evaluated in PCa, high-grade prostatic intraepithelial neoplasia (HGPIN), atrophy and normal-looking epithelium (NEp) in 20 radical prostatectomies (RPs) with pT2a Gleason score 6 prostate cancer with the aim of analyzing the differences in marker expression between PTOV1 and AMACR. The level of expression of PTOV1 and AMACR increased from NEp and atrophy through HGPIN, away from and adjacent to prostate cancer, to PCa. With the ROC curve analysis the overall accuracy in distinguishing PCa vs HGPIN away from and adjacent to cancer was higher for AMACR than for PTOV1. In conclusion, AMACR can be considered a more accurate marker than PTOV1 in the identification of HGPIN and of PCa. However, PTOV1 may aid in the diagnosis of PCa, at least to supplement AMACR as another positive marker of carcinoma and to potentially increase diagnostic accuracy.

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The use of a neck brace does not influence visual vertical perception

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000400019 ◽

2011 ◽

Vol 69 (3) ◽

pp. 509-512 ◽

Cited By ~ 6

Author(s):

Martha Funabashi ◽

Natya N.L. Silva ◽

Luciana M. Watanabe ◽

Taiza E.G Santos-Pontelli ◽

José Fernando Colafêmina ◽

...

Keyword(s):

Healthy Volunteers ◽

Healthy Subjects ◽

Afferent Input ◽

Subjective Visual Vertical ◽

Sensory Receptors ◽

Ocular Torsion ◽

Vertical Orientation ◽

Mean Values ◽

Visual Vertical ◽

The Mean

Subjective visual vertical (SVV) evaluates the individual's capacity to determine the vertical orientation. Using a neck brace (NB) allow volunteers' heads fixation to reduce cephalic tilt during the exam, preventing compensatory ocular torsion and erroneous influence on SVV result. OBJECTIVE: To analyze the influence of somatosensory inputs caused by a NB on the SVV. METHOD: Thirty healthy volunteers performed static and dynamic SVV: six measures with and six without the NB. RESULTS: The mean values for static SVV were -0.075º±1.15º without NB and -0.372º±1.21º with NB. For dynamic SVV in clockwise direction were 1.73º±2.31º without NB and 1.53º±1.80º with NB. For dynamic SVV in counterclockwise direction was -1.50º±2.44º without NB and -1.11º±2.46º with NB. Differences between measurements with and without the NB were not statistically significant. CONCLUSION: Although the neck has many sensory receptors, the use of a NB does not provide sufficient afferent input to change healthy subjects' perception of visual verticality.

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