scholarly journals Acute Vestibular Syndrome in Cerebellar Infarction: A Case Report

2021 ◽  
Vol 8 (9) ◽  
pp. 29-35
Author(s):  
Diayanti Tenti Lestari ◽  
Hanik Badriyah Hidayati
Keyword(s):  
Neurological Status ◽  
Rapid Onset ◽  
Great Sensitivity ◽  
Head Impulse Test ◽  
Symptomatic Therapy ◽  
Cerebellar Infarction ◽  
Head Impulse ◽  
Antiplatelet Medication ◽  
Acute Vestibular Syndrome ◽  
Skew Deviation

Introduction: Acute vestibular syndrome (AVS) is characterized by rapid onset of vertigo, nausea and vomiting, and gait unsteadiness in association with head motion intolerance and nystagmus, lasting days to weeks. Although the majority of AVS patients have acute peripheral vestibulopathy, some may also have brainstem or cerebellar strokes. Cerebellar infarctions sometimes only cause vertigo. The Head Impulse Test, skew deviation, and nystagmus testing provide for great sensitivity and specificity in distinguishing between peripheral vestibular impairment and stroke. Case: A 41-year-old male patient suffered from acute-onset vertigo and dizziness about 5 hours before admission, which started when he started doing his morning routine. Patients also feel gait unsteadiness and almost fall to the left side. There was no weakness in extremities, skew face or slurred speech. Patient's neurological status showed the cerebellar examination was positive left dysmetria, left dysdiadochokinesia, the Romberg test open eye fell to the left, normal Head Impulse Test (HIT), with horizontal bidirectional nystagmus and negative skew deviation test. Cerebellum infarction was discovered using computed tomography imaging. After passing through the acute stroke period, patients are offered symptomatic therapy in the form of betahistine, antiplatelet medication, and vestibular rehabilitation planning. On the tenth day after the onset, the patient's symptoms began to improve. Conclusion: Proper diagnosis of acute vestibular syndrome will guide the necessary tests. The HINTS oculomotor test at the bedside can detect acute vestibular stroke. Keywords: acute vestibular syndrome, vertigo, cerebellum, HINTS

scholarly journals VESTIBULAR NEURONITIS

2021 ◽  
Vol 2 (2) ◽  
pp. 44-48
Author(s):  
Shahdevi Nandar Kurniawan ◽  
Afiyfah Kaysa Waafi
Keyword(s):  
Viral Infections ◽  
Clinical Manifestations ◽  
Vestibular Function ◽  
Spontaneous Nystagmus ◽  
Symptomatic Therapy ◽  
Cerebellar Infarction ◽  
Upper Respiratory Tract ◽  
Acute Vestibular Syndrome ◽  
Healthy Side ◽  
Vestibular Neuronitis

Vestibular neuronitis is an acute vestibular syndrome due to inflammation of the vestibular nerve characterized by the typical symptoms of acute rotatory vertigo accompanied by nausea, vomiting, and symptoms of balance disorders. The incidence of vestibular neuronitis is about 3.5 per 100,000 people. The exact etiology of this vestibular neuronitis is unknown. However, based on existing evidence, vestibular neuronitis is associated with viral infections of the upper respiratory tract and herpes zoster infection. The clinical manifestations of vestibular neuronitis are persistent rotatory vertigo accompanied by oscillopsia, horizontal-rotatory peripheral vestibular spontaneous nystagmus on the healthy side, and a tendency to fall on the affected side. Diagnosis of vestibular neuronitis can be made by clinical diagnosis, through history, physical examination, and special examinations. Through these examinations, the differential diagnosis of vestibular neuronitis should be excluded, such as Meniere's disease, labyrinthitis, benign paroxysmal positional vertigo, and vertigo due to central lesions such as cerebellar infarction. Management of vestibular neuronitis is in the form of symptomatic therapy with vestibular suppressants, antivertigo, and redirect to relieve the symptoms that arise, then causative therapy can be done by administering corticosteroids, and in patients, physiotherapy can be done to improve vestibular function.

Vestibular vertigo in emergency neurology

2021 ◽  
Vol 26 (4) ◽  
pp. 50-59
Author(s):  
A. A. Kulesh ◽  
D. A. Dyomin ◽  
A. L. Guseva ◽  
O. I. Vinogradov ◽  
V. A. Parfyonov
Keyword(s):  
Clinical Signs ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Vertebrobasilar System ◽  
Acute Vestibular Syndrome ◽  
Vestibular Vertigo ◽  
Vestibular Neuronitis ◽  
Emergency Neurology

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

scholarly journals Quantifying the Vestibulo-Ocular Reflex with Video-Oculography: Nature and Frequency of Artifacts

2014 ◽  
Vol 20 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Georgios Mantokoudis ◽  
Ali S. Saber Tehrani ◽  
Jorge C. Kattah ◽  
Karin Eibenberger ◽  
Cynthia I. Guede ◽  
...  
Keyword(s):  
Head Impulse Test ◽  
Head Impulse ◽  
Video Oculography ◽  
Ocular Reflex ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Corrective Saccades ◽  
Coding Manual ◽  
A Prospective Study ◽  
The Impact

Video-oculography devices are now used to quantify the vestibulo-ocular reflex (VOR) at the bedside using the head impulse test (HIT). Little is known about the impact of disruptive phenomena (e.g. corrective saccades, nystagmus, fixation losses, eye-blink artifacts) on quantitative VOR assessment in acute vertigo. This study systematically characterized the frequency, nature, and impact of artifacts on HIT VOR measures. From a prospective study of 26 patients with acute vestibular syndrome (16 vestibular neuritis, 10 stroke), we classified findings using a structured coding manual. Of 1,358 individual HIT traces, 72% had abnormal disruptive saccades, 44% had at least one artifact, and 42% were uninterpretable. Physicians using quantitative recording devices to measure head impulse VOR responses for clinical diagnosis should be aware of the potential impact of disruptive eye movements and measurement artifacts. i 2014 S. Karger AG, Basel

Misleading signs in acute vertigo

2017 ◽  
Vol 18 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Sean Lance ◽  
Stuart Scott Mossman
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome ◽  
Horizontal Head ◽  
Fourth Nerve Palsy ◽  
Paroxysmal Positional Vertigo

The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them.

Recent advances in head impulse test findings in central vestibular disorders

Neurology ◽  
2018 ◽  
Vol 90 (13) ◽  
pp. 602-612 ◽  
Author(s):  
Jeong-Yoon Choi ◽  
Hyo-Jung Kim ◽  
Ji-Soo Kim
Keyword(s):  
Vestibular Nucleus ◽  
Head Rotation ◽  
Medial Longitudinal Fasciculus ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Corrective Saccades ◽  
Cerebellar Lesions ◽  
Horizontal Head

The head impulse test (HIT) is used to evaluate the vestibulo-ocular reflex (VOR) during a high-velocity head rotation. Corrective catch-up saccades that occur during or after the HITs usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal clinical (bedside) HITs should prompt a search for a central lesion. However, recent quantitative studies that evaluated HITs using magnetic search coils or video-based techniques have demonstrated that specific patterns of HIT abnormalities are associated with central vestibular disorders. While normal clinical HITs are typical of central lesions, discrepancies have been observed between clinical and quantitative HITs. The horizontal head impulse VOR gains can be significantly reduced unilaterally or bilaterally (positive HITs) in lesions involving the vestibular nucleus, nucleus prepositus hypoglossi, or flocculus. In diffuse cerebellar lesions, the VOR gain during horizontal head impulses may increase (hyperactive) with corrective saccades directed the opposite way. The presence of cross-coupled vertical corrective saccades during horizontal HITs is also suggestive of diffuse cerebellar lesions. Lesions involving the vestibular nucleus, medial longitudinal fasciculus, and cerebellum may show decreased or increased gains of the VOR during vertical HITs. Defining the differences in patterns observed during abnormal HITs may help practitioners localize the responsible lesions in both central and peripheral vestibulopathy.

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 clinical course of vestibular neuritis from the point of view of the video Head Impulse Test

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Leonardo Manzari ◽  
Domenico Graziano ◽  
Marco Tramontano
Keyword(s):  
Clinical Course ◽  
Cranial Nerves ◽  
Point Of View ◽  
Vestibular Neuritis ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Contralesional Side

Vestibular neuritis (VN) is one  of the most common causes of acute vestibular syndrome (AVS). Quantifying the vestibulo-ocular reflex (VOR) gain by the video Head Impulse Test (vHIT) could provide useful information to diagnose VN. This retrospective study is aimed to investigate the clinical course of VN evaluating the horizontal VOR gain (hVOR) values in acute and subacute stages and to correlate these values with the patients’ quality of life. Medical record of 28 patients with VN were reviewed. Patients were assigned to two groups according to the time since the acute vestibular syndrome (AVS). One group with patients assessed within seventy-two hours since the AVS (AVSg) and one group with patients evaluated from four days to six weeks since the AVS (PAVSg). hVOR gain was evaluated in all selected patients and correlated to Dizziness Handicap Inventory (DHI). Significant differences were found in the between-subjects analysis in DHI score (p=0.000) and in the ipsilesional hVOR gain values (p=0.001). The correlation analysis showed significant results (p=0.017) between DHI score ( 40±16.08) and ipsilesional VOR gain (0.65±0.22) in the PAVSg. Patients evaluated within 72 hours since the AVS showed anticompensatory saccades (AcS) turning the head toward the contralesional side. Patients with VN could have dissimilar hVOR gain values and DHI score according to the damage of the VIII pair of cranial nerves. AcS in the contralesional side is a sign of acute phase in patients with VN.

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