Hallazgos vestibulares y oculomotores en migraña vestibular: una revisión actualizada / Vestibular and Oculomotor findings in vestibular migraine: an updated review

La migraña vestibular es una de las etiologías más frecuentes del síndrome vestibular episódico a nivel mundial. Presenta varias hipótesis de patofisiología, principalmente a nivel de sistema vestibular central y genético. Su diagnóstico es fundamentalmente clínico, pero se han observado alteraciones a nivel de la función vestibular y de las pruebas oculomotoras. Los hallazgos clínicos no solo están presentes en el momento de la crisis, sino también se han observado en intervalos asintomáticos. La paresia unilateral en la prueba calórica suele ser más frecuente que una ganancia baja del reflejo vestíbulo-ocular del canal lateral en la videonistagmografía, sin embargo, existe una tasa elevada de discordancia entre ambas pruebas. Respecto a la prueba de estudio del movimiento ocular, se han observado alteraciones en el seguimiento pendular, movimiento sacádico, nistagmo optocinético, nistagmo evocado por la mirada, nistagmo espontáneo y nistagmo posicional. Es frecuente observar que el nistagmo provocado por cambios posicionales presenta características centrales durante la crisis de migraña vestibular, pero también se pueden presentar en periodos libres de síntomas en este grupo de pacientes.

Vestibular migraine is one of the most frequent etiologies of episodic vestibular syndrome worldwide. It presents several pathophysiology hypotheses, mainly at the central vestibular system and genetic level. Its diagnosis is fundamentally clinical, but changes in vestibular function and oculomotor tests have been observed. Clinical findings are present not only during the crisis, but also have been seen in the symptom-free interval. Unilateral paresis on caloric testing is usually more common than low gain of the vestibulo-ocular reflex in the lateral canal on videonystagmography, however, there is a high rate of discrepancy between these tests. Regarding the eye movement study test, alterations have been seen in pendulum tracking, saccadic movement, optokinetic nystagmus, gaze-evoked nystagmus, spontaneous nystagmus and positional nystagmus. It is common to observe that nystagmus caused by positional changes has central features during vestibular migraine attacks, but it can also be seen in the symptom-free interval in this group of patients.

Ocular findings from otoneurological examinations in children with and without dyslexia: a systematic review with meta-analysis

Abstract Objective: To investigate ocular movements measures of vectoelectro-nystagmography and video-nystagmography in dyslexic children and compare with measures of typical children. Methods: A systematic review of observational studies comparing the ocular movements differences between dyslexic and typical children with no publication date or language restriction. The literature survey included the bibliographic databases MEDLINE, ScienceDirect, Scopus, Web of Science, SciELO, Lilacs and CENTRAL. Gray literature databases were also searched, including: OpenGrey.eu, DissOnline.de, The New York Academy of Medicine and WorldCat. The meta-analysis was performed using software RevMan 5.3 (Cochran Collaboration). Results: A total of 2375 articles were found of which 113 fell within the inclusion criteria. Among these, 52 were duplicates (found in more than one research source), and 45 articles were selected for reading in full. Thirteen (13) articles were included for analysis and discussion. Meta-analysis showed statistical differences between the two groups for the total number of saccades and duration of fixation. Conclusion: The study revealed that children with dyslexia have longer duration of fixation and fewer saccades during ocular movements on vectoelectro-nystagmography and videonystagmography when compared to children without dyslexia.

Clinical characteristics of definite vestibular migraine diagnosed according to criteria jointly formulated by the Bárány Society and the International Headache Society

Abstract Objective: To investigate the clinical features of patients with definite vestibular migraine (dVM). Methods: A total of 91 patients with vestibular symptoms accompanied by migraines/migrainelike symptoms were enrolled and diagnosed according to the criteria of the Bárány Society and the International Headache Society. Baseline data were collected. Videonystagmography and immune-related laboratory tests were performed. Results: Among the 91 patients, 62 (68.1%) had dVM (11 men, 51 women). Among dVM patients, migraine occurred earlier than vestibular symptoms in 42 (67.7%) patients. Spontaneous vertigo occurred in 41 (66.1%) patients. Induced vertigo occurred in 21 (33.9%) patients. Motion sickness occurred in 33 (53.2%) patients. Central oculomotor dysfunction was observed in 11 (17.7%) patients. Caloric test revealed unilateral horizontal semicircular canal dysfunction in 12 (19.4%) patients. Severe intolerance during the test occurred in 44 (71.0%) patients with dVM. 12 (19.4%) patients showed abnormal immune-related indicators. Conclusion: dVM is more common in women. The onset of migraine precedes that of vestibular symptoms, which are often accompanied by photophobia and phonophobia. Motion sickness and severe caloric test intolerance can contribute to the diagnosis of dVM. Immunological indicators are abnormal in some patients with dVM, dVM may be secondary or an accompanying disorder, but the causal relationship needs further investigation. Level of evidence: IV.

Abnormal eye movements in patients with idiopathic rapid eye movement sleep behavior disorder / 浙江大学学报·医学版

OBJECTIVE@#To analyze the characteristics of eye movements in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD).@*METHODS@#Twenty two patients with iRBD and 20 controls were enrolled between January 2017 and May 2019 from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Clinical data including polysomnogram (PSG) results were collected. Videonystagmography (VNG) including spontaneous nystagmus, gaze, saccade, tracking and optokinetic test were performed. The difference of VNG results between iRBD patients and controls were analyzed. The factors related to the abnormal VNG results were analyzed by using logistic regression analysis.@*RESULTS@#No significant differences were found between the iRBD and control groups in the spontaneous nystagmus, gaze nystagmus, square wave jerk, involuntary eye movement, saccade and optokinetic nystagmus (all >0.05). In smooth pursuit of 0.4-0.5 Hz and 0.6-0.7 Hz, iRBD patients had more type Ⅲ-Ⅳ curve than controls (=5.177 and 5.301, both <0.05). Logistic regression analysis indicated that less sleep time of N3 stage was related to the abnormal results in smooth pursuit of 0.4-0.5 Hz (=0.963, <0.05). iRBD patients with Ⅲ-Ⅳ type curve in smooth pursuit of 0.4-0.5 Hz had less N3 sleep time than iRBD patients with Ⅰ-Ⅱ type curve (52±28 min vs. 76±23 min, =2.197, <0.05).@*CONCLUSIONS@#Abnormal smooth pursuit was found in iRBD patients, which might be related to the pathological mechanism of iRBD.

Rotational vertebral artery syndrome treated via an anterior approach and selective decompression only

We present the case of a 38-year-old male who complained of repeated dizziness and syncope. Rotational vertebral artery syndrome (RVAS) was diagnosed via videonystagmoraphy (VNG), computed tomography angiography (CTA) and three-position digital subtraction angiography (DSA). In the neutral position, CTA and DSA revealed left vertebral artery (VA) stenosis at the C2 transverse foramen and right VA hypoplasia. When the head was turned to the right, the blood flow stopped at the C2 level. The bony structure around the VA at the C2 transverse foramen was decompressed via an anterior surgical approach, and the symptoms resolved. This case present the precise stenotic point evaluation by three-position DSA is crucial for the planning of surgical treatment.

Visual Eye movement-vestibular ocular balance assessment in the diagnosis of central and peripheral vertigo / 中国综合临床

Objective To explore the role of visual oculomotor-vestibular eye balance function in the diagnosis of central and peripheral vertigo. Methods From January 2015 to June 2016,one hundred and sixty-two patients with central vertigo who were treated at Kailuan General Hospital were enrolled in the study, including 124 males and 38 females, aged ( 64. 09 ± 10. 98 ) years old; there were 166 cases of peripheral vertigo,75 males and 91 females,aged (52. 13±12. 20) years old. Spontaneous nystagmus test,gaze test,position test, saccade test, smooth visual tracking test, visual single-speed test, visual sinus test, swivel chair rotation- emergency stop test using infrared video nystagmus and static balance posture instrument,open-closed eye hard plate erect test, open-closed eye sponge soft bottom erect test balance function electrophysiological test were conducted. Results The detection rate of pathological spontaneous nystagmus and pathological gaze nystagmus was higher in the central vertigo group than that in the peripheral vertigo group (χ2=5. 674,16. 458,P<0. 05) . The occurrence rate of positional nystagmus was higher in peripheral vertigo group than that in central vertigo group (χ2=48. 896,P<0. 001). The abnormal rate of scanning test,stable visual tracking test,visual movement single speed and sinusoidal test,and static balance posture test were higher in the central vertigo group than those in the peripheral vertigo group (χ2 =137. 169, 166. 972, 150. 877, 150. 877, 27. 273, P<0. 001 ) , while the abnormal rate of rotating chair sudden stop test was higher in the central vertigo group than that in the peripheral vertigo group (χ2=51. 000,P<0. 001) . The abnormal results were mainly scanned underflush and slow scan in central vertigo group (χ2=103. 846,4. 296,P<0. 05),stable visual tracking curve (χ2=147. 389,4. 296,P<0. 05) in type III-IV,and the gain of nystagmus decreased unilaterally and bilaterally (χ2=47. 531,44. 477, 52. 529,53. 255,P<0. 001) . Anomalies of proprioception in reverse and vertical nystagmus and static balance posture were induced by rotating chair sudden stop test (χ2=11. 847, 23. 778, P<0. 001 ) , while peripheral vertigo group showed unilateral decrease of nystagmus gain induced by rotating chair sudden stop test. (χ2=79. 771, P < 0. 001 ) . Conclusion The patients with peripheral vertigo have obvious body position spontaneous vestibular response and vestibular oculomotor system dysfunction, while the patients with central vertigo mainly have visual and oculomotor system dysfunction,and may be accompanied by vestibular oculomotor system and vestibular spinal reflex dysfunction.

Central Vestibular Dysfunction in an Otorhinolaryngological Vestibular Unit: Incidence and Diagnostic Strategy

Introduction: Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective: The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit. Methods: This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required. Results: There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years). Provisional videonystagmography (VNG) results were: 40% benign paroxysmal positional vertigo (BPPV), 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41) had magnetic resonance imaging (MRI) and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23%) were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus). Conclusions: Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions...

New Proposal of Functional Status of Vestibular System Based on Vestibular Function Tests Findings in Dizzy Patients with Normal Caloric Response / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Vestibular function tests are very useful in diagnosing dizzy patients. Among them, bithermal caloric test is most commonly used test for localizing their permanent vestibular loss. However, it causes much discomfort to the patients with non-physiologic stimuli. In addition, it doesn't represent the present functional status of vestibular system. Therefore, normal caloric result does not accurately correspond to normal vestibular function in dizzy patients. Currently, rotation chair test and dynamic posturography have been introduced adjunctly to assess vestibular function accompanied by bithermal caloric test. It has not been elucidated for their specific role in diverse settings of vestibular disorders. So we planned this study to evaluate clinical usefulness of rotation chair test, videonystagmography and computerized dynamic posturogr-phy in dizzy patients with normal caloric response. MATERIALS AND METHODS: We reviewed clinical records of 46 patients who met their inclusion criteria. They were categorized into five subgroups according to abnormal vestibular function test findings. RESULTS: In each subgroup, we hypothesized its clinical relevance, possible mechanism of dizz-iness and presumed diagnosis. Five categories are as below; visual dependency, imbalance of vestibular tones, chronic peripheral vestibulopathy, abnormality in the vestibulospinal tract and abnormality of oculomotor system. CONCLUSION: We suggest new classification of abnormal vestibular functional status in dizzy patients with normal caloric results. These are comparable according their clinical features and thought to be helpful in managing and counseling each patient.

Relationship between predictable ocular motor control and cognitive function in Parkinson's disease / 上海第二医科大学学报

Objective To explore the relationship between predictable ocular motor control and cognitive function in Parkinson's disease(PD). Methods Videonystagmography was used to examine 24 patients with idiopathic PD(PD group) and 24 healthy controls(control group) on predictable ocular motor control.The accuracies of saccade were compared between two groups.The correlation among accuracy for predictive saccade(latency

Galvanic Nystagmus in Normal Person

BACKGROUND AND OBJECTIVES: Vestibulo-ocular reflex and vestibulo-spinal reflex are induced by transmatoid galvanic stimulation of vestibular system. Nystagmus and body sway are result of each reflex. Recently, videooculograph possible to record a minute ocular movement was commonly used, vestibulo-ocular reflex induced by galvanic simualtion is easily documented. The purposes of this study are to evaluate the galvanic nystagmus in nomal persons in order to better understand the physiology of the vestibular system. MATERIALS AND METHODS: Eye movement of 20 neurootologic normal subjects by both side transmstoid galvanic stimulation (40cases) were analyzing by videonystagmography. RESULT: The direction of nystagmus in fast phase was to the negative electrode. Galvanic nystagmus was occured all normal subjects when stimulus intensity was more than 2mA. There was positive correlation between slow phase velocity(SPV) and electric current but negative correlation was noted between asymmery of SPV and electric current. CONCLUSION: It is suggested that the galvanic nystagmus test could be a new diagnostic tool for evaluation of vestibular status.