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Head Impulse Test AND Nystagmus AND test Of Skew AND skew Deviation

Jorge C Kattah
Following the initial description of HINTS to diagnose acute vestibular syndrome (AVS) in 2009, there has been significant interest in the systematic evaluation of HINTs to diagnose stroke and other less common central causes of AVS. This trend increased with availability of the video head impulse test (video-HIT). This article reviews the original papers and discusses the main publications from 2009 to 2017. Many authors use video-HIT in the diagnosis of patients with AVS; this paper focuses on the major publications on the topic featuring nystagmus, manual and video-HIT, and skew deviation...
December 2018: Stroke and Vascular Neurology
T Wang, S H Qu, H Yuan, L S Ye, L Cui
Objective: To analyze the clinical characteristics of ocular tilt reaction in vestibular neuritis patients and discuss its value to the diagnosis of vestibular neuritis. Method: Thirty-five patients with vestibular neuritis confirmed between January 2016 and March 2018 underwent bedside vestibular function physical examination including nystagmus, head impulse test(HIT),head shaking nystagmus(HSN), ocular tilt reaction(OTR), Romberg sign, Fukuda stepping. All patients underwent head CT scan and brain MRI scan + DWI to exclude bleeding and infarction...
July 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Nese Celebisoy
HINTS battery involving head impulse test (HIT), nystagmus, and test of skew is the critical bedside examination to differentiate acute unilateral peripheral vestibulopathy from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). The highest sensitivity component of the battery has been reported to be the horizontal HIT, whereas skew deviation is defined as the most specific but non-sensitive sign for PCS. Video-oculography-based HIT (vHIT) may have an additional power in making the differentiation...
October 2018: Journal of Neurology
F Thömke
A significant number of patients who seek medical treatment in an emergency department because of vertigo or dizziness, suffer from acute vestibular syndrome. This is characterized by sustained vertigo, horizontal or horizontal rotatory jerk nystagmus, and unsteady stance and gait. In the acute situation it is crucial to differentiate patients with a peripheral vestibular disorder from those with a central disease. A number of recent studies have shown that a structured clinical examination enables a reliable differential diagnosis of central or peripheral disorders...
October 2018: Der Nervenarzt
Ana I Martins, João N Carvalho, Ana M Amorim, Argemiro Geraldo, Eric Eggenberger, João Lemos
An immune attack by anti-glutamic acid decarboxylase (GAD) antibodies is believed to cause a deficiency in gamma-aminobutyric acid-mediated neurotransmission in the cerebellum. This, in turn, leads to several eye movement disorders, including spontaneous downbeat (DBN) and periodic alternating nystagmus. We describe a 68-year-old diabetic woman with disabling paroxysmal positioning upbeat nystagmus (UBN) exclusively in the supine position, associated with asymptomatic spontaneous DBN, alternating skew deviation and hyperactive vestibulo-ocular reflex responses on head impulse testing, in whom high titers of anti-GAD antibodies were detected...
March 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
A Zwergal, K Möhwald, M Dieterich
Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests)...
June 2017: Der Nervenarzt
Thomas Brandt, Marianne Dieterich
Vertigo and dizziness are among the most common complaints in neurology clinics, and they account for about 13% of the patients entering emergency units. In this Review, we focus on central vestibular disorders, which are mostly attributable to acute unilateral lesions of the bilateral vestibular circuitry in the brain. In a tertiary interdisciplinary outpatient dizziness unit, central vestibular disorders, including vestibular migraine, comprise about 25% of the established diagnoses. The signs and symptoms of these disorders can mimic those of peripheral vestibular disorders with sustained rotational vertigo...
June 2017: Nature Reviews. Neurology
Michael Strupp, Thomas Brandt
Vertigo and dizziness are with an annual incidence of more than 10% and a lifetime prevalence of more than 30% among the most frequent symptoms. The keys to the diagnosis are the patient history and the bedside examination: a) for the patient history the time course, type and triggers of symptoms and accompanying symptoms, b) for the clinical examination of the vestibular system the head-impulse test (HIT), the examination for a spontaneous nystagmus, a displacement of subjective visual vertical, a positional nystagmus and the Romberg test, and c) for the differentiation between an acute peripheral and central vestibular lesion the skew deviation, central fixation nystagmus, gaze-evoked nystagmus, saccadic smooth pursuit and a normal HIT...
November 2016: Deutsche Medizinische Wochenschrift
Bela Büki, Manuela Hanschek, Heinz Jünger
OBJECTIVE: In this retrospective study, the aim of the authors was to examine the frequency of involvement of the individual semicircular canals (SCCs) in vestibular neuritis (VN) and to assess the degree of long-term recovery. A secondary aim was to retrospectively determine the usefulness of a three-step bedside oculomotor test (the HINTS-test) for the differential diagnosis of peripheral VN. METHODS: 44 cases were evaluated during the acute phase and approximately two months later...
June 2017: Auris, Nasus, Larynx
Sun-Uk Lee, Seong-Ho Park, Jeong-Jin Park, Hyo Jung Kim, Moon-Ku Han, Hee-Joon Bae, Ji-Soo Kim
BACKGROUND AND PURPOSE: The characteristics of infarctions restricted to the dorsal medulla have received little attention. This study aimed to define the distinct clinical features of dorsal medullary infarction. METHODS: Of the 172 patients with a diagnosis of medullary infarction at Seoul National University Bundang Hospital from 2003 to 2014, 18 patients with isolated dorsal medullary infarction were subjected to analyses of clinical and laboratory findings...
November 2015: Stroke; a Journal of Cerebral Circulation
Marta Martinez-Lopez, Raquel Manrique-Huarte, Nicolas Perez-Fernandez
The aim of this paper is to present for the first time the functional evaluation of each of the vestibular receptors in the six semicircular canals in a patient diagnosed with Meniere's disease during an acute attack. A 54-year-old lady was diagnosed with left Meniere's disease who during her regular clinic review suffers an acute attack of vertigo, with fullness and an increase of tinnitus in her left ear. Spontaneous nystagmus and the results in the video head-impulse test (vHIT) are shown before, during, and after the attack...
2015: Case Reports in Otolaryngology
Georgios Mantokoudis, Ali S Saber Tehrani, David E Newman-Toker
INTRODUCTION: Vertigo and dizziness are common neurological symptoms in general practice. Most patients have benign peripheral vestibular disorders, but some have dangerous central causes. Recent research has shown that bedside oculomotor examinations accurately discriminate central from peripheral lesions in those with new, acute, continuous vertigo/dizziness with nausea/vomiting, gait unsteadiness, and nystagmus, known as the acute vestibular syndrome. CASE REPORT: A 56-year-old man presented to the emergency department with acute vestibular syndrome for 1 week...
April 2015: Neurologist
J-H Choi, J-D Seo, Y R Choi, M-J Kim, H-J Kim, J S Kim, K-D Choi
BACKGROUND AND PURPOSE: The inferior cerebellar peduncle (ICP) contains various fibres to and from the cerebellum relating to the integration of the proprioceptive and vestibular functions. However, the full clinical features of isolated unilateral ICP lesions have not been defined in humans. METHODS: Eight consecutive patients with isolated unilateral ICP lesions at the pontine level (six with stroke, one with multiple sclerosis and one with brainstem encephalitis) received bedside neurological and neuro-otological evaluations and underwent laboratory tests including measurements of the subjective visual vertical (SVV) and ocular torsion, bithermal caloric tests and pure tone audiometry...
July 2015: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Young-Eun Huh, Ji-Soo Kim
In recent decades there has been marked progress in the imaging and laboratory evaluation of dizzy patients. However, detailed history taking and comprehensive bedside neurotological evaluation remain crucial for a diagnosis of dizziness. Bedside neurotological evaluation should include examinations for ocular alignment, spontaneous and gaze-evoked nystagmus, the vestibulo-ocular reflex, saccades, smooth pursuit, and balance. In patients with acute spontaneous vertigo, negative head impulse test, direction-changing nystagmus, and skew deviation mostly indicate central vestibular disorders...
October 2013: Journal of Clinical Neurology
M Strupp, C Muth, N Böttcher, O Bayer, J Teufel, K Feil, T Bremova, O Kremmyda, C S Fischer
In most patients with vertigo, the first and clinically most important question posed to neurologists is whether it is a central or a peripheral syndrome. In more than 90 % of cases, this differentiation is made possible by systematically recording the patient history (asking about the type of vertigo, the duration, triggers and accompanying symptoms) and conducting a physical examination. Particularly in the case of acute vertigo disorders, a five-step procedure has proven useful: 1. A cover test to look for vertical divergence (skew deviation) as a central sign and component of the ocular tilt reaction (OTR); 2...
September 2013: HNO
Georgios Mantokoudis, Michael C Schubert, Ali S Saber Tehrani, Aaron L Wong, Yuri Agrawal
OBJECTIVE: To describe vestibulo-ocular function in the immediate postoperative period after unilateral vestibular deafferentation from vestibular schwannoma resection. STUDY DESIGN: Prospective longitudinal study. SETTING: Tertiary medical center. PATIENTS: Five patients who underwent vestibular schwannoma resection via retrosigmoid approach. INTERVENTIONS: Bedside video-oculography and video head impulse testing (HIT)...
January 2014: Otology & Neurotology
M Strupp
The spectrum of diagnoses of patients with dizziness as the leading symptom who consult a neurologist does not differ greatly from the spectrum of those who consult ear nose and throat (ENT) specialists or general practitioners (GP). The most frequent forms are benign paroxysmal positioning vertigo (BPPV), phobic postural vertigo, central vertigo disorders, Menière's disease, vestibular neuritis and bilateral vestibulopathy. However, the first and most important question that is posed to neurologists is whether it is a central or peripheral syndrome...
January 2013: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
L Chen, W Lee, B R Chambers, H M Dewey
Acute vestibular syndrome may be due to vestibular neuritis (VN) or posterior circulation strokes. Bedside ocular motor testing performed by experts is superior to early MRI in excluding strokes. We sought to demonstrate that differentiation of strokes from VN in our stroke unit is reliable. During a prospective study at a tertiary hospital over 1 year, patients with AVS were evaluated in the emergency department (ED) and underwent admission with targeted examination: gait, gaze-holding, horizontal head impulse test (hHIT), testing for skew deviation (SD) and vertical smooth pursuit (vSP)...
May 2011: Journal of Neurology
James A Sharpe, Sunil Kumar, Arun N Sundaram
PURPOSE: This article considers vertical misalignment and torsion of the eyes that arise from disorders of vestibulo-ocular reflex (VOR) pathways. RECENT FINDINGS: Infarction of the nodulus is one of the causes of skew deviation, a vertical strabismus accompanied by torsion of the eyes and tilt of the subjective visual vertical. Vertical components of childhood strabismus may arise from dysgenesis of vestibular projections in the brainstem. If vertical misalignment decreases greatly in the supine position compared to the erect poison one may conclude that skew deviation rather than a fourth nerve palsy is responsible for the strabismus...
February 2011: Current Opinion in Neurology
Jorge C Kattah, Arun V Talkad, David Z Wang, Yu-Hsiang Hsieh, David E Newman-Toker
BACKGROUND AND PURPOSE: Acute vestibular syndrome (AVS) is often due to vestibular neuritis but can result from vertebrobasilar strokes. Misdiagnosis of posterior fossa infarcts in emergency care settings is frequent. Bedside oculomotor findings may reliably identify stroke in AVS, but prospective studies have been lacking. METHODS: The authors conducted a prospective, cross-sectional study at an academic hospital. Consecutive patients with AVS (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with >or=1 stroke risk factor underwent structured examination, including horizontal head impulse test of vestibulo-ocular reflex function, observation of nystagmus in different gaze positions, and prism cross-cover test of ocular alignment...
November 2009: Stroke; a Journal of Cerebral Circulation
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