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Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis.
Audiol Neurootol. 2012; 17(4):228-34.AN

Abstract

Although biphasic head-shaking nystagmus (HSN) is a basic response to head shaking in patients with unilateral vestibular loss, monophasic HSN is commonly seen in patients with dizziness of undetermined etiology. Since the clinical significance of HSN remains unclear, we sought to characterize different types of HSN in patients with vestibular neuritis (VN) during the acute stage (within 7 days after the onset of vertigo) and at follow-up (about 2 months after the onset of vertigo), and to compare HSN and caloric responses. We analyzed HSN, spontaneous nystagmus and caloric tests in 66 patients with VN. Overall, HSN showed high abnormal rates (94 and 89%) during the acute and follow-up stages and could detect vestibular hypofunction even when canal paresis (CP) had normalized at follow-up. All patients in the acute stage and most patients at follow-up showed HSN with the slow phase to the lesioned side (paretic). Biphasic HSN was common at follow-up, and many patients with a monophasic paretic pattern during the acute stage had evolved to a biphasic paretic pattern at follow-up. Initial slow-phase eye velocities (SPVs) in biphasic HSN were larger than those in monophasic HSN at follow-up. Absence of HSN or reversal of its direction was closely related to normalized caloric responses, but SPVs of HSN did not correlate with the severity of CP. These findings indicate that the HSN test is a sensitive detector of vestibular hypofunction upon 2-Hz head rotation. HSN may reveal previous vestibular hypofunction in the 2-Hz frequency range even at follow-up, when caloric responses detecting vestibular hypofunction in the low-frequency range had normalized. The two tests utilize different mechanisms to assess vestibular hypofunction and are complementary. Biphasic paretic HSN is the most common pattern at follow-up and occurs when the initial SPVs induced by head rotation are large enough to induce the adaptation of primary vestibular afferent activity. Monophasic HSN, which is commonly found in dizzy patients, indicates less severe vestibular hypofunction than biphasic HSN in the 2-Hz frequency range, and the caloric tests can provide further information about the side and presence of vestibular hypofunction at lower frequencies.

Authors+Show Affiliations

Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22487934

Citation

Lee, Yeo Jin, et al. "Comprehensive Analysis of Head-shaking Nystagmus in Patients With Vestibular Neuritis." Audiology & Neuro-otology, vol. 17, no. 4, 2012, pp. 228-34.
Lee YJ, Shin JE, Park MS, et al. Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. Audiol Neurootol. 2012;17(4):228-34.
Lee, Y. J., Shin, J. E., Park, M. S., Kim, J. M., Na, B. R., Kim, C. H., & Park, H. J. (2012). Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. Audiology & Neuro-otology, 17(4), 228-34. https://doi.org/10.1159/000336958
Lee YJ, et al. Comprehensive Analysis of Head-shaking Nystagmus in Patients With Vestibular Neuritis. Audiol Neurootol. 2012;17(4):228-34. PubMed PMID: 22487934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. AU - Lee,Yeo Jin, AU - Shin,Jung Eun, AU - Park,Mun Su, AU - Kim,Jae Myeong, AU - Na,Bo Ra, AU - Kim,Chang-Hee, AU - Park,Hong Ju, Y1 - 2012/04/05/ PY - 2011/09/20/received PY - 2012/01/23/accepted PY - 2012/4/11/entrez PY - 2012/4/11/pubmed PY - 2012/10/26/medline SP - 228 EP - 34 JF - Audiology & neuro-otology JO - Audiol Neurootol VL - 17 IS - 4 N2 - Although biphasic head-shaking nystagmus (HSN) is a basic response to head shaking in patients with unilateral vestibular loss, monophasic HSN is commonly seen in patients with dizziness of undetermined etiology. Since the clinical significance of HSN remains unclear, we sought to characterize different types of HSN in patients with vestibular neuritis (VN) during the acute stage (within 7 days after the onset of vertigo) and at follow-up (about 2 months after the onset of vertigo), and to compare HSN and caloric responses. We analyzed HSN, spontaneous nystagmus and caloric tests in 66 patients with VN. Overall, HSN showed high abnormal rates (94 and 89%) during the acute and follow-up stages and could detect vestibular hypofunction even when canal paresis (CP) had normalized at follow-up. All patients in the acute stage and most patients at follow-up showed HSN with the slow phase to the lesioned side (paretic). Biphasic HSN was common at follow-up, and many patients with a monophasic paretic pattern during the acute stage had evolved to a biphasic paretic pattern at follow-up. Initial slow-phase eye velocities (SPVs) in biphasic HSN were larger than those in monophasic HSN at follow-up. Absence of HSN or reversal of its direction was closely related to normalized caloric responses, but SPVs of HSN did not correlate with the severity of CP. These findings indicate that the HSN test is a sensitive detector of vestibular hypofunction upon 2-Hz head rotation. HSN may reveal previous vestibular hypofunction in the 2-Hz frequency range even at follow-up, when caloric responses detecting vestibular hypofunction in the low-frequency range had normalized. The two tests utilize different mechanisms to assess vestibular hypofunction and are complementary. Biphasic paretic HSN is the most common pattern at follow-up and occurs when the initial SPVs induced by head rotation are large enough to induce the adaptation of primary vestibular afferent activity. Monophasic HSN, which is commonly found in dizzy patients, indicates less severe vestibular hypofunction than biphasic HSN in the 2-Hz frequency range, and the caloric tests can provide further information about the side and presence of vestibular hypofunction at lower frequencies. SN - 1421-9700 UR - https://www.unboundmedicine.com/medline/citation/22487934/Comprehensive_analysis_of_head_shaking_nystagmus_in_patients_with_vestibular_neuritis_ L2 - https://www.karger.com?DOI=10.1159/000336958 DB - PRIME DP - Unbound Medicine ER -