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Vertical components of head-shaking nystagmus in vestibular neuritis, Meniere's disease and migrainous vertigo.
Clin Otolaryngol. 2014 Oct; 39(5):261-5.CO

Abstract

OBJECTIVES

To describe vertical and horizontal components of head-shaking nystagmus (HSN) in various vestibular disorders.

DESIGN

Retrospective case review.

SETTING

Tertiary care academic referral centre.

PARTICIPANTS

Head-shaking nystagmus was assessed in 66 vestibular neuritis (VN) patients at acute (<7 days) and follow-up (2 months), and 65 Meniere's disease (MD) and 76 migrainous vertigo (MV) in interictal period.

MAIN OUTCOME MEASURES

Head-shaking nystagmus was categorised as pure horizontal, pure vertical or mixed. Horizontal HSN was classified as monophasic or biphasic and paretic or recovery. Vertical HSN was classified as upbeat or downbeat.

RESULTS

Abnormal HSN (pathologic monophasic, biphasic or delayed-peak HSN) showed different positive rates depending on the vestibular disorders and compensation (94% in acute VN; 89% in FU VN; 78% in MD; 50% in MV). Paretic HSN with the nystagmus towards the lesioned side was the most common type in VN and MD; however, recovery HSN with the nystagmus towards the intact side could be rarely observed especially in patients with MD or compensated VN. Vertical nystagmus could be combined with horizontal HSN, and upbeat HSN was observed in most (83%) of the patients with acute VN, but downbeat HSN was common in follow-up VN (83%), MD (97%) and MV (85%). Weak perverted HSN, which is assumed to be a central nystagmus, was rarely observed in MD and MV (6-9%), but not in VN.

CONCLUSIONS

Head-shaking nystagmus (HSN) in horizontal plane is a valuable tool in the assessment of vestibular imbalance. Common observation of upbeat HSN in acute VN and downbeat HSN in follow-up VN, MD and MV suggests that vertical components are possibly related to the involvement of vestibular apparatus and compensation. Weak perverted HSN and delayed-peak HSN were rarely observed in MD and MV, and never observed in VN, suggesting that it is possibly related to either asymmetrically impaired vertical canals or misorientation of the velocity-storage system.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25042770

Citation

Kim, C H., et al. "Vertical Components of Head-shaking Nystagmus in Vestibular Neuritis, Meniere's Disease and Migrainous Vertigo." Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, vol. 39, no. 5, 2014, pp. 261-5.
Kim CH, Shin JE, Song CI, et al. Vertical components of head-shaking nystagmus in vestibular neuritis, Meniere's disease and migrainous vertigo. Clin Otolaryngol. 2014;39(5):261-5.
Kim, C. H., Shin, J. E., Song, C. I., Yoo, M. H., & Park, H. J. (2014). Vertical components of head-shaking nystagmus in vestibular neuritis, Meniere's disease and migrainous vertigo. Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 39(5), 261-5. https://doi.org/10.1111/coa.12286
Kim CH, et al. Vertical Components of Head-shaking Nystagmus in Vestibular Neuritis, Meniere's Disease and Migrainous Vertigo. Clin Otolaryngol. 2014;39(5):261-5. PubMed PMID: 25042770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vertical components of head-shaking nystagmus in vestibular neuritis, Meniere's disease and migrainous vertigo. AU - Kim,C H, AU - Shin,J E, AU - Song,C I, AU - Yoo,M H, AU - Park,H J, PY - 2014/07/08/accepted PY - 2014/7/22/entrez PY - 2014/7/22/pubmed PY - 2015/6/16/medline SP - 261 EP - 5 JF - Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery JO - Clin Otolaryngol VL - 39 IS - 5 N2 - OBJECTIVES: To describe vertical and horizontal components of head-shaking nystagmus (HSN) in various vestibular disorders. DESIGN: Retrospective case review. SETTING: Tertiary care academic referral centre. PARTICIPANTS: Head-shaking nystagmus was assessed in 66 vestibular neuritis (VN) patients at acute (<7 days) and follow-up (2 months), and 65 Meniere's disease (MD) and 76 migrainous vertigo (MV) in interictal period. MAIN OUTCOME MEASURES: Head-shaking nystagmus was categorised as pure horizontal, pure vertical or mixed. Horizontal HSN was classified as monophasic or biphasic and paretic or recovery. Vertical HSN was classified as upbeat or downbeat. RESULTS: Abnormal HSN (pathologic monophasic, biphasic or delayed-peak HSN) showed different positive rates depending on the vestibular disorders and compensation (94% in acute VN; 89% in FU VN; 78% in MD; 50% in MV). Paretic HSN with the nystagmus towards the lesioned side was the most common type in VN and MD; however, recovery HSN with the nystagmus towards the intact side could be rarely observed especially in patients with MD or compensated VN. Vertical nystagmus could be combined with horizontal HSN, and upbeat HSN was observed in most (83%) of the patients with acute VN, but downbeat HSN was common in follow-up VN (83%), MD (97%) and MV (85%). Weak perverted HSN, which is assumed to be a central nystagmus, was rarely observed in MD and MV (6-9%), but not in VN. CONCLUSIONS: Head-shaking nystagmus (HSN) in horizontal plane is a valuable tool in the assessment of vestibular imbalance. Common observation of upbeat HSN in acute VN and downbeat HSN in follow-up VN, MD and MV suggests that vertical components are possibly related to the involvement of vestibular apparatus and compensation. Weak perverted HSN and delayed-peak HSN were rarely observed in MD and MV, and never observed in VN, suggesting that it is possibly related to either asymmetrically impaired vertical canals or misorientation of the velocity-storage system. SN - 1749-4486 UR - https://www.unboundmedicine.com/medline/citation/25042770/Vertical_components_of_head_shaking_nystagmus_in_vestibular_neuritis_Meniere's_disease_and_migrainous_vertigo_ L2 - https://doi.org/10.1111/coa.12286 DB - PRIME DP - Unbound Medicine ER -