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Capturing acute vertigo: A vestibular event monitor.
Neurology. 2019 06 11; 92(24):e2743-e2753.Neur

Abstract

OBJECTIVE

To facilitate the diagnosis of vestibular disorders by patient-initiated capture of ictal nystagmus.

METHODS

Adults from an Australian neurology outpatient clinic reporting recurrent vertigo were recruited prospectively and taught to self-record spontaneous and positional nystagmus at home while symptomatic, using miniature video-oculography goggles. Consenting patients with ictal videorecordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included.

RESULTS

Ictal eye videos of 117 patients were analyzed. Of 43 patients with MD, 40 showed high-velocity spontaneous horizontal nystagmus (median slow-phase velocity [SPV] 39.7°/s; 21 showed horizontal nystagmus reversing direction within 12 hours [24 on separate days]). In 44 of 67 patients with VM, spontaneous horizontal (n = 28, 4.9°/s), upbeating (n = 6, 15.5°/s), or downbeating nystagmus (n = 10, 5.1°/s) was observed; 16 showed positional nystagmus only, and 7 had no nystagmus. Spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD (95% confidence interval [CI] 0.84-0.99, 0.71-0.90). Nystagmus direction change within 12 hours was highly specific (95.7%) for MD (95% CI 0.85-0.99). Spontaneous vertical nystagmus was highly specific (93.0%) for VM (95% CI 0.81-0.99). In the 7 patients with BPPV, spontaneous nystagmus was absent or <3°/s. Lying affected-ear down, patients with BPPV demonstrated paroxysmal positional nystagmus. Median time for peak SPV to halve (T50) was 19.0 seconds. Patients with VM and patients with MD demonstrated persistent positional nystagmus (median T50; 93.1 seconds, 213.2 seconds). T50s <47.3 seconds had a sensitivity and specificity of 100% and 77.8% for BPPV (95% CI 0.54-1.00, 0.64-0.88).

CONCLUSION

Patient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.

Authors+Show Affiliations

From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia. miriam@icn.usyd.edu.au.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31092626

Citation

Young, Allison S., et al. "Capturing Acute Vertigo: a Vestibular Event Monitor." Neurology, vol. 92, no. 24, 2019, pp. e2743-e2753.
Young AS, Lechner C, Bradshaw AP, et al. Capturing acute vertigo: A vestibular event monitor. Neurology. 2019;92(24):e2743-e2753.
Young, A. S., Lechner, C., Bradshaw, A. P., MacDougall, H. G., Black, D. A., Halmagyi, G. M., & Welgampola, M. S. (2019). Capturing acute vertigo: A vestibular event monitor. Neurology, 92(24), e2743-e2753. https://doi.org/10.1212/WNL.0000000000007644
Young AS, et al. Capturing Acute Vertigo: a Vestibular Event Monitor. Neurology. 2019 06 11;92(24):e2743-e2753. PubMed PMID: 31092626.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Capturing acute vertigo: A vestibular event monitor. AU - Young,Allison S, AU - Lechner,Corinna, AU - Bradshaw,Andrew P, AU - MacDougall,Hamish G, AU - Black,Deborah A, AU - Halmagyi,G Michael, AU - Welgampola,Miriam S, Y1 - 2019/05/15/ PY - 2018/08/02/received PY - 2019/02/04/accepted PY - 2019/5/17/pubmed PY - 2019/12/24/medline PY - 2019/5/17/entrez SP - e2743 EP - e2753 JF - Neurology JO - Neurology VL - 92 IS - 24 N2 - OBJECTIVE: To facilitate the diagnosis of vestibular disorders by patient-initiated capture of ictal nystagmus. METHODS: Adults from an Australian neurology outpatient clinic reporting recurrent vertigo were recruited prospectively and taught to self-record spontaneous and positional nystagmus at home while symptomatic, using miniature video-oculography goggles. Consenting patients with ictal videorecordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included. RESULTS: Ictal eye videos of 117 patients were analyzed. Of 43 patients with MD, 40 showed high-velocity spontaneous horizontal nystagmus (median slow-phase velocity [SPV] 39.7°/s; 21 showed horizontal nystagmus reversing direction within 12 hours [24 on separate days]). In 44 of 67 patients with VM, spontaneous horizontal (n = 28, 4.9°/s), upbeating (n = 6, 15.5°/s), or downbeating nystagmus (n = 10, 5.1°/s) was observed; 16 showed positional nystagmus only, and 7 had no nystagmus. Spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD (95% confidence interval [CI] 0.84-0.99, 0.71-0.90). Nystagmus direction change within 12 hours was highly specific (95.7%) for MD (95% CI 0.85-0.99). Spontaneous vertical nystagmus was highly specific (93.0%) for VM (95% CI 0.81-0.99). In the 7 patients with BPPV, spontaneous nystagmus was absent or <3°/s. Lying affected-ear down, patients with BPPV demonstrated paroxysmal positional nystagmus. Median time for peak SPV to halve (T50) was 19.0 seconds. Patients with VM and patients with MD demonstrated persistent positional nystagmus (median T50; 93.1 seconds, 213.2 seconds). T50s <47.3 seconds had a sensitivity and specificity of 100% and 77.8% for BPPV (95% CI 0.54-1.00, 0.64-0.88). CONCLUSION: Patient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/31092626/Capturing_acute_vertigo:_A_vestibular_event_monitor_ DB - PRIME DP - Unbound Medicine ER -