Acute Vestibular Syndrome with Ocular Tilt Reaction Due to Bacterial Labyrinthitis

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Identifier JNO_Case_3_AVS_Bacterial_Labyrinthitis
Title Acute Vestibular Syndrome with Ocular Tilt Reaction Due to Bacterial Labyrinthitis
Creator Daniel R. Gold, DO; Nathan H. Kung; Gregory P. Van Stavern, MD
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; (NHK) , Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri; (GPVS) Departments of Ophthalmology & Visual Sciences and Neurology, Washington University School of Medicine, St. Louis, Missouri
Subject VOR HIT; Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular
Description This is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) and right sided hearing loss, and was diagnosed with bacterial labyrinthritis. Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiology based on the presence of a skew deviation. In fact, there was a complete ocular tilt reaction - 1) skew deviation with right hypotropia (ipsilateral to the affected ear), 2) right head tilt, and 3) ocular counterroll (excylodeviation OD and incyclodeviation OS). Nystagmus was unidirectional (left-beating or contralesional), and there was a + head impulse test to the ipsilesional side, which are both typically seen with peripheral pathology. However, if any of the 3 ocular motor/vestibular tests suggest a central localization, the etiology must be assumed to be central until proven otherwise. Although a skew deviation is classically a central sign, rarely a severe peripheral utricular injury (e.g., bacterial labyrinthitis) can result in diplopia and a clinically evident skew deviation. MRI was done at one week, which did not demonstrate abnormalities of the posterior fossa, specifically regarding the central utricle-ocular motor pathways.
Date 2017
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6bg6fqh
Setname ehsl_novel_gold
ID 1253805
Reference URL https://collections.lib.utah.edu/ark:/87278/s6bg6fqh
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