Acute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating Lesion

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Identifier JNO_Case_4_AVS_Demyelinating_Medullary_Lesion
Title Acute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating Lesion
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; Acute Vestibular
Description This is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus). ; See https://collections.lib.utah.edu/details?id=187730 for additional history. ; Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiology based on the presence of a skew deviation and gaze-evoked (direction-changing) nystagmus. However, she also had a + head impulse test (HIT), which is typically a peripheral sign. 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. In the AVS, a negative (normal) HIT is more helpful since it is highly suggestive of a central etiology. A + HIT at the bedside must be seen to diagnose a peripheral etiology like vestibular neuritis with a high degree of confidence, although a + HIT can be occasionally seen with central or vascular etiologies, especially with labyrinthine ischemia or a lesion involving the vestibular nucleus. Her MRI showed an acute demyelinating plaque involving the left lateral medulla.
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/s66q5pxw
Setname ehsl_novel_gold
ID 1253806
Reference URL https://collections.lib.utah.edu/ark:/87278/s66q5pxw
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