Bilateral Vestibular Loss With Gaze-Evoked Nystagmus and Saccadic Visually Enhanced VOR

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Identifier Bilateral_vestibular_loss_with_gaze-evoked_nystagmus_and_saccadic_visually
Title Bilateral Vestibular Loss With Gaze-Evoked Nystagmus and Saccadic Visually Enhanced VOR
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal VOR-HIT; Eighth Nerve
Description This is 55-year-old man with the subacute onset of head movement-induced oscillopsia and dizziness. He had a history of psoriatic arthritis. He had not used medications known to be vestibulo-toxic such as gentamicin. ; Salient findings on his examination included 1) bilateral vestibular loss (BVL) demonstrated by bilaterally abnormal head impulse test (HIT, with corrective saccades and low gains seen bilaterally with bedside and video HIT), as well as 2) cerebellopathy demonstrated by gaze-evoked nystagmus and saccadic smooth pursuit. His vestibulo-ocular reflex suppression (VORS) was nearly normal appearing because there was no VOR to suppress (given his BVL). As expected given his bilateral VOR hypofunction and saccadic pursuit, his (slow) visually-enhanced VOR (vVOR) was saccadic. If VOR is impaired but pursuit is normal, vVOR will be normal. If pursuit is impaired but VOR is normal, vVOR will be normal. However, if VOR and pursuit are impaired - as in cerebellar ataxia, neuropathy, areflexia syndrome (CANVAS, which this patient did not have, mainly given the subacute onset) - then the vVOR will be saccadic or choppy. Patients with vestibulopathy and cerebellopathy will have significant imbalance. MRI was unrevealing and further investigation for infectious, inflammatory, autoimmune, neoplastic, nutritional etiologies is ongoing.
Date 2020-04
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/s6xt1440
Setname ehsl_novel_gold
ID 1539413
Reference URL https://collections.lib.utah.edu/ark:/87278/s6xt1440
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