Vibration and hyperventilation-induced nystagmus from vestibular schwannoma

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Identifier Vestibular_Schwannoma_Vibration_and_Hyperventilation_Nystagmus
Title Vibration and hyperventilation-induced nystagmus from vestibular schwannoma
Subject Jerk Nystagmus, Vestibular Nystagmus, Hyperventilation
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a 50-yo-woman with imbalance, and with fixation removed on her examination (with Frenzel goggles), there was no spontaneous nystagmus. Using a handheld vibrator to vibrate the mastoids and vertex, there was a rightward slow phase and corrective leftward fast phase (left-beating nystagmus). Vibration is an excitatory vestibular stimulus, and when vestibular asymmetry is present, vibration can transiently exacerbate this asymmetry and generate a slow phase that is ipsilateral to the pathology/vestibular hypofunction (towards the right in this case). After hyperventilating the patient for 40 seconds, there was robust right-beating and torsional (towards right ear) nystagmus. Hyperventilation transiently alters neuronal conductivity across a demyelinated segment of the 8th cranial nerve (e.g., acoustic neuroma or neurovascular compression), and can generate excitatory>inhibitory pattern of nystagmus (excitatory in this case with contralesional, leftward slow phase, and ipsilesional, rightward fast phases). MRI demonstrated a right sided vestibular schwannoma which explained both the right hypofunction (LBN with vibration), and the excitatory pattern (RBN) of her hyperventilation-induced nystagmus.
Imaging 1, patient with right sided vestibular schwannoma with nystagmus provoked by vibration and hyperventilation
Contributor Daniel R. Gold, D.O.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2017
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2017. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s63f8cgs
Setname ehsl_novel_gold
Date Created 2017-04-04
Date Modified 2018-10-24
ID 1213447
Reference URL
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