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
Subject VOR HIT, Alignment, Acute Vestibular
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery The Johns Hopkins School of Medicine ; Nathan H. Kung Department of Ophthalmology and Visual Sciences Washington University School of Medicine, St. Louis, Missouri, USA ; Gregory P. Van Stavern, MD, Associate Professor, Ophthalmology & Visual Sciences and Neurology, Washington University School of Medicine
Description This is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus). ; See 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.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2017
Format video/mp4
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit:
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s66q5pxw
Setname ehsl_novel_gold
Date Created 2017-06-22
Date Modified 2018-02-22
ID 1253806
Reference URL
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