Cerebellar Ataxia, Neuropathy, & Vestibular Areflexia Syndrome (CANVAS): Impaired visually-enhanced VOR and abnormal head impulse testing

Update item information
Identifier CANVAS_Impaired_vVOR_and_HIT
Title Cerebellar Ataxia, Neuropathy, & Vestibular Areflexia Syndrome (CANVAS): Impaired visually-enhanced VOR and abnormal head impulse testing
Subject VOR Abnormal, HIT Abnormal, Jerk Nystagmus, Gaze Evoked Nystagmus, Square Wave Jerks
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, 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, Departments of Ophthalmology & Visual Sciences and Neurology, Washington University School of Medicine
Description A 67 year old woman presented with 1 year of progressive numbness, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bilateral horizontal gaze-evoked nystagmus, impairment of the visually-enhanced vestibular ocular reflex (vVOR - see with slow head turning to the right and left, which is a combination of pursuit and the VOR), and impairment of the vestibular ocular reflex (VOR) during head impulse testing, in the planes of all 6 canals (horizontal, posterior and anterior). Sensory testing also showed impaired vibration in the distal extremities. A clinical diagnosis of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) was made. An impaired or saccadic vVOR suggests that there is failure of both the pursuit and (bilateral) vestibular systems, and CANVAS should be considered, especially when neuropathy is present. Other conditions that should be considered if the vVOR is impaired include Wernicke's encephalopathy if the symptom onset is acute, and if the course is more chronic, the neurodegenerative processes including multiple system atrophy as well as some of the spinocerebellar ataxias (types 1, 3, 4, 6 among several others) could be responsible.
Contributor Nathan H. Kung, MD Gregory P. Van Stavern, MD
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: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6dv5cp8
Setname ehsl_novel_gold
Date Created 2017-07-26
Date Modified 2018-02-22
ID 1256235
Reference URL https://collections.lib.utah.edu/ark:/87278/s6dv5cp8
Back to Search Results