Visual Variant of Vertigo

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Identifier Visual_Variant_of_Vertigo
Title Visual Variant of Vertigo
Subject Pathology; Vertigo
Creator Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX; Professor of Ophthalmology, Weill Cornell Medicine; Zane Foster, Baylor College of Medicine Class of 2020
Description Dr. Lee lectures medical students on visual variant of vertigo.
Transcript Today we're going to be talking about visual there in vertigo. V.V.V.: a visual variant vertigo. So vertigo, as you know, is what the patient is complaining about - it's a symptom - so they have the illusory sensation of motion. They might feel light-headed or dizzy, and it's a visual variant because it's caused by motion in their environment, not by motion of them. So there are three major things that we have to consider in patients with vertigo: (1) it could be the brain, (2) it could be your eye or (3), it could be your ear - but not the hearing part of your ear, the vestibular (the balance) portion of your ear. So we can either have a peripheral vestibulopathy, a central vestibulopathy, or it could be your eye is really jumping nystagmus that is causing the illusory sensation of motion. It is the interaction between eye, ear, and brain that produces the visual variant vertigo. Most patients with visual variant vertigo start off with a peripheral vestibulopathy that is mild and then resolves. In contrast to a peripheral vestibulopathy, the patients with visual variant vertigo have motion in their environment as the cause, so for example driving or going down the aisles in the Walmart or other stores where they see the motion in their environment. Also patterns on; floors and patterns on walls or walking down narrow hallways can trigger the visual variant. Because it is motion of their environment that triggers that not motion of them. In contrast in peripheral vestibulopathy, the patient's their vertigo symptoms are triggered by head rotation so they might be fine lying on the left side but if they try and lay on the right side, they have the illusory motion sickness: they might feel nausea and vomiting. Central vestibulopathy patients have the symptoms all the time. It is independent of their environment or their ear, and so the key; in differentiating features are to test the vestibular function, usually with the Dix Hallpike maneuver, but we can also do other tests of the vestibular system including the vestibular ocular reflex testing. (to diagnose V.V.V.) We're going to an MRI scan to look at the brain and make sure it's not a central vestibulopathy, and of course they're going to have a structurally normal eye exam. They can't have down beat or up beat or other forms of nystagmus. And the reason it's important to know this is the eye doctor has already seen the patient and did a normal exam, the ENT has already done a normal exam, the neurologist has already done a normal exam, and the brain MRI is normal. Because there's nothing wrong with the individual organs: it's a mismatch between the signal. When we have this mismatch in the signal, visual variant vertigo, precipitated by motion in the environment, the only treatments are avoidance of the triggers - which is next to impossible - or habituation and adaptation: we just get the patient used to the faulty signal, and that means vestibular rehab. So with vestibular rehabilitation we can stimulate the visual system and get the person used to the faulty signal. So that vestibular rehab is really great for most of the patients. Sometimes reassurance alone is all that's necessary. So the key and differentiating feature of the visual variant vertigo is that the vertigo - the symptoms - are precipitated by the visual environment and motion in the visual environment, not from the head position or the ear position, and the key and differentiating symptoms are shopping and driving - those are the two most common complaints - and the treatment is vestibular rehab.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019-02
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2019. 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/s69h00rb
Setname ehsl_novel_lee
Date Created 2019-03-01
Date Modified 2020-01-14
ID 1403680
Reference URL
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