Head-Shaking-Induced Nystagmus Following Ramsay Hunt Vestibulopathy

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Identifier Head-shaking-induced_nystagmus_following_Ramsay_Hunt_vestibulopathy
Title Head-Shaking-Induced Nystagmus Following Ramsay Hunt Vestibulopathy
Subject Vestibular Nystagmus; Head-Shaking; Jerk Nystagmus; Vestibularcochlear; Acute Vestibular Syndrome
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, The Johns Hopkins School of Medicine
Description This is a 50-year-old man who experienced the abrupt onset of imbalance, dizziness and left-sided hearing loss 4 months prior to this examination. He was found to have herpetic vesicles in the left external auditory canal and diagnosed with Ramsay Hunt syndrome. On exam (4 months after the onset), there was an abnormal head impulse test (HIT) to the left side, and with fixation-removed, there was very mild right-beating nystagmus. However, following 15 seconds of 2-3 Hz horizontal head-shaking, there was robust right-beating nystagmus. Video HIT showed left sided vestibular loss with low gains (<0.7 - gain is calculated with this system as the area under the eye movement velocity curve/area under the head movement velocity curve) and corrective saccades in the planes of the horizontal, anterior and posterior canals, which is commonly seen with Ramsay Hunt syndrome. Ewald's second law states that ampullopetal endolymph flow will cause greater stimulation than ampullofugal flow within the horizontal canals. Head-shaking, therefore, leads to transiently asymmetric vestibular afferents when unilateral vestibular loss is present, leading to a contralesional post-head-shake nystagmus as in this patient. Head-shaking is one of several provocative maneuvers that can bring out a patient's underlying vestibular asymmetry months or even years after the insult occurs (vibration and hyperventilation are others).
Imaging Number of Videos and legend for each: 1, Patient with peripheral head-shaking nystagmus months after a Ramsay Hunt syndrome
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019-07
Format video/mp4
Rights Management Copyright 2019. 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/s6f80x5q
Setname ehsl_novel_gold
Date Created 2019-07-25
Date Modified 2019-07-25
ID 1432828
Reference URL https://collections.lib.utah.edu/ark:/87278/s6f80x5q
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