Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test

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Identifier Acute_vestibular_neuritis_with_unidirectional_nystagmus_and_abnormal_video_head_impulse_test
Title Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test
Alternative Title Video 5.20 Acute vestibular neuritis with unidirectional nystagmus and abnormal video head impulse test (vHIT) from Neuro-Ophthalmology and Neuro-Otology Textbook
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Eighth Nerve; Abnormal VOR-HIT
Description 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is 45-year-old man who presented to the emergency department (ED) 2 days prior to this video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, consistent with the acute vestibular syndrome. Video-oculography examination in the ED demonstrated mixed left-beating and torsional (top poles beating toward left ear) nystagmus that was unidirectional (i.e., left-beating in all directions of gaze) and increased in left gaze in accordance with Alexander's law. There was no loss of hearing, video head impulse test was abnormal to the right (low gain and corrective saccades), and test of skew was normal (i.e., vertical alignment was normal with alternate cover test). Per the HINTS exam (Head Impulse, Nystagmus, Test of Skew) and in the absence of hearing loss, he was diagnosed with right-sided vestibular neuritis. He was given steroids and presented for follow-up 2 days later (the day of this recording). Nystagmus was much less intense than it had been in the ED, and symptomatically, he was much improved. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient presented to the emergency department (ED) 2 days prior to the video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, consistent with the acute vestibular syndrome. Video-oculography examination in the ED demonstrated mixed left-beating and torsional (top poles beating toward left ear) nystagmus that was unidirectional (i.e., left-beating in all directions of gaze) and increased in left gaze in accordance with Alexander's law. There was no loss of hearing, video head impulse test was abnormal to the right (low gain and corrective saccades), and test of skew was normal (i.e., vertical alignment was normal with alternate cover test). Per the HINTS exam (Head Impulse, Nystagmus, Test of Skew) and in the absence of hearing loss, he was diagnosed with right-sided vestibular neuritis. He was given steroids and presented for follow-up 2 days later (the day of this recording). Nystagmus was much less intense than it had been in the ED, and symptomatically, he was much improved. https://collections.lib.utah.edu/ark:/87278/s6pg73w3
Date 2020-04
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6pg73w3
Setname ehsl_novel_gold
ID 1550673
Reference URL https://collections.lib.utah.edu/ark:/87278/s6pg73w3
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