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TitleDescriptionSubject
1 Anti-GAD associated cerebellopathy and bilateral vestibulopathyThis is a 70-year-old woman with the subacute onset of severe imbalance and dizziness. On her initial examination, she had prominent gaze-evoked nystagmus and bilateral vestibular loss. Smooth pursuit was saccadic, although her vestibulo-ocular reflex (VOR) suppression was much smoother. Usually pur...Abnormal Pursuit, Normal VORS, VOR Abnormal, HIT Abnormal, Jerk Nystagmus, Gaze Evoked Nystagmus
2 Caloric testingCaloric testing is a peripheral vestibular test which takes advantage of the fact that the labyrinth is sensitive to temperature changes. Warm stimulation causes excitation of the semicircular canals while cold stimulation causes inhibition of the semicircular canals. Caloric testing is performed by...Normal VOR, Abnormal VOR, Vestibular Lab Testing, Calorics
3 HINTS exam and saccadic dysmetria in lateral medullary strokeThis is a 50-year-old who experienced the abrupt onset of prolonged vertigo following chiropractic therapy 2 months prior. Initial work-up included an MRI and MR angiogram - MR-diffusion weighted imaging showed an acute left lateral medullary stroke and left vertebral artery occlusion, which was tho...Abnormal Saccades, Acute Vestibular Syndrome, Jerk Nystagmus, Vestibular Nystagmus, Normal VOR, Skew Deviation, OMS Medulla
4 Pons: 6th, 7th, 8th, and middle cerebellar peduncle anatomyFrom this cross-section of the pons, the proximity of the 7th and 8th fascicles can be appreciated, and a lateral inferior pontine syndrome (anterior inferior cerebellar artery territory), which could involve both of these fascicles, could cause acute prolonged vertigo accompanied by a + ipsilateral...Sixth Nerve Palsy, OMS Pons, Facial Nerve, VOR Normal, VOR Abnormal
5 Rotary Chair TestingRotary chair testing includes rotation around a vertical axis, and evaluates the horizontal semicircular canal vestibulo-ocular reflex (VOR). The patient sits in a mechanized chair with the head secured in a neutral position or in 30 degree forward flexion (to better isolate the horizontal canals)....Normal VOR, Abnormal VOR, Vestibular Lab Testing, Rotary Chair
6 Using video head impulse testing to unmask covert saccades in compensated vestibular neuritisThis is a 30-year-old woman who experienced the acute vestibular syndrome (prolonged vertigo for >24 hours, nausea, unsteadiness, spontaneous nystagmus, head motion intolerance) and was diagnosed with vestibular neuritis. This diagnosis was based on a positive head impulse test to the left (see Figu...VOR normal; VOR abnormal
7 Using video head impulse testing to unmask covert saccades in compensated vestibular neuritis - Figures 1 and 2This is a 30-year-old woman who experienced the acute vestibular syndrome (prolonged vertigo for >24 hours, nausea, unsteadiness, spontaneous nystagmus, head motion intolerance) and was diagnosed with vestibular neuritis. This diagnosis was based on a positive head impulse test to the left (see Figu...VOR normal; VOR abnormal
8 VOR (Suppression)Deficits in pursuit and vestibulo-ocular reflex (VOR)S usually go together, except when the VOR is absent or markedly diminished in which case there is no VOR to suppress, so that VORS seems better than pursuit. This is an important clue that the VOR is diminished. Instructional ocular motor examina...vestibulo-ocular reflex (VOR) supression, exam
9 Video head impulse testingThe video head impulse test (vHIT) is a clinical assessment technique used to assess the function of the semicircular canals-the angular acceleration detectors-which initiate the vestibulo-ocular reflex (VOR). The HIT and vHIT are performed similarly (see assessment of VOR using HIT video LINK), alt...Normal VOR, Abnormal VOR, Vestibular Lab Testing, Video Head Impulse Testing
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