A. Blödow

Isolierte Rezeptorfunktionsstörung des horizontalen Bogengangs

ZusammenfassungDie moderne Rezeptorfunktionsdiagnostik ist heute in der Lage, alle fünf peripher-vestibulären Rezeptoren einzeln und seitengetrennt zu erfassen. Damit lassen sich isoliert und kombiniert auftretende Rezeptorfunktionsstörungen von Crista- und Maculaorganen zunehmend besser detektieren. Wir beschreiben den seltenen Fall einer isolierten Störung der Rezeptorfunktion des horizontalen Bogengangs bei einem 55-jährigen Patienten. Der Video-Kopfimpulstest zeigte eine Rückstellsakkade, die thermische Prüfung keine Nystagmusantworten. Luftleitungsvermittelte („air-conducted“, AC) zervikale und okuläre vestibulär evozierte myogene Potenziale (cVEMP, oVEMP) und subjektive visuelle Vertikale waren reproduzierbar normal.AbstractToday, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.Today, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.

Der Video-Kopfimpulstest

BACKGROUND Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades. MATERIALS AND METHODS As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. RESULTS A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. CONCLUSIONS By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.ZusammenfassungHintergrundDie Funktion der vestibulären Bogengangsrezeptoren und die Integrität der vestibulookulären Reflexwege lassen sich neuerdings mit dem Video-Kopfimpulstest (vKIT) seitenspezifisch analysieren. Es gibt bisher nur geringe klinische Erfahrungen an einer größeren Patientenzahl.Material und MethodenIn dieser Studie wurde mithilfe des vKIT der horizontale VOR (hVOR) bei 142 Patienten mit einer akuten oder chronischen Schwindelsymptomatik (68,4% peripher-vestibulärer Schwindel, 7% zentraler Schwindel, 24,6% unklare Ursache) sowie bei Gesunden (n = 20) als Kontrollgruppe untersucht.ErgebnisseBei Gesunden (n = 20) war ein Verstärkungsfaktor (Gain) von 0,97 ± 0,09 normal, als pathologisch wurde ein Gain von < 0,79 ermittelt. Ein regelrechter vKIT fand sich in 47,6%, in 52,4% fand sich ein pathologischer vKIT. Bei einer peripher-vestibulären Schwindelursache traten isolierte Rückstellsakkaden als offene (37%) und als verdeckte Rückstellsakkaden (13,7%) auf, am häufigsten fanden sich kombinierte Rückstellsakkaden (49,3%).SchlussfolgerungMithilfe des vKIT ist es möglich, in kürzester Zeit eine seitenspezifische und quantitative Aussage über den hVOR zu erhalten. Die Methode ist bettseitig durchführbar und prüft den hVOR unter dynamischen bzw. physiologischen Bedingungen.AbstractBackgroundSide-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades.Materials and methodsAs clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. ResultsA total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. ConclusionsBy means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.

Isolated functional loss of the lateral semicircular canal in vestibular neuritis

ZusammenfassungDie moderne Rezeptorfunktionsdiagnostik ist heute in der Lage, alle fünf peripher-vestibulären Rezeptoren einzeln und seitengetrennt zu erfassen. Damit lassen sich isoliert und kombiniert auftretende Rezeptorfunktionsstörungen von Crista- und Maculaorganen zunehmend besser detektieren. Wir beschreiben den seltenen Fall einer isolierten Störung der Rezeptorfunktion des horizontalen Bogengangs bei einem 55-jährigen Patienten. Der Video-Kopfimpulstest zeigte eine Rückstellsakkade, die thermische Prüfung keine Nystagmusantworten. Luftleitungsvermittelte („air-conducted“, AC) zervikale und okuläre vestibulär evozierte myogene Potenziale (cVEMP, oVEMP) und subjektive visuelle Vertikale waren reproduzierbar normal.AbstractToday, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.Today, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.

[The video head impulse test: first clinical experiences].

BACKGROUND Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades. MATERIALS AND METHODS As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. RESULTS A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. CONCLUSIONS By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.ZusammenfassungHintergrundDie Funktion der vestibulären Bogengangsrezeptoren und die Integrität der vestibulookulären Reflexwege lassen sich neuerdings mit dem Video-Kopfimpulstest (vKIT) seitenspezifisch analysieren. Es gibt bisher nur geringe klinische Erfahrungen an einer größeren Patientenzahl.Material und MethodenIn dieser Studie wurde mithilfe des vKIT der horizontale VOR (hVOR) bei 142 Patienten mit einer akuten oder chronischen Schwindelsymptomatik (68,4% peripher-vestibulärer Schwindel, 7% zentraler Schwindel, 24,6% unklare Ursache) sowie bei Gesunden (n = 20) als Kontrollgruppe untersucht.ErgebnisseBei Gesunden (n = 20) war ein Verstärkungsfaktor (Gain) von 0,97 ± 0,09 normal, als pathologisch wurde ein Gain von < 0,79 ermittelt. Ein regelrechter vKIT fand sich in 47,6%, in 52,4% fand sich ein pathologischer vKIT. Bei einer peripher-vestibulären Schwindelursache traten isolierte Rückstellsakkaden als offene (37%) und als verdeckte Rückstellsakkaden (13,7%) auf, am häufigsten fanden sich kombinierte Rückstellsakkaden (49,3%).SchlussfolgerungMithilfe des vKIT ist es möglich, in kürzester Zeit eine seitenspezifische und quantitative Aussage über den hVOR zu erhalten. Die Methode ist bettseitig durchführbar und prüft den hVOR unter dynamischen bzw. physiologischen Bedingungen.AbstractBackgroundSide-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades.Materials and methodsAs clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. ResultsA total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. ConclusionsBy means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.

Isolierte Rezeptorfunktionsstörung des horizontalen Bogengangs@@@Isolated functional loss of the lateral semicircular canal in vestibular neuritis

ZusammenfassungDie moderne Rezeptorfunktionsdiagnostik ist heute in der Lage, alle fünf peripher-vestibulären Rezeptoren einzeln und seitengetrennt zu erfassen. Damit lassen sich isoliert und kombiniert auftretende Rezeptorfunktionsstörungen von Crista- und Maculaorganen zunehmend besser detektieren. Wir beschreiben den seltenen Fall einer isolierten Störung der Rezeptorfunktion des horizontalen Bogengangs bei einem 55-jährigen Patienten. Der Video-Kopfimpulstest zeigte eine Rückstellsakkade, die thermische Prüfung keine Nystagmusantworten. Luftleitungsvermittelte („air-conducted“, AC) zervikale und okuläre vestibulär evozierte myogene Potenziale (cVEMP, oVEMP) und subjektive visuelle Vertikale waren reproduzierbar normal.AbstractToday, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.Today, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.

Der Video-Kopfimpulstest@@@The video head impulse test: Erste klinische Erfahrungen@@@First clinical experiences

BACKGROUND Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades. MATERIALS AND METHODS As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. RESULTS A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. CONCLUSIONS By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.ZusammenfassungHintergrundDie Funktion der vestibulären Bogengangsrezeptoren und die Integrität der vestibulookulären Reflexwege lassen sich neuerdings mit dem Video-Kopfimpulstest (vKIT) seitenspezifisch analysieren. Es gibt bisher nur geringe klinische Erfahrungen an einer größeren Patientenzahl.Material und MethodenIn dieser Studie wurde mithilfe des vKIT der horizontale VOR (hVOR) bei 142 Patienten mit einer akuten oder chronischen Schwindelsymptomatik (68,4% peripher-vestibulärer Schwindel, 7% zentraler Schwindel, 24,6% unklare Ursache) sowie bei Gesunden (n = 20) als Kontrollgruppe untersucht.ErgebnisseBei Gesunden (n = 20) war ein Verstärkungsfaktor (Gain) von 0,97 ± 0,09 normal, als pathologisch wurde ein Gain von < 0,79 ermittelt. Ein regelrechter vKIT fand sich in 47,6%, in 52,4% fand sich ein pathologischer vKIT. Bei einer peripher-vestibulären Schwindelursache traten isolierte Rückstellsakkaden als offene (37%) und als verdeckte Rückstellsakkaden (13,7%) auf, am häufigsten fanden sich kombinierte Rückstellsakkaden (49,3%).SchlussfolgerungMithilfe des vKIT ist es möglich, in kürzester Zeit eine seitenspezifische und quantitative Aussage über den hVOR zu erhalten. Die Methode ist bettseitig durchführbar und prüft den hVOR unter dynamischen bzw. physiologischen Bedingungen.AbstractBackgroundSide-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades.Materials and methodsAs clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. ResultsA total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. ConclusionsBy means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.