Zeljka Calic1, Benjamin Nham2, Andrew P Bradshaw2, Allison S Young2, Sonu Bhaskar1, Mario D'Souza3, Craig S Anderson4, Cecilia Cappelen-Smith1, Dennis Cordato1, Miriam S Welgampola5. 1. Department of Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia. 2. Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia. 3. Clinical Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 4. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. 5. Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia. Electronic address: miriam@icn.usyd.edu.au.
Abstract
OBJECTIVE: To separate vestibular neuritis (VN) from posteriorcirculation stroke (PCS) using quantitative tests of canal and otolith function. METHODS: Video Head-Impulse tests (vHIT) were used to assess all three semicircular canal pairs; vestibulo-ocular reflex (VOR) gain and saccade metrics were examined. Cervical and ocular-Vestibular-Evoked Myogenic Potentials (c- and oVEMP) and Subjective Visual Horizontal (SVH) were used to assess otolith function. RESULTS: For controls (n = 40), PCS (n = 22), and VN (n = 22), mean horizontal-canal VOR-gains were 0.96 ± 0.1, 0.85 ± 0.3 and 0.40 ± 0.2, refixation-saccade prevalence was 71.9 ± 41, 90.7 ± 57, 209.2 ± 62 per 100 impulses and cumulative-saccade amplitudes were 0.9 ± 0.4°, 2.4 ± 2.2°, 8.0 ± 3.5°. Abnormality-rates for cVEMP, oVEMP and SVH were 38%, 9%, 72% for PCS, and 43%, 50%, 91% for VN. A gain ≤0.68, refixation-saccade prevalence of ≥135% and cumulative-saccade amplitudes ≥5.3° separated VN from PCS with sensitivities of 95.5%, 95.5%, and 81.8%, and specificities of 68.2%, 86.4% and 95.5%. VOR-gain and saccade prevalence when combined, separated VN from PCS with a sensitivity and specificity of 90.9%. Abnormal oVEMP asymmetry-ratios were of low sensitivity (50%) but high specificity (90.9%) for separating VN from PCS. CONCLUSION: vHIT provided the best separation of VN from PCS. VOR-gain, refixation-saccade prevalence and amplitude were effective discriminators of VN from PCS. SIGNIFICANCE: vHIT and oVEMP could assist early identification of the aetiology of Acute Vestibular Syndrome in the Emergency Room.
OBJECTIVE: To separate vestibular neuritis (VN) from posteriorcirculation stroke (PCS) using quantitative tests of canal and otolith function. METHODS: Video Head-Impulse tests (vHIT) were used to assess all three semicircular canal pairs; vestibulo-ocular reflex (VOR) gain and saccade metrics were examined. Cervical and ocular-Vestibular-Evoked Myogenic Potentials (c- and oVEMP) and Subjective Visual Horizontal (SVH) were used to assess otolith function. RESULTS: For controls (n = 40), PCS (n = 22), and VN (n = 22), mean horizontal-canal VOR-gains were 0.96 ± 0.1, 0.85 ± 0.3 and 0.40 ± 0.2, refixation-saccade prevalence was 71.9 ± 41, 90.7 ± 57, 209.2 ± 62 per 100 impulses and cumulative-saccade amplitudes were 0.9 ± 0.4°, 2.4 ± 2.2°, 8.0 ± 3.5°. Abnormality-rates for cVEMP, oVEMP and SVH were 38%, 9%, 72% for PCS, and 43%, 50%, 91% for VN. A gain ≤0.68, refixation-saccade prevalence of ≥135% and cumulative-saccade amplitudes ≥5.3° separated VN from PCS with sensitivities of 95.5%, 95.5%, and 81.8%, and specificities of 68.2%, 86.4% and 95.5%. VOR-gain and saccade prevalence when combined, separated VN from PCS with a sensitivity and specificity of 90.9%. Abnormal oVEMP asymmetry-ratios were of low sensitivity (50%) but high specificity (90.9%) for separating VN from PCS. CONCLUSION: vHIT provided the best separation of VN from PCS. VOR-gain, refixation-saccade prevalence and amplitude were effective discriminators of VN from PCS. SIGNIFICANCE: vHIT and oVEMP could assist early identification of the aetiology of Acute Vestibular Syndrome in the Emergency Room.
Authors: Benjamin Nham; Nicole Reid; Kendall Bein; Andrew P Bradshaw; Leigh A McGarvie; Emma C Argaet; Allison S Young; Shaun R Watson; G Michael Halmagyi; Deborah A Black; Miriam S Welgampola Journal: J Neurol Date: 2021-08-16 Impact factor: 4.849
Authors: James Orton Thomas; Angelos Sharobeam; Abhay Venkat; Christopher Blair; Nese Ozalp; Zeljka Calic; Peter Wyllie; Paul M Middleton; Miriam Welgampola; Dennis Cordato; Cecilia Cappelen-Smith Journal: BMJ Neurol Open Date: 2022-05-03
Authors: Allison S Young; Benjamin Nham; Andrew P Bradshaw; Zeljka Calic; Jacob M Pogson; William P Gibson; G Michael Halmagyi; Miriam S Welgampola Journal: J Neurol Date: 2021-08-22 Impact factor: 4.849
Authors: R T Ibitoye; P Castro; A Desowska; J Cooke; A E Edwards; O Guven; Q Arshad; L Murdin; D Kaski; A M Bronstein Journal: Clin Neurophysiol Date: 2021-08-30 Impact factor: 3.708