Clinical implication of ocular torsion in peripheral vestibulopathy

Choi, Jin Woong; Kang, Seong Il; Rhee, Ji Hye; Choi, Byeong Yoon; Kim, Ji-Soo; Koo, Ja-Won

doi:10.1007/s00405-014-2952-3

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Thus, this neuronal midbrain assembly must be considered a bilateral integration center with anatomically and functionally paired and unpaired substructures. A unilateral lesion is clinically characterized mainly by ocular motor and perceptual dysfunction, especially in the vertical roll plane [6,7,54]. Therefore, perceptual and ocular motor tilts (OTR and its components), which are indicative of a unilateral INC lesion, served as clinical inclusion criteria for the current study.…”

Section: Discussionmentioning

confidence: 99%

Functional Plasticity after Unilateral Vestibular Midbrain Infarction in Human Positron Emission Tomography

et al. 2016

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The aim of the study was to uncover mechanisms of central compensation of vestibular function at brainstem, cerebellar, and cortical levels in patients with acute unilateral midbrain infarctions presenting with an acute vestibular tone imbalance. Eight out of 17 patients with unilateral midbrain infarctions were selected on the basis of signs of a vestibular tone imbalance, e.g., graviceptive (tilts of perceived verticality) and oculomotor dysfunction (skew deviation, ocular torsion) in F18-fluordeoxyglucose (FDG)-PET at two time points: A) in the acute stage, and B) after recovery 6 months later. Lesion-behavior mapping analyses with MRI verified the exact structural lesion sites. Group subtraction analyses and comparisons with healthy controls were performed with Statistic Parametric Mapping for the PET data. A comparison of PET A of acute-stage patients with that of healthy controls showed increases in glucose metabolism in the cerebellum, motion-sensitive visual cortex areas, and inferior temporal lobe, but none in vestibular cortex areas. At the supratentorial level bilateral signal decreases dominated in the thalamus, frontal eye fields, and anterior cingulum. These decreases persisted after clinical recovery in contrast to the increases. The transient activations can be attributed to ocular motor and postural recovery (cerebellum) and sensory substitution of vestibular function for motion perception (visual cortex). The persisting deactivation in the thalamic nuclei and frontal eye fields allows alternative functional interpretations of the thalamic nuclei: either a disconnection of ascending sensory input occurs or there is a functional mismatch between expected and actual vestibular activity. Our data support the view that both thalami operate separately for each hemisphere but receive vestibular input from ipsilateral and contralateral midbrain integration centers. Normally they have gatekeeper functions for multisensory input to the cortex and automatic motor output to subserve balance and locomotion, as well as sensorimotor integration.

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Section: Discussionmentioning

confidence: 99%

Functional Plasticity after Unilateral Vestibular Midbrain Infarction in Human Positron Emission Tomography

et al. 2016

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“…Studies that have compared SVV and VEMP measurements have shown mixed results without clear association between VEMP and perception of gravity in pathologies such as Meniere's disease or vestibular neuritis, with more discrepancies between acute and chronic patients [39][40][41].These findings are in line with the multisensory nature of SVV compared to VEMP as a more specific and objective measure of otolith function [42]. Similar dissociation is found between ocular torsion and SVV measurements in patients with vestibular pathologies [41,43].…”

Section: Comparisons Of Clinical Tests Of Otolith Functionmentioning

confidence: 62%

“…When analyzed separately, oVEMP and ocular torsion abnormalities were present in about 70% of cases with vestibular neuritis [39,41,[44][45][46]. However, when measured together in a same group of patients, the ocular torsion and oVEMP abnormalities overlapped in about 50% of cases [43].…”

Section: Comparisons Of Clinical Tests Of Otolith Functionmentioning

confidence: 92%

Focused Update on Clinical Testing of Otolith Organs

Hegemann,

Bery,

Kheradmand

2024

Preprint

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The overall contribution of otolith receptors to eye movements, postural control and perceptual functions is the basis for clinical testing of otolith function. With such wide range of contributions, it is important to recognize that the functional outcomes of these tests may vary depending on the specific method employed to stimulate the hair cells. In this article, we review common methods used for clinical evaluation of otolith function and how different aspects of physiology may affect the functional measurements in these tests. We compare the properties and performance of various clinical tests with the emphasis on the newly-developed video ocular counter roll (vOCR), measurement of ocular torsion on fundus photography, and subjective visual vertical or horizontal (SVV/SVH) testing.

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“…In our series, each patient followed a typical vestibular neuritis course with significant improvement over weeks, so VEMPs would not have altered their diagnosis or management. Furthermore, previous studies did not find a close correlation between ocular VEMPs and ocular counter-roll in vestibular neuritis (17,18).…”

Section: Discussionmentioning

confidence: 76%

HINTS Examination in Acute Vestibular Neuritis: Do Not Look Too Hard for the Skew

Green¹,

Gold²

2020

Journal of Neuro-Ophthalmology

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Background: An ocular tilt reaction (OTR) is a triad of a skew deviation, head tilt, and ocular counter-roll that can be partial or complete. An OTR can occur anywhere along the utriculo-ocular motor pathways from the labyrinth to the interstitial nucleus of Cajal but is almost always central in origin. In acute vestibular neuritis (AVN), case reports have described patients with an OTR due to AVN, although it is unclear whether this examination finding is common or rare. Methods: The vestibular and ocular motor features of 7 patients presenting with AVN are described. Results: Each of the 7 patients presented with typical features of AVN, including contralesional unidirectional spontaneous nystagmus and an ipsilesional abnormal head impulse test, although each patient also had a complete OTR. None of the patients had vertical diplopia or a skew deviation that was measurable with alternate cover testing (i.e., abnormal "test of skew" according to the Head Impulse, Nystagmus, Test of Skew examination); however, all had a subtle 1 prism diopter hyperphoria that was only measurable with a Maddox rod test. Conclusion: Seven cases of typical AVN with an OTR are presented, and in the authors' experience, the presence of a subtle OTR is a common feature of AVN in these patients.

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Clinical implication of ocular torsion in peripheral vestibulopathy

Cited by 8 publications

References 17 publications

Functional Plasticity after Unilateral Vestibular Midbrain Infarction in Human Positron Emission Tomography

Functional Plasticity after Unilateral Vestibular Midbrain Infarction in Human Positron Emission Tomography

Focused Update on Clinical Testing of Otolith Organs

HINTS Examination in Acute Vestibular Neuritis: Do Not Look Too Hard for the Skew

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