Ocular torsions and the subjective visual vertical with central vestibulo-ocular system lesions: independence disproved

Frisén, Lars

doi:10.1111/j.1600-0404.2012.01651.x

Cited by 7 publications

(2 citation statements)

References 9 publications

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“…In the bucket test (26, 27) the subjects evaluate the vertical orientation by properly aligning a straight line visible on the inner bottom of the bucket which the examiner rotates at random. On the outer bottom surface of the bucket an angular protractor provides the examiner to readout the tilt angle.…”

Section: Methods Of Verticality Perceptionmentioning

confidence: 99%

Perception of Verticality and Vestibular Disorders of Balance and Falls

2019

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Objective: To review current knowledge of the perception of verticality, its normal function and disorders. This is based on an integrative graviceptive input from the vertical semicircular canals and the otolith organs. Methods: The special focus is on human psychophysics, neurophysiological and imaging data on the adjustments of subjective visual vertical (SVV) and the subjective postural vertical. Furthermore, examples of mathematical modeling of specific vestibular cell functions for orientation in space in rodents and in patients are briefly presented. Results: Pathological tilts of the SVV in the roll plane are most sensitive and frequent clinical vestibular signs of unilateral lesions extending from the labyrinths via the brainstem and thalamus to the parieto-insular vestibular cortex. Due to crossings of ascending graviceptive fibers, peripheral vestibular and pontomedullary lesions cause ipsilateral tilts of the SVV; ponto-mesencephalic lesions cause contralateral tilts. In contrast, SVV tilts, which are measured in unilateral vestibular lesions at thalamic and cortical levels, have two different characteristic features: (i) they may be ipsi- or contralateral, and (ii) they are smaller than those found in lower brainstem or peripheral lesions. Motor signs such as head tilt and body lateropulsion, components of ocular tilt reaction, are typical for vestibular lesions of the peripheral vestibular organ and the pontomedullary brainstem (vestibular nucleus). They are less frequent in midbrain lesions (interstitial nucleus of Cajal) and rare in cortical lesions. Isolated body lateropulsion is chiefly found in caudal lateral medullary brainstem lesions. Vestibular function in the roll plane and its disorders can be mathematically modeled by an attractor model of angular head velocity cell and head direction cell function. Disorders manifesting with misperception of the body vertical are the pusher syndrome, the progressive supranuclear palsy, or the normal pressure hydrocephalus; they may affect roll and/or pitch plane. Conclusion: Clinical determinations of the SVV are easy and reliable. They indicate acute unilateral vestibular dysfunctions, the causative lesion of which extends from labyrinth to cortex. They allow precise topographical diagnosis of side and level in unilateral brainstem or peripheral vestibular disorders. SVV tilts may coincide with or differ from the perception of body vertical, e.g., in isolated body lateropulsion.

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Section: Methods Of Verticality Perceptionmentioning

confidence: 99%

Perception of Verticality and Vestibular Disorders of Balance and Falls

2019

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“…Subjective visual vertical (SVV), which is the measurement of the patient's ability to judge when a slit of light is earth vertical in a dark room is a promising test in MS patients [11] . SVV has been measured in variable clinical situations as peripheral and central vestibular lesions [12] , disorders of central vestibular-ocular system [13] and multiple sclerosis [14] . Brandt and Dieterich [15] proposed that SVV is an otolith function test and a sensitive sign of brainstem dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Ocular Torsions and the Subjective Visual Vertical with Brainstem and Cerebellar Lesions in Multiple Sclerosis.

Shabana,

Hamdy,

Samir

et al. 2024

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

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Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that makes a burden on patients and their families leading to disability especially in young patients. Acute or chronic lesions of MS within the brainstem and cerebellum frequently results in ocular motor disorders and deviation of subjective visual vertical (SVV). Aim: Finding a feasible, convenient way to evaluate ocular motor disorders in MS patients with brainstem and cerebellar affection and also to investigate to what extent they have problems with the estimation of verticality and also to demonstrate the relationship with stages of MS and expanded disability status scale (EDSS). Patients and Methods: Here, an observational case control study involving 95 patients: 65 patients with relapsing remitting multiple sclerosis all with brainstem and/or cerebellar affection and 30 healthy age and gender matched individual. MS patients were subjected to complete bedside evaluation, oculomotor testing and SVV testing while control group were subjected to subjective visual vertical evaluation. Results:The study found that MS patients with brainstem and/or cerebellar affection experienced variety of ocular motor disorders. SVV abnormalities were detected with both cerebellar and brainstem lesions. SVV showed a highly statistically significant difference in both groups. Conclusion: Clinical examination of eye movement and also SVV evaluation, takes only a few minutes to perform, but provide better information concerning the presence of brainstem and cerebellar involvement in MS patients.

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Subjective visual horizontal correlates better with ocular than with cervical vestibular evoked myogenic potentials

Argaet

Kwok

Bradley

et al. 2023

Clinical Neurophysiology

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Ocular torsions and the subjective visual vertical with central vestibulo-ocular system lesions: independence disproved

Abstract: Torsions and deviations are strongly dependent. This result should allow the generation of a more transparent pathophysiological model. From a practical point of view, measurements of deviation appeared more robust than those of torsion.

Cited by 7 publications

References 9 publications

Perception of Verticality and Vestibular Disorders of Balance and Falls

Perception of Verticality and Vestibular Disorders of Balance and Falls

Ocular Torsions and the Subjective Visual Vertical with Brainstem and Cerebellar Lesions in Multiple Sclerosis.

Subjective visual horizontal correlates better with ocular than with cervical vestibular evoked myogenic potentials

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