Teaching Video NeuroImages: Vestibulo-ocular reflex defect in cerebellar stroke

Abstract

A 69-year-old man presented with acute vertigo, nausea, and vomiting. The patient had leftbeating nystagmus and an abnormal vestibulo-ocular reflex with corrective saccades on right head impulse (video 1). He had impaired pursuits to the left but no other cerebellar/neurologic findings (skew/hearing loss). MRI showed an acute stroke affecting the left cerebellar flocculonodular region (figure). Prior research has shown that an abnormal head impulse test (HIT) strongly predicts a peripheral process, and is inversely associated with posterior fossa stroke. 1 Our case illustrates the limited specificity of this clinical test. Nine percent of patients with a positive HIT have cerebellar strokes. 2 Author contributions Jens Witsch: clinical care of the patient, study concept, acquisition of data, revision of the manuscript for intellectual content. Monica Ferrer: acquisition of data, drafting of the manuscript. Dhasakumar Navaratnam: clinical care of the patient, study concept, acquisition of data, revision of the manuscript for intellectual content. Figure Brain MRI (A) Left cerebellar lesion, hyperintense on the diffusion-weighted imaging sequence (arrows in A and C). (B) Hypointense apparent diffusion coefficient sequence correlate of lesion shown in A. (C, D) Caudal extension of the lesion shown in A and B (thickness of cuts 5 mm).

Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series

“…This vestibular deficit along with visual disturbances and muscle tone disorders are responsible of the loss of balance and the high risk of falls [49]. Vestibular dysfunctions, and visual and verticality impairments observed in stroke patients may be produced by an alteration of the vestibulo-ocular reflex [58] and vestibulo-spinal pathways [59]. Different authors have suggested that VR can improve the adaptation of vestibulo-ocular and vestibulo-spinal [60] reflexes.…”