The bedside examination of the vestibulo-ocular reflex (VOR): An update

Abstract

Diagnosing dizzy patients remains a daunting challenge to the clinician in spite of modern imaging and increasingly sophisticated electrophysiological testing. Here we review the major bedside tests of the vestibulo-ocular reflex and how, when combined with a proper examination of the other eye movement systems, one can arrive at an accurate vestibular diagnosis.

Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults

“…The oculomotor examination is best performed before inducing the substantial head movements that are typical for some major components of the vestibular examination. The vestibular examination includes the Dix-Hallpike and the lateral roll test, positional testing, (V)HIT, the test for DVA, the visually enhanced vestibulo-ocular reflex test, fixation suppression, the Valsalva maneuver (straining against the closed glottis and blowing out against pinched nostrils), the head shake test, the vibration test, the hyperventilation test and the Romberg test on foam rubber or in tandem [84,85]. The Romberg test mainly diagnoses ataxia and is not specific for a vestibular loss, since it also detects cerebellar and proprioceptive impairment [84,86].…”

Nistagmo inducido por vibración en Otorrinolaringología

“…Esta técnica proporciona datos de forma no invasiva y con una buena relación de coste/eficacia [8,[22][23][24]. El nistagmo inducido es predominantemente horizontal, alejándose del lado afectado en la mayoría de los casos.…”

“…En la dehiscencia del canal semicircular superior (DCSS), el nistagmo bate hacia el oído afecto, lo que sugiere que la vibración activa las aferencias del canal y no se cancela en los núcleos vestibulares del lado sano. Aparecerá un VIN en un alto porcentaje de los casos, mientras que las pruebas calóricas suelen ser negativas [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. En la otosclerosis el VIN se observa muy pocas veces y se dirige tanto hacia el lado sano como hacia el lado lesionado [17].…”

Prevalência de vestibulopatia em idosos institucionalizados de Natal - RN - Brasil

“…After a few seconds of latency, if the movement triggers a paroxysm of vertigo, with or without nystagmus, BPPV (benign paroxysmal positional vertigo) can be diagnosed 14,15,20,24 .…”

“…Clinical examination 1,11 , as the initial clinical evaluation of a patient is known, can also be used to distinguish peripheral or central vestibular problems, the degree of injury and whether the condition of the patient is acute or chronic 10,[12][13][14][15] . There are several tests included in this assessment which, depending on the author in question, vary in number and type.…”