The role of vestibular cold caloric tests in the presence of spontaneous nystagmus

Abstract

SUMMARY Objective The bithermal caloric test is commonly used to detect a canal paresis. However, in case of spontaneous nystagmus, this procedure can provide results of non-univocal interpretation. On the other hand, confirming the presence of a unilateral vestibular deficit can help to differentiate between central and a peripheral vestibular involvement. Methods We studied 78 patients suffering from acute vertigo and showing spontaneous horizontal unidirectional nystagmus. All patients were submitted to bithermal caloric tests, and the results were compared with those obtained using a monothermal (cold) caloric test. Results We demonstrate the congruence between the bithermal and monothermal (cold) caloric test through mathematical analysis of the results of both tests in patients with acute vertigo and spontaneous nystagmus. Conclusions We propose to perform the caloric test in the presence of a spontaneous nystagmus using a monothermal cold assuming that the prevalence of the response to the cold irrigation on the side towards which the nystagmus beats is a sign of the presence of pathological unilateral weakness and therefore more likely peripheral in its origin.

Comparison of Halmágyi–Curthoys Head Impulse (Thrust) Test with Romberg’s Test in Detection of Vestibular Hypofunctioning in Vertigo Patients

“…Romberg's test showed greater specificity in assessing postural stability, especially in static conditions. Correlation between objective test results and VAS scores provided a nuanced understanding of how clinical manifestations align with subjective experiences [28]. These observations contribute to a comprehensive characterization of vestibular hypofunctioning in vertigo patients, shedding light on the strengths and limitations of each diagnostic tool and their collective implications for clinical decision-making.…”