1
|
Young AS, Rosengren SM, D'Souza M, Bradshaw AP, Welgampola MS. Nystagmus characteristics of healthy controls. J Vestib Res 2020; 30:345-352. [PMID: 33285657 PMCID: PMC9249309 DOI: 10.3233/ves-200022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND: Healthy controls exhibit spontaneous and positional nystagmus which needs to be distinguished from pathological nystagmus. OBJECTIVE: Define nystagmus characteristics of healthy controls using portable video-oculography. METHODS: One-hundred and one asymptomatic community-dwelling adults were prospectively recruited. Participants answered questions regarding their audio-vestibular and headache history and were sub-categorized into migraine/non-migraine groups. Portable video-oculography was conducted in the upright, supine, left- and right-lateral positions, using miniature take-home video glasses. RESULTS: Upright position spontaneous nystagmus was found in 30.7% of subjects (slow-phase velocity (SPV)), mean 1.1±2.2 degrees per second (°/s) (range 0.0 – 9.3). Upright position spontaneous nystagmus was horizontal, up-beating or down-beating in 16.7, 7.9 and 5.9% of subjects. Nystagmus in at least one lying position was found in 70.3% of subjects with 56.4% showing nystagmus while supine, and 63.4% in at least one lateral position. While supine, 20.8% of subjects showed up-beating nystagmus, 8.9% showed down-beating, and 26.7% had horizontal nystagmus. In the lateral positions combined, 37.1% displayed horizontal nystagmus on at least one side, while 6.4% showed up-beating, 6.4% showed down-beating. Mean nystagmus SPVs in the supine, right and left lateral positions were 2.2±2.8, 2.7±3.4, and 2.1±3.2°/s. No significant difference was found between migraine and non-migraine groups for nystagmus SPVs, prevalence, vertical vs horizontal fast-phase, or low- vs high-velocity nystagmus (<5 vs > 5°/s). CONCLUSIONS: Healthy controls without a history of spontaneous vertigo show low velocity spontaneous and positional nystagmus, highlighting the importance of interictal nystagmus measures when assessing the acutely symptomatic patient.
Collapse
Affiliation(s)
- Allison S Young
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Sally M Rosengren
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mario D'Souza
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Department of Clinical Research, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew P Bradshaw
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Miriam S Welgampola
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
3
|
Macdonald NK, Kaski D, Saman Y, Al-Shaikh Sulaiman A, Anwer A, Bamiou DE. Central Positional Nystagmus: A Systematic Literature Review. Front Neurol 2017; 8:141. [PMID: 28473800 PMCID: PMC5397512 DOI: 10.3389/fneur.2017.00141] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/28/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To provide a systematic review of the clinical and radiological features of lesion-induced central positional nystagmus (CPN) and identify salient characteristics that differentiate central from peripheral positional nystagmus (PN). Methods Systematic literature search according to the preferred reporting items for systematic reviews and meta-analysis. Results A total of 82 patients from 28 studies met the participants intervention, comparison, outcomes, and study designs criteria for inclusion. An atypical direction of nystagmus for the stimulated canal was reported in 97.5% patients during Dix–Hallpike (D–H) and 54.5% upon supine roll testing. Five types of CPNs were identified during positional testing: positional horizontal nystagmus (pHN) (36.8%), positional downbeating nystagmus (pDBN) (29.2%), positional torsional nystagmus (pTN) (2.1%), positional upbeating nystagmus (pUBN) (2.1%), and a combination of the four profiles (29.9%). CPN was paroxysmal (<60 s) in 85% patients on straight head hanging (SHH), 63.9% on D–H, and 37.5% on supine roll, and had a latency <3 s upon positioning in 94.7% patients in which it was reported. Concurrent vertigo was reportedly present in 63.4% patients and 48.8% demonstrated other neurological signs. Radiologically, in 74.4%, there was mention of cerebellar involvement, isolated brainstem involvement in 8.5%, and 14.6% involved the fourth ventricle. Conclusion Currently, there is a lack of robust data on the clinical and radiological characteristics of CPN highlighting the need for better phenotyping of CPN to help differentiate this entity from peripheral causes of PN. With increased awareness of CPN, particularly in the acute setting, we may see a change in the estimated prevalence of CPN and improved clinical markers to promptly identify the frequently sinister underlying causes.
Collapse
Affiliation(s)
- Nora K Macdonald
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Yougan Saman
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - Amal Al-Shaikh Sulaiman
- UCL Ear Institute, London, UK.,Department of Otolaryngology and Head and Neck Surgery, King Fahd Hospital of University, University of Dammam, Al-Khobar, Saudi Arabia
| | | | - Doris-Eva Bamiou
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, UK.,UCL Ear Institute, London, UK
| |
Collapse
|
4
|
Choi JY, Kim JH, Kim HJ, Glasauer S, Kim JS. Central paroxysmal positional nystagmus: Characteristics and possible mechanisms. Neurology 2015; 84:2238-46. [PMID: 25957336 DOI: 10.1212/wnl.0000000000001640] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 02/23/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The diagnosis of central paroxysmal positional nystagmus (CPPN) is challenging, and the mechanisms require further elucidation. This study aimed to determine the characteristics and mechanisms of CPPN. METHODS Seventeen patients with CPPN were subjected to analyses of their clinical findings, MRI lesions, and oculographic data on spontaneous and positional nystagmus. RESULTS The direction of CPPN was mostly aligned with that of the head motion during the positioning, and 3 types of CPPN were identified: downbeat nystagmus on straight-head hanging, upbeat nystagmus on uprighting, and apogeotropic nystagmus during supine head roll test. The direction of CPPN was aligned with the vector sum of the rotational axes of the semicircular canals that were normally inhibited during the positioning. The intensity of evoked nystagmus was at its peak initially and then decreased exponentially over time. The time constants (TC) of the vertical CPPN ranged from 3 to 8 seconds, which corresponds to the TC of the vertical rotational vestibulo-ocular reflex. Sixteen patients (94.1%) showed more than one type of CPPN. Furthermore, persistent downbeat or apogeotropic positional nystagmus was associated in 11 patients (64.7%). Most patients with CPPN from a circumscribed brain lesion showed an involvement of the cerebellar nodulus or uvula. CONCLUSION CPPN may be ascribed to enhanced responses of the vestibular afferents due to lesions involving the nodulus and uvula. CPPN could be differentiated from benign paroxysmal positional nystagmus by positional nystagmus induced in multiple planes, temporal patterns of nystagmus intensity, and associated neurologic findings suggestive of central pathologies.
Collapse
Affiliation(s)
- Jeong-Yoon Choi
- From the Department of Neurology (J.-Y.C.), Korea University College of Medicine, Korea University Ansan Hospital; the Department of Neurology (J.H.K.), Korea University College of Medicine, Korea University Guro Hospital, Seoul; the Department of Biomedical Laboratory Science (H.J.K.), Kyungdong University, Goseong-gun, Gangwon-do; the Center for Sensorimotor Research (S.G.), Institute for Clinical Neuroscience, Ludwig-Maximilian University Munich, Germany; and the Department of Neurology (J.-S.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Kim
- From the Department of Neurology (J.-Y.C.), Korea University College of Medicine, Korea University Ansan Hospital; the Department of Neurology (J.H.K.), Korea University College of Medicine, Korea University Guro Hospital, Seoul; the Department of Biomedical Laboratory Science (H.J.K.), Kyungdong University, Goseong-gun, Gangwon-do; the Center for Sensorimotor Research (S.G.), Institute for Clinical Neuroscience, Ludwig-Maximilian University Munich, Germany; and the Department of Neurology (J.-S.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo Jung Kim
- From the Department of Neurology (J.-Y.C.), Korea University College of Medicine, Korea University Ansan Hospital; the Department of Neurology (J.H.K.), Korea University College of Medicine, Korea University Guro Hospital, Seoul; the Department of Biomedical Laboratory Science (H.J.K.), Kyungdong University, Goseong-gun, Gangwon-do; the Center for Sensorimotor Research (S.G.), Institute for Clinical Neuroscience, Ludwig-Maximilian University Munich, Germany; and the Department of Neurology (J.-S.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Stefan Glasauer
- From the Department of Neurology (J.-Y.C.), Korea University College of Medicine, Korea University Ansan Hospital; the Department of Neurology (J.H.K.), Korea University College of Medicine, Korea University Guro Hospital, Seoul; the Department of Biomedical Laboratory Science (H.J.K.), Kyungdong University, Goseong-gun, Gangwon-do; the Center for Sensorimotor Research (S.G.), Institute for Clinical Neuroscience, Ludwig-Maximilian University Munich, Germany; and the Department of Neurology (J.-S.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Soo Kim
- From the Department of Neurology (J.-Y.C.), Korea University College of Medicine, Korea University Ansan Hospital; the Department of Neurology (J.H.K.), Korea University College of Medicine, Korea University Guro Hospital, Seoul; the Department of Biomedical Laboratory Science (H.J.K.), Kyungdong University, Goseong-gun, Gangwon-do; the Center for Sensorimotor Research (S.G.), Institute for Clinical Neuroscience, Ludwig-Maximilian University Munich, Germany; and the Department of Neurology (J.-S.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|