Capturing acute vertigo: A vestibular event monitor

Allison S Young; Corinna Lechner; Andrew P Bradshaw; Hamish G MacDougall; Deborah A Black; G Michael Halmagyi; Miriam S Welgampola

doi:10.1212/WNL.0000000000007644

Capturing acute vertigo: A vestibular event monitor

Neurology. 2019 Jun 11;92(24):e2743-e2753. doi: 10.1212/WNL.0000000000007644. Epub 2019 May 15.

Authors

Allison S Young¹, Corinna Lechner¹, Andrew P Bradshaw¹, Hamish G MacDougall¹, Deborah A Black¹, G Michael Halmagyi¹, Miriam S Welgampola²

Affiliations

¹ From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia.
² From the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School (A.S.Y., C.L., A.P.B., G.M.H., M.S.W.), Vestibular Research Laboratory, School of Psychology (H.G.M.), and Faculty of Health Sciences (D.A.B.), University of Sydney, Australia. miriam@icn.usyd.edu.au.

PMID: 31092626
DOI: 10.1212/WNL.0000000000007644

Abstract

Objective: To facilitate the diagnosis of vestibular disorders by patient-initiated capture of ictal nystagmus.

Methods: Adults from an Australian neurology outpatient clinic reporting recurrent vertigo were recruited prospectively and taught to self-record spontaneous and positional nystagmus at home while symptomatic, using miniature video-oculography goggles. Consenting patients with ictal videorecordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included.

Results: Ictal eye videos of 117 patients were analyzed. Of 43 patients with MD, 40 showed high-velocity spontaneous horizontal nystagmus (median slow-phase velocity [SPV] 39.7°/s; 21 showed horizontal nystagmus reversing direction within 12 hours [24 on separate days]). In 44 of 67 patients with VM, spontaneous horizontal (n = 28, 4.9°/s), upbeating (n = 6, 15.5°/s), or downbeating nystagmus (n = 10, 5.1°/s) was observed; 16 showed positional nystagmus only, and 7 had no nystagmus. Spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD (95% confidence interval [CI] 0.84-0.99, 0.71-0.90). Nystagmus direction change within 12 hours was highly specific (95.7%) for MD (95% CI 0.85-0.99). Spontaneous vertical nystagmus was highly specific (93.0%) for VM (95% CI 0.81-0.99). In the 7 patients with BPPV, spontaneous nystagmus was absent or <3°/s. Lying affected-ear down, patients with BPPV demonstrated paroxysmal positional nystagmus. Median time for peak SPV to halve (T50) was 19.0 seconds. Patients with VM and patients with MD demonstrated persistent positional nystagmus (median T50; 93.1 seconds, 213.2 seconds). T50s <47.3 seconds had a sensitivity and specificity of 100% and 77.8% for BPPV (95% CI 0.54-1.00, 0.64-0.88).

Conclusion: Patient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.

MeSH terms

Adult
Aged
Benign Paroxysmal Positional Vertigo / complications
Benign Paroxysmal Positional Vertigo / diagnosis*
Eye Movement Measurements*
Female
Humans
Male
Meniere Disease / complications
Meniere Disease / diagnosis*
Middle Aged
Migraine Disorders / complications
Migraine Disorders / diagnosis*
Monitoring, Ambulatory / methods*
Nystagmus, Pathologic / diagnosis*
Nystagmus, Pathologic / etiology
Vertigo / complications
Vertigo / diagnosis