Skip to main content
SpringerLink
Log in

The Bedside Tests: Practical Key Strategies to the Diagnosis of Vestibular and Oculomotor Disorders

  • Chapter
  • First Online:
The New Neurotology

  • 769 Accesses

Abstract

The subject of this chapter are the key strategies to the diagnosis of vestibular and ocular motor disorders that include the understanding of the six eye movements, an essential knowledge of the anatomy and physiology of the vestibular and oculomotor systems, a detailed patient’s history, and a systematic clinical bedside examination. Each of these items will be thoroughly discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wong AMF. Eye movement disorders. New York: Oxford University Press; 2008.

    Google Scholar 

  2. Kingma H, Van der Berg R. Anatomy, physiology and physic of the peripheral vestibular system. Handb Clin Neurol. 2016;137:1–16. (3rd series), Neuro-Otology. https://doi.org/10.1016/B978-0-444-63437-5.00001-7.

    Article  CAS  PubMed  Google Scholar 

  3. Kheradmand A, Colpak ZD. Eye movements in vestibular disorders. Handb Clin Neurol. 2016;137. (3rd series) Neuro-Otology. J.M. Furman and T. Lempert, Eds.

    Google Scholar 

  4. Kheradmand A, Zee DS. Cerebellum and ocular motor control. Front Neurol. 2011;2:53. https://doi.org/10.3389/fneur.2011.00053. eCollection 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zuma e Maia FC, Cal RV, D’Albora R, Carmona S, Schubert MC. Head shaking tilt suppression: a clinical testy to discern central from peripheral cause of vertigo. J Neurol. 2017;264:1264. https://doi.org/10.1007/s00415-017-8524-x.

    Article  PubMed  Google Scholar 

  6. Newman-Toker DE, Edlow JA. TiTrATE: a novel approach to diagnosing acute dizziness and vertigo. Neurol Clin. 2015;33(3):577–99. https://doi.org/10.1016/j.ncl.2015.04.011.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Strupp M, et al. Central ocular motor disorders, including gaze palsy and nystagmus. J Neurol. 2014;261(Suppl 2):542. https://doi.org/10.1007/s00415-014-7385-9.

    Article  PubMed Central  Google Scholar 

  8. Kheradmand A, Zee DS. The bedside examination of the vestibular reflex (RVO): an update. Paris: Elsevier Masson SAS; 2012.

    Google Scholar 

  9. Brandt T, Dieterich M. Skew deviation with ocular torsion: a vestibular brainstem sign of topographic diagnostic value. Ann Neurol. 1993;33(5):528–34.

    Article  CAS  Google Scholar 

  10. Dieterich M, Brandt T. Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs. Ann Neurol. 1993;33:292–9.

    Article  CAS  Google Scholar 

  11. Zwergal A, Rettinger N, Frenzel C, Dieterich M, Brandt T, Strupp M. A bucket of static vestibular function. Neurology. 2009;72:1689–92.

    Article  CAS  Google Scholar 

  12. Leigh RJ, Zee DS. The neurology of eye movements. 5th ed. New York: Oxford University Press; 2015.

    Google Scholar 

  13. De Stefano A, Kulamarva G, Citraro L, Neri G, Croce A. Spontaneous nystagmus in benign paroxysmal positional vertigo. Am J Otolaryngol. 2011;32:185–9.

    Article  Google Scholar 

  14. White JA, Hughes GB, Ruggieri PN. Vibration-induced nystagmus as an office procedure for the diagnosis of superior semicircular canal dehiscence. Otol Neurotol. 2007;28:911–6.

    Article  Google Scholar 

  15. Katsarkas A, Smith H, Galiana H. Head-shaking nystagmus (HSN): the theoretical explanation and the experimental proof. Acta Otolaryngol. 2000;120(2):177–81.

    Article  CAS  Google Scholar 

  16. Lee YJ, Shin EJ, Park MS, Kim JM, Na BR, Kim CH, Park HJ. Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. Audiol Neurootol. 2012;17:228–34. https://doi.org/10.1159/000336958.

    Article  PubMed  Google Scholar 

  17. Kim YE, Kim JS, Yang HJ, Yun JY, Kim HJ, Ehm G, Kim JM, Jeon BS. Perverted head-shaking and positional downbeat nystagmus in essential tremor. Cerebellum. 2016;15(2):152–8. https://doi.org/10.1007/s12311-015-0683-7.

    Article  PubMed  Google Scholar 

  18. Kim CH, Shin JE, Song CI, Yoo MH, Park HJ. Vertical components of head-shaking nystagmus in vestibular neuritis, Meniere’s disease and migrainous vertigo. Clin Otolaryngol. 2014;39(5):261–5.

    Article  CAS  Google Scholar 

  19. Califano L, Mellilo MG, Vassalo A, Mazzone S. Hyperventilation-induced nystagmus in a large series of vestibular patients. Acta Otorhinolaryngol Ital. 2011;31(1):17–26.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Schubert M, Migliaccio AA, Ng TWC, Shaikh A, Zee DS. The Under-Compensatory Roll aVOR does not Affect Dynamic Visual Acuity. J Assoc Res Otolaryngol. 2012;13:517–25.

    Article  Google Scholar 

  21. Halmagyi GM, Gresty MA. Clinical signs of visual-vestibular interaction. J Neurol Neurosurg Psychiatry. 1979;42:934–9.

    Article  CAS  Google Scholar 

  22. Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45:737–9.

    Article  CAS  Google Scholar 

  23. Straumann D. Bedside examination. Handb Clin Neurol. 2016;137:91–101. (3rd series) Neuro-Otology. J.M. Furman, T. Lempert, eds. https://doi.org/10.1016/B978-0-444-63437-5.00007-8.

    Article  CAS  PubMed  Google Scholar 

  24. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–10. https://doi.org/10.1161/STROKEAHA.109.551234.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Newman-Toker DE, Kerber KA, Hsieh YH, Pula JH, Omron R, Saber Tehrani AS, Mantokoudis G, Hanley DF, Zee DS, Kattah JC. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013 Oct;20(10):986–96. https://doi.org/10.1111/acem.12223.

    Article  PubMed  Google Scholar 

  26. Carmona S, Martínez C, Zalazar G, Moro M, Batuecas-Caletrio A, Luis L, Gordon C. The diagnostic accuracy of truncal Ataxia and HINTS as cardinal signs for acute vestibular syndrome. Front Neurol. 2016;7:125. https://doi.org/10.3389/fneur.2016.00125. eCollection 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jaynstein D. HINTS for differentiating peripheral from central causes of vertigo. JAAPA. 2016;29(10):56–7. https://doi.org/10.1097/01.JAA.0000496966.42862.e1.

    Article  PubMed  Google Scholar 

  28. Batuecas-Caletrío A, Yáñez-González R, Sánchez-Blanco C, González-Sánchez E, Benito J, Gómez JC, Santa Cruz-Ruiz S. Vértigo periférico frente a vértigo central. Aplicación del protocolo HINTS. Rev Neurol. 2014;59(8):349–53.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Albert Einstein Hospital , São Paulo, São Paulo, Brazil

    Pedro Luiz Mangabeira Albernaz

  2. Otology / Neurotology, Clínica Maia, Canoas, Rio Grande do Sul, Brazil

    Francisco Zuma e Maia

  3. Neurotology, Fundación San Lucas para la Neurociencia, Rosário, Santa Fé, Argentina

    Sergio Carmona

  4. Curso de Medicina, Centro Universitário do Pará, Belém, Pará, Brazil

    Renato Valério Rodrigues Cal

  5. Department of Neurology in Hospital de San Luis, Fundación San Lucas para la Neurociencia, Rosario, Santa Fé, Argentina

    Guillermo Zalazar

Authors
  1. Pedro Luiz Mangabeira Albernaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francisco Zuma e Maia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergio Carmona
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Renato Valério Rodrigues Cal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guillermo Zalazar
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Albernaz, P.L.M., Zuma e Maia, F., Carmona, S., Cal, R.V.R., Zalazar, G. (2019). The Bedside Tests: Practical Key Strategies to the Diagnosis of Vestibular and Oculomotor Disorders. In: The New Neurotology. Springer, Cham. https://doi.org/10.1007/978-3-030-11283-7_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-11283-7_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11282-0

  • Online ISBN: 978-3-030-11283-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation