Age-related Refixating Saccades in the Three-Dimensional Video-Head-Impulse Test: Source and Dissociation From Unilateral Vestibular Failure.

OBJECTIVE: To examine "refixating saccades" in the three-dimensional video-head impulse test (vHIT) depending on the age and compare them to refixating saccades in pathological vHIT. DESIGN: Retrospective database study. SETTING: County hospital, specialized vertigo center. PATIENTS: Eight hundred ninety-nine patients without a peripheral vestibular hypofunction were tested with the three-dimensional vHIT and compared with 135 patients with unilateral vestibular hypofunction (UVF). MAIN OUTCOME MEASURES: Occurrence and peak velocity of refixating saccades (covert and overt) during the video-head-impulse test (vHIT) in three age groups (0-30, 30-60, and 60-100 yr) and in UVF. RESULTS: Overt saccade frequency of refixating saccades increased with increasing age, especially in the horizontal and posterior vHIT. Saccades were mostly directed opposite to the head movement. The aging effect was not explained by the VOR-gain decrease. Refixating saccades in normal vHIT were less frequent and slower than in UVF. CONCLUSION: We conclude that refixating saccades increase with higher age and could be differentiated from those in UVF by frequency and peak velocity. Saccades are not caused by a deficient VOR but might be caused by a deficient suppression of saccades to novel targets.

Prediction of Short-Term Outcome in Acute Superior Vestibular Nerve Failure: Three-Dimensional Video-Head-Impulse Test and Caloric Irrigation.

This retrospective study examines acute unilateral vestibular failure (up to seven days after onset) with modern vestibular testing (caloric irrigation and video-head-impulse test, vHIT) in 54 patients in order to test if the short-term outcome of the patients depends on the lesion pattern defined by the two tests. Patients were grouped according to a pathological unilateral caloric weakness without a pathological vHIT: group I; additional a pathological vHIT of the lateral semicircular canal (SCC): group II; and an additional pathological vHIT of the anterior SCC: group III. Patients with involvement of the posterior SCC were less frequent and not included in the analysis. Basic parameters, such as age of the subjects, days after symptom onset, gender, side of the lesion, treatment, and dizziness handicap inventory, were not different in groups I to III. The frequency of pathological clinical findings and pathological quantified measurements increased from groups I to III. The outcome parameter "days spent in the hospital" was significantly higher in group III compared to group I. The analysis shows that differential vestibular testing predicts short-term outcome of the patients and might be in future important to treat and coach patients with vestibular failure.

Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation.

The video-head-impulse test (vHIT) is an important test for examining unilateral vestibular hypofunction. Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies have shown that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. This retrospective study reproduces those finding in a much larger group of patients at a county hospital. 1063 patients were examined with the vHIT and bithermal caloric irrigation on the same day and analyzed with respect to side differences. Of those patients 13.3% had pathological vHIT and a caloric irrigation test, 4.6% a pathological vHIT only and 24.1% a pathologic caloric test only. As both tests might be necessary, we calculated the optimal sequence of the two examinations based on savings in time for the different disease groups. Especially in vestibular failure using the vHIT first and only applying the caloric irrigation in case of an unremarkable vHIT saves time and optimizes the diagnostic work up. In contrast, in Menière's disease and vestibular migraine testing caloric irrigation first might be more efficient.

Relation of video-head-impulse test and caloric irrigation: a study on the recovery in unilateral vestibular neuritis.

The head-impulse test (HIT) is an important test for examining unilateral vestibular hypofunction. The new video-head-impulse test (vHIT) is more sensitive and specific than the clinical bedside-head-impulse test. Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies have shown that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. To further explore the question, of whether vHIT and caloric irrigation test the same part of the angular horizontal vestibulo-ocular reflex (VOR), we examined patients with unilateral vestibular neuritis at different points in time. The tonic vestibular imbalance (e.g., subjective-visual-vertical, ocular torsion and spontaneous nystagmus) and dynamic dysfunction of VOR (vHIT and bithermal caloric irrigation) were measured and quantified. While parameters of the tonic vestibular imbalance were well described by single exponential decay functions, dynamic parameters were less well defined. Therefore, to better compare the time course of pairs of two different parameters, we used a linear regression analysis. No linear correlation was found in the group and individually for the gain asymmetry and the ipsilesional gain of the vHIT with the unilateral weakness of the bithermal caloric irrigation tests. Linear correlation was found for most parameters of tonic vestibular imbalance. These findings are further evidence that vHIT and caloric irrigation test different parts of the angular VOR.

Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital.

The head-impulse test (HIT) is an important test for examining unilateral vestibular hypofunction. The new video-head-impulse test (vHIT) is more sensitive and specific than the clinical bedside-head-impulse test (bHIT). Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies showed that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. To evaluate the diagnostic value of these tests, we routinely measured patients exhibiting vertigo or dizziness at our community hospital with bithermal caloric irrigation, the bHIT and the vHIT. Only those patients (n = 172) with a pathological caloric irrigation test of more than 25 % unilateral weakness in the Jongkee's formula were included. Out of these patients, 41 % had a pathologic vHIT. Among the subgroup with acute symptoms (symptom onset within 5 days), 63 % had a pathological video-head-impulse, whereas only 33 % of the non-acute group (symptom onset more than 5 days) tested pathological. A pathological HIT depended on the disease stage, the amount of unilateral weakness in caloric examination and on the test itself.

Evidence from vergence eye movements that disparities defined by luminance and contrast are sensed by independent mechanisms.

We recorded the initial disparity vergence responses (DVRs) elicited by 1-D sinusoidal gratings differing in phase at the two eyes by 1/4 wavelength and defined by luminance modulation (LM) or contrast modulation (CM) of dynamic binary noise. Both LM and CM stimuli elicited DVRs, but those to CM had longer latency (on average by ∼20 ms). DVRs showed sigmoidal dependence on depth of modulation, with higher thresholds for CM than for LM. With both LM and CM stimuli, fixing the modulation at one eye well above threshold rendered the DVR hypersensitive to low-level modulation at the other eye (dichoptic facilitation). Disparities defined by LM at one eye and CM at the other generated weak DVRs in the "wrong" direction, consistent with mediation entirely by distortion products associated with the CM stimulus. These (reversed) DVRs could be nulled by adding LM to the CM stimulus (in phase), and the greater the depth of the CM, the greater the added LM required for nulling, exactly as predicted by a simple compressive non-linearity. We conclude that disparities defined by LM and by CM are sensed by independent cortical mechanisms, at least for the purposes of generating short-latency vergence eye movements to disparity steps.