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Review
. 2022 Feb 1;35(1):75-83.
doi: 10.1097/WCO.0000000000001017.

Current concepts in acute vestibular syndrome and video-oculography

Georgios Mantokoudis  1 , Jorge Otero-Millan  2   3 , Daniel R Gold  4
Affiliations
Review

Current concepts in acute vestibular syndrome and video-oculography

Georgios Mantokoudis et al. Curr Opin Neurol. .

Abstract

Purpose of review: We present here neuro-otological tests using portable video-oculography (VOG) and strategies assisting physicians in the process of decision making beyond the classical 'HINTS' testing battery at the bedside.

Recent findings: Patients with acute vestibular syndrome (AVS) experience dizziness, gait unsteadiness and nausea/vomiting. A variety of causes can lead to this condition, including strokes. These patients cannot be adequately identified with the conventional approach by stratifying based on risk factors and symptom type. In addition to bedside methods such as HINTS and HINTS plus, quantitative methods for recording eye movements using VOG can augment the ability to diagnose and localize the lesion. In particular, the ability to identify and quantify the head impulse test (VOR gain, saccade metrics), nystagmus characteristics (waveform, beating direction and intensity), skew deviation, audiometry and lateropulsion expands our diagnostic capabilities. In addition to telemedicine, algorithms and artificial intelligence can be used to support emergency physicians and nonexperts in the future.

Summary: VOG, telemedicine and artificial intelligence may assist physicians in the diagnostic process of AVS patients.

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Conflict of interest statement

None of the investigators has any relevant financial interests, activities, relationships or affiliations that represent a relevant financial conflict of interest with respect to this article.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Video-oculography. (a) A simulated example for asymmetric gaze evoked nystagmus with two horizontal eye positional traces for right and left gaze. There is a decreasing negative exponential eye drift (waveform of slow phase velocity). The beating direction is changing for left and right gaze. Frequency of nystagmus is often lower and the amplitude of the quick phases higher on one side. (b) An example of a vestibular nystagmus (jerk nystagmus with a linear slow phase velocity wave form, which is considered grade 3, as there is spontaneous nystagmus on all horizontal gaze directions. Nystagmus slow phase velocity (SPV) increases with gaze towards the beating direction (e.g. right-beating nystagmus that increases in right gaze) following Alexander's law. Despite the fact that the SPV increases, the waveform itself remains linear.
FIGURE 2
FIGURE 2
Classical and machine learning pipelines for the analysis of nystagmus.
See this image and copyright information in PMC

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