Understanding Vestibular Disorders and Diagnosis

Oct 7, 2024

Vestibular First Lecture Notes

Presenter:

  • Helena Esmonde, Vestibular Physical Therapist and Co-founder of Vestibular First

Purpose:

  • Improving patient care for those with dizziness, vertigo, or imbalance
  • Sharing and discussing two patient cases with eye movement videos for vestibular diagnosis

Case Study 1: Elderly Patient with Downbeat Nystagmus

Background:

  • Female in her 80s
  • Experienced significant vertigo event 7 years ago
  • MRI showed no abnormalities
  • Neurologist suggests likely an old cerebellar stroke

Symptoms:

  • Spontaneous downbeat nystagmus, sometimes with left torsion
  • Mild dizziness and imbalance; uses a cane
  • Baseline nystagmus due to cerebellar stroke

BPPV Incidences:

  • Experiences BPPV approximately once a year
  • Symptoms: constant nausea without spinning/dizziness
  • Left torsional upbeat nystagmus in left Dix Hallpike position

Management:

  • Responds well to left-modified Epley Maneuvers
  • Use of infrared video goggles to detect nystagmus
  • Weekly sessions for balance training and habituation post-BPPV episode

Key Points:

  • Combination of central and peripheral vestibular issues
  • Importance of seeing all types of nystagmus to understand patient condition

Case Study 2: Patient with History of Concussion

Background:

  • Treated several times for BPPV
  • BPPV occurs in about a third of concussion patients

Testing:

  • Supine roll test with right head turn: left horizontal beat nystagmus
    • Apogeotropic nystagmus indicating horizontal canal cupulolithiasis
  • Supine roll test with left head turn: right horizontal nystagmus

Diagnosing:

  • Use of bow and lean test
    • Right horizontal beaten nystagmus indicates right horizontal canal cupulolithiasis
  • Bow test: left horizontal nystagmus confirms peripheral vestibular issue

Tools:

  • Infrared video goggles to detect mild nystagmus
  • Useful for viewing eye movements during tests

Conclusion

  • Use of infrared video goggles is crucial in detecting nystagmus in patients with vertigo
  • Encouragement to visit Vestibular First's educational resources
  • Promotion of free Journal Clubs and newsletters

Resources: