The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo
ObjectivesTo investigate the localization diagnostic value of the ocular tilt reaction (OTR) plus head tilt subjective visual vertical (SVV) in patients with acute central vascular vertigo (ACVV).MethodsWe enrolled 40 patients with acute infarction, 20 with unilateral brainstem infarction (BI) and 2...
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.1022362/full |
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| author | Yufei Feng Yufei Feng Tongtong Zhao Tongtong Zhao Yuexia Wu Xia Ling Menglu Zhang Menglu Zhang Ning Song Ji-Soo Kim Ji-Soo Kim Xu Yang |
| author_facet | Yufei Feng Yufei Feng Tongtong Zhao Tongtong Zhao Yuexia Wu Xia Ling Menglu Zhang Menglu Zhang Ning Song Ji-Soo Kim Ji-Soo Kim Xu Yang |
| author_sort | Yufei Feng |
| collection | DOAJ |
| description | ObjectivesTo investigate the localization diagnostic value of the ocular tilt reaction (OTR) plus head tilt subjective visual vertical (SVV) in patients with acute central vascular vertigo (ACVV).MethodsWe enrolled 40 patients with acute infarction, 20 with unilateral brainstem infarction (BI) and 20 with unilateral cerebellar infarction (CI). We also included 20 patients with unilateral peripheral vestibular disorders (UPVD) as the control group. The participants completed the OTR and SVV during head tilt (±45°) within 1 week of symptom onset.ResultsIn patients with ACVV, including that caused by lateral medullary infarction (100%, 2/2), partial pontine infarction (21%, 3/14), and cerebellum infarction (35%, 7/20), we observed ipsiversive OTR, similar to that seen in UPVD patients (80.0%, 16/20). Some of the patients with medial medullary infarction (50%, 1/2), partial pons infarction (42%, 6/14), midbrain infarction (100%, 2/2), and partial cerebellum infarction (30.0%, 6/20) showed contraversive OTR. The skew deviation (SD) of the BI group with ACVV was significantly greater than that of the UPVD group (6.60 ± 2.70° vs. 1.80 ± 1.30°, Z = −2.50, P = 0.012), such that the mean SD of the patients with a pons infarction was 9.50° and that of patients with medulla infarction was 5.00°. In ACVV patients with no cerebellar damage, the area under the curve of the receiver operating characteristic curve corresponding to the use of SD to predict brainstem damage was 0.92 (95%CI: 0.73–1.00), with a sensitivity of 100% and a specificity of 80% when SD ≥ 3°. We found no statistical difference in SD between the UPVD and CI groups (1.33 ± 0.58° vs. 1.80 ± 1.30°, Z = −0.344, P = 0.73). Compared with the UPVD patients, the ACVV patients with a partial pons infarction (43%, 6/14, χ2 = 13.68, P = 0.002) or medulla infarction (25%, 1/4, χ2 = 4.94, P = 0.103) exhibited signs of the ipsiversive E-effect with the contraversive A-effect, while those with a partial medulla infarction (50%, 2/4), pons infarction (43%, 6/14), or cerebellar infarction (60%, 12/20) exhibited a pathological symmetrical increase in the E-effect.ConclusionsThe evaluation of OTR plus head tilt SVV (±45°) in vertigo patients is helpful for identifying and diagnosing ACVV, especially when SD is ≥ 3° or the E-effect is symmetrically increased. |
| first_indexed | 2024-04-11T07:43:19Z |
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| language | English |
| last_indexed | 2024-04-11T07:43:19Z |
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| spelling | doaj.art-b9ba037b768d422aa417fc24464d46152022-12-22T04:36:25ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-11-011310.3389/fneur.2022.10223621022362The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigoYufei Feng0Yufei Feng1Tongtong Zhao2Tongtong Zhao3Yuexia Wu4Xia Ling5Menglu Zhang6Menglu Zhang7Ning Song8Ji-Soo Kim9Ji-Soo Kim10Xu Yang11Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaDepartment of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, ChinaDepartment of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaDepartment of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, ChinaDepartment of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaDepartment of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaDepartment of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaDepartment of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, ChinaDepartment of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaDepartment of Neurology, Seoul National University College of Medicine, Seoul, South KoreaDizziness Center, Seoul National University Bundang Hospital, Seongnam, South KoreaDepartment of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, ChinaObjectivesTo investigate the localization diagnostic value of the ocular tilt reaction (OTR) plus head tilt subjective visual vertical (SVV) in patients with acute central vascular vertigo (ACVV).MethodsWe enrolled 40 patients with acute infarction, 20 with unilateral brainstem infarction (BI) and 20 with unilateral cerebellar infarction (CI). We also included 20 patients with unilateral peripheral vestibular disorders (UPVD) as the control group. The participants completed the OTR and SVV during head tilt (±45°) within 1 week of symptom onset.ResultsIn patients with ACVV, including that caused by lateral medullary infarction (100%, 2/2), partial pontine infarction (21%, 3/14), and cerebellum infarction (35%, 7/20), we observed ipsiversive OTR, similar to that seen in UPVD patients (80.0%, 16/20). Some of the patients with medial medullary infarction (50%, 1/2), partial pons infarction (42%, 6/14), midbrain infarction (100%, 2/2), and partial cerebellum infarction (30.0%, 6/20) showed contraversive OTR. The skew deviation (SD) of the BI group with ACVV was significantly greater than that of the UPVD group (6.60 ± 2.70° vs. 1.80 ± 1.30°, Z = −2.50, P = 0.012), such that the mean SD of the patients with a pons infarction was 9.50° and that of patients with medulla infarction was 5.00°. In ACVV patients with no cerebellar damage, the area under the curve of the receiver operating characteristic curve corresponding to the use of SD to predict brainstem damage was 0.92 (95%CI: 0.73–1.00), with a sensitivity of 100% and a specificity of 80% when SD ≥ 3°. We found no statistical difference in SD between the UPVD and CI groups (1.33 ± 0.58° vs. 1.80 ± 1.30°, Z = −0.344, P = 0.73). Compared with the UPVD patients, the ACVV patients with a partial pons infarction (43%, 6/14, χ2 = 13.68, P = 0.002) or medulla infarction (25%, 1/4, χ2 = 4.94, P = 0.103) exhibited signs of the ipsiversive E-effect with the contraversive A-effect, while those with a partial medulla infarction (50%, 2/4), pons infarction (43%, 6/14), or cerebellar infarction (60%, 12/20) exhibited a pathological symmetrical increase in the E-effect.ConclusionsThe evaluation of OTR plus head tilt SVV (±45°) in vertigo patients is helpful for identifying and diagnosing ACVV, especially when SD is ≥ 3° or the E-effect is symmetrically increased.https://www.frontiersin.org/articles/10.3389/fneur.2022.1022362/fullcentral vascular vertigoocular tilt reactionsubjective visual verticalskew deviationA/E-effectunilateral peripheral vestibular disorders |
| spellingShingle | Yufei Feng Yufei Feng Tongtong Zhao Tongtong Zhao Yuexia Wu Xia Ling Menglu Zhang Menglu Zhang Ning Song Ji-Soo Kim Ji-Soo Kim Xu Yang The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo Frontiers in Neurology central vascular vertigo ocular tilt reaction subjective visual vertical skew deviation A/E-effect unilateral peripheral vestibular disorders |
| title | The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo |
| title_full | The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo |
| title_fullStr | The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo |
| title_full_unstemmed | The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo |
| title_short | The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo |
| title_sort | diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical 45° in patients with acute central vascular vertigo |
| topic | central vascular vertigo ocular tilt reaction subjective visual vertical skew deviation A/E-effect unilateral peripheral vestibular disorders |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.1022362/full |
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