ABC of vestibulo-spinal exam. Literature review
Abstract SUMMARY Introduction and objective: During the long quarantines imposed in the world by the COVID-19 pandemic, the physicians have begun to use virtual consultation modality more frequently. Neuro-otology has not been an exception in this context and using the mechanism of video calls, we have been able to give attention and containment to a good number of patients during this period. For this reason and based on the unique experience of this period, we have designed a systematic examination, based on simple vestibular-spinal tests and presented in mnemonic form (alphabet). Based on our experience and a review of the literature, we try to demonstrate the vestibular etiology and topography of the findings. Method: Narrative Review. For bibliographic research we consulted different documents in metasearch engines and databases. Period analyzed from 2001 to 2019, in various scientific journals. Results: The examination was divided into four steps according to the first four letters of the alphabet: Ataxia (gradation), Bárány (deviation of the indices), Cephalic (Tilt or tilt of the head in relation to the trunk) and Deviation (oblique deviation of the eyes or Skew test). Discussion: The use of alphabet mnemonics is proposed to order the spinal vestibule examination in patients with involvement of the vestibular system. In a simple and practical way, allowing the virtual modality. Conclusions: This simple vestibular-spinal alphabet allows, associated with a thorough interrogation, to perform an effective vestibular examination by virtual means, effectively separate central lesions from peripheral lesions in acute vestibular lesions with high sensitivity and specificity and finally make a topodiagnosis of the vestibular lesion side.
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1. Sergio Carmona, Jorge Kattah. Manejo del Síndrome Vestibular Agudo. Editorial Akadia, 2017.
2. Sandler G. Cost of unnecessary test. Br Med J. 1979;2:21-4.
3. von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710–5.
4. Katsarkas A, Kirkham TH. Paroxysmal positional vertigo—a study of 255 cases. J Otolaryngol 1978;7:320–30.
5. Neuhauser HK, Radtke A, von Brevern M, et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology. 2006;67(6):1028–33.
6. Havia M, Kentala E, Pyykko I. Prevalence of Meniere’s disease in general population of Southern Finland. Otolaryngol Head Neck Surg. 2005;133(5):762–8.
7. Bárány R. Neue Untersuchungsmethoden, die Beziehungen zwischen Vestibularapparat, Kleinhirn, Grosshirn and Ruckenmark betreffend. Wien Med Wochenschr. 1910;60:2033.
8. Asociación Madrileña de Ataxias Hereditarias. https://www.asociacionmadrilenadeataxias.org/sobre-la-ataxia/. [Citado el 16/05/2020].
9. José Biller, Gregory Gruener, Paul Brazis. DeMyer’s The Neurologic Examination – A Programmed Text. Editorial Mc Graw Hill Education, 2017.
10. Sergio Carmona, Carlos Martinez, et al. The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome. Front Neurol. 2016;7:125. doi: 10.3389/fneur.2016.00125.
11. Lee H, Sohn SI, Cho YW, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006; 67(7):1178-83.
12. Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40:3504–10. Disponible en: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.109.551234. [Citado el 04/06/2020].
13. Simone Vanni, Rudi Pecci, Jonathan Edlow, et al. Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm. Front Neurol. 2017;8:590. doi: 10.3389/fneur.2017.00590
14. Carmona S, Martino N. Differential diagnosis between fourth nerve palsy and ocular tilt reaction based on the observation of the cephalic tilt. OcularMotor Disorders, 155–159. Neuroophthalmology at the Beginning of the New Millennium, Editor James A. Sharpe. Medimond; 2000.
15. Carmona S, Asprella Libonati G. Neuro-Otología. Editorial Akadia, 4° edición, 2018.
16. Brandt T. Vertigo: Its multisensory síndromes. Springer editorial, 2° edition, 2003.
17. Eggers SDZ, Kattah JC. Approaching Acute Vertigo With Diplopia: A Rare Skew Deviation in Vestibular Neuritis. Mayo Clin Proc Innov Qual Outcomes. 2020;4(2):216-222. doi: 10.1016/j.mayocpiqo.2019.12.003
18. Brodsky MC, Donahue SP, Vaphiades M, et al. Skew deviation revisited. Surv Ophthalmol 2006;51:105–28.
19. Pia Michael, Carolina Estibaliz Oliva, et al. An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo. Front. Neurol. 2016 Disponible en: https://doi.org/10.3389/fneur.2016.00115. [Citado el 04/06/2020].
20. Fife TD, Iverson DJ, Lempert T, et al. Quality Standards Subcommittee, American Academy of Neurology. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:2067–74.
21. Radtke, A., et al. A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo. Neurology. 1999;53(6): 1358-60.
22. Carmona S, Zalazar G, Zuma e Maia F. El abecedario de los movimientos oculares. Revista ORL [Internet]. 5 Abr 2018 [citado 1 Jun 2020]; 10(1): 65-72. Disponible en: https://revistas.usal.es/cinco/index.php/2444-7986/article/view/17963. [Citado el 04/06/2020]
23. Aasef G. Shaikh, Adolfo Bronstein, Sergio Carmona, et al. Consensus statement for remote assessment of eye movement and vestibular disorders. The Cerebellum, in press.
24. Robinson DA, Zee DS, Hain TC, Holmes A, Rosenberg LF. Alexander's law: its behavior and origin in the human vestibulo-ocular reflex. Ann Neurol. 1984;16(6):714?22. doi:10.1002/ana.410160614
2. Sandler G. Cost of unnecessary test. Br Med J. 1979;2:21-4.
3. von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710–5.
4. Katsarkas A, Kirkham TH. Paroxysmal positional vertigo—a study of 255 cases. J Otolaryngol 1978;7:320–30.
5. Neuhauser HK, Radtke A, von Brevern M, et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology. 2006;67(6):1028–33.
6. Havia M, Kentala E, Pyykko I. Prevalence of Meniere’s disease in general population of Southern Finland. Otolaryngol Head Neck Surg. 2005;133(5):762–8.
7. Bárány R. Neue Untersuchungsmethoden, die Beziehungen zwischen Vestibularapparat, Kleinhirn, Grosshirn and Ruckenmark betreffend. Wien Med Wochenschr. 1910;60:2033.
8. Asociación Madrileña de Ataxias Hereditarias. https://www.asociacionmadrilenadeataxias.org/sobre-la-ataxia/. [Citado el 16/05/2020].
9. José Biller, Gregory Gruener, Paul Brazis. DeMyer’s The Neurologic Examination – A Programmed Text. Editorial Mc Graw Hill Education, 2017.
10. Sergio Carmona, Carlos Martinez, et al. The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome. Front Neurol. 2016;7:125. doi: 10.3389/fneur.2016.00125.
11. Lee H, Sohn SI, Cho YW, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006; 67(7):1178-83.
12. Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40:3504–10. Disponible en: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.109.551234. [Citado el 04/06/2020].
13. Simone Vanni, Rudi Pecci, Jonathan Edlow, et al. Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm. Front Neurol. 2017;8:590. doi: 10.3389/fneur.2017.00590
14. Carmona S, Martino N. Differential diagnosis between fourth nerve palsy and ocular tilt reaction based on the observation of the cephalic tilt. OcularMotor Disorders, 155–159. Neuroophthalmology at the Beginning of the New Millennium, Editor James A. Sharpe. Medimond; 2000.
15. Carmona S, Asprella Libonati G. Neuro-Otología. Editorial Akadia, 4° edición, 2018.
16. Brandt T. Vertigo: Its multisensory síndromes. Springer editorial, 2° edition, 2003.
17. Eggers SDZ, Kattah JC. Approaching Acute Vertigo With Diplopia: A Rare Skew Deviation in Vestibular Neuritis. Mayo Clin Proc Innov Qual Outcomes. 2020;4(2):216-222. doi: 10.1016/j.mayocpiqo.2019.12.003
18. Brodsky MC, Donahue SP, Vaphiades M, et al. Skew deviation revisited. Surv Ophthalmol 2006;51:105–28.
19. Pia Michael, Carolina Estibaliz Oliva, et al. An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo. Front. Neurol. 2016 Disponible en: https://doi.org/10.3389/fneur.2016.00115. [Citado el 04/06/2020].
20. Fife TD, Iverson DJ, Lempert T, et al. Quality Standards Subcommittee, American Academy of Neurology. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:2067–74.
21. Radtke, A., et al. A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo. Neurology. 1999;53(6): 1358-60.
22. Carmona S, Zalazar G, Zuma e Maia F. El abecedario de los movimientos oculares. Revista ORL [Internet]. 5 Abr 2018 [citado 1 Jun 2020]; 10(1): 65-72. Disponible en: https://revistas.usal.es/cinco/index.php/2444-7986/article/view/17963. [Citado el 04/06/2020]
23. Aasef G. Shaikh, Adolfo Bronstein, Sergio Carmona, et al. Consensus statement for remote assessment of eye movement and vestibular disorders. The Cerebellum, in press.
24. Robinson DA, Zee DS, Hain TC, Holmes A, Rosenberg LF. Alexander's law: its behavior and origin in the human vestibulo-ocular reflex. Ann Neurol. 1984;16(6):714?22. doi:10.1002/ana.410160614
Carmona, S., Zalazar, G., & Dachesky, I. (2020). ABC of vestibulo-spinal exam. Literature review. Revista ORL, 11(4), 439–448. https://doi.org/10.14201/orl.23214
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