A review of clinical significance of spontaneous nystagmus and head shaking test
Abstract Introduction and objective: Clinical otoneurological examination is usually initiated by oculomotor examination. This exploration allows us to evaluate static signs, such as spontaneous nystagmus, and dynamic signs such as post head-shaking nystagmus, mastoid vibration nystagmus or oculocephalic impulse test. The objective of this review will be to expose the physiopathological bases of spontaneous nystagmus and the head-shaking test as well as its clinical utility. Method: It is a narrative review where we select the bibliography that we consider most relevant for this objective. Results: We describe nystagmus as the involuntary and rhythmic movement of the eyes which appears spontaneously or provoked by different stimuli. The exploration of spontaneous nystagmus in the 5 positions of the look, as well as its characteristic, is the fundamental tool in the initial assessment of a dizzy patient, followed by performing different maneuvers that can make it to manifest or to modify. Conclusion: The appearance of a spontaneous nystagmus of peripheral characteristics in the context of an acute unilateral vestibulopathy together with the progression of the dynamic signs, are indicators of the clinical situation of the patient and the degree of vestibular compensation.
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An SY, Kim BJ, Suh MW, Rhee CK, Jung JY. Clinical roles of fixation suppression failure in dizzy patients in the ENT clinic. Acta Otolaryngol. 2014;134(11):1134-9. doi: https://doi.org/10.3109/00016489.2014.936623
Angeli S, Velandia S, Snapp H. Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy. Am J Otolaryngol. 2011;32(6):522-7. doi: https://doi.org/10.1016/j.amjoto.2010.11.004
Bárány R. Untersuchungen über das Verhalten des Vestibularapparates bei Kopftraumen und ihre praktische Bedeutng. Verhandungen der Deutschen otol Gessellschaft 252-256, 1907.
Bartual J, Pérez N: el sistema vestibular y sus alteraciones. Masson. Barcelona, 1999. Vol 1; pp. 88-90. ISBN 844580748X
Bartual-Pastor J. Semiología vestibular. Unimed. 1st ed. Cádiz, 1980. ISBN: 84-300-2862-5.
Batuecas-Caletrío A, Yánez-González R, Sánchez-Blanco C, González-Sánchez E, Benito J, Gómez JC, et al. Aplicación del protocolo HINTS. Rev Neurol. 2014;59:349-53. PMid:25297477
Brandt T, Dieterich M, Strupp M. Vertigo and Dizziness. [Ebook]. Springer-Verlag London Ltd, 2005. ISBN 978-1-84628-081-8
Brandt T, Strupp M, Dieterich M. Five keys for diagnosing most vertigo, dizziness, and imbalance syndromes: an expert opinion. J Neurol. 2014;261(1):229-31. doi: https://doi.org/10.1007/s00415-013-7190-x
Desmon AL. Vestibular function: evaluation and treatment. 1st Ed. Thieme. New York, 2004. https://doi.org/10.1055/b-0034-52125
Dumas G, Lavieille J, Schmerber S. Caractérisation du test vibratoire. Comparaison avec les résultats du «Head shaking test ». Ann Otolaryngol Chir Cervicofac. 2004;121(1):22-32. https://doi.org/10.1016/S0003-438X(04)95487-4
Gimeno-Vilar C, Rey-Martinez J, Perez N. Active versus passive head-shaking nystagmus. Acta Otolaryngol. 2007;127(7):722-8. https://doi.org/10.1080/00016480600987800 / PMid:17573568
Hain TC, Spindler J. Head-shaking nystagmus. En: Sharpe JA, Barber HO, Eds: The vestibulo-ocular reflex and vertigo. New York: Raven Press.1993:217-28. PMCid: PMC288038
Kamei T, Kimura K, Kaneko H, Noro H. Reevaluation of the head shaking test as a method of nystagmus provocation. J OtoOtolaryngol (Japan). 1964;67:1530-4. doi: https://doi.org/10.3950/jibiinkoka.67.11_1530
Kattah J, Talkad A, Wang D, Hsieh Y, Newman-Toker D. HINTS to Diagnose Stroke in the Acute Vestibular Syndrome. Stroke. 2009;40(11):3504-10. PMid: 19762709. PMCid: PMC4593511./ https://doi.org/10.1161/STROKEAHA.109.551234
Kim H, Lee H. Recent Advances in Understanding Audiovestibular Loss of a Vascular Cause. J Stroke. 2017;19(1):61-6. PMid: 28030893. PMCid: PMC5307938. / https://doi.org/10.5853/jos.2016.00857
Lalsa Shilpa P, Subjective Tests for Vestibular Dysfunction. Glob J Oto. 2017;5(3): 555664. doi: 10.19080/gjo.2017.03.555664.
Pérez Vázquez P, Rodríguez Prado N, Sequeiros Santiago G, Llorente Pendás JL, Gómez Martínez JR, Suárez Nieto C. Utilidad del nistagmo de agitación cefálica en la exploración vestibular clínica básica. Acta Otorrinolaringol Esp. 2005;56(7):300–4. doi: 10.1016/S0001-6519(05)78619- 2.
Santos Pérez S, Pérez-Fernández N, Soto Varela A, Barona de Guzmán R. Síndrome vestibular periférico. R. Rev Med Univ Navarra 2003; 7(4):38-50.
Sanz-Fernández R, Martín-Sanz E. Exploración otoneurológica. Interpretación de las pruebas vestibulares. 1st Ed. Amplifon Ibérica. Barcelona, 2016. pp. 35-6. ISBN 978-84-617-5421-2
Son E, Lim H, Choung Y, Park K, Park H. Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo. Auris Nasus Larynx. 2013;40(3):247-50. https://doi.org/10.1016/j.anl.2012.06.006
Strupp M, Hüfner K, Sandmann R, Zwergal A, Dieterich M, Jahn K, et al. Central oculomotor disturbances and nystagmus: a window into the brainstem and cerebellum. Dtsch Arztebl Int. 2011;108(12):197-204. doi: 10.3238/arztebl.2011.0197.
Vogel K. Differentialdiagnostische Anhaltspunkte für die Erkennung von Schädigungen des Gleichgewichsapparates nach Schädelverletzungen. Deutsche Med Wochenschr 1929; 55(07): 268–70. doi: https://doi.org/10.1055/s-0028-1126282
Wegmann-Vicu-a R, Mu-oz-Hernández D, Gallegos-Constantino V, Domínguez-Echavarri P, Irimia-Sieira P, Pérez-Fernández N. Acute vestibular syndrome with down-beat nystagmus as a sole clinical presentation in AICA transient ischemic attack with an uncommon clinical course. Acta Otolaryngol Case Reports. 2017;2(1):131-36. doi: https://doi.org/10.1080/23772484.2017.1367255
Zee DS. Afternystagmus and Headshaking nystagmus. Equilibrium Research. JSER;1993;52(3):442-7. doi: 10.3757/jser.52.442. https://doi.org/10.3757/jser.52.442
Angeli S, Velandia S, Snapp H. Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy. Am J Otolaryngol. 2011;32(6):522-7. doi: https://doi.org/10.1016/j.amjoto.2010.11.004
Bárány R. Untersuchungen über das Verhalten des Vestibularapparates bei Kopftraumen und ihre praktische Bedeutng. Verhandungen der Deutschen otol Gessellschaft 252-256, 1907.
Bartual J, Pérez N: el sistema vestibular y sus alteraciones. Masson. Barcelona, 1999. Vol 1; pp. 88-90. ISBN 844580748X
Bartual-Pastor J. Semiología vestibular. Unimed. 1st ed. Cádiz, 1980. ISBN: 84-300-2862-5.
Batuecas-Caletrío A, Yánez-González R, Sánchez-Blanco C, González-Sánchez E, Benito J, Gómez JC, et al. Aplicación del protocolo HINTS. Rev Neurol. 2014;59:349-53. PMid:25297477
Brandt T, Dieterich M, Strupp M. Vertigo and Dizziness. [Ebook]. Springer-Verlag London Ltd, 2005. ISBN 978-1-84628-081-8
Brandt T, Strupp M, Dieterich M. Five keys for diagnosing most vertigo, dizziness, and imbalance syndromes: an expert opinion. J Neurol. 2014;261(1):229-31. doi: https://doi.org/10.1007/s00415-013-7190-x
Desmon AL. Vestibular function: evaluation and treatment. 1st Ed. Thieme. New York, 2004. https://doi.org/10.1055/b-0034-52125
Dumas G, Lavieille J, Schmerber S. Caractérisation du test vibratoire. Comparaison avec les résultats du «Head shaking test ». Ann Otolaryngol Chir Cervicofac. 2004;121(1):22-32. https://doi.org/10.1016/S0003-438X(04)95487-4
Gimeno-Vilar C, Rey-Martinez J, Perez N. Active versus passive head-shaking nystagmus. Acta Otolaryngol. 2007;127(7):722-8. https://doi.org/10.1080/00016480600987800 / PMid:17573568
Hain TC, Spindler J. Head-shaking nystagmus. En: Sharpe JA, Barber HO, Eds: The vestibulo-ocular reflex and vertigo. New York: Raven Press.1993:217-28. PMCid: PMC288038
Kamei T, Kimura K, Kaneko H, Noro H. Reevaluation of the head shaking test as a method of nystagmus provocation. J OtoOtolaryngol (Japan). 1964;67:1530-4. doi: https://doi.org/10.3950/jibiinkoka.67.11_1530
Kattah J, Talkad A, Wang D, Hsieh Y, Newman-Toker D. HINTS to Diagnose Stroke in the Acute Vestibular Syndrome. Stroke. 2009;40(11):3504-10. PMid: 19762709. PMCid: PMC4593511./ https://doi.org/10.1161/STROKEAHA.109.551234
Kim H, Lee H. Recent Advances in Understanding Audiovestibular Loss of a Vascular Cause. J Stroke. 2017;19(1):61-6. PMid: 28030893. PMCid: PMC5307938. / https://doi.org/10.5853/jos.2016.00857
Lalsa Shilpa P, Subjective Tests for Vestibular Dysfunction. Glob J Oto. 2017;5(3): 555664. doi: 10.19080/gjo.2017.03.555664.
Pérez Vázquez P, Rodríguez Prado N, Sequeiros Santiago G, Llorente Pendás JL, Gómez Martínez JR, Suárez Nieto C. Utilidad del nistagmo de agitación cefálica en la exploración vestibular clínica básica. Acta Otorrinolaringol Esp. 2005;56(7):300–4. doi: 10.1016/S0001-6519(05)78619- 2.
Santos Pérez S, Pérez-Fernández N, Soto Varela A, Barona de Guzmán R. Síndrome vestibular periférico. R. Rev Med Univ Navarra 2003; 7(4):38-50.
Sanz-Fernández R, Martín-Sanz E. Exploración otoneurológica. Interpretación de las pruebas vestibulares. 1st Ed. Amplifon Ibérica. Barcelona, 2016. pp. 35-6. ISBN 978-84-617-5421-2
Son E, Lim H, Choung Y, Park K, Park H. Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo. Auris Nasus Larynx. 2013;40(3):247-50. https://doi.org/10.1016/j.anl.2012.06.006
Strupp M, Hüfner K, Sandmann R, Zwergal A, Dieterich M, Jahn K, et al. Central oculomotor disturbances and nystagmus: a window into the brainstem and cerebellum. Dtsch Arztebl Int. 2011;108(12):197-204. doi: 10.3238/arztebl.2011.0197.
Vogel K. Differentialdiagnostische Anhaltspunkte für die Erkennung von Schädigungen des Gleichgewichsapparates nach Schädelverletzungen. Deutsche Med Wochenschr 1929; 55(07): 268–70. doi: https://doi.org/10.1055/s-0028-1126282
Wegmann-Vicu-a R, Mu-oz-Hernández D, Gallegos-Constantino V, Domínguez-Echavarri P, Irimia-Sieira P, Pérez-Fernández N. Acute vestibular syndrome with down-beat nystagmus as a sole clinical presentation in AICA transient ischemic attack with an uncommon clinical course. Acta Otolaryngol Case Reports. 2017;2(1):131-36. doi: https://doi.org/10.1080/23772484.2017.1367255
Zee DS. Afternystagmus and Headshaking nystagmus. Equilibrium Research. JSER;1993;52(3):442-7. doi: 10.3757/jser.52.442. https://doi.org/10.3757/jser.52.442
Fernández-Cascón, S., Fernández-Moráis, R., & Álvarez-Otero, R. (2017). A review of clinical significance of spontaneous nystagmus and head shaking test. Revista ORL, 9(2), 111–119. https://doi.org/10.14201/orl.17173
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