Perception of the subjective visual vertical. Measurement and diagnostic utility
Abstract Introduction and objective: The subjective visual vertical (SVV) is the position in which a subject would place a line when it is indicated that the adjustment to the real physical vertical that coincides with the gravitational axis. It is a diagnostic test that evaluates mainly the otolithic organs. We review in this article the diagnostic utility of this test. Method: A bibliographical review of the most significant authors was carried out for this purpose. Conclusions: Its measurement is simple and does not require sophisticated equipment and although it has a high sensitivity in acute processes, in the chronic its usefulness is more debatable. Neither does it allow locating the region of the vestibular pathway affected by the pathological process.
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Anastasopoulus D, Bhatia K, Bronstein AM, Gresty MA, Marsden CD. Perception of spatial orientation in spasmodic torticollis. 2. The visual vertical. Mov Disord. 1997;12: 709-14.
https://doi.org/10.1002/mds.870120514
PMid:9380053
Böhmer A, Rickenmann J. The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. J Vestib Res. 1995;5:35-45.
https://doi.org/10.1016/0957-4271(94)00021-S
Boleas Aguirre FM, Sánchez-Ferrandiz N, Perez N. The subjective visual vertical in benign paroxysmal positional vertigo. A preliminary study. Rev Laryngol Otol Rhinol. 2005;126:253-55.
Brandt T, Dieterich M. Cyclorotacion of the eyes and subjective visual vertical in vestibular brain stem lesions. Ann NY AcadSci. 1992;22:537-49.
https://doi.org/10.1111/j.1749-6632.1992.tb25234.x
Brandt T, Dieterich M. Pathological eye-head coordination in roll: tonic ocular tilt reaction in mesencephalic and medullary lesions. Brain. 1987;110 649-66.
https://doi.org/10.1093/brain/110.3.649
PMid:3495315
Brandt T, Dieterich M. Vestibular syndromes in the roll plane: topographic diagnosis from brainstem to cortex. Ann Neurol. 1994;36:337-47.
https://doi.org/10.1002/ana.410360304
PMid:8080241
Brandt T. Vertigo. Its multisensory syndromes. Berlín: Springer; 2000; p 503.
Curthoys IS, Dai MJ, Halmagyi GM. Human ocular torsional position before and after unilateral vestibular neurectomy. Exp Brain Res. 1991;85:218-25.
https://doi.org/10.1007/BF00230003
PMid:1884760
Dieterich M, Brandt T. Ocular torsion and perceived vertical in oculomotor, trochlear and abducens nerve palsies. Brain. 1993;116:1095-1104.
https://doi.org/10.1093/brain/116.5.1095
PMid:8221049
Friedmann G. The judgement of the visual vertical and horizontal with peripheral and central vestibular lesions. Brain. 1970;93(2):313-28
https://doi.org/10.1093/brain/93.2.313
PMid:5310320
Graybiel A, Miller EF, Newson BD, Kennedy RS. The effect of water immersion on perception of the oculogravic illusion in normal and labyrinthine defective subjects. Acta Otolaryngol. 1968;65:599-610.
https://doi.org/10.3109/00016486809119294
https://doi.org/10.3109/00016486809121003
PMid:5706030
Halmagyi GM, Brandt T, Dieterich M, Curthoys IS, Stark RJ, Hoyt WF. Tonic contraversive ocular tilt reaction due to unilateral meso-diencephalic lesion. Neurol. 1990;40:1503-9.
https://doi.org/10.1212/WNL.40.10.1503
Hubel DH, Wiesel TN. Receptive fields, binocular interaction and functional architecture in the cat's visual cortex. J Physiol. 1962;160:106-54.
https://doi.org/10.1113/jphysiol.1962.sp006837
Mossman S, Halmagyi GM. Partial ocular tilt reaction due to unilateral cerebellar lesion. Neurol. 1997;49:491-3.
https://doi.org/10.1212/WNL.49.2.491
Palla A, Straumann D, Tarnutzer A. Otolith testing: roll plane disorders. En: Eggers SDZ, Zee DS, editors. Vertigo and imbalance: clinical neurophysiology of the vestibular system. Handbook of clinical neurophysiology. Edición. Amsterdan: Elsevier; 2010; p. 201-16.
https://doi.org/10.1016/S1567-4231(10)09016-7
Pinar HS, Ardic FN, Topuz B, Kara CO. Subjective visual vertical and subjective visual horizontal measures in patients with chronic dizziness. J Otolaryngol. 2005;34:121-25.
https://doi.org/10.2310/7070.2005.04014
PMid:16076411
Serra A, Derwenskus J, Downey DL, Leigh RJ. Role of eye movement examination and subjective visual vertical in clinical evaluation of multiple sclerosis. J Neurol. 2003;250: 569-75. DOI: 10.1007/s00415-003-1038-8
https://doi.org/10.1007/s00415-003-1038-8
Takay Y, Murofushi T, Ushio M, Iwasaki S. Recovery of subjective visual horizontal after unilateral vestibular deafferentation by intratympanic instillation of gentamicin. J Vestib Res. 2006;16:69-73.
Tribukait A, Bergenius J, Brantberg K. Subjective visual horizontal during follow-up after unilateral deafferentation with gentamicin. Act Otolaryngol (Stockh). 1998;118:479-87.
https://doi.org/10.1080/00016489850154595
Van Nechel CH, Toupet M, Bodson I. The Subjective Visual Vertical. En: Tran Ba Huy P, Toupet M, editors. Otolith functions and disorders. Edición. Adv Otorhinolaryngol. Basel, Karger: 2001. vol 58, p. 77-87.
https://doi.org/10.1159/000059113
PMid:11885556
Vibert D, Häusler R. Long-term evolution of subjective visual vertical after vestibular neurectomy and labyrinthectomy. Acta Otolaryngol. 2000;120:620-22.
https://doi.org/10.1080/000164800750000432
PMid:11039872
Ziyah M, Freda N. Dissociate contributions of the two cerebral hemispheres to judgments of the line orientation. J Intern Neuropsychol Soc. 1996;2:335-39.
https://doi.org/10.1017/S1355617700001351
Zwergal A, Rettinger N, Frenzel C, Dieterich M, Brandt T, Strupp M. A bucket of static vestibular function. Neurol. 2009;72:1689-92.
https://doi.org/10.1212/WNL.0b013e3181a55ecf
PMid:19433743
https://doi.org/10.1002/mds.870120514
PMid:9380053
Böhmer A, Rickenmann J. The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. J Vestib Res. 1995;5:35-45.
https://doi.org/10.1016/0957-4271(94)00021-S
Boleas Aguirre FM, Sánchez-Ferrandiz N, Perez N. The subjective visual vertical in benign paroxysmal positional vertigo. A preliminary study. Rev Laryngol Otol Rhinol. 2005;126:253-55.
Brandt T, Dieterich M. Cyclorotacion of the eyes and subjective visual vertical in vestibular brain stem lesions. Ann NY AcadSci. 1992;22:537-49.
https://doi.org/10.1111/j.1749-6632.1992.tb25234.x
Brandt T, Dieterich M. Pathological eye-head coordination in roll: tonic ocular tilt reaction in mesencephalic and medullary lesions. Brain. 1987;110 649-66.
https://doi.org/10.1093/brain/110.3.649
PMid:3495315
Brandt T, Dieterich M. Vestibular syndromes in the roll plane: topographic diagnosis from brainstem to cortex. Ann Neurol. 1994;36:337-47.
https://doi.org/10.1002/ana.410360304
PMid:8080241
Brandt T. Vertigo. Its multisensory syndromes. Berlín: Springer; 2000; p 503.
Curthoys IS, Dai MJ, Halmagyi GM. Human ocular torsional position before and after unilateral vestibular neurectomy. Exp Brain Res. 1991;85:218-25.
https://doi.org/10.1007/BF00230003
PMid:1884760
Dieterich M, Brandt T. Ocular torsion and perceived vertical in oculomotor, trochlear and abducens nerve palsies. Brain. 1993;116:1095-1104.
https://doi.org/10.1093/brain/116.5.1095
PMid:8221049
Friedmann G. The judgement of the visual vertical and horizontal with peripheral and central vestibular lesions. Brain. 1970;93(2):313-28
https://doi.org/10.1093/brain/93.2.313
PMid:5310320
Graybiel A, Miller EF, Newson BD, Kennedy RS. The effect of water immersion on perception of the oculogravic illusion in normal and labyrinthine defective subjects. Acta Otolaryngol. 1968;65:599-610.
https://doi.org/10.3109/00016486809119294
https://doi.org/10.3109/00016486809121003
PMid:5706030
Halmagyi GM, Brandt T, Dieterich M, Curthoys IS, Stark RJ, Hoyt WF. Tonic contraversive ocular tilt reaction due to unilateral meso-diencephalic lesion. Neurol. 1990;40:1503-9.
https://doi.org/10.1212/WNL.40.10.1503
Hubel DH, Wiesel TN. Receptive fields, binocular interaction and functional architecture in the cat's visual cortex. J Physiol. 1962;160:106-54.
https://doi.org/10.1113/jphysiol.1962.sp006837
Mossman S, Halmagyi GM. Partial ocular tilt reaction due to unilateral cerebellar lesion. Neurol. 1997;49:491-3.
https://doi.org/10.1212/WNL.49.2.491
Palla A, Straumann D, Tarnutzer A. Otolith testing: roll plane disorders. En: Eggers SDZ, Zee DS, editors. Vertigo and imbalance: clinical neurophysiology of the vestibular system. Handbook of clinical neurophysiology. Edición. Amsterdan: Elsevier; 2010; p. 201-16.
https://doi.org/10.1016/S1567-4231(10)09016-7
Pinar HS, Ardic FN, Topuz B, Kara CO. Subjective visual vertical and subjective visual horizontal measures in patients with chronic dizziness. J Otolaryngol. 2005;34:121-25.
https://doi.org/10.2310/7070.2005.04014
PMid:16076411
Serra A, Derwenskus J, Downey DL, Leigh RJ. Role of eye movement examination and subjective visual vertical in clinical evaluation of multiple sclerosis. J Neurol. 2003;250: 569-75. DOI: 10.1007/s00415-003-1038-8
https://doi.org/10.1007/s00415-003-1038-8
Takay Y, Murofushi T, Ushio M, Iwasaki S. Recovery of subjective visual horizontal after unilateral vestibular deafferentation by intratympanic instillation of gentamicin. J Vestib Res. 2006;16:69-73.
Tribukait A, Bergenius J, Brantberg K. Subjective visual horizontal during follow-up after unilateral deafferentation with gentamicin. Act Otolaryngol (Stockh). 1998;118:479-87.
https://doi.org/10.1080/00016489850154595
Van Nechel CH, Toupet M, Bodson I. The Subjective Visual Vertical. En: Tran Ba Huy P, Toupet M, editors. Otolith functions and disorders. Edición. Adv Otorhinolaryngol. Basel, Karger: 2001. vol 58, p. 77-87.
https://doi.org/10.1159/000059113
PMid:11885556
Vibert D, Häusler R. Long-term evolution of subjective visual vertical after vestibular neurectomy and labyrinthectomy. Acta Otolaryngol. 2000;120:620-22.
https://doi.org/10.1080/000164800750000432
PMid:11039872
Ziyah M, Freda N. Dissociate contributions of the two cerebral hemispheres to judgments of the line orientation. J Intern Neuropsychol Soc. 1996;2:335-39.
https://doi.org/10.1017/S1355617700001351
Zwergal A, Rettinger N, Frenzel C, Dieterich M, Brandt T, Strupp M. A bucket of static vestibular function. Neurol. 2009;72:1689-92.
https://doi.org/10.1212/WNL.0b013e3181a55ecf
PMid:19433743
Pérez-González, R., & Gancedo-Fernández, S. (2018). Perception of the subjective visual vertical. Measurement and diagnostic utility. Revista ORL, 9(3), 239–245. https://doi.org/10.14201/orl.17698
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