Capturing Episodic Vertigo (S19.007)

Abstract

OBJECTIVE: To enable ictal capture of acute vertigo in patients' homes. BACKGROUND: Opportunities of recording the ictal nystagmus that accompanies acute vertigo are rare and valuable; nystagmus characteristics could point to the underlying vestibular disorder. DESIGN/METHODS: Fifty consecutive patients presenting to a neuro-otology clinic with episodic vertigo were taught to record spontaneous, gaze-evoked and positional nystagmus in their own home environment, using a custom-made lightweight pair of video-goggles. Monocular video data were collected at 30Hz using infrared cameras. Portable audiometry was also recorded when aural symptoms were present. RESULTS: Four subjects had short-lived paroxysmal positional nystagmus consistent with posterior (n=3) or horizontal (n=1) canal BPV. The slow phase velocities (SPV) plotted as a function of time, had a crescendo-decrescendo profile which peaked at 3-10s and could be fitted into a 5th -8th order polynomial curve. The peak SPV ranged from 5-95°/s. SPV had declined to 0 by 60 seconds. Ten subjects who fulfilled criteria for clinically definite Meniere´s Disease and three with a diagnosis of delayed endolymphatic hydrops had episodic vertigo associated with horizontal/torsional nystagmus; three demonstrated ictal fluctuation in hearing threshold (15-60dB). Their horizontal slow phase velocities (SPV) ranged between 10-52°/s and the SPV profile was flat over a 60s recording interval. Two undertook consecutive recordings over10-15 min intervals and demonstrated irritative, paretic and recovery nystagmus. Twenty-seven subjects fulfilled criteria for clinically definite (10) or probable (17) vestibular migraine. Their ictal nystagmus was characterized by spontaneous horizontal (10) vertical upbeating (5) or downbeating (6) nystagmus with a flat SPV profile (SPV range: 5-25°/s) and enhancement during positional testing. Six subjects were unable to record ictal nystagmus at home. CONCLUSIONS: Home-video nystagmography is feasible, enables detailed study of the ictal profiles of central and peripheral vestibulopathies and facilitates differentiation between common causes of episodic vertigo Supported by : National Health & Medical Research Council Australia, Garnett passe and Rodney Williams Foundation, Australia.

Disclosure: Dr. Welgampola has nothing to disclose. Dr. Lechner has nothing to disclose. Dr. Macdougall has nothing to disclose. Dr. Halmagyi has nothing to disclose.