Multiple sclerosis. The value of clinical vestibular examination

A clinical vestibular examination was carried out on 82 patients with multiple sclerosis (MS) selected on McAlpine's criteria. Spontaneous nystagmus, positional nystagmus or pathological caloric test were found in 49 (60%) patients. Pathological horizontal optokinetic nystagmus occurred in 47 (57%) patients. In 36 cases horizontal optokinetic nystagmus was pathological to both sides, in 28 cases combined with a pathological vertical optokinetic nystagmus, indicative of diffuse intracerebral lesions. Lesions in the central vestibular system and in the optokinetic pathways were frequently discovered in early or atypical cases of MS.     

Bedside vestibular examination

A careful neuro-otologic examination is important in the diagnosis of vestibular disorders. This article reviews the bedside examination, beginning with the underlying physiologic principles. Techniques for testing static and dynamic vestibulo-ocular and vestibulospinal function are summarized. Finally, the use of specific provocative maneuvers is described.     

The value of the clinical picture and vestibular exploration in the vertiginous patient

The aim of this work is to highlight the significance on features more frequent of the troubles of the balance and vestibular system in our environment. Also we present a statistic about the symptomatology, on the results of vestibular examination and the diagnoses of a series of patients, of all ages, suffering vertigo, and studied in our department.     

Atypical clinical presentations of vestibular schwannomas.

A significant number of patients with vestibular schwannomas present atypically, with none of the classical symptoms of unilateral sensorineural hearing loss, tinnitus, and/or dysequilibrium. The aim of this study is to highlight those patients with unusual clinical symptoms. STUDY DESIGN: The clinical data of all patients who presented to the vestibular schwannoma clinic at Beaumont Hospital over the past 12 years was prospectively recorded in a computerized database. This paper reviews the atypical presenting symptoms. RESULTS: Three hundred ninety-eight patients were included in this study. A total of 3.7% of patients presented with atypical symptoms only. CONCLUSION: A significant subgroup, 3.7% in our study, did not present with the audiovestibular symptoms classically associated with vestibular schwannoma. Clinician awareness of the atypical clinical symptoms may lead to earlier detection of these lesions.     

The clinical utility of vestibular autorotation test in patients with vestibular migraine

Objective: To investigate the characteristics and clinical utility of vestibular autorotation test (VAT) in patients with vestibular migraine.

Methods: This study included two groups, an experimental group (441 patients) and a control group (65 healthy subjects). Both groups undertook VAT; the parameters evaluated were horizontal gain/phase, vertical gain/phase and asymmetry. The differences in VAT results between the two groups were investigated.

Results: There were no statistical differences between the VAT data of the control group when compared to the reference value from the manufacturer (p?>?.05). There were statistically significant differences in VAT results between the experimental and control group, namely elevated horizontal gain at frequency 2, 3, 4 and 5?Hz, horizontal phase delay at frequency 2, 4, 5 and 6?Hz, elevated vertical gain at frequency 2?6Hz and vertical phase delay at frequency 4?6Hz.

Conclusion: The results of this study using VAT in VM patients demonstrate elevated horizontal gain, vertical gain and delay in horizontal phase, vertical phase. We suggest the application of VAT as a diagnostic tool which may provide objective evidence that can contribute to the diagnosis of VM and also in differential diagnosis.     

The interpretation of clinical tests of peripheral vestibular function

Recently, new clinical tests of canal and otolith function have been introduced. They rest on sound anatomical and physiological evidence; however, the interpretation of the results of these tests has only recently been clarified. This review summarizes the anatomical and physiological evidence underpinning the tests of both canal and otolith function to provide a full picture of the interpretation of the tests, which allow the clinician to assess the status of the peripheral vestibular function of a patient--all six canals and four otoliths. The present review does not document all the minute details associated with each test, but provides an overview of the interpretation of properly presented tests and shows typical response profiles of patients with various types of vestibular loss, based on published anatomical, physiological, and clinical evidence.     

The value of cytologic examination for nasopharyngeal carcinoma

Cytologic examination is useful in the diagnosis of NPC. The actual yield in exfoliative cytologic diagnosis can be improved by a better designed applicator. Metastatic NPC in lymph node FNA shows certain features that are diagnostic. Detection of EBNA can be done with smears from fine-needle aspirates and may help to exclude NPC from the diagnosis if they are negative.