vestibular nystagmus

Vestibular nystagmus is a type of nystagmus that occurs due to disorders of the labyrinth, vestibular nerve, vestibular nuclei of the brainstem, or vestibulocerebellum. This condition can cause severe vertigo, nausea, vomiting, and autonomic features such as tachycardia and diaphoresis.

Characteristics:

• Vestibular nystagmus is often associated with a slow component caused by the vestibular input and a quick, corrective component that causes movement in the opposite direction.
• It can occur during self-rotation even in darkness, indicating that the inner ear contains motion detectors (vestibular labyrinth) which project to the vestibular nuclei and cerebellum.
• A vestibular nystagmus can also be induced by irrigating the ears with warm or cold water, resulting in a conjugate nystagmus.

Symptoms:

• Vestibular nystagmus may cause vertigo, dizziness, or loss of balance due to its association with the vestibular system.
• The condition can lead to severe vertigo, nausea, vomiting, and autonomic features such as tachycardia and diaphoresis.

Types:

• Peripheral Vestibular: Jerk Nystagmus is a type of nystagmus generated by vestibular asymmetry, which can be due to an inhibitory disorder like vestibular neuritis or an excitatory disorder like benign paroxysmal positional vertigo (BPPV).
• Caloric nystagmus is another type of vestibular nystagmus induced by irrigation of water or insufflation of air against the tympanic membrane that is different from body temperature.

References:

• [1] Vestibular nystagmus occurs during self-rotation even in darkness: the inner ear contains motion detectors (vestibular labyrinth) which project to the vestibular nuclei and cerebellum.
• [2] A vestibular nystagmus can also be induced by irrigating the ears with warm or cold water, resulting in a conjugate nystagmus.
• [3] Peripheral Vestibular: Jerk Nystagmus is a type of nystagmus generated by vestibular asymmetry, which can be due to an inhibitory disorder like vestibular neuritis or an excitatory disorder like benign paroxysmal positional vertigo (BPPV).

Vestibular Nystagmus Signs and Symptoms

Vestibular nystagmus is a condition characterized by involuntary eye movements, which can be caused by problems in the inner ear or brain. The signs and symptoms of vestibular nystagmus can vary depending on the underlying cause, but here are some common ones:

• Involuntary Eye Movements: Vestibular nystagmus is marked by rhythmic trembling of the eyeballs, which can be horizontal, vertical, rotary, or multidirectional [5].
• Dizziness and Vertigo: Many people with vestibular nystagmus experience dizziness and vertigo, which can be severe in some cases [7, 11].
• Balance Problems: Vestibular nystagmus can cause balance problems, making it difficult to walk or stand without assistance [9].
• Nausea and Vomiting: Some people with vestibular nystagmus may experience nausea and vomiting, especially when the condition is caused by a problem in the inner ear [7].
• Vision Problems: Vestibular nystagmus can cause vision problems, including blurry or shaky vision, sensitivity to light, and difficulty seeing in the dark [6, 10].
• Head Motion Intolerance: Some people with vestibular nystagmus may experience head motion intolerance, making it difficult to move their head without triggering symptoms [4].

It's essential to note that the symptoms of vestibular nystagmus can vary depending on the underlying cause and individual factors. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References:

[5] - Nystagmus is characterized by a rhythmic trembling of the eyeballs; involuntary oscillations may be horizontal, vertical, rotary or multidirectional. [6] - Nov 7, 2024 — Nystagmus Symptoms · sensitivity to light · dizziness · difficulty seeing in the dark · vision problems · holding the head in a turned or tilted ... [7] - Vestibular neuritis is an inner ear disorder that causes symptoms such as sudden, severe vertigo, dizziness, balance problems, nausea and vomiting. [9] - Nystagmus more likely to be exacerbated post horizontal headshake - horizontal nystagmus; Balance disorders can strike at any age, but are most common as you get older. [10] - Typically, vestibular issues cause symptoms like dizziness and vertigo. Types of vestibular disorders. Experts classify vestibular disorders based on where the breakdown is within your vestibular system: ... [11] - Dizziness and vertigo are classic symptoms of a vestibular balance disorder. Balance disorders can strike at any age, but are most common as you get older. ...

Vestibular Nystagmus Diagnostic Tests

Vestibular nystagmus, a type of involuntary eye movement, can be diagnosed using various tests that assess the function of the inner ear and its balance organs. Here are some diagnostic tests used to diagnose vestibular nystagmus:

• Caloric Test: This test evaluates the vestibular system at slow speeds by introducing water or air of different temperatures into the ear canal, causing eye movement (nystagmus) [6].
• Videonystagmography (VNG): VNG measures certain eye movements called nystagmus and helps diagnose disorders of the vestibular system that can cause balance problems [4].
• Electronystagmography (ENG): ENG tests measure nystagmus and other eye movements to look for signs of vestibular dysfunction or neurological problems [9].
• Positional Nystagmus Testing: This test determines whether a change of position of the patient's vestibular systems in space provokes nystagmus [8].
• Gaze Test: The gaze test assesses for nystagmus in the absence of vestibular stimulation by recording eye movements during primary gaze while looking straight ahead, up, down, 30° to the right, and 30° to the left [10

Treatment Options for Vestibular Nystagmus

Vestibular nystagmus can be treated with various medications, depending on the underlying cause and severity of the condition.

• Medications to manage symptoms: Antivirals and drugs to treat nausea, dizziness, and inflammation may be prescribed to alleviate symptoms. [4][5]
• Pharmacological therapy: Medications such as antihistamines, benzodiazepines, and corticosteroids may be used to treat vestibular disorders. [5]
• Treatment of associated vertigo, nausea, and vomiting: Medications are helpful only during the acute phase of the illness. [12]

Important Considerations

• Not all patients respond the same to medical treatment, and side effects can outweigh the benefits. [9]
• Treatment should be tailored to the individual's specific condition and needs.

References

• The various forms of vestibular disorders can be treated with pharmacological therapy, physical therapy, psychotherapeutic measures or, rarely, surgery. [5]
• Medications may be recommended to treat persistent nystagmus, but not all patients respond the same to medical treatment, and the side effects can outweigh the benefits. [9]

Vestibular Nystagmus Differential Diagnosis

Vestibular nystagmus, a type of rhythmic eye movement disorder, can be caused by various factors. The differential diagnosis for vestibular nystagmus involves identifying the underlying cause of the condition.

• Peripheral vs Central Causes: The first step in differentiating vestibular nystagmus is to determine whether it is caused by a peripheral or central issue. Peripheral causes include disorders of the labyrinth, vestibular nerve, and vestibulocerebellum, while central causes involve problems with the brainstem or cerebellum [2].
• Vertigo and Dizziness: Patients presenting with vertigo and dizziness should be considered for central nervous system etiologies, particularly when nystagmus is persistently vertical or purely torsional [3].
• Retinal Disorders: In cases where nystagmus is linked to a retinal disorder, diagnosis involves a meticulous evaluation of visual acuity and fundus appearance [4].
• Vestibular Neuritis: Patients with peripheral vestibular dysfunction can suppress nystagmus while fixating. When fixation is removed, the nystagmus may appear [8].
• Central Causes: Central causes of vestibular nystagmus include conditions such as cerebellar dizziness/vertigo and downbeat nystagmus [12].

Other Considerations

• Vestibular Migraine: The main differential diagnosis for vestibular migraine is Menière’s disease, suggesting a pathophysiological link between the two disorders [12].
• BPPV and Vestibular Neuritis: BPPV (Benign Paroxysmal Positional Vertigo) and vestibular neuritis are other conditions that can cause nystagmus and should be considered in the differential diagnosis.

References

[1] Committee on Hearing and Equilibrium. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease. Otolaryngol Head Neck Surg, 2006;135(5):S3-S12.

[2] Vestibular nystagmus occurs with disorders of the labyrinth, vestibular nerve, vestibular nuclei of the brainstem, or vestibulocerebellum [1].

[3] Classification of vestibular dysfunction as peripheral or central is the first step to narrowing the differential diagnosis. Central nervous system etiologies should be considered when patients present with vertigo and dizziness, where the examination shows a pattern of nystagmus that is persistently vertical or purely torsional [2].

[4] In cases where nystagmus is linked to a retinal disorder, diagnosis involves a meticulous evaluation of visual acuity and fundus appearance [3].

[8] Patients with peripheral vestibular dysfunction can suppress nystagmus while fixating. When fixation is removed, the nystagmus may appear [4].

[12] The main differential diagnosis for vestibular migraine is Menière’s disease. Some patients meet the diagnostic criteria for both of these disorders; this suggests a pathophysiological link between them [5].