Dissociated Results between Caloric and Video Head Impulse Tests in Dizziness: Prevalence, Pattern, Lesion Location, and Etiology
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Background and Purpose This study was designed to determine the prevalence, pattern, lesion location, and etiology of dissociation in the results of the bithermal caloric test and the horizontal video head impulse test (vHIT) in dizzy patients with various etiologies and disease durations. Methods We analyzed the results of bithermal caloric tests and vHITs performed over 26 months in 893 consecutive patients who underwent both tests within a 10-day period. Results Dissociation in the results of the two tests was found in 162 (18.1%) patients. Among them, 123 (75.9%) had abnormal caloric tests (unilateral paresis in 118 and bilateral paresis in 5) but normal vHITs. Peripheral lesions were identified in 105 (85.4%) of these patients, with the main underlying diseases being Meniere’s disease (62/105, 59%) and vestibular neuritis/ labyrinthitis (29/105, 27.6%). In contrast, central pathologies of diverse etiologies were found only in 18 (14.6%) patients. Abnormal vHIT (bilaterally positive in 18, unilaterally positive in 19, and hyperactive in 2) and normal caloric responses were found in 39 patients, with an equal prevalence of central (n=19) and peripheral (n=20) lesions. The peripheral lesions included vestibular neuritis/labyrinthitis in seven patients and Meniere’s disease in another seven. The central lesions had diverse etiologies. Conclusions Dissociation in the results between caloric tests and horizontal vHITs is not uncommon. The present patients with abnormal caloric tests and normal vHITs mostly had peripheral lesions, while central lesions were likely to underlie those with abnormal vHITs and normal caloric tests.
Abstract
Background and Purpose This study was designed to determine the prevalence, pattern, lesion location, and etiology of dissociation in the results of the bithermal caloric test and the horizontal video head impulse test (vHIT) in dizzy patients with various etiologies and disease durations. Methods We analyzed the results of bithermal caloric tests and vHITs performed over 26 months in 893 consecutive patients who underwent both tests within a 10-day period. Results Dissociation in the results of the two tests was found in 162 (18.1%) patients. Among them, 123 (75.9%) had abnormal caloric tests (unilateral paresis in 118 and bilateral paresis in 5) but normal vHITs. Peripheral lesions were identified in 105 (85.4%) of these patients, with the main underlying diseases being Meniere’s disease (62/105, 59%) and vestibular neuritis/ labyrinthitis (29/105, 27.6%). In contrast, central pathologies of diverse etiologies were found only in 18 (14.6%) patients. Abnormal vHIT (bilaterally positive in 18, unilaterally positive in 19, and hyperactive in 2) and normal caloric responses were found in 39 patients, with an equal prevalence of central (n=19) and peripheral (n=20) lesions. The peripheral lesions included vestibular neuritis/labyrinthitis in seven patients and Meniere’s disease in another seven. The central lesions had diverse etiologies. Conclusions Dissociation in the results between caloric tests and horizontal vHITs is not uncommon. The present patients with abnormal caloric tests and normal vHITs mostly had peripheral lesions, while central lesions were likely to underlie those with abnormal vHITs and normal caloric tests.
참고문헌 (28)
- Baloh RW, "Clinical neurophysiology of the vestibular system", Contemp Neurol Ser, 18, pp.1~21 (1979)
- Halmagyi GM, "A clinical sign of canal paresis", Arch Neurol, 45, pp.737~739 (1988)
- Halmagyi GM, "The video head impulse test", Front Neurol, 8, pp.258~ (2017)
- van de Berg R, "Laboratory examinations for the vestibular system", Curr Opin Neurol, 31, pp.111~116 (2018)
- 이순옥, "Normal Caloric Responses during Acute Phase of Vestibular Neuritis", Journal of Clinical Neurology, 12(3), pp.301~307 (2016), 대한신경과학회
- 백설희, "Abnormal Head Impulse Test in a Unilateral Cerebellar Lesion", Journal of Clinical Neurology, 11(3), pp.279~282 (2015), 대한신경과학회[DOI]
- Park HK, "Isolated floccular infarction : impaired vestibular responses to horizontal head impulse", J Neurol, 260, pp.1576~1582 (2013)
- Chen L, "Head impulse gain and saccade analysis in pontine-cerebellar stroke and vestibular neuritis", Neu-rology, 83, pp.1513~1522 (2014)
- Blödow A, "Caloric stimulation and video-head impulse testing in Ménière's disease and vestibular migraine", Acta Otolaryngol, 134, pp.1239~1244 (2014)
- Lee SU, "Comparison of caloric and headimpulse tests during the attacks of Meniere’s disease", Laryngoscope, 127, pp.702~708 (2017)
- McGarvie LA, "What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière’s disease?", Acta Otolaryngol, 135, pp.859~865 (2015)
- Zellhuber S, "Relation of video-head-impulse test and caloric irrigation : a study on the recovery in unilateral vestibular neuritis", Eur Arch Otorhinolaryngol, 271, pp.2375~2383 (2014)
- Shaw B, "Dissociation between caloric and head impulse testing in patients with congenital abnormalities of the semicircular canals", J Laryngol Otol, 132, pp.932~935 (2018)
- 김효정, "Bilaterally Abnormal Head Impulse Tests Indicate a Large Cerebellopontine Angle Tumor", Journal of Clinical Neurology, 12(1), pp.65~74 (2016), 대한신경과학회[DOI]
- Strupp M, "Bilateral vestibulopathy : diagnostic criteria consensus document of the Classification Committee of the Bárány Society", J Vestib Res, 27, pp.177~189 (2017)
- Choi JY, "Characteristics and mechanism of apogeotropic central positional nystagmus", Brain, 141, pp.762~775 (2018)
- Baloh RW, "Clinical practice. Vestibular neuritis", N Engl J Med, 348, pp.1027~1032 (2003)
- Lopez-Escamez JA, "Diagnostic criteria for Menière’s disease according to the Classification Committee of the Bárány Society", HNO, 65, pp.887~893 (2017)
- Hannigan IP, "Dissociation of caloric and head impulse tests: a marker of Meniere’s disease", J Neurol (2019)
- Tsuji K, "Temporal bone studies of the human peripheral vestibular system. Meniere’s disease", Ann Otol Rhinol Laryngol Suppl, 181, pp.26~31 (2000)
- Boyle R, "Efferent control of hair cell and afferent responses in the semicircular canals", J Neurophysiol, 102, pp.1513~1525 (2009)
- Pujol R, "Large basolateral processes on type II hair cells are novel processing units in mammalian vestibular organs", J Comp Neurol, 522, pp.3141~3159 (2014)
- Kim HJ, "Isolated vestibular nuclear infarction : report of two cases and review of the literature", J Neurol, 261, pp.121~129 (2014)
- Choi JY, "Recent advances in head impulse test findings in central vestibular disorders", Neurology, 90, pp.602~612 (2018)
- Sadeghi SG, "Neural correlates of motor learning in the vestibulo-ocular reflex : dynamic regulation of multimodal integration in the macaque vestibular system", J Neurosci, 30, pp.10158~10168 (2010)
- Strupp M, "Bilateral vestibulopathy", Handb Clin Neurol, 137, pp.235~240 (2016)
- Choi JY, "Reversed corrective saccades during head impulse test in acute cerebellar dysfunction", Cerebellum, 13, pp.243~247 (2014)
- Walker MF, "Cerebellar disease alters the axis of the high-acceleration vestibuloocular reflex", J Neurophysiol, 94, pp.3417~3429 (2005)