vestib tests

Question 1

• Peripheral

Static

Answer 1

• Spontaneous & gaze-evoked nystagmus
Setup: Sit in front of patient
Procedure: Look at you, look left, look right
Positive findings: Nystagmus (label direction, count beats, time to fatigue)
• Note: Change in direction of nystagmus, or up or down beating nystagmus indicates a central lesion

• Eye movements without fixation
Setup: ____
Procedure: Repeat without fixation?????????
Positive findings: As above.

Question 2

• Peripheral

* Dynamic Sensitivity Loss (push-pull combination)

Answer 2

• Eye fixation with head shaking (VOR)
Setup: Sit in front of patient, tuck chin down 30°.
Procedure: Have patient fixate on nose, shake their head slowly from side to side (30° each side), if they are able to maintain fixated gaze increase speed. Repeat with passive head movements.
Positive findings: 1 = normal; 2 = not able to fixate.

• Head shaking nystagmus without fixation (VOR)
• Setup: Sit in front of patient, tuck chin down 30°.
• Procedure: Passively shake the patients head. When you stop shaking have them look at your nose.
• Positive findings: Nystagmus

Question 3

• Peripheral
• Dynamic Sensitivity Loss (push-pull combination)
- 2

Answer 3

Head thrust test (VOR)
• Setup: Sit in front of patient, tuck chin down 30°,
• Procedure: Passively move head side to side in small oscillations, unexpectedly make a quick movement to one side and stop. Observe for fixation.
• Positive findings: When patient is unable to fixate + re-fixation of gaze to target.

Vestibular dynamic visual acuity test
• Setup: Patient 2m from chart (Snellen),
• Procedure: (1) Have patient read from top down as quickly and as far down as possible. Record last error free line. (2) With head in 30° chin tuck, oscillating at 92 beats/min. Ask patient to repeat reading of chart and record last error free line.
• Positive findings: Count the difference between the static and dynamic error free lines.
• Contraindications: Cease test if neck muscles stiffening.

Question 4

• Central

Visual tracking

Answer 4

Smooth pursuit eye movements
• Setup: Sitting in front of patient.
• Procedure: Place finger or pen in front of visual field. Get patient to follow target with eyes (roughly 70-80 degrees per second). Draw a cross and a circle. Observe for saccades.
• Positive findings: Saccades or inability to focus. Look for symmetry.

Convergence
• Same setup as smooth pursuit but want to see the eyes converge (go cross eyed)

Saccadic eye movements
• Setup: Sitting in front of patient.
• Procedure: Have patient look at nose, then target (tip of finger or pen). Go back and forth as quickly as possible when prompted. Repeat with finger in different positions
• Positive findings: Overshooting, undershooting, mini-saccades

Question 5

central

Maneuver induced eye movements

Answer 5

VOR cancellation
• Setup: Have patient tilt head into yaw, stick arms out straight in front with one thumb on top of the other.
• Procedure: Have patient move body and head together following their thumb
• Positive findings: Looking for smooth pursuit. Any jumps are a positive VOR cancellation finding

• Skew Eye Deviation
• Setup: Patient sitting
• Procedure: Cover half of face with paper. Hold for 2-3 seconds and remove paper. Repeat on other side
• Positive findings: Eye that is covered shifts. Re shifting upwards once paper is removed indicates medullary/brainstem stroke on that side