title: A video-oculographic study of acute vestibular syndromes.
abstract: OBJECTIVE
  To quantitate the vestibulo-ocular reflex (VOR) gain in patients with acute vestibular neuritis (VN) and repeat this daily using a portable video head impulse test device to assess vestibular recovery in the acute stage of VN.
  
  
  METHODS
  We enrolled adults with symptoms and signs of VN presenting to the emergency department within 48 h of symptom onset. We recorded the eye movement response to rapid head impulses using the ICS Impulse(™) video head impulse test device on each day of their hospital admission.
  
  
  RESULTS
  There were eight patients (75% men, aged 35-85 years) who had marked variation in their initial vestibulo-ocular reflex gains. Three patients had vestibulo-ocular reflex gains in the normal range initially, despite having physical signs of VN. Two patients had initial contralesional gains below the normal range, associated with markedly reduced ipsilesional gains. Most patients' vestibulo-ocular reflex gains increased during admission, but four patients' ipsilesional gains remained in the abnormal range. Patients with lower vestibulo-ocular reflex gains were less likely to improve into the normal range. No patient with initially abnormal VOR gain recovered normal vestibulo-ocular reflex gain along with resolution of physical signs.
  
  
  CONCLUSIONS
  Early video head impulse testing in the emergency department and each day of admission is feasible and well tolerated. There is marked variation in VOR gain in patients with symptoms and signs of VN, and low initial VOR gains are a predictor for low VOR gains on subsequent days. Improvement in VOR gains was seen in most patients.
authors.affiliation: Department of Medicine, Monash University, Melbourne, Vic., Australia.
authors.forename: H N
authors.initials: HN
authors.lastname: Roberts
authors.affiliation: Epworth HealthCare, Richmond, Vic., Australia.
authors.forename: S
authors.initials: S
authors.lastname: McGuigan
authors.affiliation: Department of Medicine, Monash University, Melbourne, Vic., Australia.|Epworth HealthCare, Richmond, Vic., Australia.
authors.forename: B
authors.initials: B
authors.lastname: Infeld
authors.affiliation: Epworth HealthCare, Richmond, Vic., Australia.
authors.forename: R V
authors.initials: RV
authors.lastname: Sultana
authors.affiliation: Department of Medicine, Monash University, Melbourne, Vic., Australia. richard.gerraty@monash.edu.|Epworth HealthCare, Richmond, Vic., Australia. richard.gerraty@monash.edu.
authors.forename: R P
authors.initials: RP
authors.lastname: Gerraty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005133:Eye Movements; D005260:Female; D007839:Functional Laterality; D064087:Head Impulse Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D012027:Reflex, Vestibulo-Ocular; D013577:Syndrome; D016896:Treatment Outcome; D015837:Vestibular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020338:Vestibular Neuronitis / Q000000981:diagnostic imaging / Q000503:physiopathology; D014741:Video Recording
keywords: acute vestibular neuritis; vestibular system; vestibulo-ocular reflex; video head impulse test; video-oculography