[Ocular movement and nystagmus: basics and clinical diagnosis]

Monitoring Eye Movements Depending on the Type of Visual Stimulus in Patients with Impaired Consciousness Due to Brain Damage

The eyeballs are often the only way to communicate messages as a result of brain damage. However, it is not uncommon for them to become dysfunctional, thus requiring the introduction of appropriate therapy. The trajectory of eye movements (saccadic movements and gaze fixation) during observation of a static and dynamic point presented with an eye tracker was analyzed in the present study. Twelve patients with brain injury of different etiology, with different degrees of consciousness disorders and not communicating through verbal and motor skills, qualified for the study. All participants demonstrated greater eye movement activity when presented with a dynamic task in which they observed a moving point. The findings suggest that effective eye movement therapy must incorporate dynamic stimuli.

[The "difficult" patient-Vestibular testing under difficult conditions : Part 1: History taking and clinical neurotological examination]

Der Patient mit dem Leitsymptom Schwindel stellt häufig eine Herausforderung für den Hals-Nasen-Ohren-Arzt dar. Die folgende Artikelserie beleuchtet unterschiedliche Aspekte des „schwierigen“ Schwindelpatienten. Der vorliegende erste Teil widmet sich den Besonderheiten und Fallstricken bei der Anamneseerhebung und der klinisch-neurootologischen Untersuchung. Dabei werden situationsspezifische Lösungsansätze zu folgenden Themen der Anamneseerhebung aufgezeigt: Definition von Erwartungen und Zielen, „ausschweifende“ Anamnese, Beschreibung des Symptoms Schwindel, mehrere Schwindelentitäten bei einem Patienten, Diskrepanz zwischen Symptomschwere und vestibulären Befunden, kognitive Verzerrungen und der Umgang mit Emotionen. Des Weiteren werden praxisbezogene Hinweise für die neurootologische Untersuchung von Patienten mit Halswirbelsäulenproblemen und Augenbewegungsstörungen sowie bei ängstlichen Patienten gegeben.

[Effective diagnostics for vertigo, dizziness and equilibrium disorders]

Vertigo, dizziness and equilibrium disorders are symptoms with a variety of causes. First, four cardinal questions (type and duration of the vertigo, triggering factors, accompanying symptoms) must be answered. After that, the search for a spontaneous nystagmus (differentiation of peripheral and central disorder using the HINTS[head impulse, nystagmus, test of skew]-test ) and, as part of a positioning examination, the search for a benign paroxysmal positional vertigo (BPPV) are necessary. If the result is negative an instrument-based receptor-specific examination is carried out. The caloric examination (low-frequency stimulus) tests the horizontal semicircular canal and the superior vestibular nerve, whereas the 3‑D video head impulse test (vHIT, high-frequency stimulus) is used to analyze all three semicircular canals as well as the superior and inferior vestibular nerves. Analysis of the cervical vestibular evoked myogenic potential (cVEMP) checks the function of the sacculus and that of the ocular VEMP (oVEMP) checks the function of the utriculus. The final overall analysis usually gives a definitive diagnosis or at least provides a suspected diagnosis, which then determines the further diagnostic procedure (e.g. targeted radiological diagnostics if vestibular paroxysmia, superior canal dehiscence or a vestibular schwannoma are suspected).