Retrospective review of oscillopsia: etiologies and clinical characteristics

Abstract

Background: Oscillopsia can result from dysfunction involving the vestibuloocular reflex (VOR). Few studies have detailed the full spectrum of clinical characteristics and laboratory findings of this disabling condition. Objectives: To review causes and clinical characteristics of oscillopsia. Methods: Retrospective review of clinical records of a series of patients with oscillopsia from the University Health Network Multidisciplinary Neurotology Clinic. Results: Review of 109 patients with oscillopsia showed near equal sex distribution and a mean age of 54.9 years (standard deviation 15.7). The most common peripheral vestibular causes were ototoxicity (19.3%) and Meniere’s disease (10.1%). The most common central cause involved cerebellar degeneration (7.3%). Only 43.1% complained of vertigo at any time. Head impulse testing demonstrated bilateral refixation saccades in 70% of patients, while over 95% had a loss of dynamic visual acuity ?5 lines on LogMAR chart testing. Some 38.8% of patients demonstrated normal caloric responses, whereas only 26.5% exhibited evidence of a bilateral caloric loss. Over 50% of patients maintained otolithic function as demonstrated by cervical vestibular evoked myogenic potential testing. Most patients demonstrated low VOR gains bilaterally on magnetic scleral search coil testing. Conclusions: A wide spectrum of clinical characteristics was identified in patients with oscillopsia. It is important for the physician to perform a thorough history, physical examination (including head impulse and dynamic visual acuity), and laboratory investigations. Keywords: Bilateral vestibular loss, magnetic scleral search coil, oscillopsia, vestibuloocular reflex