Visual Eye movement-vestibular ocular balance assessment in the diagnosis of central and peripheral vertigo

Abstract

Objective To explore the role of visual oculomotor-vestibular eye balance function in the diagnosis of central and peripheral vertigo. Methods From January 2015 to June 2016, one hundred and sixty-two patients with central vertigo who were treated at Kailuan General Hospital were enrolled in the study, including 124 males and 38 females, aged (64.09±10.98) years old; there were 166 cases of peripheral vertigo, 75 males and 91 females, aged (52.13±12.20) years old.Spontaneous nystagmus test, gaze test, position test, saccade test, smooth visual tracking test, visual single-speed test, visual sinus test, swivel chair rotation-emergency stop test using infrared video nystagmus and static balance posture instrument, open-closed eye hard plate erect test, open-closed eye sponge soft bottom erect test balance function electrophysiological test were conducted. Results The detection rate of pathological spontaneous nystagmus and pathological gaze nystagmus was higher in the central vertigo group than that in the peripheral vertigo group (χ2=5.674, 16.458, P<0.05). The occurrence rate of positional nystagmus was higher in peripheral vertigo group than that in central vertigo group (χ2=48.896, P<0.001). The abnormal rate of scanning test, stable visual tracking test, visual movement single speed and sinusoidal test, and static balance posture test were higher in the central vertigo group than those in the peripheral vertigo group (χ2=137.169, 166.972, 150.877, 150.877, 27.273, P<0.001), while the abnormal rate of rotating chair sudden stop test was higher in the central vertigo group than that in the peripheral vertigo group (χ2=51.000, P<0.001). The abnormal results were mainly scanned underflush and slow scan in central vertigo group (χ2=103.846, 4.296, P<0.05), stable visual tracking curve (χ2=147.389, 4.296, P<0.05) in type III-IV, and the gain of nystagmus decreased unilaterally and bilaterally (χ2=47.531, 44.477, 52.529, 53.255, P<0.001). Anomalies of proprioception in reverse and vertical nystagmus and static balance posture were induced by rotating chair sudden stop test (χ2=11.847, 23.778, P<0.001), while peripheral vertigo group showed unilateral decrease of nystagmus gain induced by rotating chair sudden stop test.(χ2=79.771, P<0.001). Conclusion The patients with peripheral vertigo have obvious body position spontaneous vestibular response and vestibular oculomotor system dysfunction, while the patients with central vertigo mainly have visual and oculomotor system dysfunction, and may be accompanied by vestibular oculomotor system and vestibular spinal reflex dysfunction. Key words: Vertigo; Videonystagmography; Static equilibrium posture