Differences in Vestibulo-Ocular Reflex Time Constants in Patients With Vestibular Migraine versus Vestibular Neuritis/Labyrinthitis

OBJECTIVE: Recurrent dizziness, vertigo, and imbalance, as well as nausea or vomiting, can be induced by central or peripheral vestibular pathology. Vestibular migraine (VM) is a central pathology in which migraines reciprocally interact with vestibular nuclei. Vestibular neuritis and labyrinthitis (VN/L) are peripheral diseases involving inflammation of structures in the vestibular nerve or labyrinth. Because VM and VN/L in early stages can produce similar symptoms, diagnosis may require prolonged clinical evaluation. It has been suggested that differences in a patient\u27s Vestibulo-Ocular Reflex (VOR) measured during the rotary chair step rotation test (RCS Test) can differentiate VM from peripheral pathologies, allowing for faster diagnosis. We sought to compare VOR time constants (VORTs) in patients with VM versus VN/L, with the goal of exploring potential diagnostic value. STUDY DESIGN: Retrospective chart review of patients seen at a hospital balance center between January 2010 and June 2019. SETTING: Tertiary referral center. PATIENTS: 68 patients (mean age = 58.15, 65 % female, 35 % male) were placed into two groups based on clinical diagnosis codes: 1) VM or 2) VN/L. MAIN OUTCOME MEASURE(S): Primary variable of VORT, evoked by rotational step testing. RESULTS: Patients in the VM group demonstrated statistically significant elevated VOR Ts outside the normed range of 10-19.5 compared to those in the VN/L group (p = 0.0003) while patients in the VN/L group demonstrated statistically significant shortened VOR Ts (p = 0.0443) with the two populations having distinctly different VOR T profiles. CONCLUSIONS: Our results support the conclusion that elevated VOR Ts are a sign of central vestibular pathology and highlight the benefit of utilizing rotary chair testing early in the diagnostic process as a powerful diagnostic tool when evaluating dizzy patients for central versus peripheral vestibular dysfunction. Our results suggest more particularly that elevated VOR Ts can be utilized to identify patients with vestibular migraine, thus offering differentiation from patients with peripheral vestibular dysfunction earlier in the process of diagnosis, with an opportunity for earlier intervention

Twentieth Symposium on COVID-19: COVID-19 as of July 14, 2022: What Have We Learned? How Can We Use What We Have Learned?

Opening Remarks and Moderator: Edward C. Halperin, M.D., M.A. Chancellor/CEO, New York Medical College, Professor of Radiation Oncology, Pediatrics, and History, Provost for Biomedical Affairs, Touro University, The Miriam Popack Chair in Biomedical Ethics After the Holocaust How Does COVID-19 Infection Affect the Eye? (About 10% of Infected Individuals Have Eye Symptoms.) Sankara Mahesh, M.D., FRCS Program Director, Ophthalmology, Westchester Medical Center, Advanced Eye Specialty Services, Associate Professor of Ophthalmology, New York Medical College How Does COVID-19 Infection and Vaccination Affect Hearing? Katrina R. Stidham, M.D. Director, Balance Center, Cochlear Implant Center, Maria Fareri Children\u27s Hospital, Westchester Medical Center, Associate Professor of Otolaryngology, New York Medical College Monkeypox: What is It? What Causes It? How Do We Manage It? Should I Be Worried About It? David Revelli, Ph.D. Research Scientist, Lovelace Biomedical Research Institute With the Evolving Data Coming In, Which of My Children Need the Vaccine and/or Booster Shots Now? Tami Hendriksz, DO, FACOP, FAAP Dean and Chief Academic Officer, Professor of Pediatrics, Touro University California College of Osteopathic Medicine Am I Just Sick and Tired of This Pandemic and the News on Television or Am I Depressed? I Don\u27t Feel Like Going Back to the Office or to Shows or Weddings Like I Used to. Ronnie Swift, M.D. Professor and Associate Chairman of Psychiatry and Behavioral Health, New York Medical College, Chief of Psychiatry, Metropolitan Hospital and Medical Center Q & A Hosted by: Edward C. Halperin, M.D., M.A. Chancellor/CEO, New York Medical College, Professor of Radiation Oncology, Pediatrics, and History, Provost for Biomedical Affairs, Touro University, The Miriam Popack Chair in Biomedical Ethics After the Holocaus