Abstract
The increased visual dependence noted in some vestibular patients may be secondary to their vertigo. We examine whether a single, brief vertigo attack, such as in benign paroxysmal positional vertigo (BPPV), modifies visual dependency. Visual dependency was measured before and after the Hallpike manoeuvre with (a) the Rod and Frame and the Rod and Disc techniques whilst seated and (b) the postural sway induced by visual roll-motion stimulation. Three subject groups were studied: 20 patients with BPPV (history and positive Hallpike manoeuvre; PosH group), 20 control patients (history of BPPV but negative Hallpike manoeuvre; NegH group) and 20 normal controls. Our findings show that while both patient groups showed enhanced visual dependency, the PosH and the normal control group decreased visual dependency on repetition of the visual tasks after the Hallpike manoeuvre. NegH patients differed from PosH patients in that their high visual dependency did not diminish on repetition of the visual stimuli; they scored higher on the situational characteristic questionnaire (‘visual vertigo’ symptoms) and showed higher incidence of migraine. We conclude that long term vestibular symptoms increase visual dependence but a single BPPV attack does not increase it further. Repetitive visual motion stimulation induces adaptation in visual dependence in peripheral vestibular disorders such as BPPV. A positional form of vestibular migraine may underlie the symptoms of some patients with a history of BPPV but negative Hallpike manoeuvre. The finding that they have non adaptable increased visual dependency may explain visuo-vestibular symptoms in this group and, perhaps more widely, in patients with migraine.
References
Bronstein AM, Golding JF, Gresty MA, Mandala M, Nuti D, Shetye A, Silove Y (2010) The social impact of dizziness in London and Siena. J Neurol 257:183–190
Brandt T, Huppert T, Hüfner K, Zingler VC, Dieterich M, Strupp M (2010) Long-term course and relapses of vestibular and balance disorders. Restor Neurol Neurosci 28:69–82
Ferreira LS, Pereira CB, Rossini S, Kanashiro AM, Adda CC, Scaff M (2010) Psychological assessment in patients with phobic postural vertigo. Arq Neuropsiquiatr 68:224–227
Faralli M, Ricci G, Ibba MC, Crognoletti M, Longari F, Frenguelli A (2009) Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress? J Otolaryngol Head Neck Surg 38:375–380
Shupak A, Issa A, Golz A, Kaminer M, Braverman I (2008) Prednisone treatment for vestibular neuritis. Otol Neurotol 29:368–374
Palla A, Straumann D, Bronstein AM (2008) Vestibular neuritis: vertigo and the high-acceleration vestibulo-ocular reflex. J Neurol 255:1479–1482
Jacob RG, Redfern MS, Furman JM (2009) Space and motion discomfort and abnormal balance control in patients with anxiety disorders. J Neurol Neurosurg Psychiatry 80:74–78
Bronstein AM (2004) Vision and vertigo: some visual aspects of vestibular disorders. J Neurol 251:381–387
Longridge NS, Mallinson AI (2005) Visual vestibular mismatch in work-related vestibular injury. Otol Neurotol 26:691–694
Bisdorff A, von Brevern M, Lempert T, Newman-Toker DE (2009) Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res 19:1–13
Witkin HA, Asch SE (1948) Studies in space orientation: further experiments on perception of the upright with displaced visual fields. J Exp Psychol 38:762–782
Witkin HA (1959) The perception of the upright. Sci Am 200:51–56
Guerraz M, Yardley L, Bertholon P, Pollak L, Rudge P, Gresty MA, Bronstein AM (2001) Visual vertigo: symptom assessment, spatial orientation and postural control. Brain 124:1646–1656
Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116:424–427
Yardley L, Masson E, Verschuur C, Haacke N, Luxon L (1992) Symptoms, anxiety and handicap in dizzy patients: development of the Vertigo Symptom Scale. J Psychosom Res 36:731–741
Golding JF (2006) Predicting individual differences in motion sickness susceptibility by questionnaire. Pers Individ Differ 41:237–248
Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders, 2nd edn. Cephalalgia 24:1–160
Stovner LJ, Andree C (2010) Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain 11:289–299
Furman JM, Jacob RG (2001) A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J Anxiety Disord 15:9–26
Staab JP, Ruckenstein MJ (2009) Chronic subjective dizziness. Otolaryngol Clin North Am 42:71–77
Best C, Tschan R, Eckhardt-Henn A, Dieterich M (2009) Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience 164:1579–1587
Bronstein AM (1995) Visual vertigo syndrome: clinical and posturography findings. J Neurol Neurosurg Psychiatry 59:472–476
Fetsch CR, Turner AH, DeAngelis GC, Angelaki DE (2009) Dynamic reweighting of visual and vestibular cues during self-motion perception. J Neurosci 29:12–1560
Hafstrom A, Fransson PA, Karlberg M, Magnusson M (2004) Ipsilesional visual field dependency for patients with vestibular schwannoma. Neuroreport 15:2201–2204
Bronstein AM (1986) Suppression of visually evoked postural responses. Exp Brain Res 63:655–658
Dobie TG, May JG, Fischer WD, Elder ST, Kubitz KA (1987) A comparison of two methods of training resistance to visually-induced motion sickness. Aviat Space Environ Med 59:A34–A41
Pavlou M, Quinn C, Murray K, Spyridakou C, Faldon M, Bronstein AM (2011) The effect of repeated visual motion stimuli on visual dependence and postural control in normal subjects. Gait Posture 33:113–118
Mast FW, Berthoz A, Kosslyn SM (2001) Mental imagery of visual motion modifies the perception of roll-vection stimulation. Perception 30(8):945–957
Querner V, Krafczyk S, Dieterich M, Brandt T (2002) Phobic postural vertigo. Body sway during visually induced roll vection. Exp Brain Res 143:269–275
Guerraz M, Bronstein AM (2008) Mechanisms underlying visually induced body sway. Neurosci Lett 443:12–16
Vitte E, Sémont A, Berthoz A (1994) Repeated optokinetic stimulation in conditions of active standing facilitates recovery from vestibular deficits. Exp Brain Res 102:141–148
Pavlou M, Lingeswaran A, Davies RA, Gresty MA, Bronstein AM (2004) Simulator based rehabilitation in refractory dizziness. J Neurol 251:983–995
Polensek SH, Tusa RJ (2010) Nystagmus during attacks of vestibular migraine: an aid in diagnosis. Audiol Neurotol 15:241–246
von Brevern M, Radtke A, Clarke AH, Lempert T (2004) Migrainous vertigo presenting as episodic positional vertigo. Neurology 62:469–472
Neuhauser HK, Lempert T (2005) Diagnostic criteria for migrainous vertigo. Acta Otolaryngol 125:1247–1248
Bergin PS, Bronstein AM, Murray NM, Sancovic S, Zeppenfeld DK (1995) Body sway and vibration perception thresholds in normal aging and in patients with polyneuropathy. J Neurol Neurosurg Psychiatry 58:335–340
Seemungal BM, Gunaratne IA, Fleming IO, Gresty MA, Bronstein AM (2004) Perceptual and nystagmic thresholds of vestibular function in yaw. J Vestib Res 14:461–466
Bronstein AM, Yardley L, Moore AP, Cleeves L (1996) Visually and posturally mediated tilt illusion in Parkinson’s disease and in labyrinthine defective subjects. Neurology 47:651–656
Peterka RJ, Benolken MS (1995) Role of somatosensory and vestibular cues in attenuating visually induced human postural sway. Exp Brain Res 105:101–110
Black FO, Nashner LM (1984) Postural disturbance in patients with benign paroxysmal positional nystagmus. Ann Otol Rhinol Laryngol 93:595–599
Balatsouras DG, Korres SG (2011) Subjective Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg (epub ahead of print)
Haynes DS, Resser JR, Labadie RF, Girasole CR, LE Scheker, Walker DC, Kovach BT (2002) Treatment of benign positional vertigo using the Semont maneuver: efficacy in patients presenting without nystagmus. Laryngoscope 112:796–801
Büki B, Simon L, Garab S, Lundberg YW, Jünger H, Straumann D (2011) Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus. J Neurol Neurosurg Psychiatry 82:98–104
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Agarwal, K., Bronstein, A.M., Faldon, M.E. et al. Visual dependence and BPPV. J Neurol 259, 1117–1124 (2012). https://doi.org/10.1007/s00415-011-6311-7
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DOI: https://doi.org/10.1007/s00415-011-6311-7