Quantitative vestibular function tests in posterior circulation stroke patients: A review.

Area of Science:

• Neurology
• Otolaryngology
• Neuroscience

Background:

• Bedside examinations are sensitive for identifying stroke in acute vestibular syndrome (AVS) patients.
• Diagnosing central vestibular dysfunction can be challenging for less experienced clinicians.
• Quantitative vestibular function testing offers objective measures to assess vestibular loss due to stroke.

Purpose of the Study:

• To provide a comprehensive overview of quantitative vestibular function test findings in stroke patients.
• To highlight the utility of tests like video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), and videonystagmography (VNG) in diagnosing central vestibular dysfunction.

Main Methods:

• Review of quantitative vestibular function test findings in stroke patients.
• Analysis of video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potentials (cVEMPs, oVEMPs), videonystagmography (VNG), and caloric testing results.
• Correlation of test findings with specific stroke locations (e.g., PICA, AICA, brainstem, cerebellum).

Main Results:

• Vestibulo-ocular reflex (VOR) gain is typically normal in posterior inferior cerebellar artery (PICA) strokes but variable in anterior inferior cerebellar artery (AICA) strokes.
• AICA and PICA strokes can impair cVEMPs, oVEMPs, and VNG (smooth pursuit, saccade functions).
• Strokes involving the vestibular nucleus, brainstem, or cerebellum can cause abnormalities in smooth pursuit, saccade, or caloric testing.

Conclusions:

• Combined evaluation of VNG, vHIT, and VEMPs accurately complements bedside vestibular assessments for diagnosing central vestibular dysfunction.
• Quantitative tests are crucial for quantifying vestibular loss and aiding differential diagnosis in stroke patients with vestibular symptoms.
• Future research should investigate vestibular dysfunction prevalence in recovering stroke patients.