Vestibulo-ocular reflex suppression: A practical guide for neurologists

Area of Science:

• Neurology
• Ophthalmology
• Vestibular Science

Background:

• Dizziness is a common complaint often caused by vestibular disorders.
• Head impulse test (HIT) is widely used, but vestibulo-ocular reflex suppression (VORS) testing offers complementary diagnostic information.
• VORS assessment can differentiate central from peripheral vestibular lesions.

Purpose of the Study:

• To review the pathophysiology, clinical utility, and etiological aspects of VORS testing.
• To highlight VORS as an underutilized bedside tool for vestibular disorder diagnosis.
• To discuss the role of VORS in differentiating central and peripheral vestibular disorders and in parkinsonism.

Main Methods:

• Review of existing literature on VORS testing.
• Discussion of VORS assessment techniques, including modern visual-interactive smartphone-based methods.
• Analysis of VORS impairment in relation to central lesions and specific conditions like Multiple System Atrophy.

Main Results:

• Impaired VORS indicates central lesions, often in the flocculonodular cerebellum, and is absent in bilateral vestibulopathies.
• VORS testing shows high sensitivity and specificity (89%) in distinguishing Multiple System Atrophy from other parkinsonian syndromes.
• VORS assessment, when integrated into a global oculomotor examination, provides valuable diagnostic clues.

Conclusions:

• VORS testing is an underutilized yet crucial bedside tool for diagnosing dizziness and vestibular disorders.
• VORS impairment is a key indicator of central vestibular dysfunction.
• Integrating VORS into clinical evaluation enhances diagnostic accuracy for vestibular and parkinsonian syndromes.