Video ENG Report
Test ID:XXXTest Operator: XXX
Test Date:01/12/2009Interpretation Date:01/20/2009
Patient Name:XXXInterpreted By:Alyn L. Benezette, DO
Patient Age:62
Gender:Male
VIDEONYSTAGMOGRAPHY
Tracking / Smooth Pursuit, Saccade, Optokinetic, Gaze Testing, Spontaneous Nystagmus, Torsion Swing, Active Head Rotation, Positional Tests, Dix / Hallpike Tests, Caloric Results testing were performed with vertical as well as horizontal recordings.
OCULOMOTOR STUDIES
Tracking / Smooth Pursuit:
For a patient of this age, common normative values for gain range from 65 – 145%. This patient elicited 52%gain and 23phase. There is a significant reduction in gain during tracking. There is also saccadic intrusion during smooth pursuit secondary to glissades. This is an abnormal finding.
Saccades:
For a patient of this age, normative peak velocity is greater than or equal to 230 deg/sec and latency less than or equal to .360 seconds. This patient elicited 390 deg/sec velocity and 0.283 second latency. There are normal velocities and latencies for fixed saccades.
Optokinetic:
Normative values for optokinetic nystagmus studies are greater than or equal to 6 deg/sec to each side with a symmetrical difference of greater than or equal to 30%. This patient elicited 9L deg/sec rightward and 9R deg/sec leftward. Optokinetic nystagmusis normal and symmetrical bilaterally.
Gaze Testing:
The study is normal.
Spontaneous Nystagmus:
Normal values for horizontal slow component velocity are 0 – 3 deg/sec. This patient elicited 8R deg/sec horizontal slow component velocity and 5D deg/sec vertical slow component velocity on spontaneous gaze. The patient elicited 1L deg/sec horizontally and 0 deg/sec vertically on spontaneous nystagmus with fixation. Right beating torsional nystagmus is seen during spontaneous nystagmus. No spontaneous nystagmus is seen with fixation.
Torsion Swing:
Torsion swingadequately suppresseswith fixation.
ACTIVE HEAD ROTATION
Active head rotation was performed at head speeds of 0 – 1 Hz. for both the vertical and horizontal vestibulo-ocular reflex (VOR). Normative values are 80-120% for horizontal velocity gain, 70-130% for vertical velocity gain, within +/- 10% for horizontal and vertical gain asymmetry, and 160-210 degrees for horizontal and vertical velocity phase. The patient elicited 100% velocity gain on horizontal active head rotation. The patient elicited between 100 and 80% velocity gain on vertical active head rotation. The patient elicited between 0 and 10% gain asymmetry on horizontal active head rotation.
ACTIVE HEAD ROTATION: Continued
The patient elicited between 5 and -35% gain asymmetry on vertical active head rotation. The patient elicited between 180 and 225 degrees of velocity phase on horizontal active head rotation. The patient elicited between 190 and 225 degrees of velocity phase on vertical active head rotation. These findings are abnormal.
POSITIONAL TESTS
Normative values for positional tests are 0 – 3 deg/sec horizontal slow component velocity for all positions. The patient elicited the following values for positional tests:
Supine, Head C / Supine, Head L / Supine, Head R / Supine, Body L / Supine, Body R2L / 1L/4U / 1L/1U / 6U / 0
Significant vertical nystagmus is seen during Supine, Head and Body Left positioning. This is an abnormal finding.
DIX / HALLPIKE TEST
Normative values for Dix-Hallpike tests are less than or equal to 3 deg/sec slow component velocity both horizontally and vertically. The patient elicited 1Ldeg/sec horizontally and 7Udeg/sec vertically on leftward testing. The patient elicited 1R deg/sec horizontally and 6U deg/sec vertically on rightward testing. Significant vertical nystagmus is seen during Hallpike Left greater than Right positioning. This is an abnormal finding.
CALORIC RESULTS
Normative values for caloric testing are a combined slow component velocity from all 4 tests (cool right, cool left, warm right, warm left) of greater than or equal to 20 deg/sec with a unilateral weakness of less than or equal to 25%. The patient elicited the following results for caloric tests:
Warm Left / Warm Right / Cool Left / Cool Right10L / 2L / 9L / 11L
There is significant bilateral weakness in the right greater than left earsto warm and cool air irrigation.
IMPRESSION
Peripheral
These results indicate significant bilateral peripheral vestibular lesions involving the right greater than left lateral semicircular canals or their afferent pathways based on the weakness seen in the right greater than left ears to warm and cool air irrigationduring bithermal caloric testing.
Central
These results indicate a significant central vestibular dysfunction based on the abnormalities seen during oculomotor and positional testing.
RECOMMENDATIONS
Balance rehabilitation is indicated, including log roll canalith repositioning maneuvers targeting the left and right lateral semicircular canals. Tracking exercises are indicated targeting the abnormalities seen during oculomotor testing. An MRI of the brain with and without contrastmay be indicatedto further assess the central nervous systembased on the abnormalities seen during this study. Clinical correlation is recommended.
This is to certify that the VNG report, performed on 01/12/2009, submitted by XXXfor XXX, was read by Alyn Benezette, DO on 01/20/2009.
Interpreter Signature
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