Vesticam assisting in diagnosis of the dizzy patients

Aim

Improve the accuracy of assessment of dizzy patients presenting to the Emergency Department, in doing so we have been able to prevent unnecessary imaging and admissions.

Outcomes

Already we have had patients that we have been able to correctly identify with nystagmus that would not have been seen without use of the vesticam goggles. This has further improved HINTS exam (Head Impulse, Nystagmus, and Test of Skew,) reducing the need for imaging of brain and cavum septum pellucidum (csp) for some dizzy patients.

Background

Emergency Department staff can correctly identify nystagmus that would not have been seen without use of the vesticam goggles. The ability to remove fixation and replay assessment of ocular movements has greatly improved the confidence and accuracy in determining peripheral versus central causes of vertigo.

Lessons Learnt

Technology has been able to assist improving sensitivity of a clinical exam.

References

Baba S, Fukumoto A, Aoyagi M, Koizumi Y, Ikezono T, Yagi T. (2004). A Comparative Study on the Observation of Spontaneous Nystagmus with Frenzel Glasses and an Infrared CCD Camera. Journal of Nippon Medical School. 71 (1): 25-29.

Newman-Toker DE1, Saber Tehrani AS, Mantokoudis G, Pula JH, Guede CI, Kerber KA, Blitz A, Ying SH, Hsieh YH, Rothman RE, Hanley DF, Zee DS, Kattah JC. "Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness: toward an ECG for the eyes." Stroke. 2013 Apr;44(4):1158-61. doi: 10.1161/STROKEAHA.111.000033. Epub 2013 Mar 5.

Jonathan A. Edlow, MD, Kiersten L. Gurley, MD, and David E. Newman-Toker, MD, PHD. "A new diagnostic approach to the adult patient with acute dizziness" J Emerg Med. 2018 Apr; 54(4): 469-483.