{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:25:30Z","timestamp":1792041930595,"version":"4.4.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Isolated (hemi)nodular strokes as underlying cause of acute dizziness are rare, thus there are still gaps of knowledge in the clinical presentation of affected patients. Clinical and experimental evidence has suggested that lesions involving the nodulus lead to various vestibulo-ocular deficits including prolonged velocity-storage, periodic-alternating nystagmus, positional nystagmus, abolished suppression of post-rotatory nystagmus by head-tilt and impaired verticality perception. At the bedside, the angular vestibulo-ocular reflex (aVOR), as assessed by the horizontal head-impulse test (HIT), has been reported to be normal, however quantitative assessments of all six semicircular canals are lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The primary aim of this case series was to characterize the spectrum of clinical presentations in isolated (hemi)nodular strokes. Furthermore, based on preliminary observations, we hypothesized that the aVOR is within normal limits in isolated nodular strokes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively included patients with isolated (hemi)nodular stroke on diffusion-weighted MR-imaging from a prospective stroke-registry. All patients received a standardized bedside neuro-otological assessment and quantitative, video-based HIT (vHIT) of all six semicircular canals. Overall ratings of vHIT (normal vs. abnormal function) were performed independently by two reviewers and disagreements were resolved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between January 2015 and December 2021 six patients with isolated nodular (<jats:italic>n<\/jats:italic> = 1) or heminodular (<jats:italic>n<\/jats:italic> = 5) ischemic stroke were included. Clinical presentation met diagnostic criteria for acute vestibular syndrome (AVS) in 5\/6 patients and for episodic vestibular syndrome (EVS) in 1\/6 patients. Ocular motor abnormalities observed included the presence of spontaneous horizontal nystagmus (<jats:italic>n<\/jats:italic> = 2), positional nystagmus (5\/6), head-shaking nystagmus (3\/6), skew deviation (<jats:italic>n<\/jats:italic> = 1), and moderate or severe truncal ataxia (5\/6). Bedside HIT was normal in all patients and no gaze-evoked or periodic alternating nystagmus was observed. aVOR-gains were within normal range in all patients and overall aVOR-function as assessed by vHIT was rated as normal in all six patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using quantitative, video-based testing of the horizontal and vertical aVOR, preserved integrity of the aVOR in (hemi)nodular strokes was confirmed, extending preliminary findings at the bedside. Furthermore, widespread deficits of both ocular stability, postural control and volitional eye movements were observed in our study cohort, being consistent with findings reported in previous studies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1124217","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T04:44:22Z","timestamp":1675658662000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Video head impulse testing in patients with isolated (hemi)nodular infarction"],"prefix":"10.3389","volume":"14","author":[{"given":"Seung-Han","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Myung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Tae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Andrea","family":"Tarnutzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"886284","DOI":"10.3389\/fnsys.2022.886284","article-title":"The otolith vermis: a systems neuroscience theory of the Nodulus and Uvula","volume":"16","author":"Laurens","year":"2022","journal-title":"Front Syst Neurosci."},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780199969289.001.0001","volume-title":"The Neurology of Eye Movements","author":"Leigh","year":"2015"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1152\/jn.1995.73.5.1729","article-title":"Inertial representation of angular motion in the vestibular system of rhesus monkeys. II Otolith-controlled transformation that depends on an intact cerebellar nodulus","volume":"73","author":"Angelaki","year":"1995","journal-title":"J Neurophysiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1126\/science.3871968","article-title":"Dynamic modification of the vestibulo-ocular reflex by the nodulus and uvula","volume":"228","author":"Waespe","year":"1985","journal-title":"Science."},{"key":"B5","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1212\/WNL.52.2.417","article-title":"Abolished tilt suppression of the vestibulo-ocular reflex caused by a selective uvulo-nodular lesion","volume":"52","author":"Wiest","year":"1999","journal-title":"Neurology."},{"key":"B6","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1212\/01.wnl.0000257111.24769.d2","article-title":"Periodic alternating nystagmus in isolated nodular infarction","volume":"68","author":"Jeong","year":"2007","journal-title":"Neurology."},{"key":"B7","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1161\/STROKEAHA.108.527762","article-title":"Isolated nodular infarction","volume":"40","author":"Moon","year":"2009","journal-title":"Stroke."},{"key":"B8","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1111\/j.1749-6632.1999.tb09178.x","article-title":"Control of spatial orientation of the angular vestibulo-ocular reflex by the nodulus and uvula of the vestibulocerebellum","volume":"871","author":"Sheliga","year":"1999","journal-title":"Ann N Y Acad Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1111\/j.1749-6632.2002.tb07553.x","article-title":"The nodulus and uvula: source of cerebellar control of spatial orientation of the angular vestibulo-ocular reflex","volume":"978","author":"Cohen","year":"2002","journal-title":"Ann N Y Acad Sci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1002\/ana.24329","article-title":"The cerebellar nodulus: perceptual and ocular processing of graviceptive input","volume":"77","author":"Tarnutzer","year":"2015","journal-title":"Ann Neurol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1136\/jnnp.53.9.731","article-title":"Infarction in the territory of the medial branch of the posterior inferior cerebellar artery","volume":"53","author":"Amarenco","year":"1990","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B12","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jns.2004.03.022","article-title":"A case of isolated nodulus infarction presenting as a vestibular neuritis","volume":"221","author":"Lee","year":"2004","journal-title":"J Neurol Sci."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1212\/01.wnl.0000238500.02302.b4","article-title":"Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns","volume":"67","author":"Lee","year":"2006","journal-title":"Neurology."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3504","DOI":"10.1161\/STROKEAHA.109.551234","article-title":"HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging","volume":"40","author":"Kattah","year":"2009","journal-title":"Stroke."},{"key":"B15","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1111\/acem.12223","article-title":"HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness","volume":"20","author":"Newman-Toker","year":"2013","journal-title":"Acad Emerg Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"120451","DOI":"10.1016\/j.jns.2022.120451","article-title":"Diagnosing and localizing the acute vestibular syndrome - Beyond the HINTS exam","volume":"442","author":"Fracica","year":"2022","journal-title":"J Neurol Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1212\/WNL.0000000000005206","article-title":"Recent advances in head impulse test findings in central vestibular disorders","volume":"90","author":"Choi","year":"2018","journal-title":"Neurology."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1212\/WNL.0000000000000906","article-title":"Head impulse gain and saccade analysis in pontine-cerebellar stroke and vestibular neuritis","volume":"83","author":"Chen","year":"2014","journal-title":"Neurology."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1007\/s00415-013-6837-y","article-title":"Isolated floccular infarction: impaired vestibular responses to horizontal head impulse","volume":"260","author":"Park","year":"2013","journal-title":"J Neurol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1007\/s12311-017-0878-1","article-title":"The floccular syndrome: dynamic changes in eye movements and vestibulo-ocular reflex in isolated infarction of the cerebellar flocculus","volume":"17","author":"Yacovino","year":"2018","journal-title":"Cerebellum."},{"key":"B21","doi-asserted-by":"publisher","first-page":"141","DOI":"10.3389\/fneur.2018.00141","article-title":"Vestibular dysfunction in Wernicke's encephalopathy: predominant impairment of the horizontal semicircular canals","volume":"9","author":"Lee","year":"2018","journal-title":"Front Neurol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e61488","DOI":"10.1371\/journal.pone.0061488","article-title":"The video Head Impulse Test (vHIT) detects vertical semicircular canal dysfunction","volume":"8","author":"Macdougall","year":"2013","journal-title":"PLoS ONE."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.1016\/j.jocn.2014.01.024","article-title":"Compensatory saccade differences between outward versus inward head impulses in chronic unilateral vestibular hypofunction","volume":"21","author":"Lee","year":"2014","journal-title":"J Clin Neurosci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"154","DOI":"10.3389\/fneur.2015.00154","article-title":"The Video Head Impulse Test (vHIT) of semicircular canal function - age-dependent normative values of VOR gain in healthy subjects","volume":"6","author":"Mcgarvie","year":"2015","journal-title":"Front Neurol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2791","DOI":"10.1016\/j.clinph.2016.05.005","article-title":"Disease-specific sparing of the anterior semicircular canals in bilateral vestibulopathy","volume":"127","author":"Tarnutzer","year":"2016","journal-title":"Clin Neurophysiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"205","DOI":"10.3233\/VES-210169","article-title":"Vascular vertigo and dizziness: diagnostic criteria","volume":"32","author":"Kim","year":"2022","journal-title":"J Vestib Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"125","DOI":"10.3389\/fneur.2016.00125","article-title":"The Diagnostic accuracy of truncal ataxia and HINTS as cardinal signs for acute vestibular syndrome","volume":"7","author":"Carmona","year":"2016","journal-title":"Front Neurol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"120374","DOI":"10.1016\/j.jns.2022.120374","article-title":"Role of incubitus truncal ataxia, and equivalent standing grade 3 ataxia in the diagnosis of central acute vestibular syndrome","volume":"441","author":"Kattah","year":"2022","journal-title":"J Neurol Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1093\/brain\/awx381","article-title":"Characteristics and mechanism of apogeotropic central positional nystagmus","volume":"141","author":"Choi","year":"2018","journal-title":"Brain."},{"key":"B30","doi-asserted-by":"publisher","first-page":"120440","DOI":"10.1016\/j.jns.2022.120440","article-title":"Less talked variants of benign paroxysmal positional vertigo","volume":"442","author":"Kim","year":"2022","journal-title":"J Neurol Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1007\/s00415-021-10852-8","article-title":"Central positional nystagmus: an update","volume":"269","author":"Lemos","year":"2022","journal-title":"J Neurol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1113\/jphysiol.2013.259614","article-title":"Diversity of vestibular nuclei neurons targeted by cerebellar nodulus inhibition","volume":"592","author":"Meng","year":"2014","journal-title":"J Physiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/BF00232438","article-title":"Stimulation of the nodulus and uvula discharges velocity storage in the vestibulo-ocular reflex","volume":"102","author":"Solomon","year":"1994","journal-title":"Exp Brain Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e13981","DOI":"10.1371\/journal.pone.0013981","article-title":"The cerebellar nodulus\/uvula integrates otolith signals for the translational vestibulo-ocular reflex","volume":"5","author":"Walker","year":"2010","journal-title":"PLoS ONE."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1124217\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T04:44:25Z","timestamp":1675658665000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1124217\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,6]]},"references-count":34,"alternative-id":["10.3389\/fneur.2023.1124217"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1124217","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,6]]},"article-number":"1124217"}}