Video-Oculography in the Emergency Department: An “ECG” for the Eyes in the Acute Vestibular Syndrome

Dizziness and vertigo are among the most common symptoms evaluated in the emergency department (ED). Patients with the acute vestibular syndrome often have vestibular neuritis, but some have dangerous posterior circulation strokes. Rapid eye movement–based diagnosis by experts is possible using the “HINTS” exam (Head Impulse test of vestibular reflexes, assessment of Nystagmus direction in different fields of gaze, and measuring Skew deviation by alternate cover testing). Unfortunately, knowledge of bedside techniques among ED providers is limited, and misdiagnosis is frequent. Commercially available, portable video-oculography (VOG) systems can now be used to instantaneously assess eye and head movements in ED patients with acute dizziness and vertigo. This noninvasive approach can bring expertise to the bedside by quantitatively measuring the HINTS parameters. When coupled with remote access to specialists via telemedicine or computer-based decision support, such VOG testing has the potential to transform diagnosis of acute dizziness and vertigo in the way electrocardiography transformed diagnosis of chest pain—making accurate, timely, and efficient ED diagnosis routinely possible.