Vestibulum
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Module

References & Acknowledgements

Due credit to the primary sources from which Vestibulum's content was synthesized.

Primary textbook

McCaslin, D. L. (Ed.). Electronystagmography/Videonystagmography (ENG/VNG). Plural Publishing.

The primary source for the neuroanatomy, oculomotor systems, bedside examination, and VNG/ENG interpretation modules. Content has been synthesized and reorganized for interactive presentation; readers seeking depth, full waveform examples, and the technical underpinnings of recording montages should consult the original text.

Supporting peer-reviewed literature

For each topic, the most authoritative consensus criteria, clinical practice guidelines, and validation studies are listed. References use APA-style formatting; DOIs are provided where available and resolve to the canonical source.

HINTS / acute vestibular syndrome

  1. []Kattah, J. C., Talkad, A. V., Wang, D. Z., Hsieh, Y.-H., & Newman-Toker, D. E. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke, 40(11), 3504–3510. https://doi.org/10.1161/STROKEAHA.109.551234
  2. []Newman-Toker, D. E., Curthoys, I. S., & Halmagyi, G. M. (2015). Diagnosing stroke in acute vertigo: the HINTS family of eye movement tests and the future of the 'eye ECG.' Seminars in Neurology, 35(5), 506–521. https://doi.org/10.1055/s-0035-1564298
  3. []Edlow, J. A., Carpenter, C., Akhter, M., Khoujah, D., et al. (GRACE-3 / SAEM Guidelines committee) (2023). Guidelines for reasonable and appropriate care in the emergency department (GRACE-3): acute dizziness and vertigo. Academic Emergency Medicine, 30(5), 442–486. https://doi.org/10.1111/acem.14728

BPPV — diagnosis & management

  1. []Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., et al. (2017). Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3 Suppl), S1–S47. https://doi.org/10.1177/0194599816689667
  2. []von Brevern, M., Bertholon, P., Brandt, T., et al. (2015). Benign paroxysmal positional vertigo: diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research, 25(3–4), 105–117. https://doi.org/10.3233/VES-150553
  3. []Balatsouras, D. G., & Korres, S. G. (2011). Subjective benign paroxysmal positional vertigo. Otolaryngology–Head and Neck Surgery, 145(1), 98–103. https://doi.org/10.1177/0194599811402247
  4. []Anagnostou, E., Kouzi, I., & Spengos, K. (2015). Diagnosis and treatment of anterior-canal benign paroxysmal positional vertigo: a systematic review. Journal of Clinical Neurology, 11(3), 262–267. https://doi.org/10.3988/jcn.2015.11.3.262

Ménière's disease

  1. []Lopez-Escamez, J. A., Carey, J., Chung, W. H., et al. (AAO-HNS / Bárány Society / EAONO / JSER) (2015). Diagnostic criteria for Menière's disease. Journal of Vestibular Research, 25(1), 1–7. https://doi.org/10.3233/VES-150549
  2. []Basura, G. J., Adams, M. E., Monfared, A., et al. (2020). Clinical practice guideline: Ménière's disease. Otolaryngology–Head and Neck Surgery, 162(2 Suppl), S1–S55. https://doi.org/10.1177/0194599820909438

Vestibular migraine

  1. []Lempert, T., Olesen, J., Furman, J., et al. (Bárány Society & International Headache Society) (2012). Vestibular migraine: diagnostic criteria. Journal of Vestibular Research, 22(4), 167–172. https://doi.org/10.3233/VES-2012-0453
  2. []Lempert, T., Olesen, J., Furman, J., et al. (2022). Vestibular migraine: diagnostic criteria (update). Journal of Vestibular Research, 32(1), 1–6. https://doi.org/10.3233/VES-201644

Persistent postural-perceptual dizziness (PPPD)

  1. []Staab, J. P., Eckhardt-Henn, A., Horii, A., et al. (2017). Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research, 27(4), 191–208. https://doi.org/10.3233/VES-170622

Vestibular neuritis & acute unilateral vestibulopathy

  1. []Strupp, M., Bisdorff, A., Furman, J., et al. (2022). Acute unilateral vestibulopathy/vestibular neuritis: diagnostic criteria. Journal of Vestibular Research, 32(5), 389–406. https://doi.org/10.3233/VES-220201

Superior semicircular canal dehiscence (SSCD)

  1. []Minor, L. B., Solomon, D., Zinreich, J. S., & Zee, D. S. (1998). Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Archives of Otolaryngology–Head & Neck Surgery, 124(3), 249–258. https://doi.org/10.1001/archotol.124.3.249
  2. []Ward, B. K., van de Berg, R., van Rompaey, V., et al. (2021). Superior semicircular canal dehiscence syndrome: diagnostic criteria consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research, 31(3), 131–141. https://doi.org/10.3233/VES-200004

Bilateral vestibulopathy

  1. []Strupp, M., Kim, J.-S., Murofushi, T., et al. (2017). Bilateral vestibulopathy: diagnostic criteria — consensus document of the Classification Committee of the Bárány Society. Journal of Vestibular Research, 27(4), 177–189. https://doi.org/10.3233/VES-170619

Eye movement systems & neuroanatomy

  1. []Leigh, R. J., & Zee, D. S. (2015). The Neurology of Eye Movements (5th ed.). Oxford University Press.
    The definitive reference on oculomotor neuroanatomy and pathology. Used for cross-checks of saccade/pursuit/VOR/gaze-holding physiology.
  2. []Brandt, T., Dieterich, M., & Strupp, M. (2013). Vertigo and Dizziness: Common Complaints (2nd ed.). Springer.

Video head impulse test (vHIT) & high-frequency VOR

  1. []Halmagyi, G. M., Chen, L., MacDougall, H. G., Weber, K. P., McGarvie, L. A., & Curthoys, I. S. (2017). The video head impulse test. Frontiers in Neurology, 8, 258. https://doi.org/10.3389/fneur.2017.00258
  2. []McCaslin, D. L., Jacobson, G. P., Bennett, M. L., Gruenwald, J. M., & Green, A. P. (2014). Predictive properties of the video head impulse test: measures of caloric symmetry and self-report dizziness handicap. Ear and Hearing, 35(5), e185–e191. https://doi.org/10.1097/AUD.0000000000000047

Posterior circulation stroke

  1. []Tarnutzer, A. A., Berkowitz, A. L., Robinson, K. A., Hsieh, Y.-H., & Newman-Toker, D. E. (2011). Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ, 183(9), E571–E592. https://doi.org/10.1503/cmaj.100174
  2. []Saber Tehrani, A. S., Kattah, J. C., Mantokoudis, G., et al. (2014). Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology, 83(2), 169–173. https://doi.org/10.1212/WNL.0000000000000573

Multiple sclerosis — vestibular & oculomotor manifestations

  1. []Thompson, A. J., Banwell, B. L., Barkhof, F., et al. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17(2), 162–173. https://doi.org/10.1016/S1474-4422(17)30470-2
  2. []Frohman, E. M., Frohman, T. C., Zee, D. S., McColl, R., & Galetta, S. (2005). The neuro-ophthalmology of multiple sclerosis. The Lancet Neurology, 4(2), 111–121. https://doi.org/10.1016/S1474-4422(05)00992-0
A note on the animations

The animated nystagmus patterns in Vestibulum are stylized representations generated parametrically from the kinematic features described in the source literature (fast/slow phase amplitudes, slow-phase shape, latency, fatigability, gaze modulation). They are not derived from patient recordings, and they intentionally exaggerate features for teaching clarity. For authentic recordings, readers should consult the McCaslin VNG textbook DVD and the published case libraries from the Bárány Society.

Acknowledgements

Vestibulum was conceived and designed by Dr. Prahlada N. B. for the educational use of medical students, ENT and neurology trainees, audiologists, and vestibular therapists.

Institutional support: Karnataka ENT Hospital and Research Center (R), Champions Educational and Medical Society (R), and Amogh Foundation.

Special thanks to the authors and editors of the source works cited above, whose careful clinical observation and rigorous criteria-building underpin every page of this atlas.

Educational use only

This material is for educational purposes only. Not for clinical use. Clinicians remain completely responsible for interpretation, formulation of differential diagnosis, and any clinical decision. Citations here support specific points in the atlas; they do not constitute clinical endorsement of any specific approach for any specific patient. Where guidelines and criteria have been updated since publication, the most recent version should be consulted.

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