Visual Vestibular Mismatch

A poorly understood presentation of balance system disease

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Chapter 13


The logical series of experiments that comprise this thesis supports the following conclusions related to newly developed visually induced vertigo and visually induced dizziness. This symptom set arises as a result of pathology in the balance system, to the point where it can no longer act as the “template” against which other sensory information is compared. The result is an inappropriate reliance on environmental visual cues, even under circumstances in which they are orientationally inaccurate. Elucidation of these symptoms from a patient requires that a comprehensive history be taken in a non-leading manner.

I suggest that from this thesis, the following statements can be made:

  1. In addition to traditional complaints voiced by patients who are suffering from vestibular pathology, there is a family of non-traditional complaints which are legitimate, and can range from being mildly irritating to being totally incapacitating.
  2. These symptoms can arise after head trauma, but are not directly related to neurological damage.
  3. Symptoms can occur in isolation or in conjunction with other commonly accepted symptoms of vestibular disease (e.g. vertigo, etc). They can sometimes occur idiopathically.
  4. Symptoms can occur as a result of head injury, but identical complaints can occur as a result of whiplash alone, which suggests strongly that otoliths are damaged similarly by both of these types of decelerative forces.
  5. Symptoms can be caused as a result of deliberate iatrogenic intervention to the inner ear.
  6. The complaints include both autonomic and vestibulospinal symptoms.
  7. The symptoms are not semicircular canal in origin, as standard caloric testing is rarely abnormal, and patients generally do not complain of symptoms that are traditionally thought to be of semicircular canal origin. (i.e. spinning). The caveat is the limitations of semicircular canal testing.
  8. Symptoms mimic
    1. the effects of alcohol on the body
    2. physiological responses to the effects of microgravity on the body
    3. The sensation and vague imbalance caused by Computerized Dynamic Posturography assessment
    4. The complaints of imbalance voiced by older people
    5. The common malady known as motion sickness
  9. As all five of the above situations are probably caused by otolithic disturbances, the findings support the hypothesis that the symptom set included in the definitions of visually induced vertigo and visually induced dizziness can originate from the otoliths of the inner ear, and otolithic pathology can be responsible for the imbalance in these patients and related autonomic symptoms that they suffer.
  10. The caveat to my conclusions is that the population of patients seen precludes an understanding of the relationship between visually induced vertigo (and also visually induced dizziness) and neurological disease, which certainly may play a role in some patients in the development of their symptoms.


I am the first author on 6 of the 9 papers referred to in this thesis and the second author on the other 3.


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