Applicability of Oculomotor Tests for Predicting Central Vestibular Disorder Using Principal Component Analysis

The videonystagmography oculomotor test battery is considered useful method for diagnosing vertigo. However, its role in diagnosing central vestibular disorder has not been clarified due to variations in interpretation. Patients (n = 103) with vertigo or dizziness symptoms undergoing the oculomotor tests and brain MRI within 1 month were analyzed. Two otology specialists retrospectively interpreted the oculomotor tests, and three neurology and neuroradiology specialists determined whether central lesions were present on brain MRI. Multivariable logistic regression analysis was performed to determine the factors contributing to discordant interpretation between oculomotor tests and brain MRI. Oculomotor tests predicting central lesions were assessed using principal component analysis. The intra- and inter-rater reliability in oculomotor test interpretation was moderate to good. Age > 60 years and multiple comorbidities were significant predictors of a discordant interpretation between MRI and oculomotor tests. Positive neurological symptoms and a higher oculomotor index (according to saccade (vertical axis), smooth pursuit (horizontal axis), and gaze-evoked nystagmus (horizontal/vertical axes) tests) significantly predicted central vestibular disorder in vertigo patients. Caution is required when interpreting the results of the oculomotor test battery for diagnosis of central lesions in older patients, as well as in those with multiple comorbidities.

Automated summary

This study analyzed 103 patients with vertigo symptoms who underwent oculomotor tests and brain MRI. The study found that age over 60 and multiple comorbidities were significant factors contributing to discordant interpretation between oculomotor tests and brain MRI. Positive neurological symptoms and higher oculomotor index were significant predictors of central vestibular disorder in patients with vertigo. Caution is needed when interpreting the oculomotor test results in older patients and those with multiple comorbidities.