1733 Sheepshead Bay Rd, Brooklyn, NY 11235. Tel.: (718) 576-6991, Fax: (718) 576-6990 e-mail:[email protected] Patient: Cha, Sample ID#: DOB: 10/22/1968 SEX: F Physician: XXXXX Sample, M.D Test Date: 01/24/13 VIDEONYSTAGMOGRAPHY The VNG showed no gaze or spontaneous nystagmus. There is no significant unilateral weakness and directional preponderance. Saccadic eye velocity and accuracy were normal. Visual tracking/pursuit and optokinetic tests were normal and symmetrical. Dix / Hallpike: The Dix Hallpike maneuvers are abnormal on the right side vertical. Positional Tests: Normative values for positional tests are 0-3deg/sec horizontal slow component velocity for all position. Patient elicited the following values for positional tests: 4U, 4L- 5U, 3L Normative values for abnormal in supine head center, right and supine body left positions Active Head rotation: Horizontal and vertical VOR testing identified significant abnormalities. Active head rotation gain (normally between 75% and 125%) in active head rotation is used to evaluate the vestibular-ocular reflex (VOR), in which increases in gain are consistent with a central nervous system dysfunction or central vestibulopathy, and a decrease in gain are consistent with a peripheral nervous system dysfunction or peripheral vestibulopathy. In addition , an asymmetry of >30% in gain value is abnormal. Increased VOR gain and the ataxia it represents may be the only abnormal finding. Balance and VOR exercises/rehabilitation may be recommended for these patients. Further diagnostic evaluation may include a referral a neurologist for a more detailed clinical assessment. Conclusion: Considering patients past medical history the above findings are consistent with central and peripheralleft and right BPPV, vestibular dysfunction. Clinical correlation is suggested. Recommendations: 1. Balance rehabilitation, targeting the above mentioned abnormalities. 2. Canalith repositioning maneuvers (i.e., Eppley, Semont and Brandt-Daroff maneuvers) may be needed. 3. Further investigation (Brain MRI, ENT consult, and lab work) may be needed. 4. Review current medication to establish any relationships to the patient’s symptoms. 5. Repeat VNG in 6-8 months. Sample Xxx, M.D. Board Certified Neurologist. NY license: 0000003 DEA: FS0000006