Kindly report the VNG WITH DIAGNOSIS
Reading File
Now I have all the VNG data from the PDF. Let me analyze the findings and produce a comprehensive clinical report with diagnosis.
VIDEONYSTAGMOGRAPHY (VNG) REPORT
Patient: Mrs. Darshana Jain
Patient ID: CCDA00350
Age/Gender: 74 years / Female
Date of Test: 21-Apr-2026
Clinic: Priority Hearing Care Pvt. Ltd.
TEST FINDINGS SUMMARY
1. SACCADE TEST
| Parameter | Right Eye | Left Eye | Normal Reference |
|---|---|---|---|
| Horizontal Velocity | 190.11 °/s | 2142.26 °/s* | 300–700 °/s |
| Horizontal Precision | 13.81 | 150.46 | <15 |
| Horizontal Latency | 470.00 ms | 322.22 ms | 150–200 ms |
| Vertical Velocity | 150.69 °/s | 614.21 °/s* | 300–700 °/s |
| Vertical Precision | 23.60 | 63.89 | <15 |
| Vertical Latency | 433.33 ms | 328.00 ms | 150–200 ms |
Note: Default calibration used — extremely high left eye velocity values are likely calibration artifacts rather than true physiological readings.
Interpretation: Markedly prolonged saccade latencies bilaterally (Right eye > Left eye), especially prominent for horizontal saccades (RE: 470 ms, LE: 322 ms vs. normal ≤200 ms). Right eye horizontal velocity is reduced at 190 °/s. Precision (dysmetria) is abnormal bilaterally. This pattern is consistent with central oculomotor dysfunction.
2. SMOOTH PURSUIT TEST
| Direction | Right Eye Gain | Left Eye Gain | Normal (≥0.7) |
|---|---|---|---|
| Rightward (H) | 0.82 | 0.07 | ≥0.70 |
| Leftward (H) | 1.00 | 0.07 | ≥0.70 |
| Upward (V) | 0.76 | 0.12 | ≥0.70 |
| Downward (V) | 0.82 | 0.21 | ≥0.70 |
Interpretation: Right eye smooth pursuit gain is within normal limits in all directions. Left eye smooth pursuit gain is severely reduced in all directions (0.07–0.21), indicating a significant left eye pursuit deficiency. This unilateral left eye tracking failure, combined with the calibration-default note, may suggest reduced left eye cooperation/contribution, or possible monocular ocular pathology on the left side.
3. OPTOKINETIC TEST (OKN)
| Stimulus Direction | RE Gain | LE Gain | Fast Phase (RE) | Fast Phase (LE) |
|---|---|---|---|---|
| Left to Right | 0.42 | 0.59 | — | — |
| Right to Left | 0.41 | 0.53 | — | 216.88° |
| Top to Bottom | 0.33 | 0.83 | — | — |
| Bottom to Top | 0.50 | 0.77 | — | — |
Normal OKN gain: ≥0.70
Interpretation: OKN gains are reduced bilaterally in horizontal directions (RE: 0.41–0.42; LE: 0.53–0.59) and right eye vertical (0.33–0.50). Absence of fast phase direction in most conditions is abnormal. Reduced OKN gain, particularly when symmetric, suggests central (brainstem/cerebellar) dysfunction affecting the optokinetic pathway.
4. SPONTANEOUS NYSTAGMUS
| Condition | Finding |
|---|---|
| In Light | No spontaneous nystagmus detected |
| In Dark | No spontaneous nystagmus detected |
Interpretation: No resting spontaneous nystagmus. This argues against an active, uncompensated peripheral vestibular lesion.
5. GAZE TEST
| Position | Fixation | Without Fixation |
|---|---|---|
| Center | No nystagmus | Nystagmus present (RE only): SPV 4.26°/s, Amplitude 3.03°, Frequency 0.90 Hz |
| Left | No nystagmus | No nystagmus |
| Right | No nystagmus | No nystagmus |
| Up | No nystagmus | No nystagmus |
| Down | No nystagmus | No nystagmus |
Interpretation: Fixation-suppressed horizontal nystagmus detected in the center position without fixation (right eye, SPV 4.26°/s). The fact that this nystagmus is present only without fixation and only in the center position — but absent with fixation — suggests a residual vestibular imbalance (likely peripheral or centrally compensated). The SPV of 4.26°/s is low-grade (borderline; >5°/s is typically considered significant).
6. SUBJECTIVE VISUAL VERTICAL (SVV)
| Condition | Deviation | Normal (≤2–3°) |
|---|---|---|
| Clockwise Trial | +8° (Right) | ≤2–3° |
| Anti-clockwise Trial | −2° (Left) | ≤2–3° |
| Blank Background Trial 1 | 90° (Right) — artifact/error | — |
| Blank Background Trial 2 | −3° (Left) | ≤2–3° |
Interpretation: The clockwise trial shows a significant SVV deviation of 8° to the right, which is abnormal (normal ≤2–3°). SVV deviation indicates utricular dysfunction. A rightward tilt of the SVV suggests dysfunction of the left otolith (utricle), as the subjective vertical tilts contralateral to the side of lesion in peripheral utricular disease, or ipsilateral in central lesions. The anti-clockwise result is within normal limits. The 90° reading in blank background Trial 1 is likely an instrument/patient error and should be disregarded.
OVERALL IMPRESSION / DIAGNOSIS
1. Central Oculomotor Dysfunction (Primary Finding)
- Markedly prolonged saccade latencies bilaterally (470 ms RE, 322 ms LE)
- Reduced and dysmetric saccades
- Bilaterally reduced OKN gain These findings are characteristic of central vestibular/oculomotor pathology, involving the brainstem (PPRF, MLF) and/or cerebellum. Given the patient's age (74 years), this may represent age-related cerebellar/brainstem degeneration, small vessel ischemic disease, or neurodegenerative process.
2. Left Utricular Dysfunction / Peripheral Vestibular Asymmetry
- SVV significantly tilted 8° to the right (clockwise)
- Fixation-suppressed low-grade nystagmus at center gaze These findings suggest left-sided otolithic/utricular impairment, possibly as a component of age-related presbyvestibulopathy.
3. Left Eye Smooth Pursuit Deficiency
- Severe reduction of left eye pursuit gain across all directions (0.07–0.21)
- May reflect monocular ocular pathology (e.g., reduced left eye visual acuity, cataract) or left-eye calibration failure; clinical correlation required.
DIAGNOSIS
Central Vestibular Dysfunction with features of Bilateral Central Oculomotor Abnormality, Left Utricular Dysfunction, and Low-Grade Vestibular Imbalance.Likely etiology: Age-related cerebellar/brainstem involvement (presbyvestibulopathy with central component) — to be correlated with MRI Brain (with emphasis on posterior fossa, cerebellum, and brainstem) and clinical history.
RECOMMENDATIONS
- MRI Brain with posterior fossa protocol — to rule out cerebellar/brainstem ischemia, white matter disease, or neurodegenerative pathology.
- Neurological consultation — given prominent central oculomotor signs.
- Caloric test / Video Head Impulse Test (vHIT) — to further quantify semicircular canal function if not already done.
- Left eye ophthalmological evaluation — to exclude monocular visual deficiency contributing to left eye tracking failure.
- Vestibular rehabilitation — may be considered once central pathology is excluded or treated.
Report prepared based on VNG data provided. Clinical correlation with patient history, symptoms, and examination findings is essential for final diagnosis.
This is a shared conversation. Sign in to Orris to start your own chat.