الفهرس 
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Abstract
The syndrome of visually -induced dizziness is the condition at which
there is worsening or triggering of vestibular symptoms in certain visual
environments ( Lopez et al. , 1996). VV is considered to be a troublesome
but treatable syndrome in patients with vestibular disorders ( Bronstein et
al.,1995 and Pavlou et al.,2004).
This work was done to study visual vertigo syndrome ,to assess the
relationship between visual vertigo and emotional state, to study the
vestibular function in patients with visual vertigo and to evaluate the
effectiveness of customized visual vertigo rehabilitation.
The present study is a retrospective Study which was conducted at
Sheffield teaching hospital, United Kingdom. The study included 65 patients
(15 males, 50 females with age range 21-80 years) suffering from visual
vertigo symptoms and referred to visual vertigo clinic in the period between
2013 and 2016 with SCQ more than 0.9. According to the results of SCQ
after the rehabilitation program ,the patients were subdivided in to2 groups
:group I, include patients with improved score of SCQ after rehabilitation
and group II, include patients with non improved score of SCQ after
rehabilitation.
All patients underwent the following ; full neuro-otological history
and full neurological examination. Basic audiological evaluation in the form
of Pure Tone Audiometry, vestibular office tests, videonystagmography, 45
patients had MRI.
Customized Vestibular rehabilitation program was provided to all the
patient for (6.8 ± 5months) according to the protocol of visual vertigo clinic
which include: assessment of the patients using vestibular office tests and
questionnaires(Situational characteristic Questionnaire, The Nijmegen
Questionnaire, Dizziness Handicap Inventory and Hospital Anxiety and
Depression Scale ),counseling of the patients regarding their symptoms and
the methods of exercise practice and the rehabilitation which include graded
and progressive gaze stabilization exercises then the introduction of visual
stimulation (patterned wallpaper) to promote visual desensitization and
optokinetic DVD was issued for home practice after improvement of gaze
stabilization exercises. Patient response to the rehabilitation program was
assessed by the same questionnaires with SCQ as the main tool for
assessment and follow up after the rehabilitation.
The study showed that VV is more common in middle age (51± 15
years) females (77% of the patients),Sense of imbalance (95.2%)was the
most common complaint among patients of visual vertigo with the mean
duration of the dizziness related complaints was (4.7 ± 3.5 years), there were
many triggers for visual vertigo and patient symptoms was usually
provoked by more than one trigger(60%),the most frequent associated illness
was Anxiety and Depression (62.8%) followed by migraine(25.6%). 47 %
of patients had abnormal caloric test and 23%had positive Dixhallpike
testtest . 75% of patients had normal MRI and white matter changes
represent 73% of abnormal MRI finding. the most common cause of VV
symptoms was vestibular neuritis(23.1%)followed by vestibular
migraine(12.3%) .
The SCQ was (2.31 ± 0.73) before the rehabilitation and improved
to (1.89 ± 0.8).75.4% of patients had statistically significant improvement in
the SCQ after the rehabilitation. There was no statistically significant
difference between 2 groups regarding the demographic data, dizziness
related symptoms ,duration of symptoms, Precipitating triggers, History of
trauma, diagnosis, radiological finding, duration of rehabilitation and the
need for additional rehabilitation methods.
The Nijmegen Questionnaire was abnormal in 61% of patients with
mean of ( 27.03 ± 9.94). After vestibular rehabilitation 62.5 % of our VV
patients had statistically significant improvement in the Nijmegen
questionnaire(24.75 ± 11.88).
In the present study, 39 % of our patients were classified as anxious
according to (HAD-A) scores (9.69 ± 4.28 )which became (9.76 ± 5.21
after rehabilitation (insignificant difference) .Depression was present in 16
% of our VV patients 7.24 ± 4.18 which improved to 9.76 ± 5.208 after
rehabilitation (insignificant difference).
All the patients in our study had abnormal DHI total score of (53.87
± 16) which improved to 50.10 ± 20.41 (statistically insignificant).
On average, the entire sample demonstrated significant improvements
in 2 of the four self-report measures( the SCQ and Nijmegen score) and
statistically insignificant improvement in the HAD (anxiety &depression)
and DHI total score after vestibular rehabilitation.
This study showed that visual vertigo is debilitating symptom to dizzy
patients which is closely related to anxiety disorder and affect the quality of
life. Customized vestibular rehabilitation using gaze stabilization exercises
combined with optokinetic stimulation using optokinetic DVD is an
effective method in the rehabilitation of visual vertigo.