Case of a 96-year-old woman with tilt of the subjective vertical axis
Tilt of the subjective visual vertical axis is an important finding in patients presenting with acute gait and balance disorder. The main causes are acute unilateral peripheral vestibular deficits and cerebral (vascular) lesions, mostly in the brainstem. The side of the SVV tilt depends on the location of the lesion. What is interesting about this case is that although there is an ipsi- and contralateral lesion that could explain the SVV tilt, the clinical symptoms of lateropulsion and SVV tilt remain without an ocular tilt response or other symptoms. However, the lesion in the brainstem is the most likely reason in this case. The bucket test (see Fig. 2) is a valid, easy–to-use, and useful test to examine the subjective vertical axis. Training can improve the tilt of the SVV. Is it recommended to provide physiotherapy and the use of a walker as long as the SVV tilt is above 3°.
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