In concussion examination for vestibulo-oculomotor impairments, which statement is correct?

In concussion examination for vestibulo-oculomotor impairments, which statement is correct?

• A. If BPPV is suspected, perform Dix-Hallpike
• B. Only assess ocular alignment in all cases
• C. Visual motion sensitivity is not part of the exam
• D. Rely solely on saccades testing without smooth pursuits

Answer: (A)

When evaluating vestibulo-oculomotor function after a concussion, you must consider that BPPV can be a contributing peripheral cause. If BPPV is suspected, the Dix-Hallpike maneuver is the appropriate test because it specifically provocative posterior canal canalithiasis or cupulolithiasis and elicits the characteristic vertigo and nystagmus, guiding targeted treatment with canalith repositioning maneuvers. Concussions can unmask or coexist with BPPV, so using this test helps identify a treatable issue rather than missing it. The other statements fall short because an effective vestibulo-oculomotor exam goes beyond ocular alignment alone and includes multiple domains, such as smooth pursuits, saccades, vestibulo-ocular reflex, vergence, and visual motion sensitivity. Visual motion sensitivity is indeed part of the evaluation, and relying only on saccades while omitting smooth pursuits and VOR undermines the comprehensiveness of the exam.

When evaluating vestibulo-oculomotor function after a concussion, you must consider that BPPV can be a contributing peripheral cause. If BPPV is suspected, the Dix-Hallpike maneuver is the appropriate test because it specifically provocative posterior canal canalithiasis or cupulolithiasis and elicits the characteristic vertigo and nystagmus, guiding targeted treatment with canalith repositioning maneuvers. Concussions can unmask or coexist with BPPV, so using this test helps identify a treatable issue rather than missing it.

The other statements fall short because an effective vestibulo-oculomotor exam goes beyond ocular alignment alone and includes multiple domains, such as smooth pursuits, saccades, vestibulo-ocular reflex, vergence, and visual motion sensitivity. Visual motion sensitivity is indeed part of the evaluation, and relying only on saccades while omitting smooth pursuits and VOR undermines the comprehensiveness of the exam.