Vestibulologists (?) have an arsenal of clinical and neurophysiological tests that no ordinary mortal is supposed to understand. But for emergency neurologists some of their tricks are actually quite useful. Starting from the question what this weird bucket is for, we discuss the physiology of the otolith organs utriculus and sacculus.
- Lateral head thrust test
- Look for the ocular tilt reaction
- Subjective vertical (use a dark room, an iPhone, a self-made device called the bucket – here is how to build one – or a quite expensive professional tool)
We note how to use the laterality of the deviation of the subjective visual vertical to distinguish between peripheral/vestibular nuclear and other brainstem lesions. We also discuss the pathophysiology of the SVV over time after vestibular neuritis.