Recent advances in head impulse test findings in central vestibular disorders

Neurology ◽  
2018 ◽  
Vol 90 (13) ◽  
pp. 602-612 ◽  
Author(s):  
Jeong-Yoon Choi ◽  
Hyo-Jung Kim ◽  
Ji-Soo Kim
Keyword(s):  
Vestibular Nucleus ◽  
Head Rotation ◽  
Medial Longitudinal Fasciculus ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Corrective Saccades ◽  
Cerebellar Lesions ◽  
Horizontal Head

The head impulse test (HIT) is used to evaluate the vestibulo-ocular reflex (VOR) during a high-velocity head rotation. Corrective catch-up saccades that occur during or after the HITs usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal clinical (bedside) HITs should prompt a search for a central lesion. However, recent quantitative studies that evaluated HITs using magnetic search coils or video-based techniques have demonstrated that specific patterns of HIT abnormalities are associated with central vestibular disorders. While normal clinical HITs are typical of central lesions, discrepancies have been observed between clinical and quantitative HITs. The horizontal head impulse VOR gains can be significantly reduced unilaterally or bilaterally (positive HITs) in lesions involving the vestibular nucleus, nucleus prepositus hypoglossi, or flocculus. In diffuse cerebellar lesions, the VOR gain during horizontal head impulses may increase (hyperactive) with corrective saccades directed the opposite way. The presence of cross-coupled vertical corrective saccades during horizontal HITs is also suggestive of diffuse cerebellar lesions. Lesions involving the vestibular nucleus, medial longitudinal fasciculus, and cerebellum may show decreased or increased gains of the VOR during vertical HITs. Defining the differences in patterns observed during abnormal HITs may help practitioners localize the responsible lesions in both central and peripheral vestibulopathy.

scholarly journals Quantifying the Vestibulo-Ocular Reflex with Video-Oculography: Nature and Frequency of Artifacts

2014 ◽  
Vol 20 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Georgios Mantokoudis ◽  
Ali S. Saber Tehrani ◽  
Jorge C. Kattah ◽  
Karin Eibenberger ◽  
Cynthia I. Guede ◽  
...  
Keyword(s):  
Head Impulse Test ◽  
Head Impulse ◽  
Video Oculography ◽  
Ocular Reflex ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Corrective Saccades ◽  
Coding Manual ◽  
A Prospective Study ◽  
The Impact

Video-oculography devices are now used to quantify the vestibulo-ocular reflex (VOR) at the bedside using the head impulse test (HIT). Little is known about the impact of disruptive phenomena (e.g. corrective saccades, nystagmus, fixation losses, eye-blink artifacts) on quantitative VOR assessment in acute vertigo. This study systematically characterized the frequency, nature, and impact of artifacts on HIT VOR measures. From a prospective study of 26 patients with acute vestibular syndrome (16 vestibular neuritis, 10 stroke), we classified findings using a structured coding manual. Of 1,358 individual HIT traces, 72% had abnormal disruptive saccades, 44% had at least one artifact, and 42% were uninterpretable. Physicians using quantitative recording devices to measure head impulse VOR responses for clinical diagnosis should be aware of the potential impact of disruptive eye movements and measurement artifacts. i 2014 S. Karger AG, Basel

Misleading signs in acute vertigo

2017 ◽  
Vol 18 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Sean Lance ◽  
Stuart Scott Mossman
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome ◽  
Horizontal Head ◽  
Fourth Nerve Palsy ◽  
Paroxysmal Positional Vertigo

The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them.

scholarly journals The Head Impulse Test as a Predictor of Videonystagmography Caloric Test Lateralization According to the Level of Examiner Experience: A Prospective Open-Label Study

2018 ◽  
Vol 97 (1-2) ◽  
pp. 16-23
Author(s):  
Ashraf Awadie ◽  
Yehuda Holdstein ◽  
Margalit Kaminer ◽  
Avi Shupak
Keyword(s):  
Eye Movement ◽  
Sensitivity And Specificity ◽  
Test Performance ◽  
Tertiary Care ◽  
False Negative ◽  
Head Rotation ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Open Label ◽  
Head Impulse

We conducted a study to compare how well the head impulse test (HIT), without and with eye-movement recordings, would predict videonystagmographic (VNG) caloric test lateralization when performed by a resident and an experienced otoneurologist. This prospective, open-label, blinded study was conducted in an ambulatory tertiary care referral center. Our study population was made up of 60 patients—29 men and 31 women, aged 20 to 82 years (mean: 56.4 ± 11.4)—with peripheral vestibulopathy who underwent HIT and VNG caloric testing. The HIT was conducted in two protocols: HIT0 and HIT1. The HIT0 was performed with passive brisk movements of the patient's head from the 0° null position to 20° sideways, and the HIT1 was performed toward the center while the null position was a 20° head rotation to the right and to the left. Each protocol was carried out without video eye-movement recordings (HIT0 and HIT1) and with such recordings (rHIT0 and rHIT1). The primary outcome measures were (1) a comparison of the HIT's sensitivity and specificity when performed by the resident and by the experienced otoneurologist and (2) the ability of video-recorded HIT to predict VNG caloric test lateralization. The sensitivity and specificity obtained by the resident were 41 and 81%, respectively, for HIT0 and 41 and 90% for HIT1. The sensitivity and specificity obtained by the experienced otoneurologist were 18 and 89% for HIT0 and 32 and 85% for HIT1. Analysis of the recorded eye-movement clips of the HIT0 and HIT1 obtained by a second experienced otoneurologist found a sensitivity and specificity of 32 and 63% for rHIT0 and 33 and 82% for rHIT1. We conclude that the HIT yields high false-negative rates in predicting significant caloric lateralization. Analysis of the eye-movement recordings was no better than normal testing alone for detecting saccades. The experience of the examining physician had no impact on test performance characteristics.

Diagnose und Differenzialdiagnose von peripheren und zentralen Schwindelsyndromen

2019 ◽  
Vol 144 (12) ◽  
pp. 821-829 ◽  
Author(s):  
Michael Strupp ◽  
Katharina Feil ◽  
Andreas Zwergal
Keyword(s):  
Laboratory Tests ◽  
Time Course ◽  
Head Impulse Test ◽  
Ocular Motor ◽  
Vestibular Disorders ◽  
Patient History ◽  
Caloric Irrigation ◽  
Head Impulse ◽  
Accompanying Symptoms ◽  
Romberg Test

AbstractThe diagnosis of the various peripheral and central vestibular disorders is mainly based on the patient history (time course, type of symptoms, modulating factors, and accompanying symptoms) and a systematic clinical examination of the vestibular, ocular motor, and cerebellar systems (examination for nystagmus, head impulse test, positional maneuvers, Romberg test and examination for central ocular motor signs). The two most important laboratory tests are the “video-head impulse test” and caloric irrigation. Fortunately, the diagnosis of vestibular disorders has become easier and more precise as a result of the very clinically oriented diagnostic criteria of the Bárány Society (www.jvr-web.org/ICVD.html).

scholarly journals Transient Positive Horizontal Head Impulse Test in Pregabalin Intoxication

2015 ◽  
Vol 5 (2) ◽  
pp. 101-103 ◽  
Author(s):  
Seong-Hae Jeong ◽  
Yong Soo Kim ◽  
Ju-Hoen Lee ◽  
Hyunjin Jo ◽  
Ae Young Lee ◽  
...  
Keyword(s):  
Head Impulse Test ◽  
Head Impulse ◽  
Horizontal Head

scholarly journals Clinical Implication of Corrective Saccades in the Video Head Impulse Test for the Diagnosis of Posterior Inferior Cerebellar Artery Infarction

2021 ◽  
Vol 12 ◽  
Author(s):  
Gi-Sung Nam ◽  
Hyun-June Shin ◽  
Jin-Ju Kang ◽  
Na-Ri Lee ◽  
Sun-Young Oh
Keyword(s):  
Semicircular Canal ◽  
Posterior Inferior Cerebellar Artery ◽  
Mean Amplitude ◽  
Head Impulse Test ◽  
Stroke Patients ◽  
Horizontal Semicircular Canal ◽  
Head Impulse ◽  
Cerebellar Artery ◽  
Corrective Saccades ◽  
The Mean

Objective: In the present study, we characterized the vestibulo-ocular reflex (VOR) gain and properties of corrective saccades (CS) in patients with posterior inferior cerebellar artery (PICA) stroke and determined the best parameter to differentiate PICA stroke from benign peripheral vestibular neuritis (VN). In particular, we studied CS amplitude and asymmetry in video head impulse tests (vHITs) to discriminate these two less-studied disease conditions.Methods: The vHITs were performed within 1 week from symptom onset in patients with PICA stroke (n = 17), patients with VN (n = 17), and healthy subjects (HS, n = 17).Results: PICA stroke patients had bilaterally reduced VOR gains in the horizontal semicircular canal (HC) and the posterior semicircular canal (PC) compared with HSs. When compared with VN patients, PICA stroke patients showed preserved gains in the HC and anterior semicircular canal (AC) bilaterally (i.e., symmetric VOR gain). Similar to VOR gain, smaller but bilaterally symmetric CS in the HC and AC were observed in PICA stroke patients compared with VN patients; the mean amplitude of CS for the ipsilesional HC was reduced (p < 0.001, Mann–Whitney U-test), but the mean amplitude of CS for the contralesional HC was increased (p < 0.03, Mann–Whitney U-test) in PICA stroke compared with VN. The receiver operating characteristic (ROC) curve showed that CS amplitude asymmetry (CSs) and VOR gain asymmetry (Gs) of HC are excellent parameters to distinguish PICA stroke from VN.Conclusion: In the current study, we quantitatively investigated the VOR gain and CS using vHITs for three semicircular canals in PICA stroke and VN patients. In addition to VOR gain, quantitative assessments of CS using vHITs can provide sensitive and objective parameters to distinguish between peripheral and central vestibulopathies.

scholarly journals The Head Impulse Test as a Predictor of Videonystagmography Caloric Test Lateralization according to the Level of Examiner Experience: A Prospective Open-Label Study

2018 ◽  
Vol 97 (1-2) ◽  
pp. 16-23
Author(s):  
Ashraf Awadie ◽  
Yehuda Holdstein ◽  
Margalit Kaminer ◽  
Avi Shupak
Keyword(s):  
Eye Movement ◽  
Sensitivity And Specificity ◽  
Test Performance ◽  
Tertiary Care ◽  
False Negative ◽  
Head Rotation ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Open Label ◽  
Head Impulse

We conducted a study to compare how well the head impulse test (HIT), without and with eye-movement recordings, would predict videonystagmographic (VNG) caloric test lateralization when performed by a resident and an experienced otoneurologist. This prospective, open-label, blinded study was conducted in an ambulatory tertiary care referral center. Our study population was made up of 60 patients–29 men and 31 women, aged 20 to 82 years (mean: 56.4 ± 11.4)—with peripheral vestibulopathy who underwent HIT and VNG caloric testing. The HIT was conducted in two protocols: HITO and HIT1. The HITO was performed with passive brisk movements of the patient's head from the 0° null position to 20° sideways, and the HIT1 was performed toward the center while the null position was a 20° head rotation to the right and to the left. Each protocol was carried out without video eye-movement recordings (HITO and HIT1) and with such recordings (rHITO and rHITl). The primary outcome measures were (1) a comparison of the HIT's sensitivity and specificity when performed by the resident and by the experienced otoneurologist and (2) the ability of video-recorded HIT to predict VNG caloric test lateralization. The sensitivity and specificity obtained by the resident were 41 and 81 %, respectively, for HITO and 41 and 90% for HIT1. The sensitivity and specificity obtained by the experienced otoneurologist were 18 and 89% for HITO and 32 and 85% for HIT1. Analysis of the recorded eye-movement clips of the HITO and HITl obtained by a second experienced otoneurologist found a sensitivity and specificity of 32 and 63% for rHITO and 33 and 82% for rHIT1. We conclude that the HIT yields high false-negative rates in predicting significant caloric lateralization. Analysis of the eye-movement recordings was no better than normal testing alone for detecting saccades. The experience of the examining physician had no impact on test performance characteristics.

Vestibular vertigo in emergency neurology

2021 ◽  
Vol 26 (4) ◽  
pp. 50-59
Author(s):  
A. A. Kulesh ◽  
D. A. Dyomin ◽  
A. L. Guseva ◽  
O. I. Vinogradov ◽  
V. A. Parfyonov
Keyword(s):  
Clinical Signs ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Vertebrobasilar System ◽  
Acute Vestibular Syndrome ◽  
Vestibular Vertigo ◽  
Vestibular Neuronitis ◽  
Emergency Neurology

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

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