Transient Positive Horizontal Head Impulse Test in Pregabalin Intoxication

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.

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Recent advances in head impulse test findings in central vestibular disorders

Neurology ◽

10.1212/wnl.0000000000005206 ◽

2018 ◽

Vol 90 (13) ◽

pp. 602-612 ◽

Cited By ~ 26

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.

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Horizontal head impulse test detects gentamicin vestibulotoxicity

Neurology ◽

10.1212/wnl.0b013e3181a18652 ◽

2009 ◽

Vol 72 (16) ◽

pp. 1417-1424 ◽

Cited By ~ 70

Author(s):

K. P. Weber ◽

S. T. Aw ◽

M. J. Todd ◽

L. A. McGarvie ◽

I. S. Curthoys ◽

...

Keyword(s):

Head Impulse Test ◽

Head Impulse ◽

Horizontal Head

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Vestibular semicircular canal function as detected by video Head Impulse Test (vHIT) is essentially unchanged in people with Parkinson’s disease compared to healthy controls

Journal of Vestibular Research ◽

10.3233/ves-201626 ◽

2021 ◽

pp. 1-9

Author(s):

Kim E. Hawkins ◽

Elodie Chiarovano ◽

Serene S. Paul ◽

Ann M Burgess ◽

Hamish G. MacDougall ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Semicircular Canal ◽

Neurodegenerative Disorder ◽

Vestibular Function ◽

Head Impulse Test ◽

Healthy Controls ◽

Video Head Impulse Test ◽

Head Impulse ◽

Vestibulo Ocular Reflex

BACKGROUND: Parkinson’s disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey’s ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

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Does the video head impulse test replace caloric testing in the assessment of patients with chronic dizziness? A systematic review and meta-analysis

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2021.01.002 ◽

2021 ◽

Author(s):

Maria Gabriela Bonilha Vallim ◽

Guilherme Paiva Gabriel ◽

Raquel Mezzalira ◽

Guita Stoler ◽

Carlos Takahiro Chone

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Caloric Testing ◽

Chronic Dizziness

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Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

Journal of Vestibular Research ◽

10.3233/ves-200007 ◽

2020 ◽

Vol 30 (6) ◽

pp. 393-399

Author(s):

Yahav Oron ◽

Ophir Handzel ◽

Zohar Habot-Wilner ◽

Keren Regev ◽

Arnon Karni ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Vestibular Function ◽

Pure Tone Audiometry ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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Surplus value of the video-head impulse test in patients with vestibular schwannoma

Journal of the Neurological Sciences ◽

10.1016/j.jns.2015.08.601 ◽

2015 ◽

Vol 357 ◽

pp. e174

Author(s):

A. Beynon

Keyword(s):

Vestibular Schwannoma ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Surplus Value

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Viewing Target Distance Influences the Vestibulo-Ocular Reflex Gain when Assessed Using the Video Head Impulse Test

Audiology and Neurotology ◽

10.1159/000493845 ◽

2018 ◽

Vol 23 (5) ◽

pp. 285-289 ◽

Cited By ~ 2

Author(s):

Patricia Castro ◽

Sara Sena Esteves ◽

Florencia Lerchundi ◽

David Buckwell ◽

Michael A. Gresty ◽

...

Keyword(s):

Head Movements ◽

Target Distance ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Gaze Stabilization ◽

Head Impulse ◽

Ocular Reflex ◽

Significant Difference ◽

Vestibulo Ocular Reflex ◽

Reflex Gain

Gaze stabilization during head movements is provided by the vestibulo-ocular reflex (VOR). Clinical assessment of this reflex is performed using the video Head Impulse Test (vHIT). To date, the influence of different fixation distances on VOR gain using the vHIT has not been explored. We assessed the effect of target proximity on the horizontal VOR using the vHIT. Firstly, we assessed the VOR gain in 18 healthy subjects with 5 viewing target distances (150, 40, 30, 20, and 10 cm). The gain increased significantly as the viewing target distance decreased. A second experiment on 10 subjects was performed in darkness whilst the subjects were imagining targets at different distances. There were significant inverse relationships between gain and distance for both the real and the imaginary targets. There was a statistically significant difference between light and dark gains for the 20- and 40-cm distances, but not for the 150-cm distance. Theoretical VOR gains for different target distances were calculated and compared with those found in light and darkness. The increase in gain observed for near targets was lower than predicted by geometrical calculations, implying a physiological ceiling effect on the VOR. The VOR gain in the dark, as assessed with the vHIT, demonstrates an enhancement associated with a reduced target distance.

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