The active head-impulse test in unilateral peripheral vestibulopathy

Ross A Black; G Michael Halmagyi; Matthew J Thurtell; Michael J Todd; Ian S Curthoys

doi:10.1001/archneur.62.2.290

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The active head-impulse test in unilateral peripheral vestibulopathy

Journal article

Open access

Peer reviewed

The active head-impulse test in unilateral peripheral vestibulopathy

Ross A Black, G Michael Halmagyi, Matthew J Thurtell, Michael J Todd and Ian S Curthoys

Archives of neurology (Chicago), Vol.62(2), pp.290-293

02/2005

DOI: 10.1001/archneur.62.2.290

PMID: 15710858

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Abstract

The head-impulse test, which is sensitive and specific for detecting severe unilateral peripheral vestibulopathy, is an accepted part of the neurological examination, especially in patients with vertigo and balance disorders. To discover if the head-impulse test is just as useful diagnostically when patients are asked to rotate their own heads, the active head-impulse test, rather than when the clinician does so as in the standard passive head-impulse test. Clinical observation of compensatory saccades and search coil measurement of compensatory eye rotations, during active and passive horizontal head-impulses in 6 patients with total unilateral vestibular deafferentation. Clinical observation showed the expected compensatory saccades with rotations toward the side with the lesion with passive head-impulses but not with active head-impulses. Search coil recordings revealed 2 reasons for this. With active head-impulses not only was vestibulo-ocular reflex gain higher, but compensatory saccade latency was shorter resulting in an occult saccade that occurred during, rather than after, head rotation. Passive head-impulses are necessary to detect a severe unilateral peripheral vestibulopathy; active head-impulses will produce a false-negative result.

Confidence Intervals

Data Interpretation, Statistical

Electromagnetic Fields

Eye Movements - physiology

Humans

Middle Aged

Male

Head - physiopathology

Vestibular Neuronitis - physiopathology

Rotation

Vestibular Neuronitis - diagnosis

Time Factors

Adult

Female

Aged

Functional Laterality - physiology

Vestibular Function Tests

Details

Title: Subtitle: The active head-impulse test in unilateral peripheral vestibulopathy
Creators: Ross A Black - Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia. rossb@icn.usyd.edu.au
G Michael Halmagyi
Matthew J Thurtell
Michael J Todd
Ian S Curthoys
Resource Type: Journal article
Publication Details: Archives of neurology (Chicago), Vol.62(2), pp.290-293
DOI: 10.1001/archneur.62.2.290
PMID: 15710858
NLM abbreviation: Arch Neurol
ISSN: 0003-9942
eISSN: 1538-3687
Publisher: American Medical Association; United States
Language: English
Date published: 02/2005
Academic Unit: Neurology; Ophthalmology and Visual Sciences
Record Identifier: 9983980041602771

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