Video head impulse testing: Pitfalls in neurological patients

Nehzat Koohi; Surangi Mendis; Amy Lennox; Darren Whelan; Diego Kaski

doi:10.1016/j.jns.2022.120417

Video head impulse testing: Pitfalls in neurological patients

J Neurol Sci. 2022 Nov 15:442:120417. doi: 10.1016/j.jns.2022.120417. Epub 2022 Sep 17.

Authors

Nehzat Koohi¹, Surangi Mendis², Amy Lennox³, Darren Whelan², Diego Kaski⁴

Affiliations

¹ Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, UK; The Ear Institute, University College London, London, UK.
² Department of Neuro-otology, Royal national ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK.
³ Hypatia Clinic, Liverpool, UK.
⁴ Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, UK; The Ear Institute, University College London, London, UK; Department of Neuro-otology, Royal national ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK. Electronic address: d.kaski@ucl.ac.uk.

PMID: 36209570
DOI: 10.1016/j.jns.2022.120417

Abstract

The video head impulse test (vHIT) assesses the vestibulo-ocular reflex (VOR) during a rapid high-velocity low amplitude (10°-20°) head rotation. Patients with peripheral vestibulopathy have a reduced VOR gain with corrective catch-up saccades during the head turn. There are several pitfalls, mainly technical, which may interfere with interpretation of vHIT data. In addition, intrusive eye movement disorders such as spontaneous nystagmus that affect normal eye position and tracking can affect the vHIT results. To date there has been little study of neurological saccadic eye movements that may interfere with the interpretation of vHIT data. Here, in ten patients with a range of central neurological disorders, we describe oculomotor abnormalities on vHIT in the presence of normal range VOR gain values, recorded at a tertiary vestibular neurology service.

Keywords: Catch-up saccades; Central vestibular disorder; Peripheral vesitibulopathy; Vertigo; vHIT.

MeSH terms

Head Impulse Test / methods
Humans
Nystagmus, Pathologic* / diagnosis
Nystagmus, Pathologic* / etiology
Ocular Motility Disorders*
Reference Values
Reflex, Vestibulo-Ocular
Saccades