Video Head Impulse Testing: From Bench to Bedside

Chen, Liming; Hálmagyi, G. Michael

doi:10.1055/s-0039-3402063

Cited by 20 publications

(9 citation statements)

References 87 publications

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“…The use of VOG enables physicians to quantify vestibular reflexes while moving the head rapidly from side to side. 27 These rapid, impulselike head movements are the first part of the 'HINTS' protocol (head impulse test) showing a VOG accuracy of 88% in detecting vestibular strokes. 23 However, VOG has never been used systematically for the assessment of the other two parameters of 'HINTS'.…”

Section: Discussionmentioning

confidence: 99%

Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients

et al. 2021

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ObjectiveFailure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem, however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown.MethodsPatients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the Emergency Department between 2015-2020. All patients received neuroimaging which served as a reference standard. We recorded fixation suppression with video-oculography (VOG) for straight, right and left gaze. The ocular fixation index (OFI) and the spontaneous nystagmus slow velocity reduction was calculated.ResultsWe screened 1646 dizzy patients in the emergency department and tested for spontaneous nystagmus in 148 included AVS patients. We analyzed 56 patients with a diagnosed acute unilateral vestibulopathy (vestibular neuritis) and 28 patients with a confirmed stroke. There was a complete nystagmus fixation suppression in 49.5% of AVS patients, in 40% of patients with vestibular neuritis and in 62.5% of vestibular strokes. OFI scores had no predictive value for detecting strokes, however, a nystagmus reduction of less than 2deg/s showed a high accuracy of 76.9% (CI 0.59-0.89) with a sensitivity of 62.2% and specificity of 84.8% in detecting strokes..ConclusionsThe presence of fixation suppression does not rule out a central lesion. The magnitude of suppression was lower compared to patients with vestibular neuritis. The nystagmus suppression test still predicts accurately vestibular strokes provided that eye movements are recorded with VOG.Classification of EvidenceThis study provides Class II evidence that in patients with an acute vestibular syndrome, decreased fixation suppression recorded with VOG occurred more often in stroke (76.9%) than in vestibular neuritis (37.8%).

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Section: Discussionmentioning

confidence: 99%

Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients

et al. 2021

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“…High-frequency function for all three semicircular canals (SCCs) was assessed by the video head impulse test (vHIT; Otometrics, Natus Medical Denmark, Taarstrup, Denmark) as described previously (34). SCC hypofunction was defined by a reduced vestibulo-ocular reflex (VOR) gain (<0.8 for the horizontal canal (HC) and <0.7 for the anterior (AC) and posterior (PC) canals) with the additional presence of corrective saccades (35)(36)(37). Repetitive vHIT measurements during the recovery process of AUPVP have revealed that corrective saccades may still be present after VOR gain values have already normalized (38,39).…”

Section: Semicircular Canal Functionmentioning

confidence: 99%

Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center

et al. 2022

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ObjectiveThe aim of the present study was to identify patients who developed acute unilateral peripheral vestibulopathy (AUPVP) after COVID-19 vaccination.MethodsFor this single-center, retrospective study, we screened the medical records of our tertiary interdisciplinary neurotology center for patients who had presented with AUPVP within 30 days after COVID-19 vaccination (study period: 1 June−31 December 2021). The initial diagnosis of AUPVP was based on a comprehensive bedside neurotological examination. Laboratory vestibular testing (video head impulse test, cervical and ocular vestibular evoked myogenic potentials, dynamic visual acuity, subjective visual vertical, video-oculography, caloric testing) was performed 1–5 months later.ResultsTwenty-six patients were diagnosed with AUPVP within the study period. Of those, n = 8 (31%) had developed acute vestibular symptoms within 30 days after COVID-19 vaccination (mean interval: 11.9 days, SD: 4.8, range: 6–20) and were thus included in the study. The mean age of the patients (two females, six males) was 46 years (SD: 11.7). Seven patients had received the Moderna mRNA vaccine and one the Pfizer/BioNTech mRNA vaccine. All patients displayed a horizontal(-torsional) spontaneous nystagmus toward the unaffected ear and a pathological clinical head impulse test toward the affected ear on initial clinical examination. Receptor-specific laboratory vestibular testing performed 1–5 months later revealed recovery of vestibular function in two patients, and heterogeneous lesion patterns of vestibular endorgans in the remaining six patients.Discussion and ConclusionsThe present study should raise clinicians' awareness for AUPVP after COVID-19 vaccination. The relatively high fraction of such cases among our AUPVP patients may be due to a certain selection bias at a tertiary neurotology center. Patients presenting with acute vestibular symptoms should be questioned about their vaccination status and the date of the last vaccination dose. Furthermore, cases of AUPVP occurring shortly after a COVID-19 vaccination should be reported to the health authorities to help determining a possible causal relationship.

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“…The first group included the patients assessed within the first 72 h after the onset of symptoms and the second group included patients tested after 72 h. The mean ipsilesional VOR gain for 15 patients who were tested within 72 h was 0.39 ± 0.17. Lee et al ( 32 ) reported a VOR gain in 13 patients with acute vestibular neuritis. The mean VOR gain for patients with acute vestibular neuritis was 0.58 ± 0.21.…”

Section: Resultsmentioning

confidence: 99%

VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review

Alfarghal¹,

Algarni²,

Sinha³

et al. 2022

Front. Neurol.

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IntroductionAcute unilateral vestibular hypofunction is characterized by sudden onset of vertigo or dizziness, vomiting/nausea, gait instability, and nystagmus. This is commonly described as an acute vestibular syndrome and usually attributed to vestibular neuritis; however, up to 25% of acute vestibular syndrome is caused by a stroke of posterior circulations. The video head impulse test is a recent tool in the vestibular test battery that assesses the vestibule-ocular reflex by measuring the VOR gain and recording overt and covert saccades, these findings have been found to be helpful in the diagnosis of various vestibular disorders.MethodA literature search was conducted in databases, including PubMed Central, PubMed, and Web of Science. All the articles that define video head impulse test (vHIT), acute vestibular hypofunction, and vestibular neuritis were considered for the preliminary search. No limits were placed on the date of publication. The searches were limited to studies with full-text availability, published in English, and including human subjects. Search words such as “head impulse test,” “video head impulse test,” “vestibular ocular reflex,” “acute vestibular syndrome,” “acute vestibular hypofunction,” “vestibular neuritis,” and “vHIT in central vestibular disorders” were entered into different databases in different combinations using boolean operators such as AND, OR, and NOT.ResultsSearches across different databases, including Web of Science, PubMed Central, and PubMed, resulted in a total of 1,790 articles. Title screening was done for all the articles. Out of the 1,790 articles, we found that 245 articles were related to vestibular hypofunction i.e., 1,545 articles were removed at this stage. A further 56 duplicate articles were removed. This led to a final screening of 189 articles. The exclusion criteria included unavailability of full text, studies reported in languages other than English, case reports, reviews, and articles including participants having other comorbid conditions. This final screening led to 133 articles being excluded, which led to the full-text screening of 56 articles. After screening the full-text articles as per the eligibility criteria, 21 articles were found to be eligible for the systematic review. Among the remaining studies, six articles were excluded due to different specific reasons. A total of 15 articles were included in this systematic review. The mean VOR gain for the patients with vestibular neuritis was 0.48 ± 0.14 for the ipsilesional ear, whereas the mean VOR gain was > 0.80 in the contralesional ear for all the patients with acute vestibular neuritis. In patients with PICA lesions, the VOR gain for the ipsilesional ear was 0.90 (range 0.87–0.94) and for the contralesional ear was 0.88 (range 0.84–0.93). In patients with AICA lesions, the mean VOR gain was variable. Based on the above mean VOR gain findings, the authors propose the following adjective description scale of VOR of the lateral canal using vHIT: normal VOR gain above 0.80, mild VOR gain loss for 0.70–0.79, moderate loss for 0.69–0.4, severe loss for 0.39–0.2, and profound loss for < 0.2.

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Video Head Impulse Testing: From Bench to Bedside

Cited by 20 publications

References 87 publications

Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients

Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients

Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center

VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review

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