Video head impulse testing: Pitfalls in neurological patients

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

doi:10.1016/j.jns.2022.120417

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…In this study video head impulse testing was used as an objective measure of vestibular dysfunction, interpreting low vestibulo‐ocular gain as a feature of peripheral vestibular dysfunction and the presence of high velocity saccades following the head impulse as a feature of central vestibulopathy, where gains were normal [8]. Regardless of the origin of the vestibular dysfunction, both peripheral and central vestibular dysfunction can benefit from vestibular rehabilitation [4, 9]; hence this is why in this study it was chosen not to pursue a differentiation between peripheral and central aetiologies—a difficult separation in patients with PMDs where both peripheral and central vestibular pathways can be affected [10].…”

Section: Discussionmentioning

confidence: 99%

“…Benign paroxysmal positional vertigo is reported to be the com- In this study video head impulse testing was used as an objective measure of vestibular dysfunction, interpreting low vestibuloocular gain as a feature of peripheral vestibular dysfunction and the presence of high velocity saccades following the head impulse as a feature of central vestibulopathy, where gains were normal [8].…”

Section: This Was Then Tested For Accuracy In a Large Cohort Of Patie...mentioning

confidence: 99%

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A diagnostic framework to identify vestibular involvement in multi‐sensory neurological disease

Male,

Holmes,

Koohi

et al. 2024

Euro J of Neurology

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Background and purposeIdentifying vestibular causes of dizziness and unsteadiness in multi‐sensory neurological disease can be challenging, with problems typically attributed to central or peripheral nerve involvement. Acknowledging vestibular dysfunction as part of the presentation provides an opportunity to access targeted vestibular rehabilitation, for which extensive evidence exists. A diagnostic framework was developed and validated to detect vestibular dysfunction, benign paroxysmal positional vertigo or vestibular migraine. The specificity and sensitivity of the diagnostic framework was tested in patients with primary mitochondrial disease.MethodsAdults with a confirmed diagnosis of primary mitochondrial disease were consented, between September 2020 and February 2022. Participants with and without dizziness or unsteadiness underwent remote physiotherapy assessment and had in‐person detailed neuro‐otological assessment. The six framework question responses were compared against objective neuro‐otological assessment or medical notes. The output was binary, with sensitivity and specificity calculated.ResultsSeventy‐four adults completed the study: age range 20–81 years (mean 48 years, ±SD 15.05 years); ratio 2:1 female to male. The framework identified a vestibular diagnosis in 35 participants, with seven having two diagnoses. The framework was able to identify vestibular diagnoses in adults with primary mitochondrial disease, with a moderate (40–59) to very high (90–100) sensitivity and positive predictive value, and moderate to high (60–74) to very high (90–100) specificity and negative predictive value.ConclusionsOverall, the clinical framework identified common vestibular diagnoses with a moderate to very high specificity and sensitivity. This presents an opportunity for patients to access effective treatment in a timely manner, to reduce falls and improve quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: This Was Then Tested For Accuracy In a Large Cohort Of Patie...mentioning

confidence: 99%

A diagnostic framework to identify vestibular involvement in multi‐sensory neurological disease

Male,

Holmes,

Koohi

et al. 2024

Euro J of Neurology

Self Cite

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“…16,17 Additionally, the evidence suggests some instances of central vestibular pathology may also exhibit abnormalities with this test. 18,19 There is varying sensitivity and specificity reported in the literature for the video head impulse test, depending on the site of lesion, clinical setting and parameters used for positive findings. When measuring vestibular weakness, there is varying sensitivity and specificity reported, ranging from as low as 40 per cent to as high as 100 per cent for both parameters.…”

Section: Video Head Impulse Testmentioning

confidence: 99%

“…16,17 Additionally, the evidence suggests some instances of central vestibular pathology may also exhibit abnormalities with this test. 18,19…”

Section: Current Trends In Vestibular Assessmentmentioning

confidence: 99%

Modernising vestibular assessment

Lennox-Bowley,

Dasgupta

2024

J. Laryngol. Otol.

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Background There is a high prevalence of dizziness, vertigo and balance symptoms in the general population. Symptoms can be generated by many inner-ear vestibular disorders and there are several diagnostic tests available that can help identify the site of the vestibular lesion. There is little consensus on what diagnostic tests are appropriate, with diagnostics either not completed or minimally performed, leading to missed diagnosis, unsatisfactory results for patients and costs to healthcare systems. Methods This study explored the literature for different neuro-vestibular diagnostic tests not currently considered in the traditional standard vestibular test battery, and examined how they fit effectively into a patient care pathway to help quickly and succinctly identify vestibular function. Results A vestibular patient care pathway is presented for acute and subacute presentation of vestibular disorders. Conclusion An accurate diagnosis following a rigorous anamnesis and vestibular testing is paramount for successful management and favourable outcomes.

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“…Of course the study of saccades and their interpretation is of very great interest because of all the extra information saccades can provide ( 66 , 67 , 70 , 71 )—e.g., they can be so useful in identifying lesions along the central pathways of the VOR in structures (such as the cerebellum) which modulate the transmission of information along those central pathways ( 22 , 72 – 75 ).…”

Section: Saccadesmentioning

confidence: 99%

A review of the geometrical basis and the principles underlying the use and interpretation of the video head impulse test (vHIT) in clinical vestibular testing

et al. 2023

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This paper is concerned mainly with the assumptions underpinning the actual testing procedure, measurement, and interpretation of the video head impulse test—vHIT. Other papers have reported in detail the artifacts which can interfere with obtaining accurate eye movement results, but here we focus not on artifacts, but on the basic questions about the assumptions and geometrical considerations by which vHIT works. These matters are crucial in understanding and appropriately interpreting the results obtained, especially as vHIT is now being applied to central disorders. The interpretation of the eye velocity responses relies on thorough knowledge of the factors which can affect the response—for example the orientation of the goggles on the head, the head pitch, and the contribution of vertical canals to the horizontal canal response. We highlight some of these issues and point to future developments and improvements. The paper assumes knowledge of how vHIT testing is conducted.

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Video head impulse testing: Pitfalls in neurological patients

Cited by 9 publications

References 13 publications

A diagnostic framework to identify vestibular involvement in multi‐sensory neurological disease

A diagnostic framework to identify vestibular involvement in multi‐sensory neurological disease

Modernising vestibular assessment

A review of the geometrical basis and the principles underlying the use and interpretation of the video head impulse test (vHIT) in clinical vestibular testing

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