Semin Neurol 2020; 40(01): 005-017
DOI: 10.1055/s-0039-3402063
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Video Head Impulse Testing: From Bench to Bedside

1   Sydney Neurology, Brain and Mind Centre, Camperdown, New South Wales, Australia
,
G. Michael Halmagyi
2   Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
14. Januar 2020 (online)

Abstract

Over 30 years ago, the head impulse test (HIT) was measured with search coil recordings and it provided robust evidence for a new test of vestibular function that could detect impairment of a single semicircular canal, that is, the lateral canal. Over the next two decades, the diagnostic spectrum of HIT was expanded to the testing of vertical canals, differentiation of central from peripheral vestibulopathy, and incorporation of visual interaction—the suppressed head impulse. However, HIT measurement was limited to very few specialized laboratories that were able to maintain the time-consuming and expensive operation of the scleral search coil system, which is the gold standard in eye movement recording. The video HIT (vHIT) was validated for the first time over 10 years ago, against the search coils, and its introduction into dizzy clinics worldwide has revolutionized the practice of neuro-otology. Here we review the basic physiology, practical aspects, and clinical application of the vHIT.

Disclosure

Prof. Halmagyi is an unpaid consultant to GN Otometrics, Taastrup, Denmark, but has received support from GN Otometrics for traveling and attending conferences and workshops.


 
  • References

  • 1 Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol 1988; 45 (07) 737-739
  • 2 Cremer PD, Halmagyi GM, Aw ST. , et al. Semicircular canal plane head impulses detect absent function of individual semicircular canals. Brain 1998; 121 (Pt 4): 699-716
  • 3 Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Head impulse test in unilateral vestibular loss: vestibulo-ocular reflex and catch-up saccades. Neurology 2008; 70 (06) 454-463
  • 4 Ludvigh E. Amount of eye movement objectively perceptible to the unaided eye. Am J Ophthalmol 1949; 32 (05) 649
  • 5 MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 2009; 73 (14) 1134-1141
  • 6 MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP. Application of the video head impulse test to detect vertical semicircular canal dysfunction. Otol Neurotol 2013; 34 (06) 974-979
  • 7 Aw ST, Fetter M, Cremer PD, Karlberg M, Halmagyi GM. Individual semicircular canal function in superior and inferior vestibular neuritis. Neurology 2001; 57 (05) 768-774
  • 8 Curthoys IS, Blanks RH, Markham CH. Semicircular canal functional anatomy in cat, guinea pig and man. Acta Otolaryngol 1977; 83 (3-4): 258-265
  • 9 Curthoys IS, Halmagyi GM. Vestibular compensation: a review of the oculomotor, neural, and clinical consequences of unilateral vestibular loss. J Vestib Res 1995; 5 (02) 67-107
  • 10 McCrea RA, Strassman A, May E, Highstein SM. Anatomical and physiological characteristics of vestibular neurons mediating the horizontal vestibulo-ocular reflex of the squirrel monkey. J Comp Neurol 1987; 264 (04) 547-570
  • 11 Highstein SM, Baker R. Excitatory termination of abducens internuclear neurons on medial rectus motoneurons: relationship to syndrome of internuclear ophthalmoplegia. J Neurophysiol 1978; 41 (06) 1647-1661
  • 12 Hullar TE, Minor LB. High-frequency dynamics of regularly discharging canal afferents provide a linear signal for angular vestibuloocular reflexes. J Neurophysiol 1999; 82 (04) 2000-2005
  • 13 Goldberg JM, Fernandez C. Physiology of peripheral neurons innervating semicircular canals of the squirrel monkey. I. Resting discharge and response to constant angular accelerations. J Neurophysiol 1971; 34 (04) 635-660
  • 14 Minor LB, Lasker DM, Backous DD, Hullar TE. Horizontal vestibuloocular reflex evoked by high-acceleration rotations in the squirrel monkey. I. Normal responses. J Neurophysiol 1999; 82 (03) 1254-1270
  • 15 Cullen KE, McCrea RA. Firing behavior of brain stem neurons during voluntary cancellation of the horizontal vestibuloocular reflex. I. Secondary vestibular neurons. J Neurophysiol 1993; 70 (02) 828-843
  • 16 Shimazu H, Precht W. Tonic and kinetic responses of cat's vestibular neurons to horizontal angular acceleration. J Neurophysiol 1965; 28 (06) 991-1013
  • 17 MacDougall HG, McGarvie LA, Halmagyi GM. , et al. A new saccadic indicator of peripheral vestibular function based on the video head impulse test. Neurology 2016; 87 (04) 410-418
  • 18 MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP. The video Head Impulse Test (vHIT) detects vertical semicircular canal dysfunction. PLoS One 2013; 8 (04) e61488
  • 19 Newman-Toker DE, Saber Tehrani AS, Mantokoudis G. , et al. Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness: toward an ECG for the eyes. Stroke 2013; 44 (04) 1158-1161
  • 20 Newman-Toker DE, Curthoys IS, Halmagyi GM. Diagnosing stroke in acute vertigo: the HINTS family of eye movement tests and the future of the “eye ECG”. Semin Neurol 2015; 35 (05) 506-521
  • 21 Mantokoudis G, Tehrani AS, Wozniak A. , et al. VOR gain by head impulse video-oculography differentiates acute vestibular neuritis from stroke. Otol Neurotol 2015; 36 (03) 457-465
  • 22 Chen L, Todd M, Halmagyi GM, Aw S. Head impulse gain and saccade analysis in pontine-cerebellar stroke and vestibular neuritis. Neurology 2014; 83 (17) 1513-1522
  • 23 Taylor RL, McGarvie LA, Reid N, Young AS, Halmagyi GM, Welgampola MS. Vestibular neuritis affects both superior and inferior vestibular nerves. Neurology 2016; 87 (16) 1704-1712
  • 24 Marques P, Manrique-Huarte R, Perez-Fernandez N. Single intratympanic gentamicin injection in Ménière's disease: VOR change and prognostic usefulness. Laryngoscope 2015; 125 (08) 1915-1920
  • 25 Yacovino DA, Hain TC, Musazzi M. Fluctuating vestibulo-ocular reflex in Ménière's disease. Otol Neurotol 2017; 38 (02) 244-247
  • 26 Akdal G, MacDougall HG, Chen L, Tanrıverdizade T, Yiğitaslan O, Halmagyi GM. Selective impairment of horizontal vestibulo-ocular reflexes in acute Wernicke's encephalopathy. J Neurol Sci 2016; 365: 167-168
  • 27 Kattah JC, Dhanani SS, Pula JH, Mantokoudis G, Tehrani ASS, Toker DEN. Vestibular signs of thiamine deficiency during the early phase of suspected Wernicke encephalopathy. Neurol Clin Pract 2013; 3 (06) 460-468
  • 28 Chen L, Halmagyi GM. Central lesions with selective semicircular canal involvement mimicking bilateral vestibulopathy. Front Neurol 2018; 9 (264) 264
  • 29 Tarnutzer AA, Bockisch CJ, Buffone E, Weiler S, Bachmann LM, Weber KP. Disease-specific sparing of the anterior semicircular canals in bilateral vestibulopathy. Clin Neurophysiol 2016; 127 (08) 2791-2801
  • 30 Tarnutzer AA, Bockisch CJ, Buffone E, Weber KP. Association of posterior semicircular canal hypofunction on video-head-impulse testing with other vestibulo-cochlear deficits. Clin Neurophysiol 2017; 128 (08) 1532-1541
  • 31 McGarvie LA, Curthoys IS, MacDougall HG, Halmagyi GM. What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière's disease?. Acta Otolaryngol 2015; 135 (09) 859-865
  • 32 McCaslin DL, Rivas A, Jacobson GP, Bennett ML. The dissociation of video head impulse test (vHIT) and bithermal caloric test results provide topological localization of vestibular system impairment in patients with “definite” Ménière's disease. Am J Audiol 2015; 24 (01) 1-10
  • 33 Mantokoudis G, Saber Tehrani AS, Kattah JC. , et al. Quantifying the vestibulo-ocular reflex with video-oculography: nature and frequency of artifacts. Audiol Neurotol 2015; 20 (01) 39-50
  • 34 Heuberger M, Grill E, Sağlam M. , et al. Usability of the video head impulse test: lessons from the population-based prospective KORA study. Front Neurol 2018; 9: 659
  • 35 Castro P, Sena Esteves S, Lerchundi F. , et al. Viewing target distance influences the vestibulo-ocular reflex gain when assessed using the video head impulse test. Audiol Neurotol 2018; 23 (05) 285-289
  • 36 Halmagyi GM, Chen L, MacDougall HG, Weber KP, McGarvie LA, Curthoys IS. The video head impulse test. Front Neurol 2017; 8 (258) 258
  • 37 Suh MW, Park JH, Kang SI, Lim JH, Park MK, Kwon SK. Effect of goggle slippage on the video head impulse test outcome and its mechanisms. Otol Neurotol 2017; 38 (01) 102-109
  • 38 McGarvie LA, Martinez-Lopez M, Burgess AM, MacDougall HG, Curthoys IS. Horizontal eye position affects measured vertical vor gain on the video head impulse test. Front Neurol 2015; 6: 58
  • 39 Cleworth TW, Carpenter MG, Honegger F, Allum JHJ. Differences in head impulse test results due to analysis techniques. J Vestib Res 2017; 27 (2-3): 163-172
  • 40 Matiño-Soler E, Esteller-More E, Martin-Sanchez JC, Martinez-Sanchez JM, Perez-Fernandez N. Normative data on angular vestibulo-ocular responses in the yaw axis measured using the video head impulse test. Otol Neurotol 2015; 36 (03) 466-471
  • 41 McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The video head impulse test (vHIT) of semicircular canal function - age-dependent normative values of VOR gain in healthy subjects. Front Neurol 2015; 6: 154
  • 42 Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 2015; 44 (01) 29
  • 43 Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Horizontal head impulse test detects gentamicin vestibulotoxicity. Neurology 2009; 72 (16) 1417-1424
  • 44 Park JW, Kim TS, Cha EH, Kang BC, Park HJ. Differences in video head impulse test gains from right versus left or outward versus inward head impulses: vHIT Gains by Right/Left, In/Out Impulses. Laryngoscope 2019; 129 (07) 1675-1679
  • 45 Weber KP, Aw ST, Todd MJ. , et al. Inter-ocular differences of the horizontal vestibulo-ocular reflex during impulsive testing. Prog Brain Res 2008; 171: 195-198
  • 46 Highstein SM, Reisine H. The ascending tract of Deiters' and horizontal gaze. Ann N Y Acad Sci 1981; 374: 102-111
  • 47 Anson ER, Bigelow RT, Carey JP. , et al. Aging increases compensatory saccade amplitude in the video head impulse test. Front Neurol 2016; 7: 113
  • 48 Rambold HA. Age-related refixating saccades in the three-dimensional video-head-impulse test: source and dissociation from unilateral vestibular failure. Otol Neurotol 2016; 37 (02) 171-178
  • 49 Young AS, Taylor RL, McGarvie LA, Halmagyi GM, Welgampola MS. Bilateral sequential peripheral vestibulopathy. Neurology 2016; 86 (15) 1454-1456
  • 50 Lee JY, Kim CH, Park JS, Kim MB. Peripheral vestibulopathy presenting as acute vertigo and spontaneous nystagmus with negative video head impulse test. Otolaryngol Head Neck Surg 2019; 160 (05) 894-901
  • 51 Lopez-Escamez JA, Carey J, Chung WH. , et al; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière's disease. J Vestib Res 2015; 25 (01) 1-7
  • 52 van Esch BF, Abolhosseini K, Masius-Olthof S, van der Zaag-Loonen HJ, van Benthem PPG, Bruintjes TD. Video-head impulse test results in patients with Menière's disease related to duration and stage of disease. J Vestib Res 2018; 28 (5-6): 401-407
  • 53 Blödow A, Heinze M, Bloching MB, von Brevern M, Radtke A, Lempert T. Caloric stimulation and video-head impulse testing in Ménière's disease and vestibular migraine. Acta Otolaryngol 2014; 134 (12) 1239-1244
  • 54 Schmid-Priscoveanu A, Böhmer A, Obzina H, Straumann D. Caloric and search-coil head-impulse testing in patients after vestibular neuritis. J Assoc Res Otolaryngol 2001; 2 (01) 72-78
  • 55 Lee SU, Kim HJ, Koo JW, Kim JS. Comparison of caloric and head-impulse tests during the attacks of Meniere's disease. Laryngoscope 2017; 127 (03) 702-708
  • 56 Manzari L, MacDougall HG, Burgess AM, Curthoys IS. New, fast, clinical vestibular tests identify whether a vertigo attack is due to early Ménière's disease or vestibular neuritis. Laryngoscope 2013; 123 (02) 507-511
  • 57 Tarnutzer AA, Bockisch CJ, Buffone E, Weber KP. Hierarchical cluster analysis of semicircular canal and otolith deficits in bilateral vestibulopathy. Front Neurol 2018; 9 (244) 244
  • 58 Choi JY, Lee SH, Kim JS. Central vertigo. Curr Opin Neurol 2018; 31 (01) 81-89
  • 59 Choi JY, Kim JS. Nystagmus and central vestibular disorders. Curr Opin Neurol 2017; 30 (01) 98-106
  • 60 Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”. J Neurol Neurosurg Psychiatry 2008; 79 (04) 458-460
  • 61 Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology 2008; 70 (24 Pt 2): 2378-2385
  • 62 Seemungal BM, Bronstein AM. A practical approach to acute vertigo. Pract Neurol 2008; 8 (04) 211-221
  • 63 Choi JY, Kim HJ, Kim JS. Recent advances in head impulse test findings in central vestibular disorders. Neurology 2018; 90 (13) 602-612
  • 64 Amarenco P, Hauw JJ. Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinicopathological study of 20 cases. Brain 1990; 113 (Pt 1): 139-155
  • 65 Park HK, Kim JS, Strupp M, Zee DS. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 2013; 260 (06) 1576-1582
  • 66 Yacovino DA, Akly MP, Luis L, Zee DS. The floccular syndrome: dynamic changes in eye movements and vestibulo-ocular reflex in isolated infarction of the cerebellar flocculus. Cerebellum 2018; 17 (02) 122-131
  • 67 Meng H, Blázquez PM, Dickman JD, Angelaki DE. Diversity of vestibular nuclei neurons targeted by cerebellar nodulus inhibition. J Physiol 2014; 592 (01) 171-188
  • 68 Kim HJ, Lee SH, Park JH, Choi JY, Kim JS. Isolated vestibular nuclear infarction: report of two cases and review of the literature. J Neurol 2014; 261 (01) 121-129
  • 69 Kim SH, Zee DS, du Lac S, Kim HJ, Kim JS. Nucleus prepositus hypoglossi lesions produce a unique ocular motor syndrome. Neurology 2016; 87 (19) 2026-2033
  • 70 Zee DS. Internuclear ophthalmoplegia: pathophysiology and diagnosis. Baillieres Clin Neurol 1992; 1 (02) 455-470
  • 71 Frohman TC, Galetta S, Fox R. , et al. Pearls & Oy-sters: the medial longitudinal fasciculus in ocular motor physiology. Neurology 2008; 70 (17) e57-e67
  • 72 Cremer PD, Migliaccio AA, Halmagyi GM, Curthoys IS. Vestibulo-ocular reflex pathways in internuclear ophthalmoplegia. Ann Neurol 1999; 45 (04) 529-533
  • 73 Aw ST, Chen L, Todd MJ, Barnett MH, Halmagyi GM. Vestibulo-ocular reflex deficits with medial longitudinal fasciculus lesions. J Neurol 2017; 264 (10) 2119-2129
  • 74 Choi SY, Kim HJ, Kim JS. Impaired vestibular responses in internuclear ophthalmoplegia: association and dissociation. Neurology 2017; 89 (24) 2476-2480
  • 75 Gordon CR, Zivotofsky AZ, Caspi A. Impaired vestibulo-ocular reflex (VOR) in spinocerebellar ataxia type 3 (SCA3): bedside and search coil evaluation. J Vestib Res 2014; 24 (5-6): 351-355
  • 76 Huh YE, Kim JS, Kim HJ. , et al. Vestibular performance during high-acceleration stimuli correlates with clinical decline in SCA6. Cerebellum 2015; 14 (03) 284-291
  • 77 Fahey MC, Cremer PD, Aw ST. , et al. Vestibular, saccadic and fixation abnormalities in genetically confirmed Friedreich ataxia. Brain 2008; 131 (Pt 4): 1035-1045
  • 78 Migliaccio AA, Halmagyi GM, McGarvie LA, Cremer PD. Cerebellar ataxia with bilateral vestibulopathy: description of a syndrome and its characteristic clinical sign. Brain 2004; 127 (Pt 2): 280-293
  • 79 Choi JY, Kim JS, Jung JM. , et al. Reversed corrective saccades during head impulse test in acute cerebellar dysfunction. Cerebellum 2014; 13 (02) 243-247
  • 80 Walker MF, Zee DS. Cerebellar disease alters the axis of the high-acceleration vestibuloocular reflex. J Neurophysiol 2005; 94 (05) 3417-3429
  • 81 Kim SH, Kim HJ, Kim JS. Perverted downward corrective saccades during horizontal head impulses in Chiari malformation. Cerebellum 2019; 18 (03) 333-339
  • 82 Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007; 6 (05) 442-455
  • 83 Lee SH, Kim SH, Kim JM, Tarnutzer AA. Vestibular dysfunction in Wernicke's Encephalopathy: predominant impairment of the horizontal semicircular canals. Front Neurol 2018; 9: 141
  • 84 Kattah JC, Guede C, Hassanzadeh B. The medial vestibular nuclei, a vulnerable target in thiamine deficiency. J Neurol 2018; 265 (01) 213-215
  • 85 Benko W, Ries M, Wiggs EA, Brady RO, Schiffmann R, Fitzgibbon EJ. The saccadic and neurological deficits in type 3 Gaucher disease. PLoS One 2011; 6 (07) e22410
  • 86 Chen L, Halmagyi GM, Todd MJ, Aw ST. Vestibular and saccadic abnormalities in Gaucher's disease. JIMD Rep 2014; 13: 111-118
  • 87 Winkelman MD, Banker BQ, Victor M, Moser HW. Non-infantile neuronopathic Gaucher's disease: a clinicopathologic study. Neurology 1983; 33 (08) 994-1008
  • 88 Bremova-Ertl T, Schiffmann R, Patterson MC. , et al. Oculomotor and vestibular findings in Gaucher disease type 3 and their correlation with neurological findings. Front Neurol 2018; 8: 711