Laryngorhinootologie 2018; 97(03): 181-188
DOI: 10.1055/s-0043-122743
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Video-Kopfimpulstest: geringer Nutzen zur Unterscheidung peripherer und zentraler Schwindel

Video-Head impulse test with little diagnostic impact in vertigo-patients
Jochen Henrik Patscheke
,
Pauline Plenz
,
Stephan Ernst
,
Jens-Peter Klußmann
Further Information

Publication History

01/05/2017

11/08/2017

Publication Date:
19 December 2017 (online)

Zusammenfassung

Hintergrund Der Video-Kopfimpulstest (V-KIT) etabliert sich zunehmend in der Abklärung von Schwindel und Gleichgewichtsstörungen und ergänzt die Funktionsprüfung des Vestibulo-okulären Reflexes (VOR). Die Videoaufzeichnung soll eine objektive Auswertung ermöglichen und helfen, die Diagnose einer peripher-vestibulären Störung (PVS) zu sichern. Dies muss in der klinischen Routine noch bestätigt werden.

Material und Methode In einer Beobachtungsstudie wurden 171 konsekutive, unselektierte Patienten mit Schwindel einer HNO-Universitätsklinik nach konventioneller klinischer und apparativer Abklärung unter Einschluss einer kalorischen Prüfung in Diagnosegruppen aufgeteilt. Zusätzlich wurde bei allen Patienten ein V-KIT in horizontaler Ausrichtung durchgeführt. Dieser wurde dann bezüglich der Größe des Gain, der Gain-Asymmetrie (GA) sowie des Auftretens von Catch-up Sakkaden (CS) in den Diagnosegruppen ausgewertet. Zusätzlich wurde die GA mit der aus der kalorischen Prüfung berechneten Seitendifferenz (Canal Paresis, CP) verglichen.

Ergebnisse Bei den Patienten mit einseitiger PVS trat in 31 % ein pathologischer Gain (definiert als < 0,8) auf, die durchschnittliche GA betrug 4,53 % (± 16,7 %) und es traten bei 60 % CS auf. Bei den Patienten mit zentraler Schwindelgenese trat bei 28 % ein pathologischer Gain auf, die durchschnittliche GA betrug -1,56 % (± 17,9 %) und es traten bei 45 % CS auf. Isolierte Covert-Sakkaden traten nur vereinzelt auf. Die GA korrelierte nicht mit der Seitendifferenz aus der kalorischen Prüfung (p = 0,114).

Schlussfolgerung Die klinisch wichtige Zuordnung einer zentralen oder peripher-vestibulären Schwindelursache ist an Hand des V-KIT in der untersuchten Kohorte nicht möglich.

Abstract

Objective Video-head impulse test (V-HIT) is more and more becoming a routine test in patients with vertigo, contributing information about the vestibulo-ocular reflex (VOR). According to Ewald’s second law, the unilateral pathological test points to this side’s peripheral organ as being diseased. The value in clinical routine is still unclear.

Material and Methods 171 consecutive patients with vertigo that had received a V-HIT and caloric testing at presentation in an academic ENT-department were included. By chart-review, they were categorized in different groups with unilateral peripheral, central and other etiology of vertigo, irrespective of their V-HIT result. Then the latter was analyzed within the different groups with respect to Gain, Gain-Asymmetry (GA) and Catch-up Saccades (CS). Canal Paresis (CP) from caloric testing was compared to GA.

Results In patients with unilateral peripheral disease, 31 % showed a pathological gain (< 0.8), the mean GA was 4.53 % (± 16.72 %) and 60 % had CSs. In patients with presumed or assured central etiology, these data were 28 %, −1,56 % (± 17,89 %) and 45 %. Isolated CS occurred only sporadically. CP was not correlated with GA in all groups (p = 0,114).

Conclusion In this study V-HIT showed little diagnostic use, especially in separating peripheral from central disease. The lacking correlation between asymmetry in caloric testing and asymmetry of V-HIT gain challenges current pathophysiological concepts of impaired VOR.

 
  • Literatur

  • 1 Kattah JC, Talkad AV, Wang DZ. et al. Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40: 3504-3510
  • 2 Bhansali SA, Honrubia V. Current status of electronystagmography testing. Otolaryngology-head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 1999; 120: 419-426
  • 3 Aw ST, Haslwanter T, Halmagyi GM. et al. Three-dimensional vector analysis of the human vestibuloocular reflex in response to high-acceleration head rotations. I. Responses in normal subjects. J Neurophysiol 1996; 76: 4009-4020
  • 4 Curthoys IS. HGMLMAMBAPBLM. Klinische Anwendung eines objektiven Tests zur Prüfung der dynamischen Bogengangsfunktion — der Video-Kopfimpuls-Test (vHIT) – Springer. Vertigo — Kontroverses und Bewährtes. 2011
  • 5 MacDougall HG, McGarvie LA, Halmagyi GM. et al. The Video Head Impulse Test (vHIT) detects Vertical Semicircular Canal Dysfunction. PLoS ONE 2013; 8 e61488
  • 6 MacDougall HG, Weber KP, McGarvie LA. et al. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 2009; 73: 1134-1141
  • 7 Weber KP, Aw ST, Todd MJ. et al. Head impulse test in unilateral vestibular loss: vestibulo-ocular reflex and catch-up saccades. Neurology 2008; 70: 454-463
  • 8 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
  • 9 Blödow A, Helbig R, Wichmann N. et al. Der Video-Kopfimpulstest. HNO 2013; 61: 327-334
  • 10 Machner B, Sprenger A, Füllgraf H. et al. Videobasierter Kopfimpulstest. Nervenarzt 2013; 84: 975-983
  • 11 Perez-Fernandez N, Gallegos-Constantino V, Barona-Lleo L. et al. Clinical and video-assisted examination of the vestibulo-ocular reflex: a comparative study. Acta Otorrinolaringol Esp 2012; 63: 429-435
  • 12 Schmidt CL, Oostvogel C, Staschinski D. Head impulse test and vibratory test in the diagnosis of vertigo. Laryngorhinootologie 2012; 91: 192-203
  • 13 Black RA, Halmagyi GM, Thurtell MJ. et al. The active Head-Impulse Test in unilateral peripheral vestibulopathy. Arch Neurol 2005; 62: 290
  • 14 Boleas-Aguirre M, Migliaccio AA, Carey JP. Vestibulo-oculomotor reflex recording using the scleral search coil technique. Review of peripheral vestibular disorders. Acta Otorrinolaringol Esp 2007; 58: 321-326
  • 15 Nicolas B, Gassmann SHDS. Kalorik und quantitativer Kopfimpulstest (KIT) irn Vergleich. KONGRESSBEITRAG Schweiz Med Forum. 2006
  • 16 Ernst A, Andresen D. Gleichgewichtsstörungen. Stuttgart, New York: Thieme; 2012
  • 17 Stoll W, Matz DR, Most E. Schwindel und Gleichgewichtsstörungen. Stuttgart [u. a.]: Thieme; 1992
  • 18 Bartl K, Lehnen N, Kohlbecher S. et al. Head impulse testing using video-oculography. Ann N Y Acad Sci 2009; 1164: 331-333
  • 19 Chen L, Todd M, Halmagyi GM. et al. Head impulse gain and saccade analysis in pontine-cerebellar stroke and vestibular neuritis. Neurology 2014; 83: 1513-1522
  • 20 Kim H, Lee H. Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy. Stroke 2010; 41: 1558-1560
  • 21 Kremmyda O, Kirchner H, Glasauer S. et al. False-positive head-impulse test in cerebellar ataxia. Front Neurol 2012; 3: 162
  • 22 Lee H, Kim JS, Chung E. et al. Infarction in the territory of anterior inferior cerebellar artery: Spectrum of audiovestibular loss. Stroke 2009; 40: 3745-3751
  • 23 Mantokoudis G, Saber Tehrani, Ali S. et al. VOR Gain by Head Impulse Video-Oculography differentiates Acute Vestibular Neuritis from stroke. Otol Neurotol. 2014
  • 24 Park H, Kim J, Strupp M. et al. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 2013; 260: 1576-1582
  • 25 Kim J, Kim HJ. Inferior vestibular neuritis. J Neurol 2012; 259: 1553-1560
  • 26 Mahringer A, Rambold HA. Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. Eur Arch Otorhinolaryngol. 2013
  • 27 Bell SL, Barker F, Heselton H. et al. A study of the relationship between the video head impulse test and air calorics. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2015; 272: 1287-1294
  • 28 Rambold HA. Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2015; 272: 2621-2628
  • 29 Blödow A, Pannasch S, Walther LE. Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders. Auris Nasus Larynx. 2012
  • 30 Walther LE, Hülse R, Blödow A. Gleichgewichtsstörungen aus HNO-ärztlicher Sicht. Ophthalmologe 2013; 110: 16-25
  • 31 Allison RS, Eizenman M, Tomlinson RD. et al. Vestibulo-ocular reflex deficits to rapid head turns following intratympanic gentamicin instillation. J Vestib Res 1997; 7: 369-380
  • 32 Schmid-Priscoveanu A, Bohmer A, Obzina H. et al. Caloric and search-coil head-impulse testing in patients after vestibular neuritis. J Assoc Res Otolaryngol 2001; 2: 72-78
  • 33 Hirvonen M, Aalto H, Migliaccio AA. et al. Motorized head impulse rotator for horizontal vestibulo-ocular reflex: Normal responses. Arch Otolaryngol Head Neck Surg 2007; 133: 157-161
  • 34 Palla A, Straumann D, Bronstein AM. Vestibular neuritis: vertigo and the high-acceleration vestibulo-ocular reflex. J Neurol 2008; 255: 1479-1482
  • 35 Jutila T, Aalto H, Hirvonen TP. Recovery of the horizontal vestibulo-ocular reflex in motorized head impulse test is common after vestibular loss. Acta Otolaryngol 2012; 132: 726-731
  • 36 Newman-Toker DE, Saber Tehrani, Ali S. et al. Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness: toward an ECG for the eyes. Stroke 2013; 44: 1158-1161
  • 37 Park HJ, Migliaccio AA, Della Santina CC. et al. Search-coil head-thrust and caloric tests in Ménière’s disease. Acta Otolaryngol 2005; 125: 852-857
  • 38 Clarke AH. Laboratory testing of the vestibular system. Curr Opin Otolaryngol Head Neck Surg 2010; 18: 425-430
  • 39 Curthoys IS. The interpretation of clinical tests of peripheral vestibular function. Laryngoscope 2012; 122: 1342-1352
  • 40 Fife TD, Tusa RJ, Furman JM. et al. Assessment: vestibular testing techniques in adults and children: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2000; 55: 1431-1441
  • 41 Kessler P, Zarandy MM, Hajioff D. et al. The clinical utility of search coil horizontal vestibulo-ocular reflex testing. Acta Otolaryngol 2008; 128: 29-37
  • 42 Blödow A, Helbig R, Bloching M. et al. Isolierte Rezeptorfunktionsstörung des horizontalen Bogengangs. HNO 2013; 61: 46-51
  • 43 Minor LB, Lasker DM. Tonic and phasic contributions to the pathways mediating compensation and adaptation of the vestibulo-ocular reflex. Journal of vestibular research: equilibrium & orientation 2009; 19: 159-170