The Video Head Impulse Test: Diagnostic Accuracy in Peripheral Vestibulopathy

Overview

Journal Neurology

Specialty Neurology

Date 2009 Oct 7

PMID 19805730

Citations 311

Authors

H G MacDougall

K P Weber

L A McGarvie

G M Halmagyi

I S Curthoys

Affiliations

Soon will be listed here.

Abstract

Background: The head impulse test (HIT) is a useful bedside test to identify peripheral vestibular deficits. However, such a deficit of the vestibulo-ocular reflex (VOR) may not be diagnosed because corrective saccades cannot always be detected by simple observation. The scleral search coil technique is the gold standard for HIT measurements, but it is not practical for routine testing or for acute patients, because they are required to wear an uncomfortable contact lens.

Objective: To develop an easy-to-use video HIT system (vHIT) as a clinical tool for identifying peripheral vestibular deficits. To validate the diagnostic accuracy of vHIT by simultaneous measures with video and search coil recordings across healthy subjects and patients with a wide range of previously identified peripheral vestibular deficits.

Methods: Horizontal HIT was recorded simultaneously with vHIT (250 Hz) and search coils (1,000 Hz) in 8 normal subjects, 6 patients with vestibular neuritis, 1 patient after unilateral intratympanic gentamicin, and 1 patient with bilateral gentamicin vestibulotoxicity.

Results: Simultaneous video and search coil recordings of eye movements were closely comparable (average concordance correlation coefficient r(c) = 0.930). Mean VOR gains measured with search coils and video were not significantly different in normal (p = 0.107) and patients (p = 0.073). With these groups, the sensitivity and specificity of both the reference and index test were 1.0 (95% confidence interval 0.69-1.0). vHIT measures detected both overt and covert saccades as accurately as coils.

Conclusions: The video head impulse test is equivalent to search coils in identifying peripheral vestibular deficits but easier to use in clinics, even in patients with acute vestibular neuritis.

Citing Articles

Normal Variations of Video Head Impulse Test in Adult Populations at Peak Head Velocity of Below 150 Degrees/Second.

Jafarzadeh S Indian J Otolaryngol Head Neck Surg. 2025; 77(1):177-183.

PMID: 40066433 PMC: 11890380. DOI: 10.1007/s12070-024-05134-4.

Separation of stroke from vestibular neuritis using the video head impulse test: machine learning models versus expert clinicians.

Wang C, Sreerama J, Nham B, Reid N, Ozalp N, Thomas J J Neurol. 2025; 272(3):248.

PMID: 40042674 PMC: 11882619. DOI: 10.1007/s00415-025-12918-3.

Inferior Vestibular Neuritis: Diagnostic Criteria, Clinical Features, and Prognosis-A Focused Review.

Musat G, Preda M, Tanase I, Anton A, Mitroi G, Musat O Medicina (Kaunas). 2025; 61(2).

PMID: 40005477 PMC: 11857415. DOI: 10.3390/medicina61020361.

Functional Outcome and Balance Compensation in Patients with Unilateral Vestibular Schwannoma After Surgical Treatment-Short- and Medium-Term Observation.

Torchalla P, Jasinska-Nowacka A, Lachowska M, Niemczyk K J Clin Med. 2025; 14(2).

PMID: 39860590 PMC: 11766155. DOI: 10.3390/jcm14020585.

Video Head Impulse Test in Children-A Systematic Review of Literature.

Dasgupta S, Mukherjee A, Crunkhorn R, Dawabah S, Aslier N, Ratnayake S J Clin Med. 2025; 14(2).

PMID: 39860374 PMC: 11765868. DOI: 10.3390/jcm14020369.

References

Weber K, Aw S, Todd M, McGarvie L, Curthoys I, Halmagyi G . Horizontal head impulse test detects gentamicin vestibulotoxicity. Neurology. 2009; 72(16):1417-24. DOI: 10.1212/WNL.0b013e3181a18652. View

Moore S, Curthoys I, McCoy S . VTM--an image-processing system for measuring ocular torsion. Comput Methods Programs Biomed. 1991; 35(3):219-30. DOI: 10.1016/0169-2607(91)90124-c. View

Black R, Halmagyi G, Thurtell M, Todd M, Curthoys I . The active head-impulse test in unilateral peripheral vestibulopathy. Arch Neurol. 2005; 62(2):290-3. DOI: 10.1001/archneur.62.2.290. View

Halmagyi G, Yavor R, McGarvie L . Testing the vestibulo-ocular reflex. Adv Otorhinolaryngol. 1997; 53:132-54. DOI: 10.1159/000059042. View

Weber K, Aw S, Todd M, McGarvie L, Curthoys I, Halmagyi G . Head impulse test in unilateral vestibular loss: vestibulo-ocular reflex and catch-up saccades. Neurology. 2008; 70(6):454-63. DOI: 10.1212/01.wnl.0000299117.48935.2e. View

Aw S, Halmagyi G, Haslwanter T, Curthoys I, Yavor R, Todd M . Three-dimensional vector analysis of the human vestibuloocular reflex in response to high-acceleration head rotations. II. responses in subjects with unilateral vestibular loss and selective semicircular canal occlusion. J Neurophysiol. 1996; 76(6):4021-30. DOI: 10.1152/jn.1996.76.6.4021. View

Newman-Toker D, Kattah J, Alvernia J, Wang D . Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology. 2008; 70(24 Pt 2):2378-85. DOI: 10.1212/01.wnl.0000314685.01433.0d. View

Bartl K, Lehnen N, Kohlbecher S, Schneider E . Head impulse testing using video-oculography. Ann N Y Acad Sci. 2009; 1164:331-3. DOI: 10.1111/j.1749-6632.2009.03850.x. View

Delori F, Webb R, Sliney D . Maximum permissible exposures for ocular safety (ANSI 2000), with emphasis on ophthalmic devices. J Opt Soc Am A Opt Image Sci Vis. 2007; 24(5):1250-65. DOI: 10.1364/josaa.24.001250. View

10.

Halmagyi G, Curthoys I . A clinical sign of canal paresis. Arch Neurol. 1988; 45(7):737-9. DOI: 10.1001/archneur.1988.00520310043015. View

11.

Aw S, Fetter M, Cremer P, Karlberg M, Halmagyi G . Individual semicircular canal function in superior and inferior vestibular neuritis. Neurology. 2001; 57(5):768-74. DOI: 10.1212/wnl.57.5.768. View

12.

Haslwanter T . Mathematics of three-dimensional eye rotations. Vision Res. 1995; 35(12):1727-39. DOI: 10.1016/0042-6989(94)00257-m. View

13.

Schmid-Priscoveanu A, Bohmer A, Obzina H, Straumann D . Caloric and search-coil head-impulse testing in patients after vestibular neuritis. J Assoc Res Otolaryngol. 2001; 2(1):72-8. PMC: 3201096. DOI: 10.1007/s101620010060. View

14.

Jorns-Haderli M, Straumann D, Palla A . Accuracy of the bedside head impulse test in detecting vestibular hypofunction. J Neurol Neurosurg Psychiatry. 2007; 78(10):1113-8. PMC: 2117540. DOI: 10.1136/jnnp.2006.109512. View

15.

Weber K, MacDougall H, Halmagyi G, Curthoys I . Impulsive testing of semicircular-canal function using video-oculography. Ann N Y Acad Sci. 2009; 1164:486-91. DOI: 10.1111/j.1749-6632.2008.03730.x. View

16.

Robinson D . A METHOD OF MEASURING EYE MOVEMENT USING A SCLERAL SEARCH COIL IN A MAGNETIC FIELD. IEEE Trans Biomed Eng. 1963; 10:137-45. DOI: 10.1109/tbmel.1963.4322822. View

17.

Bossuyt P, Reitsma J, Bruns D, Gatsonis C, Glasziou P, Irwig L . Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ. 2003; 326(7379):41-4. PMC: 1124931. DOI: 10.1136/bmj.326.7379.41. View

18.

Aw S, Haslwanter T, Halmagyi G, Curthoys I, Yavor R, Todd M . 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(6):4009-20. DOI: 10.1152/jn.1996.76.6.4009. View

19.

Cnyrim C, Newman-Toker D, Karch C, Brandt T, Strupp M . Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis". J Neurol Neurosurg Psychiatry. 2008; 79(4):458-60. DOI: 10.1136/jnnp.2007.123596. View

20.

Lin L . A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989; 45(1):255-68. View