PMID- 18541870
OWN - NLM
STAT- MEDLINE
DCOM- 20080613
LR  - 20220310
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 70
IP  - 24 Pt 2
DP  - 2008 Jun 10
TI  - Normal head impulse test differentiates acute cerebellar strokes from vestibular 
      neuritis.
PG  - 2378-85
LID - 10.1212/01.wnl.0000314685.01433.0d [doi]
AB  - OBJECTIVE: To test the diagnostic accuracy of the horizontal head impulse test 
      (h-HIT) of vestibulo-ocular reflex (VOR) function in distinguishing acute 
      peripheral vestibulopathy (APV) from stroke. Most patients with acute vertigo, 
      nausea/vomiting, and unsteady gait have benign APV (vestibular neuritis or 
      labyrinthitis) as a cause. However, some harbor life-threatening brainstem or 
      cerebellar strokes that mimic APV. A positive h-HIT (abnormal VOR) is said to 
      predict APV. METHODS: Cross-sectional study at an urban, academic hospital over 6 
      years. Consecutive acute vestibular syndrome patients at high risk for stroke 
      underwent structured examination (including h-HIT), neuroimaging, and admission. 
      Stroke was confirmed by neuroimaging (MRI or CT). APV was diagnosed by normal MRI 
      and appropriate clinical evolution in follow-up. RESULTS: Forty-three subjects 
      enrolled. One had an equivocal h-HIT. Patients with APV had a positive h-HIT (n = 
      8/8, 100%). Most patients with stroke had a negative h-HIT (n = 31/34, 91%). 
      However, contrary to conventional wisdom, three patients with stroke (9%) 
      demonstrated a positive h-HIT (1 vestibulocerebellar, 1 pontocerebellar, 1 
      pontocerebello-labyrinthine stroke). CONCLUSIONS: Patients with lateral pontine 
      and cerebellar strokes can have a positive horizontal head impulse test (h-HIT), 
      so the sign's presence cannot be solely relied upon to identify a benign 
      pathology. Additional clinical features (e.g., directionality of nystagmus, 
      severity of truncal instability, nature of hearing loss) must be considered in 
      patients with acute vestibular syndrome with a positive h-HIT before a central 
      localization can be confidently excluded. Nonetheless, the h-HIT remains a useful 
      bedside test-in acute vestibular syndrome patients, a negative h-HIT (i.e., 
      normal VOR) strongly suggests a central lesion with a pseudo-labyrinthine 
      presentation.
FAU - Newman-Toker, David E
AU  - Newman-Toker DE
AD  - Department of Neurology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
FAU - Kattah, Jorge C
AU  - Kattah JC
FAU - Alvernia, Jorge E
AU  - Alvernia JE
FAU - Wang, David Z
AU  - Wang DZ
LA  - eng
GR  - K23 RR17324-01/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cerebellar Diseases/complications/*diagnosis
MH  - Cerebellum/blood supply
MH  - Cross-Sectional Studies
MH  - Diagnosis, Differential
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Physical Examination
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - *Reflex, Vestibulo-Ocular
MH  - Stroke/complications/*diagnosis
MH  - Vestibular Neuronitis/complications/*diagnosis
EDAT- 2008/06/11 09:00
MHDA- 2008/06/14 09:00
CRDT- 2008/06/11 09:00
PHST- 2008/06/11 09:00 [pubmed]
PHST- 2008/06/14 09:00 [medline]
PHST- 2008/06/11 09:00 [entrez]
AID - 70/24_Part_2/2378 [pii]
AID - 10.1212/01.wnl.0000314685.01433.0d [doi]
PST - ppublish
SO  - Neurology. 2008 Jun 10;70(24 Pt 2):2378-85. doi: 
      10.1212/01.wnl.0000314685.01433.0d.