The Head Impulse Test

Summary

The Head Impulse Test is a diagnostic tool for peripheral vertigo, such as from vestibular neuronitis or labyrinthitis, which involves the patient and examiner facing each other with the patient's gaze fixed on the examiner's nose. The examiner then rapidly moves the patient's head 10 to 20 degrees in one direction and back, observing for eye movements. A normally functioning vestibular system maintains eye contact, while an abnormal one shows rapid side-to-side eye movements before refixing. This test is crucial for diagnosing peripheral vertigo, distinguishing it from central causes.

Takeaways

• 🔍 The head impulse test is a diagnostic tool for peripheral vertigo caused by vestibular system issues like vestibular neuronitis or labyrinthitis.
• 👥 The test requires the examiner and patient to sit upright facing each other, with the patient focusing on the examiner's nose.
• 🤲 The examiner holds the patient's head and performs rapid head jerks of 10 to 20 degrees in one direction while the patient tries to maintain eye contact.
• 🔄 The head is then slowly returned to the center before the jerk is repeated in the opposite direction.
• 🚫 It's crucial to check for any neck pain or pathology before performing the test to avoid complications.
• 👀 A normally functioning vestibular system will allow the patient to keep their eyes fixed on the examiner's nose throughout the test.
• 💫 In cases of vestibular dysfunction, such as with neuronitis or labyrinthitis, the patient's eyes will exhibit saccadic movements as they re-fixate on the nose.
• 🏥 The head impulse test helps in diagnosing peripheral vertigo and will show normal results if the patient has no current symptoms or if the vertigo is centrally caused.
• 📝 The test is an important part of the clinical examination for patients presenting with vertigo to differentiate between peripheral and central causes.
• 📉 Abnormal findings in the head impulse test can indicate a peripheral vestibular disorder, guiding further diagnostic and treatment approaches.
• 📚 Understanding the head impulse test is essential for healthcare professionals dealing with patients who experience dizziness or vertigo.

Q & A

What is the head impulse test used for?

The head impulse test is used to diagnose peripheral causes of vertigo resulting from problems with the vestibular system, such as vestibular neuronitis or labyrinthitis.

How is the head impulse test conducted?

The test involves the examiner and patient sitting upright facing each other, with the patient fixing their gaze on the examiner's nose. The examiner then holds the patient's head and rapidly jerks it 10 to 20 degrees in one direction while the patient tries to keep their gaze fixed.

What is the purpose of the patient fixing their gaze on the examiner's nose?

The patient fixes their gaze on the examiner's nose to provide a reference point for the examiner to observe the patient's eye movements during the head jerking motion.

What is the significance of the head jerking motion being 10 to 20 degrees?

The 10 to 20 degrees head jerking motion is significant as it is a quick and controlled movement that tests the vestibular system's response without causing discomfort or injury.

Why is it important to ensure the patient has no neck pain or pathology before performing the test?

It's important because neck pain or pathology could affect the patient's ability to perform the test accurately or could worsen their condition during the test.

What is the expected reaction of a patient with a normally functioning vestibular system during the test?

A patient with a normally functioning vestibular system will keep their eyes fixed on the examiner's nose without any rapid side-to-side eye movements.

What does it mean when a patient's eyes 'suckhade' during the test?

When a patient's eyes 'suckhade', it means they rapidly move side to side as they try to fix back on the examiner's nose, indicating an abnormally functioning vestibular system.

How does the head impulse test help in diagnosing vertigo?

The head impulse test helps diagnose vertigo by observing the patient's eye movements in response to a rapid head jerk. Normal eye movements suggest a peripheral cause, while abnormal movements indicate a possible vestibular issue.

What does a normal head impulse test result indicate about the patient's condition?

A normal head impulse test result indicates that the patient has no current symptoms or that their vertigo is due to a central cause rather than a peripheral one.

Can the head impulse test be used to differentiate between central and peripheral vertigo?

Yes, the head impulse test can help differentiate between central and peripheral vertigo by observing the patient's eye response to the head jerking motion.

What are some common conditions that can be identified using the head impulse test?

Some common conditions that can be identified using the head impulse test include vestibular neuronitis and labyrinthitis, both of which affect the vestibular system.