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Updated: Jul 4, 2026
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Testing of all Six Semicircular Canals with Video Head Impulse Test Systems
Published on: April 18, 2019
Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis
David E Newman-Toker1, Jorge C Kattah, Jorge E Alvernia
1Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurology
|June 11, 2008
Summary
The horizontal head impulse test (h-HIT) can help diagnose acute peripheral vestibulopathy (APV), but a positive result does not rule out stroke. Clinicians must consider other symptoms to differentiate stroke from benign APV.
Area of Science:
- Neurology
- Ophthalmology
- Otolaryngology
Background:
- Acute vertigo is often caused by benign acute peripheral vestibulopathy (APV).
- Life-threatening brainstem or cerebellar strokes can mimic APV symptoms.
- The horizontal head impulse test (h-HIT) assesses vestibulo-ocular reflex (VOR) function.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the h-HIT in differentiating APV from stroke.
- To determine if a positive h-HIT reliably indicates APV.
Main Methods:
- A cross-sectional study was conducted at an academic hospital.
- Consecutive patients with acute vestibular syndrome at high stroke risk were examined, including h-HIT.
- Neuroimaging (MRI or CT) confirmed stroke; APV diagnosis relied on normal MRI and clinical follow-up.
Main Results:
- Of 43 subjects, 8/8 (100%) with APV had a positive h-HIT.
- 31/34 (91%) of stroke patients had a negative h-HIT.
- However, 3 stroke patients (9%) showed a positive h-HIT, including vestibulocerebellar and pontocerebellar strokes.
Conclusions:
- A positive h-HIT does not exclude stroke, as some pontine and cerebellar strokes present with abnormal VOR.
- Additional clinical findings are crucial for differentiating stroke from APV when h-HIT is positive.
- A negative h-HIT strongly suggests a central lesion in patients with acute vestibular syndrome.
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