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Reversed corrective saccades during head impulse test in acute cerebellar dysfunction.

Jeong-Yoon Choi1, Ji-Soo Kim, Jin-Man Jung

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Reversed corrective saccades during the head impulse test (HIT) were observed in patients with acute cerebellitis. This paradoxical response, not previously reported, suggests cerebellar disinhibition affecting the vestibulo-ocular reflex.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Neurology

Background:

  • The horizontal head impulse test (HIT) assesses the vestibulo-ocular reflex (VOR).
  • Cerebellar lesions can cause corrective saccades (positive or perverted) during HIT.
  • Reversed corrective saccades during HIT have not been previously documented.

Observation:

  • Two patients with acute cerebellitis presented with reversed corrective saccades during horizontal HIT.
  • This paradoxical response was an initial clinical sign of cerebellitis.
  • The observed saccades were in the direction of head rotation.

Findings:

  • Reversed corrective saccades indicate abnormally increased vestibulo-ocular responses.
  • This phenomenon is attributed to cerebellar disinhibition of the VOR.
  • It contrasts with corrective saccades typically seen in peripheral vestibular paresis.

Implications:

  • Reversed corrective saccades during HIT represent a novel bedside cerebellar sign.
  • This finding expands the diagnostic repertoire for cerebellar dysfunction.
  • It highlights the VOR's sensitivity to cerebellar integrity.