Vestibular Hypofunction and the Head Impulse Test

June 11, 2023
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The head impulse test is a bedside examination that differentiates vestibular hypofunction from a stroke.  It is part of the HINTS exam and checks the integrity of the vestibulo-ocular reflex.  The patient sits on the table, instructed to maintain their visual gaze on the doctor’s nose.  The doctor places their hands on the sides of the patient’s head and quickly rotates It to the side about 30º.  If the eyes maintained their gaze on the doctor’s nose, this indicates a stroke, or central vestibular pathology, in acute vertigo.  If the eyes did not maintain their gaze or ‘jerked’ away for a moment and then corrected back to the nose, it indicates that the cause is a peripheral vestibular issue.  The doctor should make multiple attempts, testing both sides of rotation.  The doctor should do the test in a way not to allow anticipation from the patient to avoid ‘cheating.’