The active head-impulse test in unilateral peripheral vestibulopathy

Arch Neurol. 2005 Feb;62(2):290-3. doi: 10.1001/archneur.62.2.290.


Background: The head-impulse test, which is sensitive and specific for detecting severe unilateral peripheral vestibulopathy, is an accepted part of the neurological examination, especially in patients with vertigo and balance disorders.

Objective: To discover if the head-impulse test is just as useful diagnostically when patients are asked to rotate their own heads, the active head-impulse test, rather than when the clinician does so as in the standard passive head-impulse test.

Methods: Clinical observation of compensatory saccades and search coil measurement of compensatory eye rotations, during active and passive horizontal head-impulses in 6 patients with total unilateral vestibular deafferentation.

Results: Clinical observation showed the expected compensatory saccades with rotations toward the side with the lesion with passive head-impulses but not with active head-impulses. Search coil recordings revealed 2 reasons for this. With active head-impulses not only was vestibulo-ocular reflex gain higher, but compensatory saccade latency was shorter resulting in an occult saccade that occurred during, rather than after, head rotation.

Conclusions: Passive head-impulses are necessary to detect a severe unilateral peripheral vestibulopathy; active head-impulses will produce a false-negative result.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Confidence Intervals
  • Data Interpretation, Statistical
  • Electromagnetic Fields
  • Eye Movements / physiology
  • Female
  • Functional Laterality / physiology*
  • Head / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Rotation
  • Time Factors
  • Vestibular Function Tests*
  • Vestibular Neuronitis / diagnosis
  • Vestibular Neuronitis / physiopathology*