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Impulsive Testing of Semicircular Canal Function

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Neuropathies of the Auditory and Vestibular Eighth Cranial Nerves

Abstract

Head impulses are brisk, passive, unpredictable rotations of the head in the plane of parallel semicircular canal pairs. In a normal test, the vestibulo-ocular reflex stabilizes gaze in space by compensating head rotations with equal eye rotations to the opposite direction. In a patient with impaired semicircular canal function, the eyes move with the head, and the patient needs to make a catch-up saccade back to the target. Three-dimensional measurement of eye movement responses to head impulses in individual semicircular canal planes allows determining the gain of the angular vestibulo-ocular reflex in each of the six canals. At the bedside, the head impulse test is an easy way for the clinician to identify unilateral or bilateral impairment of semicircular canal function; it identifies the catch-up saccades back to the target after head rotation as an indirect sign of peripheral vestibular loss. In patients with acute spontaneous vertigo, the head impulse test helps to distinguish between a peripheral vestibular loss, where the test is positive, and a central vestibular lesion, where the test is usually negative.

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Authors and Affiliations

  1. Neurology Department, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2050, Australia

    G. Michael Halmagyi, Konrad P. Weber, Swee T. Aw, Michael J. Todd & Ian S. Curthoys

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  1. G. Michael Halmagyi
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  2. Konrad P. Weber
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  3. Swee T. Aw
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  4. Michael J. Todd
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  5. Ian S. Curthoys
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Editors and Affiliations

  1. The University of Tokyo, Tokyo, Japan

    Kimitaka Kaga M.D., Ph.D. (Emeritus Professor, Director) (Emeritus Professor, Director)

  2. National Institute of Sensory Organs, National Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan

    Kimitaka Kaga M.D., Ph.D. (Emeritus Professor, Director) (Emeritus Professor, Director)

  3. Department of Neurology and Neurobiology, University of California Irvine, Irvine, CA, 92717, USA

    Arnold Starr M.D. (Professor) (Professor)

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Michael Halmagyi, G., Weber, K.P., Aw, S.T., Todd, M.J., Curthoys, I.S. (2009). Impulsive Testing of Semicircular Canal Function. In: Kaga, K., Starr, A. (eds) Neuropathies of the Auditory and Vestibular Eighth Cranial Nerves. Springer, Tokyo. https://doi.org/10.1007/978-4-431-09433-3_11

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  • DOI: https://doi.org/10.1007/978-4-431-09433-3_11

  • Publisher Name: Springer, Tokyo

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