Journal of Neurology

, Volume 265, Supplement 1, pp 40–43 | Cite as

The video head impulse test: a right–left imbalance

  • M. Strupp
  • A. Kichler
  • Leigh McGarvie
  • O. KremmydaEmail author
Letter to the Editors


The head impulse test (HIT) was first described as a clinical bedside test in 1988 [1] and since then has become the main bedside test for the evaluation of function of the vestibulo-ocular reflex (VOR). For many years, the HIT was evaluated clinically, and was largely based on the examiner’s ability to correctly perform the test and to detect catch-up saccades.

In recent years, smartphone technology has led to the development of smaller cameras with higher spatial and temporal resolution, also allowing eye tracking with video-oculography (VOG) to expand to VOG-assisted HIT recordings, leading to the video HIT (vHIT) [2, 3, 4]. The vHIT has evolved in the last years into a valuable and widely used diagnostic tool for evaluating dizzy patients, by helping quantify the VOR gain [5] and being superior to the bedside HIT [6]. Commercially available devices include the ICS Impulse™ and the EyeSeeCamHIT™.

Although often used there are still some methodological questions to be...


Vertigo Dizziness Video head impulse test Vestibular testing Vestibulo-ocular reflex Normal subjects 


Compliance with ethical standards

Conflicts of interest

The authors report no conflict of interest.


  1. 1.
    Halmagyi GM, Curthoys IS (1988) A clinical sign of canal paresis. Arch Neurol 45(7):737–739CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73(14):1134–1141. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Weber KP, MacDougall HG, Halmagyi GM, Curthoys IS (2009) Impulsive testing of semicircular-canal function using video-oculography. Ann N Y Acad Sci 1164:486–491. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bartl K, Lehnen N, Kohlbecher S, Schneider E (2009) Head impulse testing using video-oculography. Ann N Y Acad Sci 1164:331–333. CrossRefPubMedGoogle Scholar
  5. 5.
    Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM (2009) Horizontal head impulse test detects gentamicin vestibulotoxicity. Neurology 72(16):1417–1424. CrossRefPubMedGoogle Scholar
  6. 6.
    Yip CW, Glaser M, Frenzel C, Bayer O, Strupp M (2016) Comparison of the bedside head-impulse test with the video head-impulse test in a clinical practice setting: a prospective study of 500 outpatients. Front Neurol 7:58. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mossman B, Mossman S, Purdie G, Schneider E (2015) Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 44:29. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS (2015) The video head impulse test (vHIT) of semicircular canal function—age-dependent normative values of VOR gain in healthy subjects. Front Neurol 6:154. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Macdougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP (2013) The video head impulse test (vHIT) detects vertical semicircular canal dysfunction. PLoS One 8(4):e61488. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP (2013) Application of the video head impulse test to detect vertical semicircular canal dysfunction. Otol Neurotol 34(6):974–979. CrossRefPubMedGoogle Scholar
  11. 11.
    Mantokoudis G, Saber Tehrani AS, Kattah JC, Eibenberger K, Guede CI, Zee DS, Newman-Toker DE (2015) Quantifying the vestibulo-ocular reflex with video-oculography: nature and frequency of artifacts. Audiol Neurootol 20(1):39–50. CrossRefPubMedGoogle Scholar
  12. 12.
    Weber KP, Aw ST, Todd MJ, McGarvie LA, Pratap S, Curthoys IS, Halmagyi GM (2008) Inter-ocular differences of the horizontal vestibulo-ocular reflex during impulsive testing. Prog Brain Res 171:195–198. CrossRefPubMedGoogle Scholar
  13. 13.
    Viirre E, Tweed D, Milner K, Vilis T (1986) A reexamination of the gain of the vestibuloocular reflex. J Neurophysiol 56(2):439–450CrossRefGoogle Scholar
  14. 14.
    Goldberg JM, Wilson VJ, Cullen KE (2012) The vestibular system: a sixth sense. Oxford University Press, OxfordCrossRefGoogle Scholar
  15. 15.
    Crane BT, Viirre ES, Demer JL (1997) The human horizontal vestibulo-ocular reflex during combined linear and angular acceleration. Exp Brain Res 114(2):304–320CrossRefGoogle Scholar
  16. 16.
    Rambold HA (2016) Age-related refixating saccades in the three-dimensional video-head-impulse test: source and dissociation from unilateral vestibular failure. Otol Neurotol 37(2):171–178. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • M. Strupp
    • 1
  • A. Kichler
    • 1
  • Leigh McGarvie
    • 2
  • O. Kremmyda
    • 1
    Email author
  1. 1.Department of Neurology and German Center for Vertigo and Balance Disorders, Campus GrosshadernLudwig Maximilians University, MunichMunichGermany
  2. 2.Department of Neurology, Royal Prince Alfred HospitalUniversity of SydneySydneyAustralia

Personalised recommendations