The Cerebellum

, Volume 12, Issue 5, pp 773–775 | Cite as

Perverted Head Impulse Test in Cerebellar Ataxia

  • Seong-Hae JeongEmail author
  • Ji-Soo Kim
  • In Chul Baek
  • Jong Wook Shin
  • Hyunjin Jo
  • Ae Young Lee
  • Jae-Moon Kim
Letter to the Editor


In the bedside head impulse test (HIT), the clinician identifies the catch-up saccades after head rotation as an indirect sign of vestibulo-ocular reflex (VOR) deficit [1]. Positive HIT can be observed in central vestibulopathies, in addition to peripheral vestibulopathies [2, 3, 4]. Recent reports proposed that a positive HIT in these patients with preserved caloric response is most likely due to cerebellar flocculus dysfunction, considering the findings of earlier studies related to high-frequency VOR [2, 3, 4]. Also, the dysconjugate upward eye deflection during yaw head impulse was also observed in patients with cerebellar disease [5, 6].

Here, we first documented video clips of upward trajectories during horizontal head impulses in a patient with cerebellar ataxia, i.e., perverted HIT, which could be another feature of positive HIT in central vestibulopathies.


A 62-year-old woman presented with severe imbalance and dysarthria following fever, cough, and myalgia...


Cerebellar Ataxia Head Impulse International Cooperative Ataxia Rate Scale Cerebellar Disease Head Impulse Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

All authors report no disclosures.

Supplementary material

Video 1

The video demonstrates upward deflection during horizontal head impulse. (WMV 4513 kb)

Video 2

Dissociated gain of vertical head impulse, i.e., decreased during upward pitch and increased during downward pitch, is shown on video clip. (WMV 1772 kb)


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Seong-Hae Jeong
    • 1
    Email author
  • Ji-Soo Kim
    • 2
  • In Chul Baek
    • 1
  • Jong Wook Shin
    • 1
  • Hyunjin Jo
    • 1
  • Ae Young Lee
    • 1
  • Jae-Moon Kim
    • 1
  1. 1.Department of NeurologyChungnam National University HospitalDaejeon-siSouth Korea
  2. 2.Department of NeurologySeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamSouth Korea

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