How to Uncover the Covert Saccade During the Head Impulse Test

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Abstract

Objective

The appearance of “covert” saccades in the head impulse test in patients with vestibular loss may lead to diagnostic misinterpretations. Here, we demonstrate a procedure that can convert covert eye saccades to overt when performing the head impulse test.

Patients

Patients with known vestibular deficits that have covert saccades during head impulse test.

Intervention

Diagnostic: random and sudden changes of the amplitude (degree of head turn) when performing the head impulse test.

Main Outcome Measure

Evaluation of bedside test with video recording and registration from video head impulse test (v-HIT).

Results

A video recording and registration from v-HIT that demonstrate the covert saccades of a subject and how the overt saccade is uncovered by changing the amplitude of the head impulse. Five cases are briefly presented.

Conclusion

By performing the head impulse test with random amplitudes, overt saccades may become detectable and advance accuracy in bedside diagnosis of vestibular deficits.

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