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Vestibular neuronitis - Management
Head impulse test
- Use caution if the person has neck pathology, as the head impulse test involves rapid repositioning of the head [Kuo et al, 2008b]. Always start by asking the person to rotate their neck themselves to assess for any limitation of neck movement. If in doubt about the safety of the manoeuvre, seek specialist advice or refer the person to a balance specialist.
- To carry out the head impulse test [Macleod and McAuley, 2008]:
- Advise the person to sit upright and to fix their gaze on the examiner.
- Then rapidly turn the head 20 degrees to one side and watch the eyes for corrective abnormal movements (saccades).
- Repeat several times to the same or opposite side, randomly and unpredictably, until satisfied as to the consistent presence or absence of the corrective saccade.
- A corrective saccade represents a positive test and implies moderate to severe loss of function of the horizontal semi-circular canal on the side to which the test is positive.
- Video illustrations of performing the head impulse test and demonstrating corrective saccades are available at the Imperial College London Faculty of Medicine website.
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