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Comment & Response
September 26, 2019

What Does Head Impulse Testing Really Test?

Author Affiliations
  • 1School of Psychology, Vestibular Research Laboratory, University of Sydney, Sydney, New South Wales, Australia
  • 2Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
JAMA Otolaryngol Head Neck Surg. 2019;145(11):1080. doi:10.1001/jamaoto.2019.2788

To the Editor Walther et al1 ignore a fundamental rule of neurology: the pattern of the clinical or physiological deficit indicates the site and not the pathology of the lesion. This is the principle of neurological localization—there are textbooks written about it.2 The head impulse test, just like the caloric test, or the vestibular evoked myogenic potential, or an extensor plantar response can localize a lesion but reveal nothing about its pathology. For that, one needs to consider the history and results of ancillary investigations, say magnetic resonance imaging or spinal fluid test results. Impulsive testing can localize a vestibular deficit to 1 or more of the 6 semicircular canals but can show nothing about the cause of the deficit (Ménière, or vestibular neuritis, or anterior inferior cerebellar artery territory stroke, for example).

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