What does an abnormal head impulse test look like?

[@alwaleedsaud6114]

Clear, informative, and comprehensive explanation. You won a neuro follower. Thanks

[@PeterJohns]

Thanks for the kind words! If you haven't already watch my video with detailed tips on how to perform the Head Impulse Test. kzbin.info/www/bejne/opzNiJ18iLt5fa8

[@alwaleedsaud6114]

@@PeterJohns already watched🙏

[@leahmaschke257]

Thank you so much. I am an outpost RN in the Yukon. This has really helped my assessment skills. I am continually searching for videos with excellent teaching to improve my assessment skills. You're it!

[@jxc-gz5yv]

Thank you, so much for these videos! I can see your passion for teaching and I know many would agree with me that we are extremely grateful!

[@travisvlasaty8716]

Best video and information with real patient exam for HINTS exam! Thanks!

[@drjohnvinodkumar]

Brilliant, really useful video Doctor , thank you

[@Pindakeshi]

Exellent video! Thank you for sharing your knowledge! General practitioner from the Netherlands here

[@kieranmp4143]

Probably the best video on this I have seen so far. Excellent work

[@flavio339]

Damn, this is one high grade teaching skill! Congrats!

[@ntinalondon]

You're awesome!! neuro resident here from Greece. Thank you very much!

[@felixbuffet1301]

As a medical student, your videos are by far one the top notch in the medical field. I dream of being as good as you in teaching others some arduous medical notions. For the sake of patients! A big thanks from France! Don't hesitate if you come by Burgundy, doors open! :)

[@PeterJohns]

I've been to Burgundy before, happy to be invited back!

[@ranjitrajandr]

This was such a clear description. Excellent! You are a wonderful teacher!👏👏

[@joelouisscilabra3138]

Very helpful review of such an important test. Very well done.

[@patrickgomez29]

Thank you so much for sharing your knowledge! 🙏 Greetings from Vienna,Austria

[@ajh195]

Hello Peter your videos are simply amazing because you actually record with real patients and explain everything.... Medical school student from Denmark. Thank you very much

[@PeterJohns]

Thanks so much, this is why I make these videos!

[@tja4201]

Nice sequence of vertigo/nystagmus videos. Just left a two day Masterclass with Kingma, van den Berg and Widdershoven. A pitty regular medical curriculum does not pay that much attention on these symptoms. Physicians could do a lot more in diagnostics and therapy. Keep up the good work!

[@jamesburge3977]

aaaah...now I get it!! Thanks for putting in all that effort to make a great teaching video.

[@obayal-raslan8403]

I tried to understand the details of this test and the difference between spontaneous and gaze-evoked (cerebellar) nystagmus in many neurology books. This video is way better than anything I read about these aspects. Thank you

[@manvikatiwari4646]

Beautifully explained. Thank you

[@alfarouqelboom8465]

great explanation. Much appreciated sir!

[@life-mm5do]

Very educational videos with explanations of different nystagmus and technique .

[@Valcreee]

Thank you very much for contributing to the medical community with this video. Listened to Dr. Newman-Toker podcast so this video was helpful to see some actual examples of what he was describing.

[@PeterJohns]

Was that on curbsiders?

[@Valcreee]

@@PeterJohns yes sir

[@jjero1]

Thank you so much. The multiple examples are especially useful.

[@sunshine_prophylaxis8540]

Oh my gosh, this was so helpful! Thank you so much for posting this!

[@deepikaperera2419]

Thank you so much, sir. The video is very informative and concise. I learn a lot from this video

[@ahmedfarag1336]

Great channel, great videos, I intend to finish The whole thing enshaa allah, thanks a lot prof.

[@Vincee967]

Thank you for your videos Sir, you are a great teacher!

[@sawsanalh2802]

Thank you for this video, it's great!

[@paulof2028]

I im from Brazil, Pará, thank for your video !!!!

[@Muhammad-gq8fs]

I really enjoy your vertigo videos and infact I recommend every doctor to watch your videos on this extremely topic. Just one thing that I think is not right: I note that You are advocating impulsing the head from right or left lateral to midline instead of jerking it laterally from midline primary position. This must be your own or someone else’s modification, because I have not read this method of Head Inpulse in any neuro text including Adam and Victor’s and Blumefeld’s Neuroanatomy through Clinical cases. Professor Haymalgayi who described this test has also not described it and he is the guy here in Australia who does all the advances testing in spinning chair and much more when no one can figure out what is making the patient dizzy. And I dont conceive how test ever will or ever could be validated the way it is being suggested here. There are simple and very obvious anatomical and physiological reasons why it cant be validated this way: the premise and foundation for the head impulse testing is the anatomical and physiological fact that in primary position the gaze centring mechanisms on right and left are firing equally which is necessary to keep the gaze in primary position. This ‘centring tendency’ is the default position and action of the brain mechanisms that mediate it. Lateral head position with fixing the eye on a point straight ahead is a deviation and a departure from the default state. Once you move the head to right or left those impulses have changed in their amplitude and firing frequencies to keep the eyes fixated straight forward. Moving the head from right or left lateral to the midline is not the same as jerking the head to right or left lateral because neuronal impulses have to change to make adjustments. When you move the head away from that specifically defined primary gaze position, then you have changed the afferent impulses firing rates and amplitudes of the brain mechanisms and impulses that mediate the VOR hence and keep the eyes centred, thus altering the validity of the test. So we can not just swap the test around(even if it is with the noble intentions of making it more comfortable for the patient). The primary position for VOR and semicricular canals is the primary gaze position which is head horizontal in neutral position and looking straight forward as in anatomical postion and the eyes gazing straight forward. But I look forward to be corrected and educated by such a learned and highly esteemed colleague like yourself. If you have any clinical references I look forward to reading them and the primary references they mention. Regards A 26th year medical student.

[@PeterJohns]

Watch David Newman-Toker demonstrating the HIT in this video on this page. sjrhem.ca/resident-clinical-pearl-hints-exam-in-acute-vestibular-syndrome/ And watch Jorge Kattah perform it also kzbin.info/www/bejne/e4O6ZKyorceBqck Here is Dr. Kattah performing the HIT in another patient. kzbin.info/www/bejne/najUo3qMhtd5qc0&ab_channel=WangcaiGao Drs' Newman-Toker and Kattach were the principle authors of the HINTS studies. They have both observed my technique of performing the HIT. Dr. Newman-Toker in person when I attended a vestibular masterclass at Johns Hopkins, and Dr. Kattah when I sent them a video of my head impulse test. He noted "very nice technique" when he replied to me. I've met Dr. Halmagyi as well, and he is a very nice man.

[@marcelamoonstruck3094]

Thank you so much teacher

[@marcelorodriguesbr]

Thank's for this video, Excellent work!!!

[@imo5039]

This is amazing! Thank you!

[@Jesssunlim33]

These videos are so helpful!! Amazing job :)

[@nightlydreamer_]

Excellent video, learned a lot!

[@latifaalmutairi8830]

Thank you so much

[@ejazmohdkhan]

Great video sir

[@manishaent6872]

Amazing videos. Thank you so much !

[@Squiderrant]

Fantastic. Thank you

[@ORL-HNS]

Really right ,never like dizziness

[@PeterJohns]

??

[@ORL-HNS]

@@PeterJohns Thanks sir , made me understand HINTS exam easily

[@ahmedkhaleel1025]

Thank you sir, great video.

[@drash8593]

Amazing

[@huhucat12]

what a great video! Thank u!

[@martinalazzari6182]

Me encanto ! Super practico y consizo 🫶

[@muzafferbalaban382]

Described perfektly. Thank you.

[@joyasamuel5213]

Fantastic

[@ahmedthamir9531]

I cant thank you enough sir .. but thank you anyway ♥️♥️♥️♥️♥️ , your videos are all simple educational practical and funny ☺️ .. stay safe sir.

[@killua9982]

Thank you

[@knosis]

Thanks for the video. Great entertainment value haha

[@PeterJohns]

Thanks. The dog video is funny!

[@hindbennis9106]

Love your videos! In case of using a vestibular sedative like sulpiride in the last 24h, and the patient has no nystagmus. Do you do the HINTS? And would it be affected by it?

[@PeterJohns]

I've seen studies show that vestibular sedatives can decrease the amplitude of the nystagmus, but I've never seen a study showing that it would completely suppress it. I've remove fixation with a piece of paper if I didn't see nystagmus at rest.

[@rumpledstilski9348]

Thank you for your videos, they are wonderful! I have basically memorized that in vestibular neuritis the nystagmus points away from the affected side and the head impulse test is abnormal when turning head toward the affected side. But I don’t intuitively understand why this is. Can you please explain?

[@PeterJohns]

It is not intuitive, but a result of the complicated anatomy and physiology and pathophysiology of vertigo. The first half of this video describes how a left vestibular neuritis will cause nystagmus to the right. kzbin.info/www/bejne/eJvbd3ieid-HnKc&

[@robertocarlosdiazalvarez3628]

good stuff

[@Muhammad-gq8fs]

19:20 are you saying that if nystagmus is left beating then in vestibular neuritis head impulse will also be when head is impulses to the left. That is opposite to what you have been saying earlier in this video (and many other videos). If his left vestibular nerve is affected, his HI test would have catchup saccade when his head is turned impulsed to the RIGHT, not left side. Or did misunderstood something? Would appreciate if you can clarify please. Thanks.

[@PeterJohns]

Yes, you did misunderstand something. For the case that begin at 18:24 I said his nystagmus was beating towards the RIGHT, which means his LEFT ear was affected. And that the HIT should be abnormal when the head is turned rapidly to the LEFT, which it was. And I'm pretty sure I never said in any of my videos that if the left ear is affected, that the HIT is abnormal when the head is turned to the right. Watch the video again.

[@Muhammad-gq8fs]

Thanks a lot for the reply and the clarification. Yes I think I have gotten it wrong for this video. I have watched all your videos many many times so don’t remember which one if at all you said what I claim here. I pribably am wrong on this but will let you know if find out I wasn’t because; addition to perpetually recommending your channel to all docs, I am watch your videos rather regularly on a recurrent basis when I want to revise and remind myself.. If at all you said anything it was in all likelihood the verbal/oral equivalent of a ‘typo’ error which all of us can make time to time.

[@kchadala]

Nice video. But sometimes it is imposible to do such tests with old vomiting patients with osteoporosis in the neck who dont collaborate with me. Really - I dont like vertigo :)

[@PeterJohns]

The only clinicians who like vertigo understand it well.

[@alfredopampanga9356]

Excellent teacher. Why were my teachers in med school so mediocre? There’s no substitute for intelligence. And it’s on display here like a flashing neon light. ( But not an a normal head impulse)

[@doculam]

is the HIT positive for other causes of peripheral vertigo? e.g BPPV and Labrynthitis

[@PeterJohns]

The head impulse test detects if there a problem with the vestibular nerve. So you shouldn't see an abnormal HIT in a patient with BPPV, but you should see it with labyrinthitis. Vestibular neuritis is much more common than labyrinthitis.

[@lucasglatthardt5368]

Does VPPB also causes abnormal Head impulse If tested?

[@PeterJohns]

I assume you mean BPPV. And the answer is no.

[@user-kj5lw9in7v]

What the rotatory chair test

[@life-mm5do]

What about bilateral loss signs.

[@PeterJohns]

My understanding is they will have bilateral abnormal HIT. I have not seen it myself.