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Der Video-Kopfimpulstest

Erste klinische Erfahrungen

The video head impulse test

First clinical experiences

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Zusammenfassung

Hintergrund

Die Funktion der vestibulären Bogengangsrezeptoren und die Integrität der vestibulookulären Reflexwege lassen sich neuerdings mit dem Video-Kopfimpulstest (vKIT) seitenspezifisch analysieren. Es gibt bisher nur geringe klinische Erfahrungen an einer größeren Patientenzahl.

Material und Methoden

In dieser Studie wurde mithilfe des vKIT der horizontale VOR (hVOR) bei 142 Patienten mit einer akuten oder chronischen Schwindelsymptomatik (68,4% peripher-vestibulärer Schwindel, 7% zentraler Schwindel, 24,6% unklare Ursache) sowie bei Gesunden (n = 20) als Kontrollgruppe untersucht.

Ergebnisse

Bei Gesunden (n = 20) war ein Verstärkungsfaktor (Gain) von 0,97 ± 0,09 normal, als pathologisch wurde ein Gain von < 0,79 ermittelt. Ein regelrechter vKIT fand sich in 47,6%, in 52,4% fand sich ein pathologischer vKIT. Bei einer peripher-vestibulären Schwindelursache traten isolierte Rückstellsakkaden als offene (37%) und als verdeckte Rückstellsakkaden (13,7%) auf, am häufigsten fanden sich kombinierte Rückstellsakkaden (49,3%).

Schlussfolgerung

Mithilfe des vKIT ist es möglich, in kürzester Zeit eine seitenspezifische und quantitative Aussage über den hVOR zu erhalten. Die Methode ist bettseitig durchführbar und prüft den hVOR unter dynamischen bzw. physiologischen Bedingungen.

Abstract

Background

Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades.

Materials and methods

As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome.

Results

A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders.

Conclusions

By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.

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Authors and Affiliations

  1. Klinik für Hals-, Nasen-, Ohrenheilkunde, Plastische Chirurgie und Kommunikationsstörungen, Helios-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland

    A. Blödow, R. Helbig, N. Wichmann & M. Bloching

  2. HNO-Universitätsklinik Mannheim, Mannheim, Deutschland

    L.E. Walther

  3. HNO-Gemeinschaftspraxis, Main-Taunus-Zentrum, Sulzbach (Taunus), Deutschland

    L.E. Walther

Authors
  1. A. Blödow
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  2. R. Helbig
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  3. N. Wichmann
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  4. M. Bloching
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  5. L.E. Walther
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Correspondence to A. Blödow.

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Blödow, A., Helbig, R., Wichmann, N. et al. Der Video-Kopfimpulstest. HNO 61, 327–334 (2013). https://doi.org/10.1007/s00106-012-2592-0

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  • DOI: https://doi.org/10.1007/s00106-012-2592-0

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