The video head impulse test Diagnostic accuracy in peripheral vestibulopathy
The video head impulse test Diagnostic accuracy in peripheral vestibulopathy
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DOI：
10.1212/wnl.0b013e3181bacf85
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发表时间：
2009-10-06
期刊：
影响因子：
9.9
通讯作者：
Curthoys, I. S.
中科院分区：
文献类型：
--
作者：
MacDougall, H. G.;Weber, K. P.;Curthoys, I. S.
背景：头脉冲试验（HIT）是一种有用的床旁试验，以确定外周前庭功能障碍。然而，这种前庭眼反射（VOR）的缺陷可能无法诊断，因为矫正性扫视不能总是通过简单的观察来检测。巩膜探测线圈技术是HIT测量的金标准，但它是不实用的常规测试或急性患者，因为他们需要戴一个不舒服的接触透镜。目的：开发一个易于使用的视频HIT系统（vHIT）作为一个临床工具，用于识别外周前庭功能障碍。为了验证vHIT的诊断准确性，通过同时测量健康受试者和患有广泛的先前确定的外周前庭缺陷的患者的视频和搜索线圈记录。同时用vHIT（250 Hz）和搜索线圈记录水平HIT（1，000 Hz），其中8例正常人，6例前庭神经炎患者，1例单侧鼓室内庆大霉素中毒患者，1例双侧庆大霉素前庭中毒患者。同时视频和搜索线圈记录的眼球运动是密切可比的（平均一致性相关系数r（c）= 0.930）。在正常人（p = 0.107）和患者（p = 0.073）中，使用搜索线圈和视频测量的平均VOR增益没有显著差异。对于这些组，参考和索引测试的灵敏度和特异性均为1.0（95%置信区间0.69 - 1.0）。vHIT措施检测明显和隐蔽扫视准确coils.Conclusions：视频头部脉冲测试是相当于搜索线圈在识别外周前庭功能障碍，但更容易在临床上使用，即使在急性前庭神经炎患者。神经病学（R）2009; 73：1134 - 1141
Background: The head impulse test (HIT) is a useful bedside test to identify peripheral vestibular deficits. However, such a deficit of the vestibulo-ocular reflex (VOR) may not be diagnosed because corrective saccades cannot always be detected by simple observation. The scleral search coil technique is the gold standard for HIT measurements, but it is not practical for routine testing or for acute patients, because they are required to wear an uncomfortable contact lens.Objective: To develop an easy-to-use video HIT system (vHIT) as a clinical tool for identifying peripheral vestibular deficits. To validate the diagnostic accuracy of vHIT by simultaneous measures with video and search coil recordings across healthy subjects and patients with a wide range of previously identified peripheral vestibular deficits.Methods: Horizontal HIT was recorded simultaneously with vHIT (250 Hz) and search coils (1,000 Hz) in 8 normal subjects, 6 patients with vestibular neuritis, 1 patient after unilateral intratympanic gentamicin, and 1 patient with bilateral gentamicin vestibulotoxicity.Results: Simultaneous video and search coil recordings of eye movements were closely comparable (average concordance correlation coefficient r(c) = 0.930). Mean VOR gains measured with search coils and video were not significantly different in normal (p = 0.107) and patients (p = 0.073). With these groups, the sensitivity and specificity of both the reference and index test were 1.0 (95% confidence interval 0.69-1.0). vHIT measures detected both overt and covert saccades as accurately as coils.Conclusions: The video head impulse test is equivalent to search coils in identifying peripheral vestibular deficits but easier to use in clinics, even in patients with acute vestibular neuritis. Neurology (R) 2009; 73: 1134-1141