Head-impulse tests aid in differentiation of multiple system atrophy from Parkinson’s disease

Kim, Jae-Gyum; Kim, Sunghwan; Lee, Sun-Uk; Lee, Chan Nyoung; Kim, Byung Jo; Kim, Ji-Soo; Park, Kunwoo

doi:10.1007/s00415-021-10885-z

Cited by 9 publications

(5 citation statements)

References 42 publications

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“…Meanwhile, patients with PCS can exhibit either normal 20 or abnormal responses, depending on the involvement of the VOR pathway. 5 Compared with the VOR gain, central lesions also show abnormalities in their VOR ballistics that include perverted, 17,21 early acceleration followed by premature deceleration, 22 or hyperactive HITs. 5,23 Along with those findings, our study adds evidence that analysis of the dynamic pattern of HITs can help differentiate peripheral from central vestibulopathy The closer the ROC curve approaches the top lefthand corner, the better the particular test predicting VN.…”

Section: Discussionmentioning

confidence: 99%

“…Wrong-way saccades were defined as being present when saccades occurred in the direction of head rotation, and the peak eye velocity exceeded 60°/s with the cutoff value decided by the main sequence of saccades (Figure 1). 16,17…”

Section: Methodsmentioning

confidence: 99%

“…16,17 The presence of perverted HITs was determined when there were significant differences in the trajectory between the eye velocity and head velocity, as previously described. 17 Based on the velocity-time graph, digitized eye position data were extracted using MATLAB software (version R2011b; MathWorks, Natick, MA). We refined the corrective saccades by detecting extra movements of the eye that do not match the head movements during horizontal or vertical head impulses.…”

Section: Hitsmentioning

confidence: 99%

“…Perverted saccades were determined to be present when the average value exceeded the mean + 2 SD (>4.0°) of those obtained from 24 patients with chronic VN (11 men, age range = 40-82 years, mean ± SD = 63 ± 14). 17…”

Section: Hitsmentioning

confidence: 99%

“…6 Wrong-way saccades were defined as being present when saccades occurred in the direction of head rotation, and the peak eye velocity exceeded 60°/s with the cutoff value decided by the main sequence of saccades (Figure 1). 16,17 The presence of perverted HITs was determined when there were significant differences in the trajectory between the eye velocity and head velocity, as previously described. 17 Based on the velocity-time graph, digitized eye position data were extracted using MATLAB software (version R2011b; MathWorks, Natick, MA).…”

Section: Hitsmentioning

confidence: 99%

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Analyses of Head-Impulse Tests in Patients With Posterior Circulation Stroke and Vestibular Neuritis

et al. 2023

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Background and Objectives:The interpretation of video head-impulse tests (video-HITs) can often be complicated, limiting their clinical utility in acute vestibular syndrome. We aimed to determine video-HIT findings in patients with posterior circulation strokes (PCS) and vestibular neuritis (VN).Methods:We retrospectively analyzed the results of video-HITs in 59 patients with PCS. Irrespective of the actual lesion revealed later on MRIs, ipsilateral and contralateral sides were assigned according to the direction of slow-phase of spontaneous nystagmus (SN). Then, the patterns of video-HIT findings were classified according to the vestibulo-ocular reflex (VOR) gain for the horizontal canals; 1) ipsilaterally positive, 2) contralaterally positive, 3) bilaterally normal, and 4) bilaterally positive. The abnormal responses were further defined into 5) wrong-way saccades, 6) perverted, and 7) early acceleration followed by premature deceleration. We also analyzed the asymmetry of the corrective saccadic amplitude between the sides, calculated from the sum of cumulative saccadic amplitudes on both sides. The results were compared with video-HIT results from 71 patients with VN.Results:Video-HITs were normal in 32 (54%), ipsilaterally positive in 11 (19%), bilaterally positive in 10 (17%), and contralaterally positive in six (10%) patients with PCS. Wrong-way saccades were more frequently observed in VN than PCS [31/71 (44%) vs. 5/59 (9%),p< 0.001]. Saccadic amplitude asymmetry was greater in VN than PCS [median = 100% (IQR = 82–144, 95% CI = 109–160) vs. 0% (-29–34, -10–22,p< 0.001)]. When differentiating VN from PCS, the sensitivity was 81.7%, and specificity was 91.5% at the cut-off value of 71% for saccadic amplitude asymmetry with an area under the curve (AUC) of 0.91 (95% CI = 0.86–0.97). The AUC for saccadic amplitude asymmetry was larger than that for the ipsilateral VOR gain (p= 0.041) and other parameters.Discussion:Patients with PCS may show various head-impulse responses that deviate from the findings expected in VN, which include normal, contralaterally positive, and negative saccadic amplitude asymmetry (i.e. a greater cumulative saccadic amplitude contralaterally). A thorough analysis of corrective saccades in video-HITs can improve the differentiation of PCS from VN even before MRIs.

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