新しい半規管機能検査法―video Head Impulse Test―
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1 Equilibrium Res Vol. (1) video Head Impulse Test The video head impulse test as a novel semicircular canals function test Susumu Shindo 1)2), Kazuki Sugizaki 1)2), Akinori Itoh 2), Osamu Shibasaki 2), Masahiro Mizuno 2), Han Matsuda 1), Tomoe Inoue 1), Yasuhiro Kase 1), Tetsuo Ikezono 1) 1) Department of Otorhinolaryngology, Saitama medical school Hospital 2) Department of Neurotology, Saitama medical school Hospital The head impulse test (HIT) is a safe and quick way of assessing semicircular canal function in patients with peripheral vestibular loss at the bedside, first described in This test is practical even in sick patients and needs no equipment. The clinician identifies overt (=visible) catch-up saccades back to the target after passive head rotation as a clinical sign of canal paresis. However, it is known that some patients with absence of vestibular function do not make overt saccades, but instead make covert catch up saccades during the passive unpredictable head turn, which are extremely difficult for the clinician to detect with the naked eye. Recently, a new lightweight, nonslip, high-speed video-oculography system (vhit; video head impulse test) has been developed that measures eye velocity during head rotations.. This system is easy to use in a clinical setting, provides an objective measure of the vestibulo-ocular-reflex (VOR), and detects both overt and covert catchup saccades in patients with vestibular loss. Key words: video Head Impulse Test, Vestibulo-ocular reflex, Overt catch up saccade, Covert catch up saccade head impulse testhit HIT Halmagyi Curthoys HIT (22)
2 Equilibrium Res Vol. (1) vhit vhit PC vestibulo-ocular reflexvor head impulse VOR catch up saccade refixation saccade corrective saccade CUS canal paresiscp HIT CP HIT CP CUS overt catch up saccadeovert OCUS covert catch up saccade covert CCUS HIT HIT video head impulse testvhit vhit OCUS CCUS vhit vhit vhit head impulse /sec ICS impulsegn Otometrics, Tastrup, Denmark vhit OtosuiteV PC ICS impulse vhit (23)
3 Equilibrium Res Vol. (1) vhit head impulse head impulse head impulse accept reject accept, reject vhit CUS CP CP CP CP CP VOR CUS CP vestibulo-ocular reflex catch up saccade canal paresis vhit vhit vhit 1.2 vhit lateral head impulse head impulse (24)
4 Equilibrium Res Vol. (1) ( /sec) 3 a ( b c /sec) ( /sec) (msec) (msec) (msec) catch up saccadecus CUS head impulse vhit peak velocity CUS spikecovert CUS CCUS overt CUSOCUS /secmsec CUS OCUS CUS CCUS saccade peak velocity tiny catch up saccade CUS overtcovert saccade CUS /sec head impulse vhit Head impulse accept slowtoo much over shoot reject accept vhit peak velocity CUS CP eye movementhead movement vhit CUS HIT HIT CUS OCUS CCUS vhit CUS CCUS CUS OCUS CCUS OCUS CUS CUS peak velocity tiny catch up saccade CP CP (25)
5 Equilibrium Res Vol. (1) ( /sec) - 3 ( /sec) vhit head impulse head impulse catch up saccade CP CPab/ab ab CP CP CP CP CP CP CP vhit CUS CUS CP CP VOR gain catch up saccade CP CP (26)
6 Equilibrium Res Vol. (1) CP vhit CUS CP covert overt CP CP CP CP CP CP CP CP CP CP CP CP CP CP CP 91 CP 86 CP 82 CP 74 CP 53 CP 46 CP CP CP CP CP 51 CP 39 CP 35 CP 3 CUS catch up saccade, CP canal paresis, VOR vestibulo-ocular reflex CUS CUS Halmagyi Curthoys HIT HIT CP ENG VOG/VNG HITvHIT HIT HIT HIT saccade vhit vhit HIT HIT head impulse saccade CP vhit CUS CP vhit reject accept CUS HIT OCUS CCUS Blödow vhit OCUS (27)
7 Equilibrium Res Vol. (1) ( /sec) - ( /sec) CP vhit vhit head impulse catch up saccade covert catch up saccadeovert catch up saccade head impulse) saccade peak velocity tiny catch up saccade tiny catch up saccade CP CP CP vhit VOR gain VOR gain CUS CP CP CP VOR vestibulo-ocular reflex CUS catch up saccade OCUS HIT OCUS vhit CUS CCUS vhit vhit HIT vhit CP HIT vhit OCUS HIT saccade OCUS vhit saccade OCUS vhit OCUS saccade saccade HIT CP vhit vhit CUS CP CUS tiny catch up saccade CP CUS peak velocity tiny catch up saccade (28)
8 Equilibrium Res Vol. (1) ( /sec) ( /sec) CP vhit vhit catch up saccade covert catch up saccade overt catch up saccade ENG HIT vhit peak velocity Weber tiny catch up saccade CP vhit vhit vhit vhit vhit VOR / sec (29)
9 Equilibrium Res Vol. (1) /sec VOR vhit / sec VOR vhit vhit VOG vhit vhit vhit HIT Bartolomeo vhit CP vhit Bartolomeo CP vhit CP vhit CP CP CP vhit CP vhit CP vhit vhit ampullopetal flow ampullofugal flow VOR head impulse ampullopetal flow spike CUS head impulse ampullofugal flow spike VOR CUS CP CP ampullopetal flow spike ampullofugal flow spike head impulse CUS vhit vhit VOR vhit vhit CTMRIPET ABR vhit (3)
10 Equilibrium Res Vol. (1) Halmagyi GM, Curthoys IS: A clinical sign of canal paresis. Arch Neurol 45: , 1988 Head Impulse Test Harvey SA, Wood DJ: Relationship of the head impulse test and head-shake nystagmus in reference to caloric testing. Am J Otol. 18: 27213, 1997 Beynon GJ, Jani P: A clinical evaluation of head impulse testing. Clin Otolaryungol 23: , 1998 Weber KP, Aw ST, Todd MJ, et al.: Head impulse test in unilateral vestibular loss : vestibulo-ocular reflex and catch-up saccades. Neurology 7: , 8 Weber KP, MacDougall HG, Halmagyi GM, et al.: Impulsive testing of semicircular-canal function using video-oculography. Ann N Y Acad Sci 1164: , 9 Perez N, Rama-Lopez J: Head-impulse and caloric tests in patients with dizziness. Otol Neurotol 24: , 3 Mahringer A, Rambold HA: Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. Eur Arch Otorhinolaryngol: 213 (Epub ahead of print) Blödow A, Pannasch S, Walther LE: Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders. Auris Nasus Larynx. 4: , 213 Bartolomeo M, Biboulet R, Pierre G, et al.: Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur Arch Otorhinolaryngol 213 Mar 29 (Epub ahead of print) Macdougall HG, McGarvie LA, Halmagyi GM, et al.: Application of the video head impulse test to detect vertical semicircular canal dysfunction. Otol Neurotol 34: , 213 Rossi ML, Bonifazzi C, Martini M, et al.: Static and dynamic properties of synaptic transmission at the cytoneural junction of frog labyrinth posterior canal. J Gen Physiol 94: 33327, 1989 Goldberg JM, Fernandez C: Physiology of peripheral neurons innervating semicircular canals of the squirrel monkey. I. Resting discharge and response to constant angular accelerations. J Neurophysiol 34: 63566, 1971 Becker GD: Sources of error n interpretation of caloric tests. Otolaryngol 86: , 1978 Baloh RW, Solingen L, Sills AW, et al.: Caloric testing. 1. Effect of different conditions of ocular fixation. Ann Otol Rhinol Laryngol Suppl 86: 16, 1977 Yukawa K, Horiguchi S, Suzuki M: Congenital inner ear malformations without sensorineural hearing loss. Auris Nasus Larynx 35: , 8 Feldmann H, Huttenbrink KB, Delank KW: Heat radiation-an essential factor of heat transport in caloric vestibular tests? Current experimental findings. Laryngorhinootol 7: , 1991 Zangemeister WH, Bock O: The influence of pneumatization of mastoid bone on caloric nystagmus response. Acta Otolaryngol 88: 1519, 1979 Davis RI, Mann RC: The effects of alerting tasks on caloric induced vestibular nystagmus.earhear8:586, 1987 Heiss WD, Raab P, Lanfermann H: Multimodality assessment of brain tumors and tumor recurrence. J Nucl Med 52: , 211 (31)
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vestibulo-ocular reflex: VOR optokinetic nystagmus: OKN Vestibulo-optokinetic interaction: VOI) unilateral peripheral vestibular disfunction: UPVD VOI UPVD canal paresis: CP % VOR VOR OKN electro-oculography:
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25 1 17 22, 2012 QOL Canal wall up Bell 17 25 1 (%) 100 ** P0.008 80 60 40 20 No recovery Complete recovery 0 2W 6M 0-20 years n=18 2W 6M 2W 6M 21-40 years n=15 41-60 years n=27 3 2 1 Noninfla COMChole
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