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“Clinical Reasoning: Labyrinthine hemorrhage: An unusual etiology for peripheral vertigo” discussed the case of a man with worsening vertigo caused by a spontaneous labyrinthine hemorrhage. Dr. Chen comments that while the head impulse test remains the most important clinical test to differentiate peripheral from central causes of vertigo, it is a subjective test. He argues for the use of video head impulse test (vHIT), a system for testing the vestibulo-ocular reflex of each semicircular canal at high frequency, which is more sensitive than the clinical head impulse test. Drs. Parikh and Frank, authors of the article, agree with Dr. Chen but add that caloric testing is more sensitive than vHIT in patients with Meniere disease and in patients with only moderate vestibular dysfunction. They explain that while clinicians should continue to consider incorporating technology such as vHIT as additional neurologic tools, the clinical history and examination remain the cornerstone of neurology; therefore, the head impulse test should remain the starting point.
“Clinical Reasoning: Labyrinthine hemorrhage: An unusual etiology for peripheral vertigo” discussed the case of a man with worsening vertigo caused by a spontaneous labyrinthine hemorrhage. Dr. Chen comments that while the head impulse test remains the most important clinical test to differentiate peripheral from central causes of vertigo, it is a subjective test.
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