What does a positive head impulse test indicate?

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Multiple Choice

What does a positive head impulse test indicate?

Explanation:
A quick, high-acceleration head turn tests the vestibulo-ocular reflex. In a normal system the eyes stay fixed on the target despite the head movement. If the reflex is reduced on one side, turning toward that side causes the eyes to move with the head and a rapid corrective saccade is needed to re-fixate. That corrective catch-up eye movement is what makes the head impulse test positive. It points to a peripheral problem on the tested side—unilateral vestibular hypofunction. Normal VOR without saccades suggests normal vestibular function, and central vestibular pathway lesions typically don’t produce this kind of corrective saccade.

A quick, high-acceleration head turn tests the vestibulo-ocular reflex. In a normal system the eyes stay fixed on the target despite the head movement. If the reflex is reduced on one side, turning toward that side causes the eyes to move with the head and a rapid corrective saccade is needed to re-fixate. That corrective catch-up eye movement is what makes the head impulse test positive. It points to a peripheral problem on the tested side—unilateral vestibular hypofunction. Normal VOR without saccades suggests normal vestibular function, and central vestibular pathway lesions typically don’t produce this kind of corrective saccade.

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