Head impulse (both sides)Peripheral · treat

Bilateral abnormal head impulse

Catch-up saccades on thrusts to both sides.

Head impulse (both sides)Live

When the head impulse is abnormal testing to either side, a single peripheral lesion cannot explain it. It points to bilateral vestibular loss, for example after ototoxic drugs, which gives oscillopsia and imbalance worse in the dark. With new hearing loss and acute vertigo, bilaterally abnormal impulses can instead flag an AICA-territory stroke.

Source: Barany Society bilateral vestibulopathy criteria; Lee 2009 (Stroke, AICA).

Practice this in the trainerPlay today’s case

Other signs

Horizontal direction-changing

Supine roll test

Horizontal apogeotropic

Supine roll test

Unidirectional horizontal

Gaze, fixation removed

Stylised teaching animations authored by NeuroDash. Not real-patient recordings, not board-certified, and not reviewed by an outside specialist. Educational only — not medical advice or a diagnosis.