Peripheral · treat

Bilateral abnormal head impulse

Catch-up saccades on thrusts to both sides.

Live · Head impulse (both sides)
Stylised teaching animation, exaggerated for visibility — not a recording of a real patient, and not a diagnosis.
Localises toPeripheral
Bedside testHead impulse (both sides)
Fast phaseCatch-up saccade, overt
Reading

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 (Barany Society criteria). With acute vertigo and NEW unilateral hearing loss, an abnormal impulse on that same side does not secure a peripheral cause — AICA-territory stroke infarcts the inner ear and brainstem together and can mimic labyrinthitis (Lee 2009, Stroke); see HINTS-plus. The animation shows one side for clarity; in the patient with bilateral loss the catch-up saccade appears on thrusts to either direction.

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 and not a diagnosis.