Question

A 45-year-old woman is diagnosed with right vestibular neuritis. What findings are expected during the head impulse test in this patient?

• A. When the head is turned to the left, the eyeballs move to the left with Nystagmus.
• B. When the head is turned to the left, the eyeballs move to the right with nystagmus.
• C. When the head is turned to the right, the eyeballs move to the left with Nystagmus.
• D. When the head is turned to the right, the eyeballs move to the right with nystagmus.

Hint:

For vestibular neuritis, remember that the head impulse test will show abnormal eye movement toward the unaffected side (opposite of the impaired ear).

Answer 1

The Correct Option is C

The head impulse test is used to assess the function of the vestibulo-ocular reflex (VOR), which stabilizes gaze during rapid head movements. In this case, the patient has right vestibular neuritis, indicating impaired function on the right side of the vestibular system.

Explanation: In a normal VOR, when the head is turned quickly to one side (e.g., to the right), the eyes reflexively move in the opposite direction (e.g., to the left) to maintain steady gaze on a target. If the right vestibular apparatus is damaged, such as in right vestibular neuritis, it cannot properly convey signals during a rightward head impulse.

Expected Findings:

• During a rapid head turn to the right, the VOR should cause the eyes to move left. However, in right vestibular neuritis, the impaired response results in inadequate compensatory eye movement.
• This causes a catch-up saccade to the left, as the eyes attempt to fixate back on the target.
• This manifests as an observable fast-phase nystagmus to the left.

Conclusion: During the head impulse test for a patient with right vestibular neuritis, when the head is turned quickly to the right, the expected finding is that the eyeballs will move to the left with a corrective saccade (nystagmus) to refocus on the target.

Head Turn Direction	Expected Eye Movement
Right	Left with Nystagmus