Vertigo
22-07-2019 -Source: General practitioners emergency care
You know the drill. During shift at the station that patient with acute vertigo. Is this a harmless peripheral cause or should I still Think of a central cause like a cerebellar infarction? Now there’s a test to help to differentiate which is also in the NHG standard Dizziness is mentioned.
Head Impulse Test (HIT)
Preparing materials
Place two chairs facing each other, so that the patient is at eye level can sit across from you. Have a container/cup ready for when the patient during the examination becomes nauseous and vomiting.
Preparation
Have the patient sit at eye level across from you.
Explain the examination to the patient.
Ask the patient to fixate on the tip of your nose throughout the examination.
Explanation
Holds the head of the patient on both sides.
First, gently turn the head a few times 20 degrees to the left and to right, until the patient is used to it and the neck muscles relax sufficiently be.
Ask the patient to continue to fixate on the tip of your nose and open their eyes. hold.
Move the patient’s head 20 degrees to the right, then turn the Head back to the center suddenly and as quickly as possible, see test.
The research may also be carried out the other way around; rotate the head from the as far to the right as possible.
Pay attention to the movement of The Eyes
When the eyes first move in the direction of the lateral movement and then compensatory ‘refixing’ (refixation accade) then the test is positive.
If the patient can continue to fixate, then the test is negative.
Repeat the test to the left, see test.
Aftercare education
A positive HIT test confirms a peripheral cause.
A negative HIT test suggests a central vestibular syndrome and leads to consultation with a neurologist. Want to see a test? Check out https://www.youtube.com/watch?v=Wh2ojfgbC3I.