Kattah et al developed a simple bedside test for stroke in a patient with the acute vestibular syndrome. The authors are from the University of Illinois, Illinois Neurological Institute, and the Johns Hopkins University.
Patient selection: acute vestibular syndrome
Parts of the exam:
(1) head impulse to the right and left (HI)
(2) nystagmus on gaze testing (N)
(3) test of skew with alternate cover testing (TS)
Findings in a "central" vestibular lesion, which most often is a stroke:
(1) head impulse normal bilaterally (an abnormal finding suggests a vestibular/peripheral cause)
(2) nystagmus shows fast-phase alternating (bilateral, direction-changing, horizontal gaze-evoked, or predominantly vertical or torsional nystagmus)
(3) test of skew shows refixation on cover test (skew deviation)
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