Bilaterally Abnormal Head Impulse Tests Indicate a Large Cerebellopontine Angle Tumor
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Background and Purpose Tumors involving the cerebellopontine angle (CPA) pose a diagnostic challenge due to their diverse manifestations. Head impulse tests (HITs) have been used to evaluate vestibular function, but few studies have explored the head impulse gain of the vestibulo-ocular refex (VOR) in patients with a vestibular schwannoma. Tis study tested whether the head impulse gain of the VOR is an indicator of the size of a unilateral CPA tumor. Methods Twenty-eight patients (21 women; age=64±12 years, mean±SD) with a unilateral CPA tumor underwent a recording of the HITs using a magnetic search coil technique. Patients were classifed into non-compressing (T1–T3) and compressing (T4) groups according to the Hannover classifcation. Results Most (23/28, 82%) of the patients showed abnormal HITs for the semicircular canals on the lesion side. Te bilateral abnormality in HITs was more common in the compressing group than the non-compressing group (80% vs. 8%, Pearson’s chi-square test: p<0.001). Te tumor size was inversely correlated with the head impulse gain of the VOR in either direction. Conclusions Bilaterally abnormal HITs indicate that a patient has a large unilateral CPA tumor. Te abnormal HITs in the contralesional direction may be explained either by adaptation or by compression and resultant dysfunction of the cerebellar and brainstem structures. Te serial evaluation of HITs may provide information on tumor growth, and thereby reduce the number of costly brain scans required when following up patients with CPA tumors.
Abstract
Background and Purpose Tumors involving the cerebellopontine angle (CPA) pose a diagnostic challenge due to their diverse manifestations. Head impulse tests (HITs) have been used to evaluate vestibular function, but few studies have explored the head impulse gain of the vestibulo-ocular refex (VOR) in patients with a vestibular schwannoma. Tis study tested whether the head impulse gain of the VOR is an indicator of the size of a unilateral CPA tumor. Methods Twenty-eight patients (21 women; age=64±12 years, mean±SD) with a unilateral CPA tumor underwent a recording of the HITs using a magnetic search coil technique. Patients were classifed into non-compressing (T1–T3) and compressing (T4) groups according to the Hannover classifcation. Results Most (23/28, 82%) of the patients showed abnormal HITs for the semicircular canals on the lesion side. Te bilateral abnormality in HITs was more common in the compressing group than the non-compressing group (80% vs. 8%, Pearson’s chi-square test: p<0.001). Te tumor size was inversely correlated with the head impulse gain of the VOR in either direction. Conclusions Bilaterally abnormal HITs indicate that a patient has a large unilateral CPA tumor. Te abnormal HITs in the contralesional direction may be explained either by adaptation or by compression and resultant dysfunction of the cerebellar and brainstem structures. Te serial evaluation of HITs may provide information on tumor growth, and thereby reduce the number of costly brain scans required when following up patients with CPA tumors.
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