A 45-year-old man presents to the clinic with episodic, severe dizziness. He describes the sensation as the room spinning, which is often exacerbated by rapid head movements. A comprehensive neurological and vestibular physical examination is performed to differentiate between peripheral and central etiologies of his vertigo. Match the following bedside vestibular physical examination maneuvers with their corresponding diagnostic significance or classical positive finding.
- Dix-Hallpike maneuverElicits transient upbeating and torsional nystagmus indicative of posterior semicircular canal canalithiasis.
- Head impulse testReveals a corrective saccade demonstrating a deficient vestibulo-ocular reflex in peripheral vestibulopathy.
- Test of skewDemonstrates vertical realignment of the eyes upon uncovering, strongly suggesting a central brainstem lesion.
- Fukuda stepping testResults in progressive body rotation toward the affected side due to vestibulospinal reflex asymmetry.
Answer
Dix-Hallpike maneuver correlates with upbeating/torsional nystagmus. Head impulse test correlates with a corrective saccade. Test of skew correlates with vertical ocular realignment. Fukuda stepping test correlates with progressive body rotation.
Correct matching relies on understanding the precise anatomic pathways tested by each maneuver. The Dix-Hallpike targets the posterior canal. The Head impulse test assesses the integrity of the peripheral vestibulo-ocular reflex arc. The Test of skew evaluates for brainstem-level disruption of ocular alignment. The Fukuda stepping test evaluates descending vestibulospinal tract balance. Each maneuver isolates a different component of the complex vestibular system to localize the lesion.
Step-by-Step Solution
Key Concept
Diagnostic Bedside Vestibular Physical Examination Maneuvers