A 62-year-old man presents with acute onset severe vertigo, nausea, and vomiting for 6 hours. On examination, the head impulse test shows a corrective saccade when the head is rapidly turned to the left. There is no skew deviation or direction-changing nystagmus. This finding localizes the lesion to:

• A The left peripheral vestibular system ✓
• B The right peripheral vestibular system
• C The cerebellum
• D The brainstem

Explanation

A positive head impulse test, indicated by a corrective saccade, localizes to the peripheral vestibular system on the side being tested. When the head is turned to the left, the left horizontal semicircular canal is stimulated. A corrective saccade indicates reduced left peripheral vestibular function. The absence of skew deviation or direction-changing nystagmus helps exclude a central cause such as posterior circulation stroke.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.