On video head impulse test (vHIT), a patient shows normal vestibulo-ocular reflex gain bilaterally but demonstrates overt catch-up saccades after horizontal head impulses. This finding is most consistent with:

• A Bilateral vestibular loss
• B Acute unilateral peripheral vestibular loss
• C Normal aging
• D Cerebellar degeneration ✓

Explanation

Normal gain with overt catch-up saccades indicates the VOR arc is intact but the cerebellum fails to calibrate it properly, a finding seen in cerebellar disease. Acute peripheral loss shows reduced gain with catch-up saccades. Bilateral loss shows markedly reduced gain. Normal aging does not produce overt saccades with normal gain.

Reference: Otology and Neurotology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.