ICS Impulse making a difference in differential diagnosis: Interesting and informative case reportsThese two case reports demonstrate why a test battery is important. One case reports on a suspected case of bilateral loss of vestibular function. The second case reports on a recent onset disequilibrium mimicking acute vestibulopathy in early multiple sclerosis. With the addition of the oculomotor module to the ICS Impulse, one can perform several valuable tests (gaze, spontaneous and skew deviation). These tests along with the video head impulse test increases the ability to differentially diagnosis patients using one small portable goggle.
The findings in the first case led to the conclusion that “absent responses in caloric and rotatory tests alone are not sufficient to diagnose bilateral loss of vestibular function. Because vHIT evaluates the six semicircular canals, it should be considered essential in the evaluation of vestibular function absence”. The second case concluded this case represents the value of utilizing the HINTS rule. The analysis of nystagmus direction and an abnormal head impulse test initially raised the question of an exception to the rule. However, the skew deviation detected by cross-cover testing motivated us to get additional history, neurotologic testing and neuroimaging, concluding with a diagnosis of multiple sclerosis with the benefit of early intervention to procure a better neurological prognosis.