The clinical value of vHIT saccadic parameters in the diagnosis and management of central vestibular disorders: a narrative review

Li Qian, S J Yang, Wang Hulin, Chen Xu, Tang Enjie, Ling Li

Central vestibular disorders significantly impair human balance and spatial orientation, and are associated with high rates of disability and mortality. Precise diagnosis and management are crucial for improving patient prognosis. As an advanced vestibular function assessment technique, the video head impulse test (vHIT) has been widely applied in clinical practice due to its non-invasive, accessible, and quantitative properties. Although the vestibulo-ocular reflex (VOR) gain serves as the core metric of vHIT, it presents notable limitations due to the influence of various factors such as testing techniques and patient compliance. Relying solely on the VOR gain poses a challenge to reliably differentiate central from peripheral vestibular disorders in acute vestibular syndrome. This limitation may lead to misdiagnosis when distinguishing conditions such as vestibular neuritis from cerebellar ischemic stroke. In recent years, clinical research has increasingly focused on the quantitative characteristics of compensatory saccades. When interpreted together with VOR gain and clinical context, multidimensional saccadic parameters, including latency, amplitude, symmetry, and dispersion, may provide complementary information on vestibular compensation and central ocular motor control. This narrative review provides a clinically oriented synthesis of the potential value of multidimensional saccadic parameters in differential diagnosis, selected lesion-localization contexts, and compensation monitoring, while emphasizing that these parameters should be interpreted together with VOR gain and broader clinical findings.