Bedside Head Impulse Test: A Useful Tool for Patients With Sensory Ataxia

An 85-year-old man suffered from a 20-year history of idiopathic sensory neuronopathy (figure). Neurologic examination was characterized by severe sensory ataxia needing bilateral support during walking, subtle dysarthria, and reduced sensation for all modalities. Bedside head impulse test (HIT) revealed vestibular areflexia (video 1), arising suspicion of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS), then confirmed by the presence of biallelic expansion in RFC1 gene.1 Clinical sensory involvement can be the only manifestation in some CANVAS patients,2 and HIT, although overlooked in neurologic examination, should be performed in all patients with sensory ataxia to raise suspicion of CANVAS.

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