The head thrust maneuver is a simple bedside test of the higher frequency vestibulo-ocular reflex, which is based on Ewald's second law. It is performed by grasping the patient's head and applying a brief, small-amplitude, high-acceleration head turn, first to one side and then to the other. The patient fixates on the examiner's nose and the examiner watches for corrective rapid eye movements (saccades), which are a sign of decreased vestibular response. The "catch-up" saccades after a head thrust in one direction indicate a peripheral vestibular lesion on that side (in the labyrinth or the 8th nerve including the root's entry zone in the brain stem). An individual pair of vertical semicircular canals can also be stimulated by turning the head to the right or left by 45�and then by rotating the head in the pitch plane relative to the body. Recent studies have suggested that assessment of individual semicircular canal function by head thrust test mayprovide useful information for anatomical and functional details of a variety of peripheral vestibulopathies and for predicting the prognosis of vestibular neuritis. In central vestibulopathy, the head thrust test may also be valuable sign to determine dysfunction of the central pathways from individual semicircular canals and its role for the development of diverse central nystagmus.
