{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:41:38Z","timestamp":1790710898409,"version":"4.1.0"},"reference-count":95,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>The horizontal head-shaking test (HST) is a simple, rapid, and non-invasive bedside maneuver that provides valuable insights into both peripheral and central vestibular function. Originally described in the late 19th century and standardized in the 1970s, the HST predominantly stimulates the lateral semicircular canals (LSCs) at high frequencies. Its diagnostic power lies in revealing dynamic asymmetries of the angular vestibulo-ocular reflex (aVOR) and uncovering central abnormalities involving the brainstem and, above all, cerebellum. The pathophysiological basis of post-head-shaking nystagmus (post-HSN) derives from Ewald\u2019s second law, which explains the excitatory\u2013inhibitory imbalance between the labyrinths, further processed through the velocity storage mechanism (VSM). The VSM extends and integrates canal signals, aligning them with gravity through the action of the cerebellar nodulus and ventral uvula. Its modulation determines the direction, duration, and morphology of post-HSN, accounting for central features such as perverted or minimal-stimulus responses. The VSM is furthermore crucial for higher-order functions such as motion perception, spatial orientation, and postural stability. Clinically, the HST contributes to discrimination between peripheral lesions\u2014typically producing monophasic or biphasic horizontal post-HSN\u2014and central disorders, which yield vertical or torsional (perverted) responses, or exaggerated responses due to cerebellar disinhibition. Thus, rather than an empirical test, the HST represents a neurophysiologically grounded tool that bridges bedside observation and the vestibular integration. When interpreted within a comprehensive clinical framework, it offers diagnostic, prognostic, and educational value, serving as a window into the physiology and pathology of vestibular\u2013cerebellar networks.<\/jats:p>","DOI":"10.3389\/fneur.2025.1735948","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:14:08Z","timestamp":1767762848000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Horizontal head-shaking test: pathophysiological mechanisms and clinical interpretation"],"prefix":"10.3389","volume":"16","author":[{"given":"Vincenzo","family":"Marcelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Giannoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampiero","family":"Volpe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Cavaliere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Marcelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Faralli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Rita","family":"Fetoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito E.","family":"Pettorossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/BF01669801","article-title":"Ueber den \u201ceinseitigen Drehschwindel\u201d","author":"Adler","year":"1897","journal-title":"Dtsch Z Nervenheilk"},{"key":"ref2","first-page":"252","article-title":"Untersuchungen \u00fcber das Verhlaten des Vestibularapparatus bei Kopftraumen und ihre praktische Bedeutung","volume":"16","author":"Barany","year":"1907","journal-title":"Verh Deutsch Otol Gesel"},{"key":"ref3","first-page":"202","article-title":"Ueber den Nachweis des latenten Spontannystagmus","volume":"22","author":"Vogel","year":"1932","journal-title":"Z Laryngol Rhinol Otol"},{"key":"ref4","first-page":"48","article-title":"Ueber klinische Anhaltspunkte zur Unterscheidung von peripher und zentral bedingtem Nystagmus","volume":"6","author":"Vogel","year":"1954","journal-title":"Dtsch Med J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/s0196-0709(87)80017-0","article-title":"Head-shaking nystagmus in patients with unilateral peripheral vestibular lesions","volume":"8","author":"Hain","year":"1987","journal-title":"Am J Otolaryngol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1212\/wnl.57.5.887","article-title":"Perverted head-shaking nystagmus: a possible mechanism","volume":"57","author":"Minagar","year":"2001","journal-title":"Neurology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.jns.2010.11.009","article-title":"Perverted head shaking nystagmus in focal pontine infarction","volume":"301","author":"Kim","year":"2011","journal-title":"J Neurol Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1212\/01.WNL.0000150729.87682.79","article-title":"Isolated perverted head-shaking nystagmus in focal cerebellar infarction","volume":"64","author":"Kim","year":"2005","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"258","DOI":"10.3109\/00016487709128843","article-title":"Semicircular canal functional anatomy in cat, guinea pig and man","volume":"83","author":"Curthoys","year":"1977","journal-title":"Acta Otolaryngol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3417","DOI":"10.1152\/jn.00375.2005","article-title":"Cerebellar disease alters the axis of the high-acceleration vestibuloocular reflex","volume":"94","author":"Walker","year":"2005","journal-title":"J Neurophysiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1152\/jn.1971.34.4.635","article-title":"Physiology of peripheral neurons innervating semicircular canals of the squirrel monkey. 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