Video-Oculography-Assisted Head Impulse Test and Caloric Testing for Detecting Stroke in Acute Vertigo Patients via Modified HINTS Plus.

Timo Siepmann,Lars-Peder Pallesen,Hagen H Kitzler,Heinz Reichmann,Jessica Barlinn,Kristian Barlinn,Erik Simon,Volker Puetz,Cosima Gruener,Annahita Sedghi

doi:10.3390/jcm10194471

Timo Siepmann, Lars-Peder Pallesen + Show 8 more

Open Access

https://doi.org/10.3390/jcm10194471

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Abstract

Background: We assessed whether detection of stroke underlying acute vertigo using HINTS plus (head-impulse test, nystagmus type, test of skew, hearing loss) can be improved by video-oculography for automated head-impulse test (V-HIT) analysis. Methods: We evaluated patients with acute vestibular syndrome (AVS) presenting to the emergency room using HINTS plus and V-HIT-assisted HINTS plus in a randomized sequence followed by cranial MRI and caloric testing. Image-confirmed posterior circulation stroke or vertebrobasilar TIA were the reference standards to calculate diagnostic accuracy. We repeated statistical analysis for a third protocol that was composed post hoc by replacing the head-impulse test with caloric testing in the HINTS plus protocol. Results: We included 30 AVS patients (ages 55.4 ± 17.2 years, 14 females). Of these, 11 (36.7%) had posterior circulation stroke (n = 4) or TIA (n = 7). Acute V-HIT-assisted HINTS plus was feasible and displayed tendentially higher accuracy than conventional HINTS plus (sensitivity: 81.8%, 95% CI 48.2–97.7%; specificity 31.6%, 95% CI 12.6–56.6% vs. sensitivity 72.7%, 95% CI 39.0–94.0%; specificity 36.8%, 95% CI 16.3–61.6%). The new caloric-supported algorithm showed high accuracy (sensitivity 100%, 95% CI 66.4–100%; specificity 66.7%, 95% CI 41–86.7%). Conclusions: Our study provides pilot data on V-HIT-assisted HINTS plus for acute AVS assessment and indicates the diagnostic value of integrated acute caloric testing.

Highlights

Dizziness accounts for up to 4–6% of all emergency department visits, and 4% of these patients have an underlying cerebrovascular pathology [1]
Vertebrobasilar stroke frequently presents with sole acute vestibular syndrome (AVS), defined as new and persistent acute vertigo or dizziness, with additional nausea/vomiting, head motion intolerance, or new gait unsteadiness, its detection is missed in up to one third of these patients [2]
Is frequently not available, several tools have been designed to detect stroke patients among those presenting with AVS at the emergency department including HINTS plus and video-oculographyassisted HIT (V-HIT) [3,4,5]

Summary

Introduction

Dizziness accounts for up to 4–6% of all emergency department visits, and 4% of these patients have an underlying cerebrovascular pathology [1]. Vertebrobasilar stroke frequently presents with sole acute vestibular syndrome (AVS), defined as new and persistent acute vertigo or dizziness, with additional nausea/vomiting, head motion intolerance, or new gait unsteadiness, its detection is missed in up to one third of these patients [2]. Is frequently not available, several tools have been designed to detect stroke patients among those presenting with AVS at the emergency department including HINTS plus (headimpulse test [HIT], nystagmus type, test of skew, hearing loss) and video-oculographyassisted HIT (V-HIT) [3,4,5].

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