Evaluation of patients with vertigo of vertebrobasilar insufficiency origin using auditory brainstem response, electronystagmography, and transcranial Doppler.

OBJECTIVES: Vertigo can be a manifestation of underlying vertebrobasilar stroke in older adults. The study objectives were to investigate the correlation, sensitivity, and specificity of the auditory brainstem response (ABR), electronystagmorgraphy (ENG), and transcranial Doppler (TCD) collectively to distinguish between vertigo due to vertebrobasilar insufficiency (VBI) and vertigo due to non-VBI. DESIGN: Prospective experimental study comparing ENG, ABR, and TCD battery findings between two groups of patients with vertigo and a control group. STUDY SAMPLE: Participants included 14 patients with vertigo of VBI origin, 14 patients with vertigo of non-VBI, and 11 matched controls. RESULTS: Participants with VBI had more abnormal findings in the ENG (86%), TCD (72%), and ABR (64%) compared to the non-VBI group (64%, 21%, and 7%, respectively) and the control group. The combined battery revealed positive correlations, 64% sensitivity, and 84% positive predictive value (PPV) in the VBI group, and 100% specificity with lack of correlations in the non-VBI group. CONCLUSIONS: The modest sensitivity and PPV helps with early detection of VBI, thus preventing risk of vertebrobasilar stroke in 84% to 64% of patients. The 100% specificity in the non-VBI group rules out VBI, thus reducing the referral rate for unnecessary, diagnostic evaluations and ineffective treatment.