Central nystagmus plus ABCD2 identifying stroke in acute dizziness presentations.
Acad Emerg Med
; 28(10): 1118-1123, 2021 10.
Article
em En
| MEDLINE
| ID: mdl-34014605
ABSTRACT
OBJECTIVE:
The objective was to explore the ability of head impulse-nystagmus-test of skew (HINTS) combined with ABCD2 score to identify cerebrovascular causes of dizziness. MATERIALS ANDMETHODS:
We prospectively recruited 85 patients with acute onset of dizziness from September 2016 to December 2018 and analyzed their clinical characteristics, ABCD2 scores, HINTS, and neuroimages data.RESULTS:
Acute stroke was identified by MRI in 21 of 85 patients. The mean ± SD ABCD2 scores were significantly higher among patients with acute stroke than those without acute stroke (4.0 ± 0.8 h vs. 2.5 ± 0.7 h, p < 0.01). The majority (71.4%) of patients with cerebrovascular causes had central pattern of nystagmus at the initial 48 h from symptoms onset. The sensitivity and specificity of HINTS were 100% and 87% for the presence of stroke in patients with nystagmus. When combined central pattern of nystagmus and ABCD2 ≥ 4, the sensitivity increased to 100% for identifying cerebrovascular causes. Nystagmus were absence at time of examination in 16.5% of our patients, and ABCD2 scores in patients who had cerebrovascular diagnoses were all ≥ 4.CONCLUSION:
HINTS examinations could efficiently differentiate stroke from nonstroke under the condition that patients remaining symptomatic, including spontaneous or gaze-evoked nystagmus. It is more practical to apply the combination of central pattern of nystagmus and ABCD2 ≥ 4 in ED setting. If patients were absence of central nystagmus at admission, cerebrovascular event should be a priority diagnosis when their ABCD2 ≥ 4.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Nistagmo Patológico
/
Acidente Vascular Cerebral
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article