Your browser doesn't support javascript.
loading
Video head impulse testing to differentiate vestibular neuritis from posterior circulation stroke in the emergency department: a prospective observational study.
Thomas, James Orton; Sharobeam, Angelos; Venkat, Abhay; Blair, Christopher; Ozalp, Nese; Calic, Zeljka; Wyllie, Peter; Middleton, Paul M; Welgampola, Miriam; Cordato, Dennis; Cappelen-Smith, Cecilia.
Afiliación
  • Thomas JO; Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia.
  • Sharobeam A; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
  • Venkat A; Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, Victoria, Australia.
  • Blair C; Department of Neurology, Wollongong Hospital, Wollongong, New South Wales, Australia.
  • Ozalp N; Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia.
  • Calic Z; Ingham Institute, Liverpool, New South Wales, Australia.
  • Wyllie P; Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia.
  • Middleton PM; Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia.
  • Welgampola M; South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
  • Cordato D; Emergency Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.
  • Cappelen-Smith C; South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
BMJ Neurol Open ; 4(1): e000284, 2022.
Article en En | MEDLINE | ID: mdl-35571585
Background and aims: Vertigo is a common presentation to the emergency department (ED) with 5% of presentations due to posterior circulation stroke (PCS). Bedside investigations such as the head impulse test (HIT) are used to risk stratify patients, but interpretation is operator dependent. The video HIT (v-HIT) provides objective measurement of the vestibular-ocular-reflex (VOR) and may improve diagnostic accuracy in acute vestibular syndrome (AVS). We aimed to evaluate the use of v-HIT as an adjunct to clinical assessment to acutely differentiate vestibular neuritis (VN) from PCS. Methods: 133 patients with AVS were consecutively enrolled from the ED of our comprehensive stroke centre between 2018 and 2021. Patient assessment included a targeted vestibular history, HINTs examination (Head Impulse, Nystagmus and Test of Skew), v-HIT and MRI>48 hours after symptom onset. The HINTS/v-HIT findings were analysed and compared between VN, PCS and other cause AVS. Clinical course, v-HIT and MRI findings were used to determine diagnosis. Results: Final diagnosis was VN in 40%, PCS 15%, migraine 16% and other cause AVS 29%. PCS patients were older than VN patients (mean age 68.5±10.6 vs 60.1±14.2 years, p=0.14) and had more cardiovascular risk factors (3 vs 2, p=0.002). Mean VOR gain was reduced (<0.8) in ipsilateral horizontal and (<0.7) anterior canals in VN but was normal in PCS, migraine and other cause AVS. V-HIT combined with HINTs was 89% sensitive and 96% specific for a diagnosis of VN. Conclusions V-HIT combined with HINTs is a reliable tool to exclude PCS in the ED.
Palabras clave

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Observational_studies / Risk_factors_studies Idioma: En Revista: BMJ Neurol Open Año: 2022 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Observational_studies / Risk_factors_studies Idioma: En Revista: BMJ Neurol Open Año: 2022 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido