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. 2021 Sep 28;10(19):4471.
doi: 10.3390/jcm10194471.

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

Timo Siepmann  1 , Cosima Gruener  1 , Erik Simon  1 , Annahita Sedghi  1 , Hagen H Kitzler  2 , Lars-Peder Pallesen  1 , Jessica Barlinn  1 , Heinz Reichmann  1 , Volker Puetz  1 , Kristian Barlinn  1
Affiliations

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

Timo Siepmann et al. J Clin Med. .

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.

Keywords: HINTS; V-HIT; acute vestibular syndrome; dizziness; neurology; stroke; vertigo; video-oculography.

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Conflict of interest statement

T.S. is an editorial board member of J. Clin. Med. C.G., E.S., A.S., H.H.K., L.P., J.B., H.R., V.P. and K.B. declare no conflict of interest.

Figures

Figure 1
Figure 1
STARD Flow diagram. (A) C-HINTS plus; (B) V-HIT assisted HINTS plus; (C) Cal-NTS plus.
Figure 1
Figure 1
STARD Flow diagram. (A) C-HINTS plus; (B) V-HIT assisted HINTS plus; (C) Cal-NTS plus.
Figure 1
Figure 1
STARD Flow diagram. (A) C-HINTS plus; (B) V-HIT assisted HINTS plus; (C) Cal-NTS plus.
Figure 2
Figure 2
Video-oculography and cranial MRI correlates. (A) Conventional and V-HIT-assisted HINTS plus with an abnormal pattern, but normal caloric testing and brainstem and cerebellar MRI without pathological findings (diffusion trace map). (B) Abnormal pattern on conventional and V-HIT-assisted HINTS plus suggestive of a central lesion. Right paramedian punctuate diffusion restriction of an acute pontine infarction (yellow arrow). (C) Benign pattern on both HINTS plus examinations suggestive of peripheral vestibulopathy, unremarkable diffusion MRI, caloric testing confirmed unilateral vestibulopathy on the right side.
See this image and copyright information in PMC

References

    1. Newman-Toker D.E., Hsieh Y.H., Camargo C.A., Jr., Pelletier A.J., Butchy G.T., Edlow J.A. Spectrum of dizziness visits to US emergency departments: Cross-sectional analysis from a nationally representative sample. Mayo Clin. Proc. 2008;83:765–775. doi: 10.4065/83.7.765. - DOI - PMC - PubMed
    1. Saber Tehrani A.S., Kattah J.C., Mantokoudis G., Pula J.H., Nair D., Blitz A., Ying S., Hanley D.F., Zee D.S., Newman-Toker D.E. Small strokes causing severe vertigo: Frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 2014;83:169–173. doi: 10.1212/WNL.0000000000000573. - DOI - PMC - PubMed
    1. Lee S.H., Kim J.S. Differential diagnosis of acute vascular vertigo. Curr. Opin. Neurol. 2020;33:142–149. doi: 10.1097/WCO.0000000000000776. - DOI - PubMed
    1. Newman-Toker D.E., Kerber K.A., Hsieh Y.H., Pula J.H., Omron R., Saber Tehrani A.S., Mantokoudis G., Hanley D.F., Zee D.S., Kattah J.C. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad. Emerg. Med. 2013;20:986–996. doi: 10.1111/acem.12223. - DOI - PubMed
    1. MacDougall H.G., Weber K.P., McGarvie L.A., Halmagyi G.M., Curthoys I.S. The video head im-pulse test: Diagnostic accuracy in peripheral vestibulopathy. Neurology. 2009;73:1134–1141. doi: 10.1212/WNL.0b013e3181bacf85. - DOI - PMC - PubMed

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