Clinical and video head impulse test in the diagnosis of posterior circulation stroke presenting as acute vestibular syndrome in the emergency department

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dc.contributor.authorGuler, Ayse
dc.contributor.authorAkarca, Funda Karbek
dc.contributor.authorEraslan, Cenk
dc.contributor.authorTarhan, Ceyda
dc.contributor.authorBilgen, Cem
dc.contributor.authorKirazli, Tayfun
dc.contributor.authorCelebisoy, Nese
dc.date.accessioned2019-10-27T11:19:47Z
dc.date.available2019-10-27T11:19:47Z
dc.date.issued2017
dc.departmentEge Üniversitesien_US
dc.description.abstractINTRODUCTION: Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS: Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow. RESULTS: Forty patients 26 male, 14 female with a mean age of 49 years were included in the analyses. Final diagnoses were VN in 24 and PCS in 16 patients. In the VN group, clinical HIT was assessed as abnormal in 19(80%) cases by the emergency specialist and in 20(83%) by the neurologist. In all PCS patients, HIT was recorded as normal both by the emergency specialist and the neurologist (100%). On vHIT, patients with VN had significantly low gain values for both the ipsilesional and contralesional sides when compared with the healthy controls, with significantly lower figures for the ipsilesional side (p < 0.001). All patients in this group had normal DWI-MRI. PCS patients had bilaterally low gain (p < 0.05) on vHIT. However, gain asymmetry was not significant. Subgroup analyses according to presence of brainstem involvement revealed bilateral low gain (p < 0.05) in patients with brainstem infarction (anterior inferior cerebellar artery-posterior inferior cerebellar artery stroke, AICA-PICA stroke) whereas patients with pure cerebellar infarction (posterior inferior cerebellar artery-superior cerebellar artery stroke, PICA-SCA stroke) had gain values similar to healthy controls. With a gain cut-off <= 0.75 and gain asymmetry cut-off >= 17%, as determined by ROC analysis, 100% of PCS patients and 80% of VN patients were correctly diagnosed. CONCLUSIONS: Clinical HIT, either performed by an emergency specialist or neurologist is equivalent to vHIT gain and gain asymmetry analysis as conducted by neuro-otologist in the diagnosis of PCS, albeit mislabeling about 20% of VN patients. vHIT does not appear to yield additional diagnostic information. These findings indicate the strength of clinical HIT. Pure gain-based vHIT analysis seems limited and needs to be incorporated with saccade analysis.en_US
dc.identifier.doi10.3233/VES-170620en_US
dc.identifier.endpage242en_US
dc.identifier.issn0957-4271
dc.identifier.issn1878-6464
dc.identifier.issue4en_US
dc.identifier.pmid29081427en_US
dc.identifier.scopusqualityQ2en_US
dc.identifier.startpage233en_US
dc.identifier.urihttps://doi.org/10.3233/VES-170620
dc.identifier.urihttps://hdl.handle.net/11454/32832
dc.identifier.volume27en_US
dc.identifier.wosWOS:000413530100006en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherIos Pressen_US
dc.relation.ispartofJournal of Vestibular Research-Equilibrium & Orientationen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectAcute vestibular syndromeen_US
dc.subjecthead impulse testen_US
dc.subjectvideo-oculography based head impulse testen_US
dc.subjectvestibular neuritisen_US
dc.subjectposterior circulation strokeen_US
dc.titleClinical and video head impulse test in the diagnosis of posterior circulation stroke presenting as acute vestibular syndrome in the emergency departmenten_US
dc.typeArticleen_US

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