Clinician’s perspectives of head impulse-nystagmus-test of skew for acute vestibular syndrome

2021 ◽  
Vol 429 ◽  
pp. 119633
Author(s):  
Charlotte Barrett ◽  
Lisa Bunn ◽  
Nehzat Koohi ◽  
Gunnar Schmidtmann ◽  
Jenny Freeman ◽  
...  
Keyword(s):  
Head Impulse ◽  
Acute Vestibular Syndrome

scholarly journals Quantifying the Vestibulo-Ocular Reflex with Video-Oculography: Nature and Frequency of Artifacts

2014 ◽  
Vol 20 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Georgios Mantokoudis ◽  
Ali S. Saber Tehrani ◽  
Jorge C. Kattah ◽  
Karin Eibenberger ◽  
Cynthia I. Guede ◽  
...  
Keyword(s):  
Head Impulse Test ◽  
Head Impulse ◽  
Video Oculography ◽  
Ocular Reflex ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Corrective Saccades ◽  
Coding Manual ◽  
A Prospective Study ◽  
The Impact

Video-oculography devices are now used to quantify the vestibulo-ocular reflex (VOR) at the bedside using the head impulse test (HIT). Little is known about the impact of disruptive phenomena (e.g. corrective saccades, nystagmus, fixation losses, eye-blink artifacts) on quantitative VOR assessment in acute vertigo. This study systematically characterized the frequency, nature, and impact of artifacts on HIT VOR measures. From a prospective study of 26 patients with acute vestibular syndrome (16 vestibular neuritis, 10 stroke), we classified findings using a structured coding manual. Of 1,358 individual HIT traces, 72% had abnormal disruptive saccades, 44% had at least one artifact, and 42% were uninterpretable. Physicians using quantitative recording devices to measure head impulse VOR responses for clinical diagnosis should be aware of the potential impact of disruptive eye movements and measurement artifacts. i 2014 S. Karger AG, Basel

Misleading signs in acute vertigo

2017 ◽  
Vol 18 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Sean Lance ◽  
Stuart Scott Mossman
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome ◽  
Horizontal Head ◽  
Fourth Nerve Palsy ◽  
Paroxysmal Positional Vertigo

The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them.

scholarly journals Acute Vestibular Syndrome in Cerebellar Infarction: A Case Report

2021 ◽  
Vol 8 (9) ◽  
pp. 29-35
Author(s):  
Diayanti Tenti Lestari ◽  
Hanik Badriyah Hidayati
Keyword(s):  
Neurological Status ◽  
Rapid Onset ◽  
Great Sensitivity ◽  
Head Impulse Test ◽  
Symptomatic Therapy ◽  
Cerebellar Infarction ◽  
Head Impulse ◽  
Antiplatelet Medication ◽  
Acute Vestibular Syndrome ◽  
Skew Deviation

Introduction: Acute vestibular syndrome (AVS) is characterized by rapid onset of vertigo, nausea and vomiting, and gait unsteadiness in association with head motion intolerance and nystagmus, lasting days to weeks. Although the majority of AVS patients have acute peripheral vestibulopathy, some may also have brainstem or cerebellar strokes. Cerebellar infarctions sometimes only cause vertigo. The Head Impulse Test, skew deviation, and nystagmus testing provide for great sensitivity and specificity in distinguishing between peripheral vestibular impairment and stroke. Case: A 41-year-old male patient suffered from acute-onset vertigo and dizziness about 5 hours before admission, which started when he started doing his morning routine. Patients also feel gait unsteadiness and almost fall to the left side. There was no weakness in extremities, skew face or slurred speech. Patient's neurological status showed the cerebellar examination was positive left dysmetria, left dysdiadochokinesia, the Romberg test open eye fell to the left, normal Head Impulse Test (HIT), with horizontal bidirectional nystagmus and negative skew deviation test. Cerebellum infarction was discovered using computed tomography imaging. After passing through the acute stroke period, patients are offered symptomatic therapy in the form of betahistine, antiplatelet medication, and vestibular rehabilitation planning. On the tenth day after the onset, the patient's symptoms began to improve. Conclusion: Proper diagnosis of acute vestibular syndrome will guide the necessary tests. The HINTS oculomotor test at the bedside can detect acute vestibular stroke. Keywords: acute vestibular syndrome, vertigo, cerebellum, HINTS

Recent advances in head impulse test findings in central vestibular disorders

Neurology ◽  
2018 ◽  
Vol 90 (13) ◽  
pp. 602-612 ◽  
Author(s):  
Jeong-Yoon Choi ◽  
Hyo-Jung Kim ◽  
Ji-Soo Kim
Keyword(s):  
Vestibular Nucleus ◽  
Head Rotation ◽  
Medial Longitudinal Fasciculus ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Corrective Saccades ◽  
Cerebellar Lesions ◽  
Horizontal Head

The head impulse test (HIT) is used to evaluate the vestibulo-ocular reflex (VOR) during a high-velocity head rotation. Corrective catch-up saccades that occur during or after the HITs usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal clinical (bedside) HITs should prompt a search for a central lesion. However, recent quantitative studies that evaluated HITs using magnetic search coils or video-based techniques have demonstrated that specific patterns of HIT abnormalities are associated with central vestibular disorders. While normal clinical HITs are typical of central lesions, discrepancies have been observed between clinical and quantitative HITs. The horizontal head impulse VOR gains can be significantly reduced unilaterally or bilaterally (positive HITs) in lesions involving the vestibular nucleus, nucleus prepositus hypoglossi, or flocculus. In diffuse cerebellar lesions, the VOR gain during horizontal head impulses may increase (hyperactive) with corrective saccades directed the opposite way. The presence of cross-coupled vertical corrective saccades during horizontal HITs is also suggestive of diffuse cerebellar lesions. Lesions involving the vestibular nucleus, medial longitudinal fasciculus, and cerebellum may show decreased or increased gains of the VOR during vertical HITs. Defining the differences in patterns observed during abnormal HITs may help practitioners localize the responsible lesions in both central and peripheral vestibulopathy.

scholarly journals The clinical course of vestibular neuritis from the point of view of the video Head Impulse Test

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Leonardo Manzari ◽  
Domenico Graziano ◽  
Marco Tramontano
Keyword(s):  
Clinical Course ◽  
Cranial Nerves ◽  
Point Of View ◽  
Vestibular Neuritis ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Contralesional Side

Vestibular neuritis (VN) is one  of the most common causes of acute vestibular syndrome (AVS). Quantifying the vestibulo-ocular reflex (VOR) gain by the video Head Impulse Test (vHIT) could provide useful information to diagnose VN. This retrospective study is aimed to investigate the clinical course of VN evaluating the horizontal VOR gain (hVOR) values in acute and subacute stages and to correlate these values with the patients’ quality of life. Medical record of 28 patients with VN were reviewed. Patients were assigned to two groups according to the time since the acute vestibular syndrome (AVS). One group with patients assessed within seventy-two hours since the AVS (AVSg) and one group with patients evaluated from four days to six weeks since the AVS (PAVSg). hVOR gain was evaluated in all selected patients and correlated to Dizziness Handicap Inventory (DHI). Significant differences were found in the between-subjects analysis in DHI score (p=0.000) and in the ipsilesional hVOR gain values (p=0.001). The correlation analysis showed significant results (p=0.017) between DHI score ( 40±16.08) and ipsilesional VOR gain (0.65±0.22) in the PAVSg. Patients evaluated within 72 hours since the AVS showed anticompensatory saccades (AcS) turning the head toward the contralesional side. Patients with VN could have dissimilar hVOR gain values and DHI score according to the damage of the VIII pair of cranial nerves. AcS in the contralesional side is a sign of acute phase in patients with VN.

scholarly journals P.079 Factors influencing HINTS exam usage by Canadian Emergency Medicine Physicians

2021 ◽  
Vol 48 (s3) ◽  
pp. S42-S42
Author(s):  
M Byworth ◽  
P Johns ◽  
A Pardhan ◽  
K Srivastava ◽  
M Sharma
Keyword(s):  
Emergency Medicine ◽  
Residency Training ◽  
Older Age ◽  
Head Impulse Test ◽  
Emergency Physicians ◽  
Academic Practice ◽  
Head Impulse ◽  
Factors Influencing ◽  
Canadian Association ◽  
Acute Vestibular Syndrome

Background: The HINTS examination is a sensitive and specific tool for determining whether a patient presenting with an acute vestibular syndrome has had a stroke. Despite its efficacy, it is often not used by Emergency Medicine (EM) physicians when assessing patients with vertigo. Methods: To ascertain why, we surveyed, by email, physicians registered with the Canadian Association of Emergency Physicians, to gather information on their practices when assessing patients with vertigo, and their utilization and perspectives concerning the HINTS examination. Results: 185 participants responded to our survey, demographically representative of Canadian EM physicians. The majority regularly use the HINTS exam in the appropriate setting, but significant minorities employ the exam inappropriately, such as in patients without nystagmus, with other neurological findings, or alongside tests for intermittent vertigo. Misapplication was associated with older age, years of practice, non-academic practice settings, and less residency training (p<0.05). The predominant reasons for not using this examination are lack of confidence in recalling and performing component exam techniques, particularly the head-impulse test, and doubts about the necessity, safety, or validity of this examination. Conclusions: HINTS examination use is limited by lack of provider skill, safety concerns, and doubts on its validity in excluding stroke when employed by EM physicians.

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

2021 ◽  
Vol 10 (19) ◽  
pp. 4471
Author(s):  
Timo Siepmann ◽  
Cosima Gruener ◽  
Erik Simon ◽  
Annahita Sedghi ◽  
Hagen H. Kitzler ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Posterior Circulation ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Caloric Testing ◽  
Patients Âgés ◽  
Video Oculography ◽  
Posterior Circulation Stroke ◽  
Acute Vestibular Syndrome ◽  
Cranial Mri

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.

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