HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging

Stroke

Volumn 40, Issue 11, 2009, Pages 3504-3510

  Kattah, Jorge C ^a   Talkad, Arun V ^a   Wang, David Z ^a   Hsieh, Yu Hsiang ^b   Newman Toker, David E ^c  

^a Department of Neurology ^*

^b UNIVERSITY OF ILLINOIS   (United States)

^c JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Cerebrovascular accident; Diagnosis; Neurologic examination; Sensitivity and specificity; Vertigo

Indexed keywords

ACUTE PERIPHERAL VESTIBULOPATHY; ACUTE VESTIBULAR SYNDROME; ADULT; AGED; ARTICLE; BRAIN HEMORRHAGE; CEREBROVASCULAR ACCIDENT; CLINICAL FEATURE; DIAGNOSTIC ACCURACY; DIFFERENTIAL DIAGNOSIS; DIFFUSION WEIGHTED IMAGING; EYE EXAMINATION; FEMALE; FOLLOW UP; HEAD IMPULSE NYSTAGMUS TEST OF SKEW; HIGH RISK PATIENT; HUMAN; INTERMETHOD COMPARISON; MAJOR CLINICAL STUDY; MALE; NEUROIMAGING; NEUROLOGIC EXAMINATION; NYSTAGMUS; POINT OF CARE TESTING; PONS ANGLE; PRIORITY JOURNAL; STROKE; VESTIBULAR DISORDER; VESTIBULOOCULAR REFLEX;

ACUTE DISEASE; ADULT; AGED; AGED, 80 AND OVER; CROSS-SECTIONAL STUDIES; DIFFUSION MAGNETIC RESONANCE IMAGING; FEMALE; HUMANS; MALE; MIDDLE AGED; NAUSEA; NYSTAGMUS, PATHOLOGIC; POINT-OF-CARE SYSTEMS; PROSPECTIVE STUDIES; REFLEX, VESTIBULO-OCULAR; STROKE; SYNDROME; TIME FACTORS; VERTIGO; VOMITING;

EID: 70350548207     PISSN: 00392499     EISSN: None     Source Type: Journal    
DOI: 10.1161/STROKEAHA.109.551234     Document Type: Article

References (26)

1. Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83:765-775.
2. Huang CY, Yu YL. Small cerebellar strokes may mimic labyrinthine lesions. J Neurol Neurosurg Psychiatry. 1985;48:263-265.
3. Norrving B, Magnusson M, Holtas S. Isolated acute vertigo in the elderly; vestibular or vascular disease? Acta Neurol Scand. 1995;91:43-48.
4. Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, Baloh RW. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67:1178-1183.
5. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central 'vestibular pseudo-neuritis.' J Neurol Neurosurg Psychiatry. 2008;79:458-460.
6. Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology. 2008;70:2378-2385.
7. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293-298.
8. Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol. 2008;7:951-964.
9. Oppenheim C, Stanescu R, Dormont D, Crozier S, Marro B, Samson Y, Rancurel G, Marsault C. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol. 2000;21: 1434-1440.
10. Marx JJ, Thoemke F, Mika-Gruettner A, Fitzek S, Vucurevic G, Urban PP, Stoeter P, Dieterich M, Hopf HC. Diffusion-weighted MRT in ver-tebrobasilar ischemia. Application, sensitivity, and prognostic value [in German]. Nervenarzt. 2004;75:341-346.
11. Derebery MJ. The diagnosis and treatment of dizziness. Med Clin North Am. 1999;83:163-177.
12. Rosenberg ML, Gizzi M. Neuro-otologic history. Otolaryngol Clin North Am. 2000;33:471-482.
13. Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45:737-739.
14. Halmagyi GM. Diagnosis and management of vertigo. Clin Med. 2005; 5:159-165.
15. Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med. 1998;339:680-685.
16. Newman-Toker DE, Sharma P, Chowdhury M, Clemons TM, Zee DS, Della Santina CC. Penlight-cover test-a new bedside method to unmask nystagmus. J Neurol Neurosurg Psychiatry. 2009;80:900-903.
17. Brodsky MC, Donahue SP, Vaphiades M, Brandt T. Skew deviation revisited. Surv Ophthalmol. 2006;51:105-128.
18. Halmagyi GM, Gresty MA, Gibson WP. Ocular tilt reaction with peripheral vestibular lesion. Ann Neurol. 1979;6:80-83.
19. Mennel S, Hergan K, Peter S. Skew deviation: a precursor to basilar artery thrombosis. Clin Experiment Ophthalmol. 2005;33:536-538.
20. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37: 2484-2487.
21. Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14:63-68.
22. Stanton VA, Hsieh YH, Camargo CA Jr, Edlow JA, Lovett P, Goldstein JN, Abbuhl S, Lin M, Chanmugam A, Rothman RE, Newman-Toker DE. Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proc. 2007;82: 1319-1328.
23. Malm J, Kristensen B, Carlberg B, Fagerlund M, Olsson T. Clinical features and prognosis in young adults with infratentorial infarcts. Cerebrovasc Dis. 1999;9:282-289.
24. Braverman I, River Y, Rappaport JM, Eliashar R, Elidan J. Spontaneous vertebral artery dissection mimicking acute vertigo. Case report. Ann Otol Rhinol Laryngol. 1999;108:1170-1173.
25. Jorns-Häderli M, Straumann D, Palla A. Accuracy of the bedside head impulse test in detecting vestibular hypofunction. J Neurol Neurosurg Psychiatry. 2007;78:1113-1118.
26. Aw ST, Fetter M, Cremer PD, Karlberg M, Halmagyi GM. Individual semicircular canal function in superior and inferior vestibular neuritis. Neurology. 2001;57:768-774.