PMID- 21153732
OWN - NLM
STAT- MEDLINE
DCOM- 20110923
LR  - 20211020
IS  - 1432-1459 (Electronic)
IS  - 0340-5354 (Linking)
VI  - 258
IP  - 5
DP  - 2011 May
TI  - Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit.
PG  - 855-61
LID - 10.1007/s00415-010-5853-4 [doi]
AB  - Acute vestibular syndrome may be due to vestibular neuritis (VN) or posterior 
      circulation strokes. Bedside ocular motor testing performed by experts is 
      superior to early MRI in excluding strokes. We sought to demonstrate that 
      differentiation of strokes from VN in our stroke unit is reliable. During a 
      prospective study at a tertiary hospital over 1 year, patients with AVS were 
      evaluated in the emergency department (ED) and underwent admission with targeted 
      examination: gait, gaze-holding, horizontal head impulse test (hHIT), testing for 
      skew deviation (SD) and vertical smooth pursuit (vSP). Neuroimaging included CT, 
      transcranial Doppler (TCD) and MRI with MR angiogram (MRA). VN was diagnosed with 
      normal diffusion-weighted images (DWI) and absence of neurological deficits on 
      follow-up. Acute strokes were confirmed with DWI. A total of 24 patients with AVS 
      were enrolled and divided in two groups. In the pure vestibular group (n = 20), 
      all VN (n = 10/10) had positive hHIT and unidirectional nystagmus, but 1 patient 
      had SD and abnormal vertical smooth pursuit (SP). In all the strokes (n = 10/10), 
      one of the following signs suggestive of central lesion was present: negative 
      hHIT, central-type nystagmus, SD or abnormal vSP. Finding one of these was 100% 
      sensitive and 90% specific for stroke. In the cochleovestibular group (n = 4) all 
      had normal DWI, but 3 patients had central ocular motor signs (abnormal vertical 
      SP and SD). Whilst the study is small, classification of AVS in our stroke unit 
      is reliable. The sensitivity and specificity of bedside ocular motor testing are 
      comparable to those previously reported by expert neuro-otologists. Acute 
      cochleovestibular loss and normal DWI may signify a labyrinthine infarct but 
      differentiating between different causes of inner ear dysfunction is not possible 
      with bedside testing.
FAU - Chen, L
AU  - Chen L
AD  - Department of Neurology, Austin Health, Heidelberg, Melbourne, VIC, 3084, 
      Australia. lukechen@internode.on.net
FAU - Lee, W
AU  - Lee W
FAU - Chambers, B R
AU  - Chambers BR
FAU - Dewey, H M
AU  - Dewey HM
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20101212
PL  - Germany
TA  - J Neurol
JT  - Journal of neurology
JID - 0423161
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Diagnosis, Differential
MH  - Diffusion Magnetic Resonance Imaging
MH  - Eye Movements
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neurologic Examination
MH  - Sensitivity and Specificity
MH  - Stroke/complications/*diagnosis
MH  - Vertigo/etiology
MH  - Vestibular Neuronitis/complications/*diagnosis
EDAT- 2010/12/15 06:00
MHDA- 2011/09/29 06:00
CRDT- 2010/12/15 06:00
PHST- 2010/06/27 00:00 [received]
PHST- 2010/11/25 00:00 [accepted]
PHST- 2010/11/15 00:00 [revised]
PHST- 2010/12/15 06:00 [entrez]
PHST- 2010/12/15 06:00 [pubmed]
PHST- 2011/09/29 06:00 [medline]
AID - 10.1007/s00415-010-5853-4 [doi]
PST - ppublish
SO  - J Neurol. 2011 May;258(5):855-61. doi: 10.1007/s00415-010-5853-4. Epub 2010 Dec 
      12.