Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke
BackgroundVideo head impulse tests (vHITs), assessing the vestibulo-ocular reflex (VOR), may be helpful in the differential diagnosis of acute dizziness. We aimed to investigate vHITs in patients with acute posterior circulation stroke (PCS) to examine whether these findings could exhibit significan...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1256826/full |
| _version_ | 1797676746244358144 |
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| author | Sang Hee Ha Sang Hee Ha Dong Kyu Lee Gayoung Park Bum Joon Kim Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Hong Ju Park Eun-Jae Lee |
| author_facet | Sang Hee Ha Sang Hee Ha Dong Kyu Lee Gayoung Park Bum Joon Kim Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Hong Ju Park Eun-Jae Lee |
| author_sort | Sang Hee Ha |
| collection | DOAJ |
| description | BackgroundVideo head impulse tests (vHITs), assessing the vestibulo-ocular reflex (VOR), may be helpful in the differential diagnosis of acute dizziness. We aimed to investigate vHITs in patients with acute posterior circulation stroke (PCS) to examine whether these findings could exhibit significant abnormalities based on lesion locations, and to evaluate diagnostic value of vHIT in differentiating dizziness between PCS and vestibular neuritis (VN).MethodsWe prospectively recruited consecutive 80 patients with acute PCS and analyzed vHIT findings according to the presence of dorsal brainstem stroke (DBS). We also compared vHIT findings between PCS patients with dizziness and a previously studied VN group (n = 29). Receiver operating characteristic (ROC) analysis was performed to assess the performance of VOR gain and its asymmetry in distinguishing dizziness between PCS and VN.ResultsPatients with PCS underwent vHIT within a median of 2 days from stroke onset. Mean horizontal VOR gain was 0.97, and there was no significant difference between PCS patients with DBS (n = 15) and without (n = 65). None exhibited pathologic overt corrective saccades. When comparing the PCS group with dizziness (n = 40) to the VN group (n = 29), patients with VN demonstrated significantly lower mean VOR gains in the ipsilesional horizontal canals (1.00 vs. 0.57, p < 0.001). VOR gain and their asymmetry effectively differentiated dizziness in the PCS from VN groups, with an area under the ROC curve of 0.86 (95% CI 0.74–0.98) and 0.91 (95% CI 0.83–0.99, p < 0.001), respectively.ConclusionSignificantly abnormal vHIT results were rare in patients with acute PCS, even in the presence of DBS. Moreover, vHIT effectively differentiated dizziness between PCS and VN, highlighting its potential for aiding differential diagnosis of acute dizziness. |
| first_indexed | 2024-03-11T22:34:46Z |
| format | Article |
| id | doaj.art-52a72dda093a4aff843bd5fe95e09275 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T22:34:46Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-52a72dda093a4aff843bd5fe95e092752023-09-22T15:50:33ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-09-011410.3389/fneur.2023.12568261256826Prospective analysis of video head impulse tests in patients with acute posterior circulation strokeSang Hee Ha0Sang Hee Ha1Dong Kyu Lee2Gayoung Park3Bum Joon Kim4Jun Young Chang5Dong-Wha Kang6Sun U. Kwon7Jong S. Kim8Hong Ju Park9Eun-Jae Lee10Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Gil Medical Center, Gachon University, Incheon, Republic of KoreaDepartment of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Gangneung Asan Hospital, University of Ulsan, Gangneung, Gangwon-do, Republic of KoreaDepartment of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaBackgroundVideo head impulse tests (vHITs), assessing the vestibulo-ocular reflex (VOR), may be helpful in the differential diagnosis of acute dizziness. We aimed to investigate vHITs in patients with acute posterior circulation stroke (PCS) to examine whether these findings could exhibit significant abnormalities based on lesion locations, and to evaluate diagnostic value of vHIT in differentiating dizziness between PCS and vestibular neuritis (VN).MethodsWe prospectively recruited consecutive 80 patients with acute PCS and analyzed vHIT findings according to the presence of dorsal brainstem stroke (DBS). We also compared vHIT findings between PCS patients with dizziness and a previously studied VN group (n = 29). Receiver operating characteristic (ROC) analysis was performed to assess the performance of VOR gain and its asymmetry in distinguishing dizziness between PCS and VN.ResultsPatients with PCS underwent vHIT within a median of 2 days from stroke onset. Mean horizontal VOR gain was 0.97, and there was no significant difference between PCS patients with DBS (n = 15) and without (n = 65). None exhibited pathologic overt corrective saccades. When comparing the PCS group with dizziness (n = 40) to the VN group (n = 29), patients with VN demonstrated significantly lower mean VOR gains in the ipsilesional horizontal canals (1.00 vs. 0.57, p < 0.001). VOR gain and their asymmetry effectively differentiated dizziness in the PCS from VN groups, with an area under the ROC curve of 0.86 (95% CI 0.74–0.98) and 0.91 (95% CI 0.83–0.99, p < 0.001), respectively.ConclusionSignificantly abnormal vHIT results were rare in patients with acute PCS, even in the presence of DBS. Moreover, vHIT effectively differentiated dizziness between PCS and VN, highlighting its potential for aiding differential diagnosis of acute dizziness.https://www.frontiersin.org/articles/10.3389/fneur.2023.1256826/fullcorrective saccadesdorsal brainstem strokeposterior circulation strokevestibular neuritisvestibulo-ocular reflexvideo head impulse test |
| spellingShingle | Sang Hee Ha Sang Hee Ha Dong Kyu Lee Gayoung Park Bum Joon Kim Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Hong Ju Park Eun-Jae Lee Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke Frontiers in Neurology corrective saccades dorsal brainstem stroke posterior circulation stroke vestibular neuritis vestibulo-ocular reflex video head impulse test |
| title | Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke |
| title_full | Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke |
| title_fullStr | Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke |
| title_full_unstemmed | Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke |
| title_short | Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke |
| title_sort | prospective analysis of video head impulse tests in patients with acute posterior circulation stroke |
| topic | corrective saccades dorsal brainstem stroke posterior circulation stroke vestibular neuritis vestibulo-ocular reflex video head impulse test |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1256826/full |
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