A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome
Objective: The head impulse test (HIT) assesses the vestibulo-ocular reflex (VOR) and is used to differentiate vestibular neuritis (abnormal VOR) from stroke (normal VOR) in patients presenting with an acute vestibular syndrome (AVS). The video-oculography-based HIT (vHIT) quantifies VOR function an...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-10-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.741859/full |
| _version_ | 1818725340227305472 |
|---|---|
| author | Björn Machner Kira Erber Jin Hee Choi Andreas Sprenger Christoph Helmchen Peter Trillenberg |
| author_facet | Björn Machner Kira Erber Jin Hee Choi Andreas Sprenger Christoph Helmchen Peter Trillenberg |
| author_sort | Björn Machner |
| collection | DOAJ |
| description | Objective: The head impulse test (HIT) assesses the vestibulo-ocular reflex (VOR) and is used to differentiate vestibular neuritis (abnormal VOR) from stroke (normal VOR) in patients presenting with an acute vestibular syndrome (AVS). The video-oculography-based HIT (vHIT) quantifies VOR function and provides information imperceptible for the clinician during clinical bedside HIT. However, the vHIT—like an electrocardiogram—requires experienced interpretation, which is especially difficult in the emergency setting. This calls for a simple, reliable and rater-independent way of analysis.Methods: We retrospectively collected 171 vHITs performed in patients presenting with AVS to our emergency department. Three neuro-otological experts comprehensively assessed the vHITs including interpretability (artifacts), VOR gain (eye/head velocity ratio), velocity profile (abrupt decline) and corrective saccades (overt/covert). Their consensus rating (abnormal/peripheral vs. normal/central) was compared to a simple algorithm that automatically classified the vHITs based on a single VOR gain cutoff (0.7).Results: Inter-rater agreement between experts was high (Fleiss' kappa = 0.74). Five (2.9 %) vHITs were “uninterpretable” according to experts' consensus, 80 (46.8 %) were rated “normal” and 86 (50.3 %) “abnormal”. The algorithm had substantial agreement with the experts' consensus (Cohen's kappa = 0.75). Importantly, it correctly classified all of the normal/central vHITs denoted by the experts (100% specificity) and at the same time it had sufficient sensitivity (75.6%) in detecting abnormal/peripheral vHITs.Conclusion: A simple, automated, gain-based evaluation of the vHIT reliably detects normal/central VOR and may be a feasible and effective tool to screen AVS patients for potentially underlying stroke in the emergency setting. |
| first_indexed | 2024-12-17T21:40:45Z |
| format | Article |
| id | doaj.art-9791b36f55024136aaf1059febbad800 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-17T21:40:45Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-9791b36f55024136aaf1059febbad8002022-12-21T21:31:38ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-10-011210.3389/fneur.2021.741859741859A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular SyndromeBjörn Machner0Kira Erber1Jin Hee Choi2Andreas Sprenger3Christoph Helmchen4Peter Trillenberg5Department of Neurology, University Hospitals Schleswig-Holstein, Lübeck, GermanyDepartment of Anesthesiology and Intensive Care, University Hospitals Schleswig-Holstein, Lübeck, GermanyDepartment of Neurology, University Hospitals Schleswig-Holstein, Lübeck, GermanyDepartment of Neurology, University Hospitals Schleswig-Holstein, Lübeck, GermanyDepartment of Neurology, University Hospitals Schleswig-Holstein, Lübeck, GermanyDepartment of Neurology, University Hospitals Schleswig-Holstein, Lübeck, GermanyObjective: The head impulse test (HIT) assesses the vestibulo-ocular reflex (VOR) and is used to differentiate vestibular neuritis (abnormal VOR) from stroke (normal VOR) in patients presenting with an acute vestibular syndrome (AVS). The video-oculography-based HIT (vHIT) quantifies VOR function and provides information imperceptible for the clinician during clinical bedside HIT. However, the vHIT—like an electrocardiogram—requires experienced interpretation, which is especially difficult in the emergency setting. This calls for a simple, reliable and rater-independent way of analysis.Methods: We retrospectively collected 171 vHITs performed in patients presenting with AVS to our emergency department. Three neuro-otological experts comprehensively assessed the vHITs including interpretability (artifacts), VOR gain (eye/head velocity ratio), velocity profile (abrupt decline) and corrective saccades (overt/covert). Their consensus rating (abnormal/peripheral vs. normal/central) was compared to a simple algorithm that automatically classified the vHITs based on a single VOR gain cutoff (0.7).Results: Inter-rater agreement between experts was high (Fleiss' kappa = 0.74). Five (2.9 %) vHITs were “uninterpretable” according to experts' consensus, 80 (46.8 %) were rated “normal” and 86 (50.3 %) “abnormal”. The algorithm had substantial agreement with the experts' consensus (Cohen's kappa = 0.75). Importantly, it correctly classified all of the normal/central vHITs denoted by the experts (100% specificity) and at the same time it had sufficient sensitivity (75.6%) in detecting abnormal/peripheral vHITs.Conclusion: A simple, automated, gain-based evaluation of the vHIT reliably detects normal/central VOR and may be a feasible and effective tool to screen AVS patients for potentially underlying stroke in the emergency setting.https://www.frontiersin.org/articles/10.3389/fneur.2021.741859/fullstrokedizzinessvertigoemergency department (ED)video-HIT |
| spellingShingle | Björn Machner Kira Erber Jin Hee Choi Andreas Sprenger Christoph Helmchen Peter Trillenberg A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome Frontiers in Neurology stroke dizziness vertigo emergency department (ED) video-HIT |
| title | A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome |
| title_full | A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome |
| title_fullStr | A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome |
| title_full_unstemmed | A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome |
| title_short | A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome |
| title_sort | simple gain based evaluation of the video head impulse test reliably detects normal vestibulo ocular reflex indicative of stroke in patients with acute vestibular syndrome |
| topic | stroke dizziness vertigo emergency department (ED) video-HIT |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.741859/full |
| work_keys_str_mv | AT bjornmachner asimplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT kiraerber asimplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT jinheechoi asimplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT andreassprenger asimplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT christophhelmchen asimplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT petertrillenberg asimplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT bjornmachner simplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT kiraerber simplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT jinheechoi simplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT andreassprenger simplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT christophhelmchen simplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome AT petertrillenberg simplegainbasedevaluationofthevideoheadimpulsetestreliablydetectsnormalvestibuloocularreflexindicativeofstrokeinpatientswithacutevestibularsyndrome |