Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke

Frontiers in Neurology

Neurology

Eun-Jae Lee¹  Bum Joon Kim¹  Gayoung Park¹  Dong-Wha Kang¹  Jun Young Chang¹  Sun U. Kwon¹  Sang Hee Ha²  Jong S. Kim³  Dong Kyu Lee⁴  Hong Ju Park⁴ 

[1] Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;Department of Neurology, Gil Medical Center, Gachon University, Incheon, Republic of Korea;Department of Neurology, Gangneung Asan Hospital, University of Ulsan, Gangneung, Gangwon-do, Republic of Korea;Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;

关键词: corrective saccades;    dorsal brainstem stroke;    posterior circulation stroke;    vestibular neuritis;    vestibulo-ocular reflex;    video head impulse test;   

DOI  :  10.3389/fneur.2023.1256826

 received in 2023-07-12, accepted in 2023-09-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

Unknown   
Copyright © 2023 Ha, Lee, Park, Kim, Chang, Kang, Kwon, Kim, Park and Lee.