| Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. | |
| | |
MedLine Citation:
|
PMID: 18541870 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To test the diagnostic accuracy of the horizontal head impulse test (h-HIT) of vestibulo-ocular reflex (VOR) function in distinguishing acute peripheral vestibulopathy (APV) from stroke. Most patients with acute vertigo, nausea/vomiting, and unsteady gait have benign APV (vestibular neuritis or labyrinthitis) as a cause. However, some harbor life-threatening brainstem or cerebellar strokes that mimic APV. A positive h-HIT (abnormal VOR) is said to predict APV. METHODS: Cross-sectional study at an urban, academic hospital over 6 years. Consecutive acute vestibular syndrome patients at high risk for stroke underwent structured examination (including h-HIT), neuroimaging, and admission. Stroke was confirmed by neuroimaging (MRI or CT). APV was diagnosed by normal MRI and appropriate clinical evolution in follow-up. RESULTS: Forty-three subjects enrolled. One had an equivocal h-HIT. Patients with APV had a positive h-HIT (n = 8/8, 100%). Most patients with stroke had a negative h-HIT (n = 31/34, 91%). However, contrary to conventional wisdom, three patients with stroke (9%) demonstrated a positive h-HIT (1 vestibulocerebellar, 1 pontocerebellar, 1 pontocerebello-labyrinthine stroke). CONCLUSIONS: Patients with lateral pontine and cerebellar strokes can have a positive horizontal head impulse test (h-HIT), so the sign's presence cannot be solely relied upon to identify a benign pathology. Additional clinical features (e.g., directionality of nystagmus, severity of truncal instability, nature of hearing loss) must be considered in patients with acute vestibular syndrome with a positive h-HIT before a central localization can be confidently excluded. Nonetheless, the h-HIT remains a useful bedside test-in acute vestibular syndrome patients, a negative h-HIT (i.e., normal VOR) strongly suggests a central lesion with a pseudo-labyrinthine presentation. |
| | |
Authors:
|
David E Newman-Toker; Jorge C Kattah; Jorge E Alvernia; David Z Wang |
Publication Detail:
|
Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
|
Title: Neurology Volume: 70 ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2008 Jun |
Date Detail:
|
Created Date: 2008-06-10 Completed Date: 2008-06-13 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
|
Languages: eng Pagination: 2378-85 Citation Subset: AIM; IM |
Affiliation:
|
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Cerebellar Diseases / complications, diagnosis* Cerebellum / blood supply Cross-Sectional Studies Diagnosis, Differential Female Humans Male Middle Aged Physical Examination Predictive Value of Tests Prospective Studies Reflex, Vestibulo-Ocular* Stroke / complications, diagnosis* Vestibular Neuronitis / complications, diagnosis* |
| Grant Support | |
ID/Acronym/Agency:
|
K23 RR17324-01/RR/NCRR NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Impact of vision loss on costs and outcomes in medicare beneficiaries with glaucoma.
Next Document: Anterior cerebral artery infarction: stroke mechanism and clinical-imaging study in 100 patients.