Acute evaluation of the acute vestibular syndrome - differentiating posterior circulation stroke from acute peripheral vestibulopathies.
Intern Med J. 2017 Jul 11;:
Authors: Tsang BK, Chen AS, Paine M
This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke presenting as an acute vestibular syndrome has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/ Nystagmus/Test-of-skew) examination battery, yields a higher sensitivity for diagnosis of posterior circulation stroke than even standard magnetic resonance imaging with diffusion weighted imaging. However, most studies have only validated the utility of the HINTS examination when performed by experts, who interpret the most powerful component of HINTS, namely the head impulse test (HIT), considerably different to the novice. Several investigations useful in the differentiation of the AVS are becoming more accessible and portable such as videooculography with Frenzel goggles and video head impulse testing (vHIT) which allows for quantitative assessment of the HIT. In clinical practice, vHIT has already become accepted as standard of care in the evaluation of AVS.
PMID: 28696571 [PubMed - as supplied by publisher]