Central nystagmus plus ABCD² identifying stroke in acute dizziness presentations

The objective was to explore the ability of head impulse-nystagmus-test of skew (HINTS) combined with ABCD²  score to identify cerebrovascular causes of dizziness.

We prospectively recruited 85 patients with acute onset of dizziness from September 2016 to December 2018 and analyzed their clinical characteristics, ABCD²  scores, HINTS, and neuroimages data.

Acute stroke was identified by MRI in 21 of 85 patients. The mean ± SD ABCD²  scores were significantly higher among patients with acute stroke than those without acute stroke (4.0 ± 0.8 h vs. 2.5 ± 0.7 h, p < 0.01). The majority (71.4%) of patients with cerebrovascular causes had central pattern of nystagmus at the initial 48 h from symptoms onset. The sensitivity and specificity of HINTS were 100% and 87% for the presence of stroke in patients with nystagmus. When combined central pattern of nystagmus and ABCD²  ≥ 4, the sensitivity increased to 100% for identifying cerebrovascular causes. Nystagmus were absence at time of examination in 16.5% of our patients, and ABCD²  scores in patients who had cerebrovascular diagnoses were all ≥ 4.

HINTS examinations could efficiently differentiate stroke from nonstroke under the condition that patients remaining symptomatic, including spontaneous or gaze-evoked nystagmus. It is more practical to apply the combination of central pattern of nystagmus and ABCD²  ≥ 4 in ED setting. If patients were absence of central nystagmus at admission, cerebrovascular event should be a priority diagnosis when their ABCD²  ≥ 4.