Videooculography "HINTS" in Acute Vestibular Syndrome: A Prospective Study

Area of Science:

• Neurology
• Ophthalmology
• Emergency Medicine

Background:

• Acute Vestibular Syndrome (AVS) diagnosis relies on differentiating peripheral from central causes.
• The bedside HINTS (Head Impulse-Nystagmus-Test of Skew) exam is a standard diagnostic tool.
• Videooculography (VOG) allows for objective quantification of eye movements.

Purpose of the Study:

• To compare the diagnostic accuracy of VOG-based HINTS (vHINTS) against expert clinical HINTS (cHINTS) in AVS patients.
• To evaluate vHINTS's performance in identifying central pathologies, specifically stroke.

Main Methods:

• Prospective study of AVS patients in an emergency department setting (July 2015 - April 2020).
• All patients underwent both clinical HINTS (cHINTS) and vHINTS assessments.
• Delayed MRI served as the gold standard for stroke confirmation.

Main Results:

• vHINTS demonstrated an overall accuracy of 94.2% for central pathology, with 100% sensitivity and 88.9% specificity.
• cHINTS, assessed by experts, had lower accuracy (88.3%), sensitivity (90.9%), and specificity (85.7%).
• vHINTS showed a 9% higher sensitivity in detecting strokes compared to expert evaluation.

Conclusions:

• vHINTS is a highly accurate tool for diagnosing stroke in AVS patients.
• The assessment of nystagmus direction remains a challenging component of the HINTS examination.
• vHINTS offers superior sensitivity for stroke detection in AVS compared to traditional clinical assessment.