2252 Use of video head impulse testing to improve diagnosis of posterior circulation stroke in the emergency department – a prospective observational study

• Published in: BMJ neurology open Vol. 4; no. Suppl 1; p. A1
• Main Authors: Thomas, James, Sharobeam, Angelos, Venkat, Abhay, Blair, Christopher, Ozalp, Nese, Calic, Zeljka, Wyllie, Peter, Middleton, Paul M, Welgampola, Miriam, Cordato, Dennis, Cappelen-Smith, Cecilia
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.08.2022; BMJ Publishing Group LTD
• Subjects: Abstracts; Emergency medical care; Migraine; Stroke
• ISSN: 2632-6140
• DOI: 10.1136/bmjno-2022-ANZAN.1

OutcomesVertigo is a common presentation to the Emergency Department (ED) with 5% of presentations due to posterior circulation stroke (PCS). Bedside investigations such as the head impulse test are used to risk stratify patients, but interpretation is operator dependent. The video head impulse test (vHIT) provides objective measurement of the vestibular-ocular-reflex (VOR) and may improve diagnostic accuracy in acute vestibular syndrome (AVS). Our aim was to evaluate the use of vHIT as an adjunct to clinical assessment to improve diagnosis of PCS.Methods133 patients with AVS were consecutively enrolled from the ED of our comprehensive stroke centre between 2018 and 2021. Patient assessment included a targeted vestibular history, HINTs examination (Head Impulse, Nystagmus and Test of Skew), vHIT and MRI >48hrs after symptom onset. The HINTS/vHIT findings were analysed and compared between vestibular neuritis (VN), PCS and other cause AVS. Clinical course, vHIT and MRI findings were used to determine diagnosis.ResultsFinal diagnosis was VN in 40%, PCS 15%, migraine 16% and other cause AVS 29%. PCS patients were older than VN patients (mean age 68.5±10.6 vs 60.1±14.2 y, p=0.14) and had more cardiovascular risk factors (3 vs 2, p=0.002). Mean VOR gain was reduced (<0.8) in ipsilateral horizontal and (<0.7) anterior canals in VN but was normal in PCS, migraine, and other cause AVS. V-HIT combined with HINTs was 89% sensitive and 96% specific for a diagnosis of VN.ConclusionsV-HIT combined with HINTs is a reliable tool to exclude PCS in the ED.