FIRST TRIAGE OF A PATIENT WITH ACUTE VERTIGO USING A TELEMEDICALLY CONTROLLED VIDEO-HEAD IMPULSE TEST (VHIT) SYSTEM

• Main Author: Hubert, Gordian J
• Format: Web Resource
• Language: English
• Published: Morressier 01.01.2017
• DOI: 10.26226/morressier.5cb58cebc668520010b5601e

Introduction: Acute dizziness is a common symptom in emergency departments. Stroke has to be distinguished from vestibular diseases. Existing telestroke videoconference systems are not sensitive enough to detect subtle eye movements, neither able to examine head impulse test. Aim: To test feasibility of a triage system in emergency departments of primary care hospitals deploying a telemedical vHIT system.Methods:An existing vHIT was integrated into an adapted telemedicine videoconference system. An algorithm based on the HINTS rule (Head-Impulse-test, Nystagmus, Test of Skew) for patients with acute dizziness was developed. The first two steps identify internal medicine causes and focal neurological signs (examined via videoconference). For step three to five, vHIT system is used to test for eye movement disturbances (slow eye movements, skew deviation, nystagmus, head impulse test) and Dix-Hallpike-manoeuvre. Patients with acute unilateral vestibular hypofunction or positional vertigo are admitted to normal ward, all others to stroke unit. Results: Triage was successfully applied in a videoconference on a 30 years old man, suffering from acute vertigo with nausea and headache since the previous day. Tests showed no abnormal results, he was admitted to stroke unit with suspicion of central cause. Further examinations with MRI-Scan, duplexsonography of brain vessels and echocardiography showed normal results. Vertigo recovered within 48 hours. Due to accompanying headache vestibular migraine was presumed as possible diagnosis for the central vestibular syndrome. Conclusion: Telemedical examination of patients with dizziness using an integrated vHIT system within a defined triage algorithm is feasible and may overcome lack of neurootological expertise in rural areas.