The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome
The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients...
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Published in | Frontiers in neurology Vol. 7; p. 125 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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08.08.2016
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Abstract | The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate. |
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AbstractList | The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate. The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests and negative MRI), and the rest with Stroke: 32 in the PICA territory (positive HINTS findings, positive MRI) and 10 in the AICA territory (variable findings and grade 3 Ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture.When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate. The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia ( n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient’s age. Grade 2–3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2–3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate. |
Author | Carmona, Sergio Moro, Marcela Zalazar, Guillermo Luis, Leonel Gordon, Carlos Martínez, Carlos Batuecas-Caletrio, Angel |
AuthorAffiliation | 2 Hospital José María Cullen , Santa Fe , Argentina 4 Translational Clinical Physiology Unit, Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon , Lisbon , Portugal 7 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel 1 Fundación San Lucas , Rosario , Argentina 5 Otolaryngology Unit, Department of Surgical Specialities and Anesthesiology, Hospital de Cascais , Lisbon , Portugal 6 Department of Neurology, Meir Medical Center , Kfar-Saba , Israel 3 Unidad de Otoneurología, Servicio de Otorrinolaringología y Patología Máxilofacial, Hospital Universitario de Salamanca , Salamanca , Spain |
AuthorAffiliation_xml | – name: 4 Translational Clinical Physiology Unit, Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon , Lisbon , Portugal – name: 6 Department of Neurology, Meir Medical Center , Kfar-Saba , Israel – name: 2 Hospital José María Cullen , Santa Fe , Argentina – name: 3 Unidad de Otoneurología, Servicio de Otorrinolaringología y Patología Máxilofacial, Hospital Universitario de Salamanca , Salamanca , Spain – name: 7 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel – name: 5 Otolaryngology Unit, Department of Surgical Specialities and Anesthesiology, Hospital de Cascais , Lisbon , Portugal – name: 1 Fundación San Lucas , Rosario , Argentina |
Author_xml | – sequence: 1 givenname: Sergio surname: Carmona fullname: Carmona, Sergio organization: Fundación San Lucas , Rosario , Argentina – sequence: 2 givenname: Carlos surname: Martínez fullname: Martínez, Carlos organization: Hospital José María Cullen , Santa Fe , Argentina – sequence: 3 givenname: Guillermo surname: Zalazar fullname: Zalazar, Guillermo organization: Hospital José María Cullen , Santa Fe , Argentina – sequence: 4 givenname: Marcela surname: Moro fullname: Moro, Marcela organization: Hospital José María Cullen , Santa Fe , Argentina – sequence: 5 givenname: Angel surname: Batuecas-Caletrio fullname: Batuecas-Caletrio, Angel organization: Unidad de Otoneurología, Servicio de Otorrinolaringología y Patología Máxilofacial, Hospital Universitario de Salamanca , Salamanca , Spain – sequence: 6 givenname: Leonel surname: Luis fullname: Luis, Leonel organization: Translational Clinical Physiology Unit, Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal; Otolaryngology Unit, Department of Surgical Specialities and Anesthesiology, Hospital de Cascais, Lisbon, Portugal – sequence: 7 givenname: Carlos surname: Gordon fullname: Gordon, Carlos organization: Department of Neurology, Meir Medical Center, Kfar-Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel |
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Copyright | Copyright © 2016 Carmona, Martínez, Zalazar, Moro, Batuecas-Caletrio, Luis and Gordon. 2016 Carmona, Martínez, Zalazar, Moro, Batuecas-Caletrio, Luis and Gordon |
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Keywords | AICA pica truncal ataxia hints AVS vestibular neuritis |
Language | English |
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StartPage | 125 |
SubjectTerms | AICA AVS hints Neuroscience Pica Truncal ataxia Vestibular Neuritis |
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Title | The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome |
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