caa a22 4500 445810122 CHVBK 20180317145209.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1007/s00415-010-5853-4 doi (NATIONALLICENCE)springer-10.1007/s00415-010-5853-4 Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit [Elektronische Daten] [L. Chen, W. Lee, B. Chambers, H. Dewey] Acute vestibular syndrome may be due to vestibular neuritis (VN) or posterior circulation strokes. Bedside ocular motor testing performed by experts is superior to early MRI in excluding strokes. We sought to demonstrate that differentiation of strokes from VN in our stroke unit is reliable. During a prospective study at a tertiary hospital over 1year, patients with AVS were evaluated in the emergency department (ED) and underwent admission with targeted examination: gait, gaze-holding, horizontal head impulse test (hHIT), testing for skew deviation (SD) and vertical smooth pursuit (vSP). Neuroimaging included CT, transcranial Doppler (TCD) and MRI with MR angiogram (MRA). VN was diagnosed with normal diffusion-weighted images (DWI) and absence of neurological deficits on follow-up. Acute strokes were confirmed with DWI. A total of 24 patients with AVS were enrolled and divided in two groups. In the pure vestibular group (n=20), all VN (n=10/10) had positive hHIT and unidirectional nystagmus, but 1patient had SD and abnormal vertical smooth pursuit (SP). In all the strokes (n=10/10), one of the following signs suggestive of central lesion was present: negative hHIT, central-type nystagmus, SD or abnormal vSP. Finding one of these was 100% sensitive and 90% specific for stroke. In the cochleovestibular group (n=4) all had normal DWI, but 3patients had central ocular motor signs (abnormal vertical SP and SD). Whilst the study is small, classification of AVS in our stroke unit is reliable. The sensitivity and specificity of bedside ocular motor testing are comparable to those previously reported by expert neuro-otologists. Acute cochleovestibular loss and normal DWI may signify a labyrinthine infarct but differentiating between different causes of inner ear dysfunction is not possible with bedside testing. Springer-Verlag, 2010 Acute vestibular syndrome nationallicence Vestibular neuritis nationallicence Brainstem stroke nationallicence Ocular motility, nystagmus, skew deviation, vertigo nationallicence Neurological examination nationallicence Chen L. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut Lee W. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut Chambers B. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut Dewey H. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut Journal of Neurology Springer-Verlag 258/5(2011-05-01), 855-861 0340-5354 258:5<855 2011 258 415 https://doi.org/10.1007/s00415-010-5853-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00415-010-5853-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Chen L. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut NATIONALLICENCE 700 1- Lee W. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut NATIONALLICENCE 700 1- Chambers B. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut NATIONALLICENCE 700 1- Dewey H. Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Melbourne, VIC, Australia aut NATIONALLICENCE 773 0- Journal of Neurology Springer-Verlag 258/5(2011-05-01), 855-861 0340-5354 258:5<855 2011 258 415 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer