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A presentation at the 134th annual meeting of the American Neurological Association says that systematic bedside exam more sensitive than neuroimaging for posterior fossa strokes

If you need to figure out which of your patients who presents with acute vestibular syndrome (AVS) has actually had a brainstem or cerebellar stroke, you might be better off with a systematic bedside examination than with neuroimaging and other methods, according to a presentation at the 134th annual meeting of the American Neurological Association.

"When patients come in sick, dizzy and puking, with gait unsteadiness and head motion intolerance, most have AVS, but it's estimated that 10-25% have strokes," presenter Dr. David E. Newman-Toker told Reuters Health.

To improve the approach to AVS, Dr. Newman-Toker, at Johns Hopkins University School of Medicine in Baltimore, and Dr. Jorge C. Kattah at the University of Illinois College of Medicine at Peoria came up with a bedside oculomotor examination they dubbed "HINTS" because it consists of a normal horizontal head impulse test of vestibulo-ocular reflex function; direction-changing, gaze-evoked horizontal nystagmus; and skew deviation (ocular misalignment).

Their prospective study included 101 patients with risk factors for stroke and symptoms of acute vestibular syndrome. The final diagnoses were acute vestibular syndrome in 25, and central pathology in the remaining 76, including 69 ischemic strokes, 4 hemorrhagic strokes, and 3 "other."

HINTS was compared with initial diffusion-weighted MRI and an assessment of general neurological signs. HINTS was 100% sensitive and 96% specific in identifying patients with brainstem or cerebellar strokes, followed by initial MRI at 88%. General neurologic signs performed worst, at 19% sensitivity.

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Source: ACR