Department of Neurology, Ege University Medical School, 35100, Bornova, Izmir, Turkey.
J Neurol. 2018 Oct;265(Suppl 1):44-47. doi: 10.1007/s00415-018-8804-0. Epub 2018 Mar 5.
HINTS battery involving head impulse test (HIT), nystagmus, and test of skew is the critical bedside examination to differentiate acute unilateral peripheral vestibulopathy from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). The highest sensitivity component of the battery has been reported to be the horizontal HIT, whereas skew deviation is defined as the most specific but non-sensitive sign for PCS. Video-oculography-based HIT (vHIT) may have an additional power in making the differentiation. If vHIT is undertaken, then both gain and gain asymmetry should be taken into account as anterior inferior cerebellar artery (AICA) strokes are at risk of being misclassified based on VOR gain alone. Further refinement in video technology, increased operator proficiency and incorporation with saccade analysis will increase the sensitivity of vHIT for PCS diagnosis. For the time being, clinical examination seems adequate in frontline diagnostic evaluation of AVS.
HINTS 电池包括头部脉冲测试 (HIT)、眼球震颤和斜视测试，是急性前庭综合征 (AVS) 中区分急性单侧周围前庭病变和后循环卒中 (PCS) 的关键床边检查。据报道，该电池的最高灵敏度组件是水平 HIT，而斜视偏差被定义为 PCS 最特异但非敏感的征象。基于视频眼动图的 HIT (vHIT) 可能在进行区分方面具有额外的优势。如果进行 vHIT，则应考虑增益和增益不对称性，因为根据单纯的 VOR 增益，小脑前下动脉 (AICA) 卒中存在被误诊的风险。视频技术的进一步改进、操作人员技能的提高以及与扫视分析的结合将提高 vHIT 对 PCS 诊断的敏感性。目前，在 AVS 的一线诊断评估中，临床检查似乎足够了。
