Krishnan Kailash, Bassilious Kerolos, Eriksen Erik, Bath Philip M, Sprigg Nikola, Brækken Sigrun Kierulf, Ihle-Hansen Hege, Horn Morten Andreas, Sandset Else Charlotte
Stroke, Acute Medicine, Nottingham University Hospitals, Nottingham, UK.
Department of Neurology, Oslo University Hospital, Oslo, Norway.
Eur Stroke J. 2019 Sep;4(3):233-239. doi: 10.1177/2396987319843701. Epub 2019 Apr 10.
Acute vestibular syndrome - vertigo, nausea/vomiting, nystagmus and gait unsteadiness - is common, and differentiating posterior circulation stroke from a peripheral cause can be challenging. The National Institute of Health Stroke Scale (NIHSS) does not include acute vestibular syndrome, and early computed tomography scanning cannot rule out acute ischaemia. A positive Head Impulse-Nystagmus-Test of Skew (HINTS) test suggests posterior circulation stroke in acute vestibular syndrome when any of three signs are present: normal horizontal head impulse, gaze-direction nystagmus or eye skew deviation. This systematic review examined the of positive HINTS in identifying posterior circulation stroke in acute vestibular syndrome patients.
We searched MEDLINE (1966 to 21 December 2017), EMBASE (1980 to December 2017), Web of Science and scanned bibliographies. Two authors independently screened relevant articles and extracted data. We included studies where HINTS was used to identify posterior circulation stroke with diagnosis confirmed using magnetic resonance imaging.
Six studies (n = 644 patients) were identified. Acute stroke was confirmed in 200 (31.1%) patients. There was a 15-fold increased risk of posterior circulation stroke in patients with positive HINTS test compared to those with no abnormality (RR: 15.84, 95% CI: 5.25-47.79). For any stroke, the pooled sensitivity was 95.5% (95% CI: 92.6-98.4%) and specificity was 71.2% (95% CI: 67.0-75.4%).
The data suggest that the HINTS test as one element of clinical evaluation is useful to differentiate posterior circulation stroke from peripheral causes in acute vestibular syndrome. Further studies are needed to validate HINTS as a clinical prediction tool in emergency department settings and selection of patients for reperfusion treatment.
急性前庭综合征——眩晕、恶心/呕吐、眼球震颤和步态不稳——很常见，区分后循环卒中与外周病因具有挑战性。美国国立卫生研究院卒中量表（NIHSS）不包括急性前庭综合征，早期计算机断层扫描也无法排除急性缺血。当出现以下三个体征中的任何一个时，头部脉冲-眼球震颤-斜视试验（HINTS）阳性提示急性前庭综合征患者发生后循环卒中：正常水平头部脉冲、注视方向眼球震颤或眼斜偏。本系统评价研究了HINTS阳性在识别急性前庭综合征患者后循环卒中方面的作用。
我们检索了MEDLINE（1966年至2017年12月21日）、EMBASE（1980年至2017年12月）、科学网并浏览了参考文献。两位作者独立筛选相关文章并提取数据。我们纳入了使用HINTS识别后循环卒中且诊断经磁共振成像确认的研究。
共识别出6项研究（n = 644例患者）。200例（31.1%）患者确诊为急性卒中。与无异常的患者相比，HINTS试验阳性的患者发生后循环卒中的风险增加了15倍（RR：15.84，95%CI：5.25 - 47.79）。对于任何卒中，合并敏感性为95.5%（95%CI：92.6 - 98.4%），特异性为71.2%（95%CI：67.0 - 75.4%）。
数据表明，HINTS试验作为临床评估的一个要素，有助于在急性前庭综合征中区分后循环卒中和外周病因。需要进一步研究以验证HINTS作为急诊科临床预测工具以及选择再灌注治疗患者的有效性。
