Ha Sang Hee, Lee Dong Kyu, Park Gayoung, Kim Bum Joon, Chang Jun Young, Kang Dong-Wha, Kwon Sun U, Kim Jong S, Park Hong Ju, Lee Eun-Jae
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
Front Neurol. 2023 Sep 22;14:1256826. doi: 10.3389/fneur.2023.1256826. eCollection 2023.
Video head impulse tests (vHITs), assessing the vestibulo-ocular reflex (VOR), may be helpful in the differential diagnosis of acute dizziness. We aimed to investigate vHITs in patients with acute posterior circulation stroke (PCS) to examine whether these findings could exhibit significant abnormalities based on lesion locations, and to evaluate diagnostic value of vHIT in differentiating dizziness between PCS and vestibular neuritis (VN).
We prospectively recruited consecutive 80 patients with acute PCS and analyzed vHIT findings according to the presence of dorsal brainstem stroke (DBS). We also compared vHIT findings between PCS patients with dizziness and a previously studied VN group ( = 29). Receiver operating characteristic (ROC) analysis was performed to assess the performance of VOR gain and its asymmetry in distinguishing dizziness between PCS and VN.
Patients with PCS underwent vHIT within a median of 2 days from stroke onset. Mean horizontal VOR gain was 0.97, and there was no significant difference between PCS patients with DBS ( = 15) and without ( = 65). None exhibited pathologic overt corrective saccades. When comparing the PCS group with dizziness ( = 40) to the VN group ( = 29), patients with VN demonstrated significantly lower mean VOR gains in the ipsilesional horizontal canals (1.00 vs. 0.57, < 0.001). VOR gain and their asymmetry effectively differentiated dizziness in the PCS from VN groups, with an area under the ROC curve of 0.86 (95% CI 0.74-0.98) and 0.91 (95% CI 0.83-0.99, < 0.001), respectively.
Significantly abnormal vHIT results were rare in patients with acute PCS, even in the presence of DBS. Moreover, vHIT effectively differentiated dizziness between PCS and VN, highlighting its potential for aiding differential diagnosis of acute dizziness.
视频头脉冲试验（vHIT）用于评估前庭眼反射（VOR），可能有助于急性头晕的鉴别诊断。我们旨在研究急性后循环卒中（PCS）患者的vHIT，以检查这些结果是否会根据病变部位显示出显著异常，并评估vHIT在鉴别PCS和前庭神经炎（VN）引起的头晕方面的诊断价值。
我们前瞻性地连续招募了80例急性PCS患者，并根据是否存在脑桥背侧卒中（DBS）分析vHIT结果。我们还比较了有头晕症状的PCS患者与先前研究的VN组（n = 29）之间的vHIT结果。进行了受试者操作特征（ROC）分析，以评估VOR增益及其不对称性在区分PCS和VN引起的头晕方面的性能。
PCS患者在卒中发作后中位数2天内接受了vHIT。平均水平VOR增益为0.97，有DBS的PCS患者（n = 15）和无DBS的患者（n = 65）之间无显著差异。均未出现明显的病理性纠正性扫视。将有头晕症状的PCS组（n = 40）与VN组（n = 29）进行比较时，VN患者在同侧水平半规管的平均VOR增益显著较低（1.00对0.57，P < 0.001）。VOR增益及其不对称性有效地区分了PCS组和VN组的头晕，ROC曲线下面积分别为0.86（95%CI 0.74 - 0.98）和0.91（95%CI 0.83 - 0.99，P < 0.001）。
急性PCS患者中vHIT结果显著异常的情况很少见，即使存在DBS也是如此。此外，vHIT有效地鉴别了PCS和VN引起的头晕，突出了其在急性头晕鉴别诊断中的潜在作用。
