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Head Impulse AND nystagmus AND test Of Skew

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https://www.readbyqxmd.com/read/29508131/acute-vestibular-syndrome-clinical-head-impulse-test-versus-video-head-impulse-test
#1
Nese Celebisoy
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...
March 5, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29500503/-management-of-acute-vertigo-and-dizziness-patients-in-emergency-departments-in-germany
#2
J Löhler, D Eßer, B Wollenberg, L E Walther
BACKGROUND: Dizziness and vertigo are some of the most common reasons for seeking medical help. Acute dizziness and vertigo require interdisciplinary cooperation. New diagnostic methods (the video head impulse test) and modern algorithms (HINTS: head impulse test/nystagmus [direction changing]/test-of-skew) are increasingly used in case of the acute vestibular syndrome in emergency care. METHODS: In a survey on the management and participation of the ENT specialist area, the authors interviewed 168 German ENT clinics during the spring of 2017 using an online survey...
June 2018: HNO
https://www.readbyqxmd.com/read/29319559/hints-in-the-acute-vestibular-syndrome-pearls-and-pitfalls
#3
Nathan H Kung, Gregory P Van Stavern, Daniel R Gold
The acute vestibular syndrome (AVS) is characterized by the rapid onset of vertigo, nausea/vomiting, nystagmus, unsteady gait, and head motion intolerance lasting more than 24 hours. We present 4 patients with AVS to illustrate the pearls and pitfalls of the Head Impulse, Nystagmus, Test of Skew (HINTS) examination.
June 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
https://www.readbyqxmd.com/read/29282699/dizziness-in-the-emergency-department-an-update-on-diagnosis
#4
Rainer Spiegel, Mark Kirsch, Christiane Rosin, Heiko Rust, Thomas Baumann, Raoul Sutter, Hergen Friedrich, Martina Göldlin, René Müri, Roger Kalla, Roland Bingisser, Georgios Mantokoudis
This review aims to assist emergency physicians in finding the underlying aetiology when a patient presents with dizziness to the emergency department. After reading this review, the emergency physician will be able to consider the most relevant differential diagnoses and have an idea about dangerous aetiologies that require immediate action. The emergency physician will also know what diagnostic steps need to be taken at what time, such as the three-component HINTS Test (Head Impulse, Nystagmus, and Test-of-Skew), which helps with distinguishing central from peripheral causes of the acute vestibular syndrome...
December 28, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29234822/-acute-vestibular-syndrome-clinical-examination-outperforms-mri-in-the-detection-of-central-lesions
#5
REVIEW
F Thömke
A significant number of patients who seek medical treatment in an emergency department because of vertigo or dizziness, suffer from acute vestibular syndrome. This is characterized by sustained vertigo, horizontal or horizontal rotatory jerk nystagmus, and unsteady stance and gait. In the acute situation it is crucial to differentiate patients with a peripheral vestibular disorder from those with a central disease. A number of recent studies have shown that a structured clinical examination enables a reliable differential diagnosis of central or peripheral disorders...
December 12, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/29084063/central-vertigo
#6
REVIEW
Jeong-Yoon Choi, Seung-Han Lee, Ji-Soo Kim
PURPOSE OF REVIEW: This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. RECENT FINDINGS: Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/28767521/disabling-central-paroxysmal-positioning-upbeat-nystagmus-and-vertigo-associated-with-the-presence-of-anti-glutamic-acid-decarboxylase-antibodies
#7
Ana I Martins, João N Carvalho, Ana M Amorim, Argemiro Geraldo, Eric Eggenberger, João Lemos
An immune attack by anti-glutamic acid decarboxylase (GAD) antibodies is believed to cause a deficiency in gamma-aminobutyric acid-mediated neurotransmission in the cerebellum. This, in turn, leads to several eye movement disorders, including spontaneous downbeat (DBN) and periodic alternating nystagmus. We describe a 68-year-old diabetic woman with disabling paroxysmal positioning upbeat nystagmus (UBN) exclusively in the supine position, associated with asymptomatic spontaneous DBN, alternating skew deviation and hyperactive vestibulo-ocular reflex responses on head impulse testing, in whom high titers of anti-GAD antibodies were detected...
March 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
https://www.readbyqxmd.com/read/28696571/acute-evaluation-of-the-acute-vestibular-syndrome-differentiating-posterior-circulation-stroke-from-acute-peripheral-vestibulopathies
#8
REVIEW
Benjamin K T Tsang, Alex S K Chen, Mark Paine
This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke (PCS) presenting as an AVS has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/Nystagmus/Test-of-skew) examination battery, yields a higher sensitivity for the diagnosis of PCS than even standard magnetic resonance imaging with diffusion-weighted imaging...
December 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28484820/-vertigo-and-dizziness-in-the-emergency-room
#9
REVIEW
A Zwergal, K Möhwald, M Dieterich
Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests)...
June 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28429801/the-dizzy-patient-don-t-forget-disorders-of-the-central-vestibular-system
#10
REVIEW
Thomas Brandt, Marianne Dieterich
Vertigo and dizziness are among the most common complaints in neurology clinics, and they account for about 13% of the patients entering emergency units. In this Review, we focus on central vestibular disorders, which are mostly attributable to acute unilateral lesions of the bilateral vestibular circuitry in the brain. In a tertiary interdisciplinary outpatient dizziness unit, central vestibular disorders, including vestibular migraine, comprise about 25% of the established diagnoses. The signs and symptoms of these disorders can mimic those of peripheral vestibular disorders with sustained rotational vertigo...
June 2017: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/28145669/dizziness-approach-to-evaluation-and-management
#11
Herbert L Muncie, Susan M Sirmans, Ernest James
Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient's history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss suggests Meniere disease...
February 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28100765/acute-transient-vestibular-syndrome-prevalence-of-stroke-and-efficacy-of-bedside-evaluation
#12
Jae-Hwan Choi, Min-Gyu Park, Seo Young Choi, Kyung-Pil Park, Seung Kug Baik, Ji-Soo Kim, Kwang-Dong Choi
BACKGROUND AND PURPOSE: The aim of this study was to determine the prevalence of stroke and efficacy of bedside evaluation in diagnosing stroke in acute transient vestibular syndrome (ATVS). METHODS: We performed a prospective, single-center, observational study that had consecutively recruited 86 patients presenting with ATVS to the emergency department of Pusan National University Yangsan Hospital from January to December 2014. All patients received a constructed evaluation, including HINTS plus (head impulse, nystagmus patterns, test of skew, and finger rubbing) and brain magnetic resonance imagings...
March 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27855460/-diagnosis-and-current-therapy-of-vestibular-syndromes
#13
REVIEW
Michael Strupp, Thomas Brandt
Vertigo and dizziness are with an annual incidence of more than 10% and a lifetime prevalence of more than 30% among the most frequent symptoms. The keys to the diagnosis are the patient history and the bedside examination: a) for the patient history the time course, type and triggers of symptoms and accompanying symptoms, b) for the clinical examination of the vestibular system the head-impulse test (HIT), the examination for a spontaneous nystagmus, a displacement of subjective visual vertical, a positional nystagmus and the Romberg test, and c) for the differentiation between an acute peripheral and central vestibular lesion the skew deviation, central fixation nystagmus, gaze-evoked nystagmus, saccadic smooth pursuit and a normal HIT...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27551274/the-diagnostic-accuracy-of-truncal-ataxia-and-hints-as-cardinal-signs-for-acute-vestibular-syndrome
#14
Sergio Carmona, Carlos Martínez, Guillermo Zalazar, Marcela Moro, Angel Batuecas-Caletrio, Leonel Luis, Carlos Gordon
The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI)...
2016: Frontiers in Neurology
https://www.readbyqxmd.com/read/27545414/vestibular-neuritis-involvement-and-long-term-recovery-of-individual-semicircular-canals
#15
Bela Büki, Manuela Hanschek, Heinz Jünger
OBJECTIVE: In this retrospective study, the aim of the authors was to examine the frequency of involvement of the individual semicircular canals (SCCs) in vestibular neuritis (VN) and to assess the degree of long-term recovery. A secondary aim was to retrospectively determine the usefulness of a three-step bedside oculomotor test (the HINTS-test) for the differential diagnosis of peripheral VN. METHODS: 44 cases were evaluated during the acute phase and approximately two months later...
June 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/26511453/stroke-risk-stratification-in-acute-dizziness-presentations-a-prospective-imaging-based-study
#16
Kevin A Kerber, William J Meurer, Devin L Brown, James F Burke, Timothy P Hofer, Alexander Tsodikov, Ellen G Hoeffner, A M Fendrick, Eric E Adelman, Lewis B Morgenstern
OBJECTIVE: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations. METHODS: Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset...
November 24, 2015: Neurology
https://www.readbyqxmd.com/read/26463694/dorsal-medullary-infarction-distinct-syndrome-of-isolated-central-vestibulopathy
#17
Sun-Uk Lee, Seong-Ho Park, Jeong-Jin Park, Hyo Jung Kim, Moon-Ku Han, Hee-Joon Bae, Ji-Soo Kim
BACKGROUND AND PURPOSE: The characteristics of infarctions restricted to the dorsal medulla have received little attention. This study aimed to define the distinct clinical features of dorsal medullary infarction. METHODS: Of the 172 patients with a diagnosis of medullary infarction at Seoul National University Bundang Hospital from 2003 to 2014, 18 patients with isolated dorsal medullary infarction were subjected to analyses of clinical and laboratory findings...
November 2015: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/26444396/diagnosing-stroke-in-acute-vertigo-the-hints-family-of-eye-movement-tests-and-the-future-of-the-eye-ecg
#18
REVIEW
David E Newman-Toker, Ian S Curthoys, G Michael Halmagyi
Patients who present to the emergency department with symptoms of acute vertigo or dizziness are frequently misdiagnosed. Missed opportunities to promptly treat dangerous strokes can result in poor clinical outcomes. Inappropriate testing and incorrect treatments for those with benign peripheral vestibular disorders leads to patient harm and unnecessary costs. Over the past decade, novel bedside approaches to diagnose patients with the acute vestibular syndrome have been developed and refined. A battery of three bedside tests of ocular motor physiology known as "HINTS" (head impulse, nystagmus, test of skew) has been shown to identify acute strokes more accurately than even magnetic resonance imaging with diffusion-weighted imaging (MRI-DWI) when applied in the early acute period by eye-movement specialists...
October 2015: Seminars in Neurology
https://www.readbyqxmd.com/read/26167320/a-puzzle-of-vestibular-physiology-in-a-meniere-s-disease-acute-attack
#19
Marta Martinez-Lopez, Raquel Manrique-Huarte, Nicolas Perez-Fernandez
The aim of this paper is to present for the first time the functional evaluation of each of the vestibular receptors in the six semicircular canals in a patient diagnosed with Meniere's disease during an acute attack. A 54-year-old lady was diagnosed with left Meniere's disease who during her regular clinic review suffers an acute attack of vertigo, with fullness and an increase of tinnitus in her left ear. Spontaneous nystagmus and the results in the video head-impulse test (vHIT) are shown before, during, and after the attack...
2015: Case Reports in Otolaryngology
https://www.readbyqxmd.com/read/25888195/an-unusual-stroke-like-clinical-presentation-of-creutzfeldt-jakob-disease-acute-vestibular-syndrome
#20
Georgios Mantokoudis, Ali S Saber Tehrani, David E Newman-Toker
INTRODUCTION: Vertigo and dizziness are common neurological symptoms in general practice. Most patients have benign peripheral vestibular disorders, but some have dangerous central causes. Recent research has shown that bedside oculomotor examinations accurately discriminate central from peripheral lesions in those with new, acute, continuous vertigo/dizziness with nausea/vomiting, gait unsteadiness, and nystagmus, known as the acute vestibular syndrome. CASE REPORT: A 56-year-old man presented to the emergency department with acute vestibular syndrome for 1 week...
April 2015: Neurologist
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