Abstract Details

Title Quantitative Video-Oculography for Diagnosing Stroke at the Bedside in Acute Vertigo: An "ECG" for the Eyes

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) IN4 - (-)

Poster/Presentation
Number 006

Objective

Background An estimated 250-500,000 patients present to US emergency departments annually with new, severe, persistent vertigo or dizziness. Roughly 70% have vestibular neuritis, but about 25% have posterior fossa strokes. Strokes can be distinguished from benign peripheral causes of AVS using three rapid bedside oculomotor tests (HINTS). The H.I.N.T.S. approach is more sensitive and less costly than MRI for acute stroke diagnosis in AVS, but requires expertise not routinely available.

Design/Methods Prospective diagnostic accuracy study (08/2011-06/2012). Adult emergency department patients with AVS defined as new, persistent dizziness/vertigo, nystagmus, plus one or more of the following: (1) nausea/vomiting, (2) head motion intolerance, (3) new gait unsteadiness. We measured H.I.N.T.S. results including quantitative horizontal head impulse testing of vestibulo-ocular reflex function. Two masked vestibular experts rated oculomotor findings, which were compared to final diagnoses. Final diagnoses were considered "gold-standard" if masked neuroimaging raters agreed MRI brain with diffusion-weighted imaging (MRI-DWI) showed an acute stroke at any time or was negative >48 hours but <7 days after symptom-onset.

Results We identified 22 consecutive AVS patients and included 20. Mean age was 60 years (range 30-76) and 15 were men. All underwent MRI-DWI, 12 in the optimal time window. Expert-rated video-oculography-based H.I.N.T.S. exam was 100% accurate (10 strokes, 10 peripheral vestibular) relative to gold-standard neuroimaging diagnoses (n=12) or final expert clinical diagnoses (n=8).

Conclusions Device-based physiologic diagnosis of vertebrobasilar stroke in AVS is possible. This bedside "eye ECG" approach could fulfill a critical need for timely, accurate, efficient diagnosis in emergency department patients with dizziness and vertigo.

Authors/Disclosures
Ali Saber Tehrani, MD (Johns Hopkins University School of Medicine) PRESENTER	Dr. Saber Tehrani has nothing to disclose.
	No disclosure on file
John Pula, MD, FAAN (NorthShore University HealthSystem)	Dr. Pula has nothing to disclose.
Christopher C. LaGanke, MD (North Central Neurology Associates, PC)	Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for GSK. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Serono EMD. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. LaGanke has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. LaGanke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG Therapeutics.
Cynthia I. Guede, NP (OSF HealthCare Illinois Neurological Institute)	No disclosure on file
Kevin A. Kerber, MD (Ohio State University Department of Neurology)	Dr. Kerber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Academy of Neurology. The institution of Dr. Kerber has received research support from National Institutes of Health. The institution of Dr. Kerber has received research support from Genentech, Inc . Dr. Kerber has received publishing royalties from a publication relating to health care.
Ari Blitz, MD (Johns Hopkins)	No disclosure on file
Sarah H. Ying, MD (MEEI)	Dr. Ying has nothing to disclose.
	No disclosure on file
	No disclosure on file
Daniel F. Hanley, MD, FAAN (Johns Hopkins Medicine, Acute Care Neurology)	Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.
David S. Zee, MD (Johns Hopkins Hospital)	Dr. Zee has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for florida legal. Dr. Zee has received publishing royalties from a publication relating to health care. Dr. Zee has received personal compensation in the range of $500-$4,999 for serving as a lectuer with u of pittsburg physical therapy. Dr. Zee has received personal compensation in the range of $500-$4,999 for serving as a lecturer with johms hopkins CME.
Jorge C. Kattah, MD, FAAN (University of Illinois College of Medicine at Peoria)	Dr. Kattah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Bonezzi, Switzer , Poilitto and Hupp Legal Firm.
David E. Newman-Toker, MD, PhD, FAAN (Johns Hopkins Unversity School of Medicine, Dept of Neurology)	The institution of Dr. Newman-Toker has received research support from NIH, AHRQ, AHA, Moore Foundation. Dr. Newman-Toker has received intellectual property interests from a discovery or technology relating to health care.