Videooculography "HINTS" in Acute Vestibular Syndrome: A Prospective Study

Athanasia Korda; Wilhelm Wimmer; Ewa Zamaro; Franca Wagner; Thomas C Sauter; Marco D Caversaccio; Georgios Mantokoudis

doi:10.3389/fneur.2022.920357

Videooculography "HINTS" in Acute Vestibular Syndrome: A Prospective Study

Front Neurol. 2022 Jul 12:13:920357. doi: 10.3389/fneur.2022.920357. eCollection 2022.

Authors

Athanasia Korda¹, Wilhelm Wimmer^{1

2}, Ewa Zamaro¹, Franca Wagner³, Thomas C Sauter⁴, Marco D Caversaccio¹, Georgios Mantokoudis¹

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
² Hearing Research Laboratory, ARTORG Center, University of Bern, Bern, Switzerland.
³ University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
⁴ Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.

Abstract

Objective: A three-step bedside test ("HINTS": Head Impulse-Nystagmus-Test of Skew), is a well-established way to differentiate peripheral from central causes in patients with acute vestibular syndrome (AVS). Nowadays, the use of videooculography gives physicians the possibility to quantify all eye movements. The goal of this study is to compare the accuracy of VOG "HINTS" (vHINTS) to an expert evaluation.

Methods: We performed a prospective study from July 2015 to April 2020 on all patients presenting at the emergency department with signs of AVS. All the patients underwent clinical HINTS (cHINTS) and vHINTS followed by delayed MRI, which served as a gold standard for stroke confirmation.

Results: We assessed 46 patients with AVS, 35 patients with acute unilateral vestibulopathy, and 11 patients with stroke. The overall accuracy of vHINTS in detecting a central pathology was 94.2% with 100% sensitivity and 88.9% specificity. Experts, however, assessed cHINTS with a lower accuracy of 88.3%, 90.9% sensitivity, and 85.7% specificity. The agreement between clinical and video head impulse tests was good, whereas for nystagmus direction was fair.

Conclusions: vHINTS proved to be very accurate in detecting strokes in patients AVS, with 9% points better sensitivity than the expert. The evaluation of nystagmus direction was the most difficult part of HINTS.

Keywords: HINTS; acute unilateral vestibulopathy; stroke; vertigo; videooculography.