Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke

Sang Hee Ha; Dong Kyu Lee; Gayoung Park; Bum Joon Kim; Jun Young Chang; Dong-Wha Kang; Sun U Kwon; Jong S Kim; Hong Ju Park; Eun-Jae Lee

doi:10.3389/fneur.2023.1256826

Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke

Front Neurol. 2023 Sep 22:14:1256826. doi: 10.3389/fneur.2023.1256826. eCollection 2023.

Authors

Sang Hee Ha^{1

2}, Dong Kyu Lee³, Gayoung Park¹, Bum Joon Kim¹, Jun Young Chang¹, Dong-Wha Kang¹, Sun U Kwon¹, Jong S Kim⁴, Hong Ju Park³, Eun-Jae Lee¹

Affiliations

¹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
² Department of Neurology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
³ Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁴ Department of Neurology, Gangneung Asan Hospital, University of Ulsan, Gangneung, Gangwon-do, Republic of Korea.

Abstract

Background: 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).

Methods: 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 (n = 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.

Results: 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 (n = 15) and without (n = 65). None exhibited pathologic overt corrective saccades. When comparing the PCS group with dizziness (n = 40) to the VN group (n = 29), patients with VN demonstrated significantly lower mean VOR gains in the ipsilesional horizontal canals (1.00 vs. 0.57, p < 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, p < 0.001), respectively.

Conclusion: 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.

Keywords: corrective saccades; dorsal brainstem stroke; posterior circulation stroke; vestibular neuritis; vestibulo-ocular reflex; video head impulse test.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Ministry of Health and Welfare, Republic of Korea (grant number: HR18C0016).