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In this issue of Neurology®, Kerber et al.1 describe 272 emergency department patients with acute, continuous dizziness and nystagmus or gait unsteadiness, 29 (11%) with strokes by MRI neuroimaging. Their population is similar to those described previously as the acute vestibular syndrome (AVS).2 The authors compare clinical features (ABCD2 [age, blood pressure, clinical features, duration, and diabetes] risk score, general neurologic examination, and head impulse, nystagmus pattern, test of skew [HINTS]2 eye movement tests) in stroke and nonstroke patients. They contend that no single examination “can identify a sufficiently low-risk group” to rule out stroke in AVS. They suggest instead a mathematical modeling approach combining all of these factors to identify a very low-risk population (86 [32%] without stroke).
Footnotes
Study funding: Dr. Newman-Toker's effort was supported partly by a grant from the NIH, National Institute on Deafness and Other Communication Disorders (1U01DC013778-01A1).
Disclosure: D.E. Newman-Toker has received research grants (NIH) and has been loaned research equipment (GN Otometrics, Interacoustics) related to diagnosis of dizziness using eye movement analysis. Go to Neurology.org for full disclosures.
- © 2015 American Academy of Neurology
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