Separating Posterior-circulation Stroke from Vestibular Neuritis with Quantitative Vestibular Testing

Separating Posterior-circulation Stroke from Vestibular Neuritis with Quantitative Vestibular Testing:



Publication date: Available online 8 June 2020

Source: Clinical Neurophysiology

Author(s): Zeljka Calic, Benjamin Nham, Andrew P. Bradshaw, Allison S. Young, Sonu Bhaskar, Mario D'Souza, Craig S. Anderson, Ceclilia Cappelen-Smith, Dennis Cordato, Miriam S. Welgampola







HINTS testing is a three-part examination that consists of head impulse testing, nystagmus assessment, and test of skew. This test is the gold standard for diagnosis of posterior circulation strokes, as its sensitivity is higher than any imaging modality in the first 24-48 hours after symptom onset.



Test of Skew

Have patient look at your nose with their eyes and then cover one eye.

Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.

Repeat with on each eye. Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome.