Capturing nystagmus in the emergency room: posterior circulation stroke versus acute vestibular neuritis

• DOI: 10.1007/s00415-022-11202-y
• Publication Date: 2022-07-18T11:02:51Z
• Authors: B. Nham; G. Akdal; A. S. Young; P. Özçelik; T. Tanrıverdizade; R. T. Ala; A. P. Bradshaw; C. Wang; S. Men; B. F. Giarola; D. A. Black; E. O. Thompson; G. M. Halmagyi; M. S. Welgampola
• Keywords: Neuroradiology; Stroke; Optic neuritis; Electronystagmography; Acute stroke

To compare acute nystagmus characteristics of posterior circulation stroke (PCS) and vestibular neuritis (AVN) in the emergency room (ER) within 24 h presentation.ER-based video-nystagmography (VNG) was conducted, recording ictal 101 patients with PCS (on imaging) 104 AVN, diagnosed on accepted clinical test criteria.Patients brainstem (38/101, affecting midbrain (n = 7), pons 19), medulla 12)), cerebellum (31/101), both (15/101) or other locations (17/101) were recruited. Common territories included posterior-inferior-cerebellar-artery (41/101), pontine perforators (18/101), multiple-territories anterior-inferior-cerebellar-artery (7/101). In PCS, 44/101 had no spontaneous nystagmus. Remaining primary position horizontal (44/101), vertical (8/101) torsional (5/101) Horizontal 50% ipsiversive contraversive lateralised PCS. Most (28/44) unidirectional "peripheral-appearing" 32/101 gaze-evoked AVN affected superior, inferior divisions nerve 55/104, 4/104 45/104. (102/104) nystagmus; none Two VN torsional-downbeat SPV ≥ 5.8 °/s separated from sensitivity specificity 91.2% 83.0%. Absent nystagmus, vertical-torsional highly specific for (100%, 100% 98.1%).Nystagmus is often absent always present AVN. Unidirectional 'peripheral-appearing' can be seen ER-based VNG assessment could provide useful diagnostic information when separating