Special Issue "The beside Evaluation of the Patient with Acute Vertigo: From Ocular to Vestibulo-Spinal Signs"

A special issue of Audiology Research (ISSN 2039-4349).

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 671

Special Issue Editors

1. Neurotology Department at INEBA, Institute of Neurosciences Buenos Aires, Buenos Aires, Argentina
2. Neurophysiology Department, National University of Rosario, Santa Fe, Argentina
Interests: stroke; hearing disorders; migraine; vertigo; acute vestibular syndrome; vestibulospinal
Prof. Dr. Jorge Kattah
E-Mail Website
Guest Editor
Department of Neurology, University of Illinois College of Medicine, Chicago, IL 60612-7332, USA
Interests: the acute vestibular syndrome; applications of HINTS plus; wernicke’s thiamine deficiency; eye movement and vestibular pathophysiology; neuroophthalmology

Special Issue Information

Dear Colleagues,

Bedside evaluation of the patient with Acute Vestibular Syndrome, from ocular to vestibulospinal signs. This is now a hot topic in Neurotology since there is new more evidence about the use of simpler, faster, and easy-to-evaluate signs in this context. In the last two years our group, together with many international colleagues (UK, Israel, Italy, Portugal, and Spain) has been publishing contributions in the topic and we believe is time for a comprehensive special issue. 

The scope of this volume is to provide information about the usefulness of the vestibulospinal pathway in patients with vertigo and imbalance. Exploring the vestibulospinal pathway is mandatory in any patient with vertigo and imbalance and in any neurological patient. Anatomical and physiological information is mandatory. Analyzing the historical evolution of the signs is important to provide a common terminology among colleagues. The estibulospinal pathway is easy to explore, in our experience the interpretation of the signs is simpler in comparison with the oculomotor system and the bias between different observers is less. In the context of Acute Vestibular Syndrome, the exploration of the gait and static vestibulospinal signs has proven to be very sensitive. This issue will a unique source of information on this topic in the present literature.

Dr. Sergio Carmona
Prof. Dr. Jorge Kattah
Guest Editors

Manuscript Submission Information

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  • vestibulospinal
  • acute truncal ataxia
  • truncal ataxia grade 1, 2 and 3
  • AICA stroke
  • PICA stroke
  • thalamic stroke

Published Papers (1 paper)

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Bedside Testing in Acute Vestibular Syndrome—Evaluating HINTS Plus and Beyond—A Critical Review
Audiol. Res. 2023, 13(5), 670-685; https://doi.org/10.3390/audiolres13050059 - 01 Sep 2023
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Acute vertigo and dizziness are frequent presenting symptoms in patients in the emergency department. These symptoms, which can be subtle and transient, present diagnostic challenges because they can be caused by a broad range of conditions that cut across many specialties and organ [...] Read more.
Acute vertigo and dizziness are frequent presenting symptoms in patients in the emergency department. These symptoms, which can be subtle and transient, present diagnostic challenges because they can be caused by a broad range of conditions that cut across many specialties and organ systems. Previous work has emphasized the value of combining structured history taking and a targeted examination focusing on subtle oculomotor signs. In this review, we discuss various diagnostic bedside algorithms proposed for the acutely dizzy patient. We analyzed these different approaches by calculating their area-under-the-curve (ROC) characteristics and sensitivity/specificity. We found that the algorithms that incorporated structured history taking and the use of subtle oculomotor signs had the highest diagnostic accuracy. In fact, both the HINTS+ bedside exam and the STANDING algorithm can more accurately diagnose acute strokes than early (<24 to 48 h after symptom onset) MRI with diffusion-weighted imaging (DWI). An important caveat is that HINTS and STANDING require moderate training to achieve this accuracy. Therefore, for physicians who have not undergone adequate training, other approaches are needed. These other approaches (e.g., ABCD2 score, PCI score, and TriAGe+ score) rely on vascular risk factors, clinical symptoms, and focal neurologic findings. While these other scores are easier for frontline providers to use, their diagnostic accuracy is far lower than HINTS+ or STANDING. Therefore, a focus on providing dedicated training in HINTS+ or STANDING techniques to frontline clinicians will be key to improving diagnostic accuracy and avoiding unnecessary brain imaging. Full article
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