title: The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome.
abstract: The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate.
authors.affiliation: Fundación San Lucas , Rosario , Argentina.
authors.forename: Sergio
authors.initials: S
authors.lastname: Carmona
authors.affiliation: Hospital José María Cullen , Santa Fe , Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Hospital José María Cullen , Santa Fe , Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Zalazar
authors.affiliation: Hospital José María Cullen , Santa Fe , Argentina.
authors.forename: Marcela
authors.initials: M
authors.lastname: Moro
authors.affiliation: Unidad de Otoneurología, Servicio de Otorrinolaringología y Patología Máxilofacial, Hospital Universitario de Salamanca , Salamanca , Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Batuecas-Caletrio
authors.affiliation: Translational Clinical Physiology Unit, Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal; Otolaryngology Unit, Department of Surgical Specialities and Anesthesiology, Hospital de Cascais, Lisbon, Portugal.
authors.forename: Leonel
authors.initials: L
authors.lastname: Luis
authors.affiliation: Department of Neurology, Meir Medical Center, Kfar-Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Carlos
authors.initials: C
authors.lastname: Gordon
keywords: AICA; AVS; hints; pica; truncal ataxia; vestibular neuritis