title: Acute Transient Vestibular Syndrome: Prevalence of Stroke and Efficacy of Bedside Evaluation.
abstract: OBJECTIVE
  The aim of this study was to determine the prevalence of stroke and efficacy of bedside evaluation in diagnosing stroke in acute transient vestibular syndrome (ATVS).
  
  
  METHODS
  We performed a prospective, single-center, observational study that had consecutively recruited 86 patients presenting with ATVS to the emergency department of Pusan National University Yangsan Hospital from January to December 2014. All patients received a constructed evaluation, including HINTS plus (head impulse, nystagmus patterns, test of skew, and finger rubbing) and brain magnetic resonance imagings. Patients without an obvious cause further received perfusion-weighted imaging. Multivariable logistic regression was used to determine clinical parameters to identify stroke in ATVS.
  
  
  RESULTS
  The prevalence of stroke was 27% in ATVS. HINTS plus could not be applied to the majority of patients because of the resolution of the vestibular symptoms, and magnetic resonance imagings were falsely negative in 43% of confirmed strokes. Ten patients (12%) showed unilateral cerebellar hypoperfusion on perfusion-weighted imaging without an infarction on diffusion-weighted imaging, and 8 of them had a focal stenosis or hypoplasia of the corresponding vertebral artery. The higher risk of stroke in ATVS was found in association with craniocervical pain (odds ratio, 9.6; 95% confidence interval, 2.0-45.2) and focal neurological symptoms/signs (odds ratio, 15.2; 95% confidence interval, 2.5-93.8).
  
  
  CONCLUSIONS
  Bedside examination and routine magnetic resonance imagings have a limitation in diagnosing strokes presenting with ATVS, and perfusion imaging may help to identify strokes in ATVS of unknown cause. Associated craniocervical pain and focal neurological symptoms/signs are the useful clues for strokes in ATVS.
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Choi
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
authors.forename: Min-Gyu
authors.initials: MG
authors.lastname: Park
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
authors.forename: Seo Young
authors.initials: SY
authors.lastname: Choi
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
authors.forename: Kyung-Pil
authors.initials: KP
authors.lastname: Park
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
authors.forename: Seung Kug
authors.initials: SK
authors.lastname: Baik
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
authors.forename: Ji-Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.). kdchoi@pusan.ac.kr.
authors.forename: Kwang-Dong
authors.initials: KD
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004244:Dizziness / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D015995:Prevalence; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D013577:Syndrome; D055815:Young Adult
keywords: dizziness; perfusion imaging; stroke; vertigo