11/7/2023 0 Comments Left pica strokeAll subjects completed the study protocol without complications. Normal subjects (n = 17, 14 men, aged 26–80, 50.5 ± 15.4 years) without vestibular or neurologic disorders consisted of ambulatory care staff or relatives of outpatients. ≤7 days from vertigo onset (PCS: 3.4 ± 2.0 days VN: 3.4 ± 2.3 days). Twenty VN (10 men aged 37–85, 59.2 ± 14.5 years) were diagnosed by normal DWI, a benign targeted examination (unidirectional nystagmus, positive clinical HIT, no skew deviation), and lack of neurologic deficits on follow-up (discharge and 6–8 weeks). Subtypes of AICA strokes were defined: (1) AICA p with peripheral characteristics, indicated by positive clinical HIT and (2) AICA c with central characteristics, indicated by negative clinical HIT. Thirty-three patients with PCS (26 men aged 24–80, 58.5 ± 15.8 years ) were identified by abnormal DWI in the territories of posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), or superior cerebellar artery (SCA). Patients underwent targeted neuro-otological examination (HIT, skew deviation, and direction-changing nystagmus) 6, – 8 and MRI examiners were not explicitly masked to imaging or other test results. Patients with anterior circulation (n = 3) and lateral medullary stroke (n = 7) were excluded. We prospectively recruited 63 nonconsecutive patients from inpatient neurology at a quaternary hospital between 20, based on symptoms of acute prolonged spontaneous vertigo (>24 hours) and gait imbalance consistent with AVS. In this study, we used the gold-standard search coil technique to record the HIT, analyzing aVOR gain and saccade characteristics in PCS subgroups as defined by vascular territories and lesional anatomy, and compared the findings with VN and normal subjects. We hypothesized that aVOR gain and compensatory saccade measures would differ between PCS subgroups and VN. 11 However, the quantitative aspect of the pivotal sign of clinical HIT, the presence or absence of a compensatory saccade, 12 remains to be investigated in AVS. A small video-oculographic (VOG) study has compared the angular vestibulo-ocular reflex (aVOR) gain, the ratio of eye velocity to head velocity, in a contemporaneous group of patients with AVS consisting of PCS and VN. 8, 9īecause clinical HIT is subjective, 10 quantitative assessment is desirable. 2, – 4 A negative clinical head impulse test (HIT), or absence of compensatory saccade, plus assessment for skew deviation and direction-changing nystagmus predict PCS in the context of AVS 5, – 8 better than the reference standard, diffusion-weighted imaging (DWI), which may be falsely negative. Acute vestibular syndrome (AVS), characterized by prolonged spontaneous vertigo, 1 is frequently due to vestibular neuritis (VN) but may be caused by pontine-cerebellar stroke (PCS).
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