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10.1161/STROKEAHA.109.551234 http://scihub22266oqcxt.onion/10.1161/STROKEAHA.109.551234 C4593511!4593511!19762709     free     free     free Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\19762709.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117       Stroke 2009 ; 40 (11): 3504-10 Nephropedia Template TP {{tp|p=19762709|t=2009. H I N T S to Diagnose Stroke in the Acute Vestibular Syndrome?Three-Step Bedside Oculomotor Exam More Sensitive than Early MRI DWI |pdf=|usr=}}{{19762709}} gab.com Text H I N T S to Diagnose Stroke in the Acute Vestibular Syndrome Three-Step Bedside Oculomotor Exam More Sensitive than Early MRI DWI JO: Stroke http://www.kidney.de/pget.php?&tw=1&pmid=19762709 #FOAvip Background and Purpose: Acute vestibular syndrome (AVS) is often due to vestibular neuritis but can result from vertebrobasilar strokes. Misdiagnosis of posterior fossa infarcts in emergency-care settings is frequent. Bedside oculomotor findings may reliably identify stroke in AVS, but prospective studies have been lacking. Methods: Prospective, cross-sectional study at an academic hospital. Consecutive AVS patients (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with ?1 stroke risk factor underwent structured examination including horizontal head impulse test (h-HIT) of vestibulo-ocular-reflex function, observation of nystagmus in different gaze positions, and prism cross-cover test of ocular alignment. All underwent neuroimaging and admission (generally <72 hours after symptom onset). Strokes were diagnosed by MRI or CT. Peripheral lesions were diagnosed by normal MRI and clinical follow-up. Results: 101 high-risk AVS patients included 25 peripheral and 76 central lesions (69 ischemic strokes, 4 hemorrhages, 3 other). The presence of either normal h-HIT, direction-changing nystagmus in eccentric gaze, or skew deviation (vertical ocular misalignment) was 100% sensitive and 96% specific for stroke. Skew was present in 17% and associated with brainstem lesions (4% peripheral, 4% pure cerebellar, 30% brainstem involvement, ?2 p=0.003). Skew correctly predicted lateral pontine stroke in 2 of 3 cases where an abnormal h-HIT erroneously suggested peripheral localization. Initial MRI DWI was falsely negative in 12% (all <48hrs after symptom onset). Conclusions: Skew predicts brainstem involvement in AVS and can identify stroke when an abnormal h-HIT falsely suggests a peripheral lesion. A three-step bedside oculomotor exam (H.I.N.T.S.: Head-Impulse?Nystagmus?Test-of-Skew) appears more sensitive for stroke than early MRI in AVS. Twit Text FOAVip H I N T S to Diagnose Stroke in the Acute Vestibular Syndrome Three-Step Bedside Oculomotor Exam More Sensitive than Early MRI DWI ????Stroke http://www.kidney.de/pget.php?&tw=1&pmid=19762709 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=19762709 #FOAvip English Wikipedia <ref>{{Cite pmid|19762709}}</ref> H I N T S to Diagnose Stroke in the Acute Vestibular Syndrome?Three-Step Bedside Oculomotor Exam More Sensitive than Early MRI DWI #MMPMID19762709 Newman-Toker DE; Kattah JC; Talkad AV; Wang DZ; Hsieh YH; Newman-Toker DE Stroke 2009[Nov]; 40 (11): 3504-10 PMID19762709show ga Background and Purpose: Acute vestibular syndrome (AVS) is often due to vestibular neuritis but can result from vertebrobasilar strokes. Misdiagnosis of posterior fossa infarcts in emergency-care settings is frequent. Bedside oculomotor findings may reliably identify stroke in AVS, but prospective studies have been lacking. Methods: Prospective, cross-sectional study at an academic hospital. Consecutive AVS patients (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with ?1 stroke risk factor underwent structured examination including horizontal head impulse test (h-HIT) of vestibulo-ocular-reflex function, observation of nystagmus in different gaze positions, and prism cross-cover test of ocular alignment. All underwent neuroimaging and admission (generally <72 hours after symptom onset). Strokes were diagnosed by MRI or CT. Peripheral lesions were diagnosed by normal MRI and clinical follow-up. Results: 101 high-risk AVS patients included 25 peripheral and 76 central lesions (69 ischemic strokes, 4 hemorrhages, 3 other). The presence of either normal h-HIT, direction-changing nystagmus in eccentric gaze, or skew deviation (vertical ocular misalignment) was 100% sensitive and 96% specific for stroke. Skew was present in 17% and associated with brainstem lesions (4% peripheral, 4% pure cerebellar, 30% brainstem involvement, ?2 p=0.003). Skew correctly predicted lateral pontine stroke in 2 of 3 cases where an abnormal h-HIT erroneously suggested peripheral localization. Initial MRI DWI was falsely negative in 12% (all <48hrs after symptom onset). Conclusions: Skew predicts brainstem involvement in AVS and can identify stroke when an abnormal h-HIT falsely suggests a peripheral lesion. A three-step bedside oculomotor exam (H.I.N.T.S.: Head-Impulse?Nystagmus?Test-of-Skew) appears more sensitive for stroke than early MRI in AVS. �H I N T S to Diagnose Stroke in the Acute Vestibular Syndrome?Three-S(epmc).pdf DeepDyve Pubget Overpricing