Introduction: Acute vestibular syndrome (AVS - vertigo, nystagmus, head motion intolerance, ataxia, and nausea/vomiting) is a subset of patients presenting with vertigo. They are most often due to benign vestibular neuritis but can be a sign of a vertebrobasilar stroke. The HINTS (head impulse test, nystagmus, positive test of skew) exam has been proposed as an extremely accurate bedside test to rule out stroke in those presenting with AVS. Is the HINTS exam compared to MRI sufficiently sensitive to rule out vertebrobasliar stroke in an adult population presenting to the emergency department with AVS. Methods: We searched in Pubmed, Medline, Embase, the Cochrane database, and relevant conference abstracts from 1968 to December 2018 and performed hand searches. No restrictions for language or study type were imposed. Relevant studies were reviewed and data was extracted by two independent reviewers. Gold standard in ruling out stroke was; Negative late acute (72 hrs–10d) cranial MRI with DWI OR Negative early acute (0–72hrs) cranial MRI plus negative follow-up cranial MRI or clinical follow-up for TIA/stroke of ≥3 months. Included studies were prospective or retrospective with patients presenting with acute vestibular syndrome. Studies combined if low clinical and statstitical heterogeonity. Study quality was assessed using the QUADAS tool. Random effects meta analysis using Revman 5 and SAS9.3 was performed. Results: 6 studies with 715 participants were included( QUADAS 12/14 SD 1.2). Average study length 5.3 years ( STD 3.3 years) . Prevalence of vertebrobasilar stroke ranged 9.3-76% (Mean 39.1% SD 17.1). The most common diagnosis were vertebrobasilar stroke (Mean 34.8% SD 17.1%), peripheral cause (Mean 30.9% SD 16%). Intra cerebral haemorrhage (Mean 2.2%, SD 0.5%). Neurologist/neuro ophthalmologist performed the exam in 5/6 studies. 1 study reported a kappa between emergency medicine physician and neurologist of 0.24-0.41. The HINTS exam had a sensitivity of 96% (CI 95% 0.92-0.98, I2-0%), Specificity 91.4% (CI 95% 64.5-98.4% I2 94%). Positive likelihood ratio 11.9 ( CI 95% 2.9-48.8) and a negative likelihood ratio of 0.04 ( CI 95% 0.01– 0.14). Conclusion: The HINTS exam has excellent diagnostic accuracy for ruling out stroke when performed by a neurologist. The lack of ER proven diagnostic accuracy and high prevalence of serious diagnosis in those presenting with acute vestibular syndrome suggests care should be taken in ruling out central cause of dizziness in this population.

This study compared speed of information processing in patients with relapsing–remitting or secondary progressive multiple sclerosis (MS) and healthy controls using the Stroop Test and a Picture Naming Test (PNT). While both tests evaluated processing speed within a format calling for rapid serial processing of stimulus information, the PNT included trials designed to impose greater verbal–motor and ocular–motor challenges by using novel rather than repeated pictures and by presenting the pictures in distributed locations rather than always centered on the screen. The results confirmed that a decrease in the speed of information processing is a key feature of the cognitive impairment occurring in conjunction with MS. When this feature is evaluated with tests requiring rapid serial processing of stimulus information, the contribution of peripheral motor deficits appears to be modest. (JINS, 2008, 14, 646–650.)

Analysis of eye movements is essential for investigating vestibular disturbances. Video-oculography, although expensive, is a valuable and sensitive tool that allows accurate estimation of eye movements. We describe a simple and inexpensive method of recording as well as analysing eye movements using a commercially available miniature digital video surveillance camera and an MP4 digital media recorder.

Objective: To evaluate the prognostic factors in benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning procedures (CRPs).

Material and methods: Retrospective study of consecutive BPPV cases diagnosed over three years. All patients underwent a complete otolaryngologic, audiologic and neurotologic evaluation. The appropriate CRP was performed, depending on the type of BPPV. Prognostic factors studied included age, sex, aetiology, duration of disease, abnormal electronystagmographic findings, canal involvement, improper performance of manoeuvres, response on first or repeat treatment, and presence of recurrences.

Results: One hundred and fifty-five patients were studied, 66 men and 89 women, with mean ages of 58.7 and 60.4 years, respectively. Age and the involvement of two canals or bilateral disease had an effect on initial treatment outcome and were correlated to increased recurrences but not to repeat treatment outcome. Secondary BPPV, abnormal electronystagmographic findings and improper performance of manoeuvres had a significant effect both on initial and repeat treatment, but not on recurrences. Sex and duration of symptoms had no effect.

Conclusion: Canalith repositioning procedures provide fast and long-lasting treatment of BPPV in most patients. However, in a small subgroup of patients, failures may be noticed that may be attributed to various prognostic factors.