Quantitative Video-Oculography for Diagnosing Stroke at the Bedside in Acute Vertigo: An "ECG" for the Eyes

An estimated 250-500,000 patients present to US emergency departments annually with new, severe, persistent vertigo or dizziness. Roughly 70% have vestibular neuritis, but about 25% have posterior fossa strokes. Strokes can be distinguished from benign peripheral casuses of AVS using three rapid bedside oculomotor tests (HINTS - Head Impulse test, Nystagmus, Test of Skew) The H.I.N.T.S. approach is more sensitive and less costly than MRI for acute stroke diagnosis in AVS, but requires expertise not routinely available. We sought to standardize the H.I.N.T.S. approach to stroke diagnosis in acute vestibular syndrome using a portable video-oculography device measuring oculomotor physiology in real time, conceptually similar to using electrocardiography (ECG) to diagnose myocardial infarction in chest pain.