@misc{MorrisonKerkeniKordaetal., author = {Morrison, Miranda and Kerkeni, Hassen and Korda, Athanasia and R{\"a}ss, Simone and Caversaccio, Marco Domenico and Abegg, Mathias and Schneider, Erich and Mantokoudis, Georgios}, title = {Automated alternate cover test for 'HINTS' assessment: a validation study}, series = {European archives of oto-rhino-laryngology and head \& neck}, journal = {European archives of oto-rhino-laryngology and head \& neck}, issn = {1434-4726}, doi = {10.1007/s00405-021-06998-w}, pages = {2873 -- 2879}, abstract = {Objective The alternate cover test (ACT) in patients with acute vestibular syndrome is part of the 'HINTS' battery test. Although quantitative, the ACT is highly dependent on the examiner's experience and could theoretically vary greatly between examiners. In this study, we sought to validate an automated video-oculography (VOG) system based on eye tracking and dedicated glasses. Methods We artificially induced a vertical strabismus to simulate a skew deviation on ten healthy subjects, aged from 26 to 66, using different press-on Fresnel prisms on one eye while recording eye position with VOG of the contralateral eye. We then compared the system's performance to that of a blinded trained orthoptist using conventional, semi-quantitative method of skew measurement known as the alternate prism cover test (APCT) as a gold standard. Results We found a significant correlation between the reference APCT and the Skew VOG (Pearson's R2 = 0.606, p < 0.05). There was a good agreement between the two tests (intraclass correlation coefficient 0.852, 95 CI 0.728-0.917, p < 0.001). The overall accuracy of the VOG was estimated at 80.53\% with an error rate of 19.46\%. There was no significant difference in VOG skew estimations compared with the gold standard except for very small skews. Conclusions VOG offers an objective and quantitative skew measurement and proved to be accurate in measuring vertical eye misalignment compared to the ACT with prisms. Precision was moderate, which mandates a sufficient number of tests per subject.}, language = {en} } @misc{KordaZamaroWagneretal., author = {Korda, Athanasia and Zamaro, Ewa and Wagner, Franca and Morrison, Miranda and Schneider, Erich and Caversaccio, Marco Domenico and Sauter, Thomas C. and Mantokoudis, Georgios}, title = {Acute vestibular syndrome: is skew deviation a central sign?}, series = {Journal of Neurology}, volume = {269}, journal = {Journal of Neurology}, number = {3}, issn = {1432-1459}, doi = {10.1007/s00415-021-10692-6}, pages = {1396 -- 1403}, abstract = {Objective Skew deviation results from a dysfunction of the graviceptive pathways in patients with an acute vestibular syndrome (AVS) leading to vertical diplopia due to vertical ocular misalignment. It is considered as a central sign, however, the prevalence of skew and the accuracy of its test is not well known . Methods We performed a prospective study from February 2015 until September 2020 of all patients presenting at our emergency department (ED) with signs of AVS. All patients underwent clinical HINTS and video test of skew (vTS) followed by a delayed MRI, which served as a gold standard for vestibular stroke confirmation. Results We assessed 58 healthy subjects, 53 acute unilateral vestibulopathy patients (AUVP) and 24 stroke patients. Skew deviation prevalence was 24\% in AUVP and 29\% in strokes. For a positive clinical test of skew, the cut-off of vertical misalignment was 3 deg with a very low sensitivity of 15\% and specificity of 98.2\%. The sensitivity of vTS was 29.2\% with a specificity of 75.5\%. Conclusions Contrary to prior knowledge, skew deviation proved to be more prevalent in patients with AVS and occurred in every forth patient with AUVP. Large skew deviations (> 3.3 deg), were pointing toward a central lesion. Clinical and video test of skew offered little additional diagnostic value compared to other diagnostic tests such as the head impulse test and nystagmus test. Video test of skew could aid to quantify skew in the ED setting in which neurotological expertise is not always readily available.}, language = {en} } @misc{MichailidouKordaWyssetal., author = {Michailidou, Efterpi and Korda, Athanasia and Wyss, Thomas and Bardins, Stanislav and Schneider, Erich and Morrison, Miranda and Wagner, Franca and Caversaccio, Marco Domenico and Mantokoudis, Georgios}, title = {The value of saccade metrics and VOR gain in detecting a vestibular stroke}, series = {Journal of Vestibular Research}, volume = {34}, journal = {Journal of Vestibular Research}, number = {1}, issn = {1878-6464}, doi = {10.3233/VES-230083}, pages = {49 -- 61}, abstract = {Objective: A normal video Head Impulse Test is the gold standard in the emergency department to rule-in patients with an acute vestibular syndrome and a stroke. We aimed to compare the diagnostic accuracy of vHIT metrics regarding the vestibulo-ocular reflex gain and the corrective saccades in detecting vestibular strokes. Methods: Prospective cross-sectional study (convenience sample) of patients presenting with acute vestibular syndrome in the emergency department of a tertiary referral centre between February 2015 and May 2020. We screened 1677 patients and enrolled 76 patients fulfilling the inclusion criteria of acute vestibular syndrome. All patients underwent video head impulse test with automated and manual data analysis. A delayed MRI served as a gold standard for vestibular stroke confirmation. Results: Out of 76 patients, 52 were diagnosed with acute unilateral vestibulopathy and 24 with vestibular strokes. The overall accuracy of detecting stroke with an automated vestibulo-ocular reflex gain was 86.8\%, compared to 77.6\% for cumulative saccade amplitude and automatic saccade mean peak velocity measured by an expert and 71\% for cumulative saccade amplitude and saccade mean peak velocity measured automatically. Gain misclassified 13.1\% of the patients as false positive or false negative, manual cumulative saccade amplitude and saccade mean peak velocity 22.3\%, and automated cumulative saccade amplitude and saccade mean peak velocity 28.9\% respectively. Conclusions: We found a better accuracy of video head impulse test for the diagnosis of vestibular strokes when using the vestibulo-ocular reflex gain than using saccade metrics. Nevertheless, saccades provide an additional and important information for video head impulse test evaluation. The automated saccade detection algorithm is not yet perfect compared to expert analysis, but it may become a valuable tool for future non-expert video head impulse test evaluations.}, language = {en} }