TY - GEN A1 - Dong-Han, Lee A1 - Schneider, Erich A1 - Sang-Yeon, Lee A1 - Kim, Ji-Soo A1 - Koo, Ja-Won T1 - Objective measurement of HINTS (Head Impulse, Nystagmus, Test of Skew) in peripheral vestibulopathy T2 - Auris Nasus Larynx N2 - ABSTRACT Objective To evaluate how often the positive sign of HINTS (Head-Impulse, Gaze Evoked Nystagmus, Test of Skew) appears in patients with acute peripheral vestibular lesion, HINTS findings were quantitatively measured and analyzed in patients with peripheral vestibulopathy accompanying spontaneous nystagmus. Methods HINTS was evaluated in 14 vertigo patients with spontaneous nystagmus. Horizontal vestibulo-ocular reflex (VOR) gain was measured using the video head impulse test (vHIT). To evaluate gaze-evoked nystagmus (GEN), slow-phase velocities at different points of lateral gaze were measured and plotted, then the slope and its inverse value, the neural integrator time constant, were calculated. Skew deviation was tested using anaglyph filters to simulate the alternate cover test, and the degree and latency of vertical eyeball deviation were measured. The ABCD2 score was calculated to evaluate the risk of stroke. Results Among 13 patients of peripheral vestibulopathy, 7 showed positive signs in HINTS (normal vHIT: 5, direction-changing GEN: 0, skew deviation: 3). One patient with a cerebellopontine angle tumor presented with both a peripheral and central pattern and showed positive HINTS findings (presence of direction-changing GEN). The mean VOR gain of patients with abnormal vHIT was 0.58±0.29 and 1.10±0.11 in the affected and contralateral side, respectively, while those in patients with normal vHIT were 1.04±0.21 and 1.13±0.12, respectively. The neural integrator time constant calculated from the mean slope of horizontal slow-phase velocity according to horizontal eye position was 42.9 s. The mean vertical eyeball deviation of patients with positive skew was 2.14±1.18° while uncovering the eye on the affected side, and -1.97±1.59° while uncovering the eye on the unaffected side. The median ABCD2 score of 14 patients was 2 (range, 1-3). Conclusions HINTS findings were objectively measured in vertigo patients with spontaneous nystagmus. Although positive findings of HINTS have been recognized as a central sign, 54% (7/13) of cases with peripheral vestibulopathy showed positive HINTS signs. HINTS results should be interpreted carefully considering that a substantial proportion of peripheral vestibulopathy shows a positive HINTS sign. KW - Dizziness KW - Vertigo KW - Head impulse test KW - Nystagmus KW - Skew deviation Y1 - 2022 U6 - https://doi.org/10.1016/j.anl.2022.03.003 SN - 1879-1476 SN - 0385-8146 VL - 49 IS - 6 SP - 938 EP - 949 ER - TY - GEN A1 - Choi, Jeong-Yoon A1 - Glasauer, Stefan A1 - Zee, David S. A1 - Kim, Ji-Soo T1 - Characteristics and Mechanism of Apogeotropic Central Positional Nystagmus T2 - Brain Y1 - 2018 U6 - https://doi.org/10.1093/brain/awx381 SN - 1460-2156 SN - 0006-8950 VL - 141 IS - 3 SP - 762 EP - 775 ER -