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Wang C, Sreerama J, Nham B, Reid N, Ozalp N, Thomas JO, Cappelen-Smith C, Calic Z, Bradshaw AP, Rosengren SM, Akdal G, Halmagyi GM, Black DA, Burke D, Prasad M, Bharathy GK, Welgampola MS. Separation of stroke from vestibular neuritis using the video head impulse test: machine learning models versus expert clinicians. J Neurol 2025; 272:248. [PMID: 40042674 PMCID: PMC11882619 DOI: 10.1007/s00415-025-12918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 01/09/2025] [Accepted: 01/12/2025] [Indexed: 03/09/2025]
Abstract
BACKGROUND Acute vestibular syndrome usually represents either vestibular neuritis (VN), an innocuous viral illness, or posterior circulation stroke (PCS), a potentially life-threatening event. The video head impulse test (VHIT) is a quantitative measure of the vestibulo-ocular reflex that can distinguish between these two diagnoses. It can be rapidly performed at the bedside by any trained healthcare professional but requires interpretation by an expert clinician. We developed machine learning models to differentiate between PCS and VN using only the VHIT. METHODS We trained machine learning classification models using unedited head- and eye-velocity data from acute VHIT performed in an Emergency Room on patients presenting with acute vestibular syndrome and whose final diagnosis was VN or PCS. The models were validated using an independent test dataset collected at a second institution. We compared the performance of the models against expert clinicians as well as a widely used VHIT metric: the gain cutoff value. RESULTS The training and test datasets comprised 252 and 49 patients, respectively. In the test dataset, the best machine learning model identified VN with 87.8% (95% CI 77.6%-95.9%) accuracy. Model performance was not significantly different (p = 0.56) from that of blinded expert clinicians who achieved 85.7% accuracy (75.5%-93.9%) and was superior (p = 0.01) to that of the optimal gain cutoff value (75.5% accuracy (63.8%-85.7%)). CONCLUSION Machine learning models can effectively differentiate PCS from VN using only VHIT data, with comparable accuracy to expert clinicians. They hold promise as a tool to assist Emergency Room clinicians evaluating patients with acute vestibular syndrome.
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Affiliation(s)
- Chao Wang
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jeevan Sreerama
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Benjamin Nham
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Nicole Reid
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nese Ozalp
- Department of Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
| | - James O Thomas
- Department of Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Zeljka Calic
- Department of Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Andrew P Bradshaw
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sally M Rosengren
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gülden Akdal
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, Izmir, Türkiye
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Türkiye
| | - G Michael Halmagyi
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Deborah A Black
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Burke
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mukesh Prasad
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Gnana K Bharathy
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Miriam S Welgampola
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Tramontano M, Ferri N, Turolla A, Orejel Bustos AS, Casagrande Conti L, Sorge C, Pillastrini P, Manzari L. Video head impulse test in subacute and chronic stroke survivors: new perspectives for implementation of assessment in rehabilitation. Eur Arch Otorhinolaryngol 2024; 281:5129-5134. [PMID: 38758244 DOI: 10.1007/s00405-024-08721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Video Head Impulse Test (vHIT) is a safe and reliable assessment of peripheral vestibular function. Many studies tested its accuracy in clinical settings for differential diagnosis and quantification of the vestibulo-oculomotor reflex (VOR) in various disorders. However, the results of its application after lesions of the CNS are discordant and have never been studied in rehabilitation. This study aims to assess the VOR performance in a sample of stroke survivors. METHODS This is a cross-sectional study on 36 subacute and chronic stroke survivors; only persons with first-ever stroke and able to walk independently, even with supervision, were included. We performed VOR assessments for each semicircular canal by vHIT and balance assessments by the Berg Balance Scale and the MiniBESTest scale. RESULTS Two hundred and sixteen semicircular canals were assessed using the Head Impulse paradigm (in both the vertical and horizontal planes), while 72 semicircular canals were assessed using the Suppressed Head Impulse paradigm (horizontal plane). There was a high prevalence of participants with dysfunctional canals, particularly for the left anterior and right posterior canals, which were each prevalent in more than one-third of our sample. Furthermore, 16 persons showed an isolated canal dysfunction. The mean VOR gain for the vertical canals had confidence intervals out of the normal values (0.74-0.91 right anterior; 0.74-0.82 right posterior; 0.73-0.87 left anterior). CONCLUSION Our findings suggest that peripheral vestibular function may be impaired in people with stroke; a systematic assessment in a rehabilitation setting could allow a more personalized and patient-centred approach.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Chiara Sorge
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
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Jasinska-Nowacka A, Niemczyk K. Application of a Video Head Impulse Test in the Diagnosis of Vestibular Neuritis. Life (Basel) 2024; 14:757. [PMID: 38929740 PMCID: PMC11204878 DOI: 10.3390/life14060757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
In patients presenting in the emergency department with acute vertigo, a rapid and accurate differential diagnosis is crucial, as posterior circulation strokes can mimic acute vestibular losses, leading to inappropriate treatment. The diagnosis of vestibular neuritis is made based on the clinical manifestation and a bedside otoneurological assessment. In the clinical examination, an evaluation of the vestibulo-ocular reflex is the key element; however, the accuracy of the bedside head impulse test depends on the clinician's experience. Thus, new diagnostic methods are needed to objectify and facilitate such rapid vestibular evaluations. The aim of our paper is to provide a comprehensive review of the video head impulse test's application in the diagnosis of vestibular neuritis. Numerous studies have reported advantages that make this method helpful in detailed otoneurological evaluations; in contrast to the bedside head impulse test, it enables an analysis of all six semicircular canals function and records the covert corrective saccades, which are invisible to the naked eye. As a portable and easy diagnostic tool, it is known to improve the diagnostic accuracy in patients with acute vertigo presenting in the emergency department. Moreover, as it evaluates the vestibulo-ocular reflex across different frequencies, as compared to caloric tests, it can be used as an additional test that is complementary to videonystagmography. Recently, several papers have described the application of the video head impulse test in follow-up and recovery evaluations in patients with vestibular neuritis.
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Affiliation(s)
- Agnieszka Jasinska-Nowacka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-091 Warszawa, Poland;
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Jaganathan N, Mohamed MH, Md Pauzi AL, Mahayidin H, Hanapai AF, Wan Sulaiman WA, Basri H, Inche Mat L. Video head impulse test in stroke: a review of published studies. Front Neurol 2024; 15:1339039. [PMID: 38497038 PMCID: PMC10940455 DOI: 10.3389/fneur.2024.1339039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Accurate and timely diagnosis of posterior circulation stroke in patients with acute dizziness is a challenge that can lead to misdiagnosis and significant harm. The present review sought to identify and describe published research on the clinical application of vHIT in posterior circulation stroke. vHIT, a portable device, has gained prominence in evaluating peripheral vestibular disorders and offers potential applications in diagnosing neurological disorders, particularly posterior circulation stroke. Several studies have shown that vHIT can differentiate between stroke and vestibular neuritis based on VOR gain values, with high sensitivity and specificity. The manuscript also discusses vHIT's performance in differentiating between types of posterior circulation stroke, such as PICA, AICA, and SCA strokes. While vHIT has demonstrated promise, the review emphasizes the need for further research to validate its use as a tool to rule out stroke in acute dizziness patients in the emergency department. In conclusion, the manuscript underscores the potential of vHIT as a valuable addition to the diagnostic arsenal for acute dizziness, particularly in the context of posterior circulation stroke. It calls for further research and wider adoption of vHIT in clinical settings to improve patient care and reduce unnecessary costs associated with misdiagnoses.
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Affiliation(s)
- Niranjana Jaganathan
- Department of Neurology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hazmi Mohamed
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ahmad Luqman Md Pauzi
- Department of Emergency, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hasni Mahayidin
- Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ahmad Firdaus Hanapai
- Department of Neurology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hamidon Basri
- Department of Neurology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Liyana Inche Mat
- Department of Neurology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
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