SynthesisAnnals of neurology2023
Impact of Clinician Training Background and Stroke Location on Bedside Diagnostic Test Accuracy in the Acute Vestibular Syndrome - A Meta-Analysis.
Synthesis in Annals of neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06668857 (Oculomotor Profile in Acute Vestibular Syndrome - Value of Saccades, Pursuit Eye Movements and Pupillary Reflexes in Differentiating Central and Peripheral Causes), which is not on this map. Cited by 35 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Oculomotor Profile in Acute Vestibular Syndrome - Value of Saccades, Pursuit Eye Movements and Pupillary Reflexes in Differentiating Central and Peripheral Causes
Who cites it
35 citing papers in PubMed, 6 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- The Epidemiology and Clinical Presentation of the Acute Imbalance Syndrome (AIS)-A Systematic Review and Meta-Analysis.European journal of neurology · 2026Pooled it
- The epidemiology and clinical presentation of acute vestibular syndromes: a systematic review of the literature.Journal of neurology · 2026Pooled it
- HINTS+ to diagnose AICA stroke: systematic review of the diagnostic impact of acute unilateral hearing loss in the acute vestibular syndrome.Journal of neurology · 2026Pooled it
- Intravenous thrombolysis in patients with acute dizziness or imbalance and suspected ischemic stroke-systematic review.Journal of neurology · 2025Pooled it
- Systematic Review and Meta-Analysis of the Diagnostic Accuracy of a Graded Gait and Truncal Instability Rating in Acutely Dizzy and Ataxic Patients.Cerebellum (London, England) · 2024Pooled it
- Systematic review and meta-analysis of the diagnostic accuracy of spontaneous nystagmus patterns in acute vestibular syndrome.Frontiers in neurology · 2023Pooled it
- An update on neuro-otology and neuro-ophthalmology - focusing on new developments in the last three years.Journal of neurology · 2026Review
- Separating stroke and acute unilateral vestibulopathy using history, examination and vestibular tests: a machine learning approach.Journal of neurology · 2026Article
- A Guide to Patients with Acute Transient Vestibular Symptoms in the Emergency Department.Brain sciences · 2026Review
- Age-related metabolomic signatures and stroke susceptibility in a population-based cohort.GeroScience · 2026Article
- Prediction Model for Etiologic Differentiation of Isolated Vestibular Syndrome in Emergency Settings.Annals of clinical and translational neurology · 2026Article
- Diagnostic challenges in posterior circulation ischemic stroke presenting with acute dizziness and vertigo.Frontiers in neurology · 2026Review
- Recalibrating neurological examination: from binary signs to probabilistic and multidimensional assessment using mobile technologies in acute neurology.Frontiers in neurology · 2026Article
- Review
- Time to Include Vestibular Neurology as a Core Competency for Neurology Trainees.Neurology. Education · 2025Article
- Acute Vertigo, Dizziness and Imbalance in the Emergency Department-Beyond Stroke and Acute Unilateral Vestibulopathy-A Narrative Review.Brain sciences · 2025Review
- Eye movement features for assisting differentiation between posterior circulation infarction and vestibular neuritis in patients of acute vestibular syndrome.European journal of medical research · 2025Article
- Vestibular event monitoring in acute posterior circulation stroke: from emergency room to stroke unit and beyond.Journal of neurology · 2025Article
- The Challenge of Diagnosing Labyrinthine Stroke-A Critical Review.Brain sciences · 2025Review
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
objectiveAcute dizziness/vertigo is usually due to benign inner-ear causes but is occasionally due to dangerous neurologic ones, particularly stroke. Because symptoms and signs overlap, misdiagnosis is frequent and overuse of neuroimaging is common. We assessed the accuracy of bedside findings to differentiate peripheral vestibular from central neurologic causes.
methodsWe performed a systematic search (MEDLINE and Embase) to identify studies reporting on diagnostic accuracy of physical examination in adults with acute, prolonged dizziness/vertigo ("acute vestibular syndrome" [AVS]). Diagnostic test properties were calculated for findings. Results were stratified by examiner type and stroke location.
resultsWe identified 6,089 citations and included 14 articles representing 10 study cohorts (n = 800). The Head Impulse, Nystagmus, Test of Skew (HINTS) eye movement battery had high sensitivity 95.3% (95% confidence interval [CI] = 92.5-98.1) and specificity 92.6% (95% CI = 88.6-96.5). Sensitivity was similar by examiner type (subspecialists 94.3% [95% CI = 88.2-100.0] vs non-subspecialists 95.0% [95% CI = 91.2-98.9], p = 0.55), but specificity was higher among subspecialists (97.6% [95% CI = 94.9-100.0] vs 89.1% [95% CI = 83.0-95.2], p = 0.007). HINTS sensitivity was lower in anterior cerebellar artery (AICA) than posterior inferior cerebellar artery (PICA) strokes (84.0% [95% CI = 65.3-93.6] vs 97.7% [95% CI = 93.3-99.2], p = 0.014) but was "rescued" by the addition of bedside hearing tests (HINTS+). Severe (grade 3) gait/truncal instability had high specificity 99.2% (95% CI = 97.8-100.0) but low sensitivity 35.8% (95% CI = 5.2-66.5). Early magnetic resonance imaging (MRI)-diffusion-weighted imaging (DWI; within 24-48 hours) was falsely negative in 15% of strokes (sensitivity 85.1% [95% CI = 79.2-91.0]).
interpretationIn AVS, HINTS examination by appropriately trained clinicians can differentiate peripheral from central causes and has higher diagnostic accuracy for stroke than MRI-DWI in the first 24-48 hours. These techniques should be disseminated to all clinicians evaluating dizziness/vertigo. ANN NEUROL 2023;94:295-308.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.