El protocolo de impulso de la cabeza, tipo de nistagmo, prueba de sesgo (HINTS) estableció un nuevo paradigma para diferenciar la enfermedad vestibular periférica del accidente cerebrovascular en pacientes con síndrome vestibular agudo (SVA). La relación entre el grado de ataxia troncal y el accidente cerebrovascular no se ha estudiado sistemáticamente en pacientes con SVA por lo que los especialistas estudiaron a 114 pacientes que ingresaron en un Hospital General debido a AVS, comprobando que la ataxia es menos sensible que HINTS pero mucho más fácil de evaluar. Para conocer más sobre el estudio y sus resultados, hacer clic aquí.
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Frontiers in Neurology: The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome.

Sergio Carmona(1*), Carlos Martínez(2), Guillermo Zalazar(2), Marcela Moro(2), Angel Batuecas-Caletrio(3), Leonel Luis(4,5) and Carlos Gordon(6,7)

(1) Fundación San Lucas, Rosario, Argentina, (2) Hospital José María Cullen, Santa Fe, Argentina, (3) Unidad de Otoneurología, Servicio de Otorrinolaringología y Patología Máxilofacial, Hospital Universitario de Salamanca, Salamanca, Spain, (4) Translational Clinical Physiology Unit, Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal, (5) Otolaryngology Unit, Department of Surgical Specialities and Anesthesiology, Hospital de Cascais, Lisbon, Portugal, (6) Department of Neurology, Meir Medical Center, Kfar-Saba, Israel, (7) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior  inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory

(variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient’s age. Grade 2–3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2–3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate.