Sensitivity and specificity of ocular movements test (HINTS) in detection of central acute vestibular syndrome

Abstract

Background : Acute vestibular syndrome may seem intimidating due to the large overlap of symptoms with vestibular and non-vestibular causes, including serious and benign causes. In addition to the lack of a diagnostic method to differentiate between central and peripheral causes early.
Objective : This study aimed to evaluate the sensitivity and specificity of ocular movements test (HINTS) in detection of central acute vestibular syndrome.
Materials and Methods : A prospective cross-sectional study was designed which included (n=58) patients admitted with a complaint of acute vestibular syndrome to Tishreen University Hospital in Lattakia during the years 2021-2022. Patients with acute vestibular syndrome (according to the definition of the International Classification of Vestibular Disorders) who were admitted to the hospital and who had at least one risk factor for stroke, were included. Patients with a history of recurrent vertigo, those with diseases that would preclude HINTS testing such as cervical or ocular diseases, and those for whom MRI was contraindicated were excluded. HINTS testing and brain CT were performed on admission. Brain MRI was performed 48 hours after the onset of symptoms. The central lesion was diagnosed with a positive CT scan or MRI.
Results : Among the 58 patients 23 patients were diagnosed with a central lesion and 35 patients with a peripheral lesion. We found that in patients with a central lesion, ischemic stroke was the most common cause at all, and cerebellar infarction was the most common with a rate of 34.78%. We found bulbar infarction in 5 patients with a rate of 21.74%, pontine infarction in 4 with a rate of 17.39%, cerebellar metastasis in 3 with a rate of 13.04%, cerebellar peduncle infarction in 2 with a rate of 8.70%, and cerebellar hemorrhage in 1 with a rate of 4.35%. The HINTS test was positive (i.e. indicate a central lesion), in 22 patients with a central lesion, and negative (i.e. indicate a peripheral lesion), in 33 patients with a peripheral lesion. Thus, the sensitivity of the HINTS test in detecting central acute vestibular syndrome reached 95.65% and its specificity reached 94.29%.
Conclusion : The HINTS test is of particular importance because it is a simple clinical test that can be performed within minutes and without cost. The HINTS test has high sensitivity and specificity in diagnosing central acute vestibular syndrome.