Eye movement features for assisting differentiation between posterior circulation infarction and vestibular neuritis in patients of acute vestibular syndrome

A significant portion of patients with acute vestibular syndrome (AVS) due to posterior circulation infarction (PCI) is free of non-vestibular signs. A differential diagnosis of this form from that due to vestibular neuritis (VN) can be challenging. We herein aimed to understand whether quantitative eye movement signature could be used to assist such a diagnosis. A total of 56 patients with AVS due to PCI free of non-vestibular signs, 71 patients with AVS due to VN, and 127 controls were selected retrospectively into the study from our hospital database. Demographic, clinical data, and videooculography results were extracted. Patients with PCI or VN differed from controls in most eye movement metrics. Patients with PCI also differed from those with VN in multiple metrics, including contralesional speed of horizontal saccade, gain of downward saccade, speed and gain of upward saccade, contralesional gain and gain asymmetry of smooth pursuit, and ipsilesional gain of optokinetic nystagmus. A detection model, built on the basis of age, hypertension, gain of upward saccade, and gain asymmetry of smooth pursuit, distinguished PCI from VN with area under the curve at 0.964 (0.929, 0.998) and 0.961 (0.915, 1.000) in the training and test sessions, respectively. We demonstrate that eye movements are differentially impaired in patients with PCI free of non-vestibular signs and those with VN. The detection model built on smooth pursuit gain asymmetry and upward saccade gain may assist the differentiation between PCI and VN in AVS patients by trained clinicians.

• Publication year

  2025

• Venue

  European Journal of Medical Research

• Publication date

  2025-08-20

• Fields of study

  Medicine

• Identifiers
  DOI 10.1186/s40001-025-03046-9PMID 40830990PMCID 12366142
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Advances in the diagnosis and management of acute vertigo

  2024cited by this paper
• Impact of Clinician Training Background and Stroke Location on Bedside Diagnostic Test Accuracy in the Acute Vestibular Syndrome – A Meta‐Analysis

  2023cited by this paper
• Videooculography “HINTS” in Acute Vestibular Syndrome: A Prospective Study

  2022cited by this paper
• Current concepts in acute vestibular syndrome and video-oculography

  2021cited by this paper
• Video Head Impulse Testing: From Bench to Bedside

  2020cited by this paper
• Separating posterior-circulation stroke from vestibular neuritis with quantitative vestibular testing.

  2020cited by this paper
• Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives

  2020cited by this paper
• Diagnostic value of eye movement and vestibular function tests in patients with posterior circulation infarction

  2019cited by this paper
• Segmental Analysis of the Vestibular Nerve and the Efferents of the Vestibular Complex

  2019cited by this paper
• Vestibular Rehabilitation for the Patients with Intractable Vestibular Neuritis

  2018cited by this paper
• Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls.

  2018cited by this paper
• A case of double depressor palsy followed by pursuit deficit due to sequential infarction in bilateral thalamus and right medial superior temporal area

  2017cited by this paper
• Selective Unidirectional Horizontal Saccadic Paralysis From Acute Ipsilateral Pontine Stroke

  2017cited by this paper
• The Video Head Impulse Test

  2017cited by this paper
• Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm

  2017cited by this paper
• An active-efficient-coding model of optokinetic nystagmus.

  2016cited by this paper
• Missed stroke in acute vertigo and dizziness: It is time for action, not debate

  2016cited by this paper
• Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management

  2014cited by this paper
• Isolated vestibular syndrome in posterior circulation stroke: Frequency and involved structures

  2014cited by this paper
• Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

  2014cited by this paper
• Isolated unilateral infarction of the cerebellar tonsil: Ocular motor findings

  2014cited by this paper
• Clinical significance of pathological eye movements in diagnosing posterior fossa stroke

  2013cited by this paper
• Vertical supranuclear gaze palsy in Niemann-Pick type C disease

  2012cited by this paper
• Symptoms and signs of posterior circulation ischemia in the new England medical center posterior circulation registry.

  2012cited by this paper
• Factors associated with misdiagnosis of acute stroke in young adults.

  2011cited by this paper
• Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome

  2011cited by this paper
• Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit

  2011cited by this paper
• Visual guidance of smooth-pursuit eye movements: sensation, action, and what happens in between.

  2010cited by this paper
• HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging

  2009cited by this paper
• Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”

  2008cited by this paper
• Head impulse test in unilateral vestibular loss

  2008cited by this paper
• A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects.

  2007cited by this paper
• Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison.

  2007cited by this paper
• Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison.

  2007cited by this paper
• Oculomotor evaluation in patients with peripheral vestibular dysfunction

  2006cited by this paper
• Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency Department: A Population-Based Study

  2006cited by this paper
• Smooth Pursuit in Patients with Downbeat Nystagmus

  2005cited by this paper
• Clinical practice. Vestibular neuritis.

  2003cited by this paper
• Acute vestibular syndrome.

  1999cited by this paper
• Acute vestibular syndrome.

  1998cited by this paper
• Selective vertical saccadic palsy from unilateral medial thalamic infarction: clinical, neurophysiologic and MRI correlates

  1997cited by this paper
• The microscopic anatomy and physiology of the mammalian saccadic system.

  1996cited by this paper
• Gaze-evoked nystagmus and smooth pursuit deficits: Their relationship studied in 52 patients

  1995cited by this paper
• Isolated acute vertigo in the elderly; vestibular or vascular disease?

  1995cited by this paper
• Velocity and asymmetry of optokinetic nystagmus in the evaluation of vestibular lesions.

  1986cited by this paper
• [Vestibular neuritis].

  1968cited by this paper

• No citing papers are available for this paper.