July 23, 2013 - A bedside eye echocardiogram (ECG)
device for the physiological diagnosis of vertebrobasilar stroke may provide an
efficient method to diagnose emergency department (ED) patients with vertigo or
dizziness who are at high risk for stroke.
In a recent study,1 researchers evaluated the
viability of using a portable video-oculography device measuring vestibular
physiology in real time to diagnose stroke in acute vestibular syndrome, as a
more sensitive and less costly alternative to using magnetic resonance
imaging (MRI). According to a report by Johns Hopkins researchers, emergency
room visits for severe dizziness have grown exponentially in recent years, with
costs topping $3.9 billion in 2011 and projected to reach $4.4 billion by 2015. After
analyzing records from two large, national public databases, the Johns Hopkins
research team concluded that a large percentage of patients who come to the ED
with dizziness are suffering from a benign inner-ear disorder, while just 5% of
those whose major complaint is dizziness are having a stroke.
"We’re spending hundreds of millions of dollars a
year on expensive stroke work-ups that are unnecessary, and probably missing
the chance to save tens of thousands of lives because we aren’t properly
diagnosing their dizziness or vertigo as stroke symptoms," says David
Newman-Toker, MD PhD, an associate professor of neurology and otolaryngology at
the Johns Hopkins University School of Medicine and leader of the study described
in the journal Stroke.
Newman-Toker says if additional larger studies confirm
these results, the device could one day be the equivalent of an
electrocardiogram (EKG), a simple noninvasive test routinely used to rule out
heart attack in patients with chest pain. And, he adds, universal use of the
device could "virtually eliminate deaths from misdiagnosis and save a lot
of time and money."
The results showed that of the 12 consecutive patients
who underwent confirmatory MRI exams, the video-oculography–based head impulse
test, nystagmus, test-of-skew examination was 100% accurate (6 strokes, 6
They concluded that if confirmed in a larger sample,
this bedside eye ECG approach could eventually help fulfill a critical need for
timely, accurate, efficient diagnosis in emergency department patients with
vertigo or dizziness who are at high risk for stroke.
Reference: Newman-Toker DE, Tehrani ASS, Mantokoudis
G, et al. Quantitative Video-Oculography to Help Diagnose Stroke in Acute Vertigo
and Dizziness. Stroke. http://stroke.ahajournals.org/content/44/4/1158.
Updated July 22, 2013.
For more information: www.hopkinsmedicine.org and www.appliedradiology.com