TY - JOUR AU - Sidra Tahir, Nouvaira Tahir, Lubna Meraj, Neelum Zaka, Sadaf Zaman, Kausar Malik, Sidra Tahir, Nouvaira Tahir, Lubna Meraj, Neelum Zaka, Sadaf Zaman, Kausar Malik PY - 2022/03/31 Y2 - 2024/03/28 TI - Can “HINTS” aid the Diagnosis of Posterior Circulation Stroke among patients with Acute Vestibular Syndrome? JF - Journal of Rawalpindi Medical College JA - JRMC VL - 26 IS - 1 SE - Review Article DO - 10.37939/jrmc.v26i1.1766 UR - https://journalrmc.com/index.php/JRMC/article/view/1766 SP - AB - <p><strong>Introduction:</strong></p><p>Identifying posterior circulation stroke in patients with AVS without obvious focal neurological deficits poses a difficult diagnostic challenge. It is estimated that about 10% to 20% of patients who present with acute dizziness to the Emergency department have AVS<sup>7.</sup>&nbsp;Most AVS patients have a benign peripheral vestibular cause (vestibular neuritis or nonbacterial labyrinthitis), but&nbsp;about&nbsp;25% have brainstem or cerebellar strokes<sup>7, 9-10</sup>. Rapid, accurate diagnosis of posterior stroke is important for early management as well as prevention of devastating complications. HINTS is a clinical three-step bedside oculomotor exam, that has been suggested of high diagnostic accuracy in identifying posterior circulation stroke in patients with isolated continuous vertigo.</p><p><strong>Methods:</strong></p><p>A comprehensive systematic search of literature was done using the NHS Evidence healthcare databases Medline, EMBASE, CLINIL, Google scholar and Cochrane.</p><p><strong>Results:</strong></p><p>10 relevant articles were identified, combining the results of all six prospective studies showed a total of 338 patients on which Clinical HINTS exam was performed. The&nbsp;overall Hints exam sensitivity was 96.86% 95%CI (92.8-99), specificity 96.09%&nbsp;95%CI (92.1-98.4) and negative predictive value was 0.03 95%CI (0.01-0.08). ROC&nbsp;analysis was done in which area under curve was found to be 0.965.</p><p><strong>Conclusion:</strong></p><p>Delay in diagnosis of posterior stroke can result in 8-fold increase in mortality<sup>7</sup>. HINTS is a useful clinical bed side oculomotor exam, which if done appropriately by trained ED doctors, could aid in the early recognition of a subtly presenting posterior stroke with “acute isolated continuous vertigo”. Hence, will improve the overall diagnostic evaluation of acute vestibular syndrome.</p> ER -