Central nystagmus plus ABCD2 identifying stroke in acute dizziness presentations

Acad Emerg Med. 2021 Oct;28(10):1118-1123. doi: 10.1111/acem.14295. Epub 2021 Jun 9.


Objective: The objective was to explore the ability of head impulse-nystagmus-test of skew (HINTS) combined with ABCD2 score to identify cerebrovascular causes of dizziness.

Materials and methods: We prospectively recruited 85 patients with acute onset of dizziness from September 2016 to December 2018 and analyzed their clinical characteristics, ABCD2 scores, HINTS, and neuroimages data.

Results: Acute stroke was identified by MRI in 21 of 85 patients. The mean ± SD ABCD2 scores were significantly higher among patients with acute stroke than those without acute stroke (4.0 ± 0.8 h vs. 2.5 ± 0.7 h, p < 0.01). The majority (71.4%) of patients with cerebrovascular causes had central pattern of nystagmus at the initial 48 h from symptoms onset. The sensitivity and specificity of HINTS were 100% and 87% for the presence of stroke in patients with nystagmus. When combined central pattern of nystagmus and ABCD2 ≥ 4, the sensitivity increased to 100% for identifying cerebrovascular causes. Nystagmus were absence at time of examination in 16.5% of our patients, and ABCD2 scores in patients who had cerebrovascular diagnoses were all ≥ 4.

Conclusion: HINTS examinations could efficiently differentiate stroke from nonstroke under the condition that patients remaining symptomatic, including spontaneous or gaze-evoked nystagmus. It is more practical to apply the combination of central pattern of nystagmus and ABCD2 ≥ 4 in ED setting. If patients were absence of central nystagmus at admission, cerebrovascular event should be a priority diagnosis when their ABCD2 ≥ 4.

Keywords: ABCD2 scores; HINTS; acute dizziness; nystagmus; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dizziness / diagnosis
  • Dizziness / etiology
  • Humans
  • Magnetic Resonance Imaging
  • Nystagmus, Pathologic* / diagnosis
  • Stroke* / complications
  • Stroke* / diagnosis
  • Vertigo