Duplex Sonography of Vertebral Arteries for Evaluation of Patients with Acute Vertigo

Nazerian, Peiman; Bigiarini, Sofia; Pecci, Raffaella; Taurino, Lucia; Moretti, Marco; Pavellini, Andrea; Capretti, Elisa; Grifoni, Stefano; Vanni, Simone

doi:10.1016/j.ultrasmedbio.2017.11.002

Cited by 12 publications

(20 citation statements)

References 17 publications

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“…The reference standard used was MRI in four studies and clinical follow‐up with/without further imaging in two studies. Three studies evaluated the outcome of stroke, with sensitivity ranging from 6.7% to 75.0% and specificity ranging from 77.3% to 99.0% 5,20,23 . three studies evaluated the outcome of all central causes, with sensitivity ranging from 21.4% to 43.4% and specificity ranging from 90% to 100% 19,21,22 .…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for the guidelines for reasonable and appropriate care in the emergency department

Shah

Silva

Farah

et al. 2022

Academic Emergency Medicine

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Background: Patients presenting to the emergency department (ED) with acute vertigo or dizziness represent a diagnostic challenge. Neuroimaging has variable indications and yield. We aimed to conduct a systematic review and meta-analysis of the diagnostic test accuracy of neuroimaging for patients presenting with acute vertigo or dizziness. Methods: An electronic search was designed following patient-intervention-controloutcome (PICO) question-(P) adult patients with acute vertigo or dizziness presenting to the ED; (I) neuroimaging including computed tomography (CT), CT angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and ultrasound (US); (C) MRI/clinical criterion standard; and (O) central causes (stroke, hemorrhage, tumor, others) versus peripheral causes of symptoms. Articles were assessed in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess certainty of evidence in pooled estimates. Results:We included studies that reported diagnostic test accuracy. From 6309 titles, 460 articles were retrieved, and 12 were included: noncontrast CT scan-six studies, 771 patients, pooled sensitivity 28.5% (95% confidence interval [CI] 14.4%-48.5%, moderate certainty) and specificity 98.9% (95% CI 93.4%-99.8%, moderate certainty); MRI-five studies, 943 patients, sensitivity 79.8% (95% CI 71.4%-86.2%, high certainty) and specificity 98.8% (95% CI 96.2%-100%, high certainty); CTA-one study, 153 patients, sensitivity 14.3% (95% CI 1.8%-42.8%) and specificity 97.7% (95% CI 93.8%-99.6%), CT had higher sensitivity than CTA (21.4% and 14.3%) for central etiology; MRA-one study, 24 patients, sensitivity 60.0% (95% CI 26.2%-87.8%) and

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Section: Resultsmentioning

confidence: 99%

“…Three studies evaluated 258 patients with ultrasonography (Table 2). 23,28,29 The reference standard was an MRI in two studies 28,29 and clinical follow-up with or without further neuroimaging in one. 23 Sensitivity ranged from 30% to 53.6%, with specificity ranging from 94.9% to 100.0%.…”

Section: Ultrasonographymentioning

confidence: 99%

Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for the guidelines for reasonable and appropriate care in the emergency department

Shah

Silva

Farah

et al. 2022

Academic Emergency Medicine

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“… 18 In the literature, the diagnostic value of Doppler ultrasonography has been investigated by the comparison of different imaging modalities. According to Nazerian et al, 9 any abnormalities in the VA could be detected by ECCSVA with a sensitivity at 54% and a specificity at 95%. In the meta-analysis by Khan et al, 18 the sensitivity and specificity of ECCSVA for diagnosis of vertebral stenosis were 70% and 98%, respectively, compared with angiography.…”

Section: Discussionmentioning

confidence: 99%

“…Extracranial color-coded duplex sonography (ECCSVA) of VAs can be a useful screening tool for the evaluation of posterior cerebral circulation. 9 ECCSVA is a useful imaging modality which is cost-effective and can be easily performed at the clinic.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of BPPV with vertebral artery values

Yazıcı¹,

İnanç²

2018

NDT

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ObjectivesThe aim of this study was to investigate the association between benign paroxysmal positional vertigo (BPPV) and vertebral artery (VA) flow rates and diameters by using Doppler ultrasonography in patients with BPPV. Additionally, we aimed to investigate the abnormalities of VA values obtained by extracranial color-coded duplex sonography in BPPV, which could be accepted as a precursor lesion for posterior cerebral ischemic stroke.Materials and methodsBetween September 2017 to February 2018, 50 patients diagnosed with BPPV were enrolled in this study. Otorhinolaryngology medical examination and medical history assessment were performed at the otorhinolaryngology clinic. Afterward, neurologic examination and ultrasonography of VAs was undertaken in the neurology clinic of University of Gaziantep Medical Faculty.ResultsThe types of BPPV found were as follows: right posterior in 27 (54%), right lateral in 4 (8%), left posterior in 16 (32%), and left lateral in 3 (6%), respectively. The most common variables found in the BPPV were smoking (26%), hypertension (26%), and hyperlipidemia (22%).ConclusionVA flow rates and diameters were found to be affected at the site of BPPV. These findings might suggest that BPPV could be related to an atherosclerotic milieu and may be a precursor clinical condition for future intracranial atherosclerotic diseases.

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“…Hearing loss was assessed by finger rub in one study 17 and by pure tone audiogram in two studies, 58,59 and the exact method was not reported in four studies. 48,54,66,69…”

Section: Hearing Lossmentioning

confidence: 99%

Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for GRACE‐3

Shah

Silva

Farah

et al. 2023

Academic Emergency Medicine

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Background History and physical examination are key features to narrow the differential diagnosis of central versus peripheral causes in patients presenting with acute vertigo. We conducted a systematic review and meta‐analysis of the diagnostic test accuracy of physical examination findings. Methods This study involved a patient–intervention–control–outcome (PICO) question: (P) adult ED patients with vertigo/dizziness; (I) presence/absence of specific physical examination findings; and (O) central (ischemic stroke, hemorrhage, others) versus peripheral etiology. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was assessed. Results From 6309 titles, 460 articles were retrieved, and 43 met the inclusion criteria: general neurologic examination—five studies, 869 patients, pooled sensitivity 46.8% (95% confidence interval [CI] 32.3%–61.9%, moderate certainty) and specificity 92.8% (95% CI 75.7%–98.1%, low certainty); limb weakness/hemiparesis—four studies, 893 patients, sensitivity 11.4% (95% CI 5.1%–23.6%, high) and specificity 98.5% (95% CI 97.1%–99.2%, high); truncal/gait ataxia—10 studies, 1810 patients (increasing severity of truncal ataxia had an increasing sensitivity for central etiology, sensitivity 69.7% [43.3%–87.9%, low] and specificity 83.7% [95% CI 52.1%–96.0%, low]); dysmetria signs—four studies, 1135 patients, sensitivity 24.6% (95% CI 15.6%–36.5%, high) and specificity 97.8% (94.4%–99.2%, high); head impulse test (HIT)—17 studies, 1366 patients, sensitivity 76.8% (64.4%–85.8%, low) and specificity 89.1% (95% CI 75.8%–95.6%, moderate); spontaneous nystagmus—six studies, 621 patients, sensitivity 52.3% (29.8%–74.0%, moderate) and specificity 42.0% (95% CI 15.5%–74.1%, moderate); nystagmus type—16 studies, 1366 patients (bidirectional, vertical, direction changing, or pure torsional nystagmus are consistent with a central cause of vertigo, sensitivity 50.7% [95% CI 41.1%–60.2%, moderate] and specificity 98.5% [95% CI 91.7%–99.7%, moderate]); test of skew—15 studies, 1150 patients (skew deviation is abnormal and consistent with central etiology, sensitivity was 23.7% [95% CI 15%–35.4%, moderate] and specificity 97.6% [95% CI 96%–98.6%, moderate]); HINTS (head impulse, nystagmus, test of skew)—14 studies, 1781 patients, sensitivity 92.9% (95% CI 79.1%–97.9%, high) and specificity 83.4% (95% CI 69.6%–91.7%, moderate); and HINTS+ (HINTS with hearing component)—five studies, 342 patients, sensitivity 99.0% (95% CI 73.6%–100%, high) and specificity 84.8% (95% CI 70.1%–93.0%, high). Conclusions Most neurologic examination findings have low sensitivity and high specificity for a central cause in patients with acute vertigo or dizziness. In acute vestibular syndrome (monophasic, continuous, persistent dizziness), HINTS and HINTS+ have high sensitivity when performed by trained clinicians.

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Duplex Sonography of Vertebral Arteries for Evaluation of Patients with Acute Vertigo

Cited by 12 publications

References 17 publications

Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for the guidelines for reasonable and appropriate care in the emergency department

Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for the guidelines for reasonable and appropriate care in the emergency department

Evaluation of BPPV with vertebral artery values

Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for GRACE‐3

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