FV12. Development of a diagnostic index test for stroke as a cause of vertigo, dizziness and imbalance in the emergency room: First results from the prospective EMVERT trial

Aim Identifying stroke as a cause of acute vertigo, dizziness and imbalance in the emergency room is still a clinical challenge. The aim of the EMVERT trial was to develop a diagnostic index test to identify patients with the high risk to have a stroke as the cause of the balance symptoms. Methods Patients with acute onset of vertigo, dizziness, postural imbalance, gait instability or double vision with symptoms in the last 24 h lasting for at least 10 min were eligible to be included in the study. 840 patients were prospectively screened for inclusion in the study. Patients with benign paroxysmal positional vertigo, recurrent attacks of Meniere’s disease, as well as clear clinical signs of stroke (i.e. hemiparese, hemihypaesthesia) were excluded. 345 patients were included in the study and underwent standardized clinical and apparative neuro-ophthalmological/-physiological testing (including video-oculography, video head impulse testing, mobile posturography, measurement of subjective visual vertical) as well as scores and scales for symptom intensity and vascular risk factors (EMVERT block 1). Within 10 days a standardized magnetic resonance imaging (MRI) protocol was performed as a reference test to identify stroke (EMVERT block 2). Data from block 2 (MRI and clinical follow up) were compared to results from EMVERT block 1 in order to compose a diagnostic index test with a high specificity and sensitivity to predict the risk of stroke in the emergency room. Results In 44 enrolled patients a cerebral ischemia was diagnosed based on diffusion-weighted MRI (12.7%). The most frequent lesion side was the vascular territory of the posterior inferior cerebellar artery. The group of all stroke patients showed significantly higher ABCD2-Scores compared to all other patients (p Conclusion About 5% of all patients with acute vertigo, dizziness and gait instability presenting to the emergency room suffer from stroke. Assessment of the cardio-vascular risk profile by the ABCD2 score and testing of the head impulse test, gaze evoked nystagmus and vertical deviation of the eyes are helpful to detect stroke. Apparative testing by videooculography increases the chance to detect pathological neuro-ophthalmological signs.