{"id":16513,"date":"2025-09-18T17:35:12","date_gmt":"2025-09-18T15:35:12","guid":{"rendered":"https:\/\/ivrt.de\/?p=16513"},"modified":"2026-02-06T17:46:44","modified_gmt":"2026-02-06T16:46:44","slug":"akutes-vestibulaeres-syndrom-nystagmusbeobachtung-im-schlaganfallverlauf-warum-hints-der-schluessel-bleibt","status":"publish","type":"post","link":"https:\/\/ivrt.de\/en\/studien-evidenz\/akutes-vestibulaeres-syndrom-nystagmusbeobachtung-im-schlaganfallverlauf-warum-hints-der-schluessel-bleibt\/","title":{"rendered":"Acute vestibular syndrome: nystagmus observation in stroke progression \u2013 why HINTS remains key\""},"content":{"rendered":"<p><strong>For Healthcare Professionals:<\/strong><\/p>\n\n\n\n<p>In patients with acute vestibular syndrome (AVS), distinguishing between <a href=\"https:\/\/ivrt.de\/en\/schwindelerkrankungen\/neuritis-vestibularis\/\" data-type=\"post\" data-id=\"7427\">Vestibular neuritis<\/a> and a <a href=\"https:\/\/ivrt.de\/en\/schwindelerkrankungen\/labyrinthinfarkt\/\" data-type=\"post\" data-id=\"6001\">stroke<\/a> (posterior circulation stroke; PCS) is one of the most important tasks in the emergency department. The HINTS test (Head Impulse, Nystagmus,  and Test of Skew) has proven to be more sensitive than an early MRI.<\/p>\n\n\n\n<p>\ud83d\udd17 Akdal G, Nham B, Kwok B, et al. Vestibular event monitoring in acute posterior circulation stroke: from emergency room to stroke unit and beyond.&nbsp;<em>J Neurol<\/em>. 2025;272(8):510. Published 2025 Jul 15. doi:10.1007\/s00415-025-13163-4<\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40664905\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Original study<\/strong><\/a><\/p>\n\n\n\n<p><strong>Study design:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>80 patients with acute PCS and AVS symptoms (dizziness, imbalance)<\/li>\n\n\n\n<li>Videonystagmography (VNG) at presentation and up to 9 days thereafter, with a total of 238 recordings<\/li>\n\n\n\n<li>Observation of whether nystagmus was present at presentation or developed during the course<\/li>\n<\/ul>\n\n\n\n<p><strong>Key results<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>47\/80 patients had nystagmus at presentation (appearing central or peripheral)<\/li>\n\n\n\n<li>33\/80 patients showed no nystagmus at presentation; 12 of them developed nystagmus during follow-up<\/li>\n\n\n\n<li>21\/80 patients remained completely free of nystagmus<\/li>\n\n\n\n<li>The type of nystagmus remained stable, with no shifts between \u201cperipheral\u201d and \u201ccentral.<\/li>\n<\/ul>\n\n\n\n<p><strong><strong>Clinical Relevance<\/strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The absence of nystagmus at initial examination does not rule out stroke<\/li>\n\n\n\n<li>Nystagmus may develop with delay<\/li>\n\n\n\n<li>Patients require inpatient monitoring with repeated clinical examinations and, if indicated, MRI<\/li>\n\n\n\n<li>\u201eAbsence of evidence is not evidence of absence.\u201c<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclusion for Practice<\/strong><\/p>\n\n\n\n<p>The study confirms that HINTS, when performed by physicians, remains indispensable in acute diagnostics. Absence of nystagmus must not be misinterpreted\u2014repeated examinations are essential.<\/p>\n\n\n\n<p>Therapists have their role in the subsequent course: they can comprehensively assess the severity and nature of the vestibular disorder and provide targeted rehabilitation\u2014whether of peripheral or central origin.<br><br><strong>\ud83d\udc49 Are you interested in a comprehensive further training in <a href=\"https:\/\/ivrt.de\/en\/patientenedukation\/vestibulaere-rehabilitationstherapie-und-gleichgewichtstraining\/\" data-type=\"post\" data-id=\"8932\">vestibular rehabilitation<\/a> and how vestibular disorders can be differentiated and rehabilitated after the acute phase?<\/strong><\/p>\n\n\n\n<p>Current further education opportunities can be found in the <strong><a href=\"https:\/\/ivrt.de\/en\/fuer-medizinisches-fachpersonal\/fortbildungssuche\/\" data-type=\"link\" data-id=\"https:\/\/ivrt.de\/fuer-medizinisches-fachpersonal\/fortbildungssuche\/\">IVRT Course search<\/a>.<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>For Patients \u2013 Easy to Understand<\/strong><\/p>\n\n\n\n<p><strong><strong>Dizziness in the Emergency Department: Why the Absence of Nystagmus Is Not Always Reassuring<\/strong><\/strong><\/p>\n\n\n\n<p>Sudden severe dizziness can be caused by a <a href=\"https:\/\/ivrt.de\/en\/schwindelerkrankungen\/neuritis-vestibularis\/\" data-type=\"post\" data-id=\"7427\">inflammation of the inner ear<\/a> or by a <a href=\"https:\/\/ivrt.de\/en\/schwindelerkrankungen\/labyrinthinfarkt\/\" data-type=\"post\" data-id=\"6001\">stroke <\/a>. A specific test\u2014the HINTS exam\u2014is often more accurate than early MRI in the emergency department.<br><br>\ud83d\udcc4 Akdal G, Nham B, Kwok B, et al. Vestibular event monitoring in acute posterior circulation stroke: from emergency room to stroke unit and beyond.\u00a0<em>J Neurol<\/em>. 2025;272(8):510. Published 2025 Jul 15. doi:10.1007\/s00415-025-13163-4<\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40664905\/\" data-type=\"link\" data-id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40421807\/\" target=\"_blank\" rel=\"noreferrer noopener\">Original study<\/a><\/p>\n\n\n\n<p><strong><strong>What does this mean<\/strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The diagnosis in the initial, severe phase of dizziness must be made exclusively by physicians.<\/li>\n\n\n\n<li>Nystagmus may arise in both inner ear inflammation and stroke.<\/li>\n\n\n\n<li>Even if no nystagmus is visible at the beginning, it may still be a stroke.<\/li>\n\n\n\n<li>Therefore, repeated medical examinations and often an MRI after a few days are necessary.<\/li>\n<\/ul>\n\n\n\n<p><strong>What role do therapists play in this context?<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>After initial medical care, specially trained vestibular therapists take over further assessment.<\/li>\n\n\n\n<li>They assess the extent to which the balance system is affected.<\/li>\n\n\n\n<li>They initiate targeted <a href=\"https:\/\/ivrt.de\/en\/schwindelerkrankungen\/vestibulaere-rehabilitationstherapie-und-gleichgewichtstraining\/\" data-type=\"post\" data-id=\"8932\">exercise programs for rehabilitation <\/a>\u2014 regardless of whether the cause lies in the inner ear or the brain.<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclusion<\/strong><\/p>\n\n\n\n<p><strong>What does this mean for you?<\/strong><\/p>\n\n\n\n<p>In cases of sudden severe dizziness, the initial assessment and diagnosis must be carried out by physicians. Later, specialized therapists can help patients train their balance and regain confidence in their own movements.<\/p>\n\n\n\n<p>\ud83c\udfaf <strong>Our IVRT\u00ae-certified dizziness and vestibular therapists<\/strong>, who can support you individually, can be found through our <strong><a href=\"https:\/\/ivrt.de\/en\/fuer-betroffene\/therapeutensuche\/\" data-type=\"page\" data-id=\"101\" target=\"_blank\" rel=\"noreferrer noopener\">IVRT therapist search<\/a><\/strong><\/p>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p>F\u00fcr Fachpersonal: Bei Patient:innen mit akutem vestibul\u00e4rem Syndrom (AVS) z\u00e4hlt die Unterscheidung zwischen Neuritis Vestibularis und einem Schlaganfall (posterior circulation stroke; PCS) zu den wichtigsten Aufgaben in der Notaufnahme. Der HINTS-Test (Head Impulse, Nystagmus, Test of Skew) hat sich dabei als sensibler als ein fr\u00fches MRT erwiesen. \ud83d\udd17 Akdal G, Nham B, Kwok B, et [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":16534,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_surecart_dashboard_logo_width":"180px","_surecart_dashboard_show_logo":true,"_surecart_dashboard_navigation_orders":true,"_surecart_dashboard_navigation_invoices":true,"_surecart_dashboard_navigation_subscriptions":true,"_surecart_dashboard_navigation_downloads":true,"_surecart_dashboard_navigation_billing":true,"_surecart_dashboard_navigation_account":true,"_jf_save_progress":"","iawp_total_views":210,"footnotes":""},"categories":[215],"tags":[],"class_list":["post-16513","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-studien-evidenz"],"_links":{"self":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts\/16513","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/comments?post=16513"}],"version-history":[{"count":1,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts\/16513\/revisions"}],"predecessor-version":[{"id":17494,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts\/16513\/revisions\/17494"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/media\/16534"}],"wp:attachment":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/media?parent=16513"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/categories?post=16513"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/tags?post=16513"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}