Evaluation of patients with vertigo of vertebrobasilar insufficiency origin using auditory brainstem response, electronystagmography, and transcranial Doppler

Abstract

Objectives: Vertigo can be a manifestation of underlying vertebrobasilar stroke in older adults. The study objectives were to investigate the correlation, sensitivity, and specificity of the auditory brainstem response (ABR), electronystagmorgraphy (ENG), and transcranial Doppler (TCD) collectively to distinguish between vertigo due to vertebrobasilar insufficiency (VBI) and vertigo due to non-VBI. Design: Prospective experimental study comparing ENG, ABR, and TCD battery findings between two groups of patients with vertigo and a control group. Study sample: Participants included 14 patients with vertigo of VBI origin, 14 patients with vertigo of non-VBI, and 11 matched controls. Results: Participants with VBI had more abnormal findings in the ENG (86%), TCD (72%), and ABR (64%) compared to the non-VBI group (64%, 21%, and 7%, respectively) and the control group. The combined battery revealed positive correlations, 64% sensitivity, and 84% positive predictive value (PPV) in the VBI group, and 100% specificity with lack of correlations in the non-VBI group. Conclusions: The modest sensitivity and PPV helps with early detection of VBI, thus preventing risk of vertebrobasilar stroke in 84% to 64% of patients. The 100% specificity in the non-VBI group rules out VBI, thus reducing the referral rate for unnecessary, diagnostic evaluations and ineffective treatment.

Key Words::

• Vertigo
• vertebrobasilar insufficiency (VBI)
• electronystagmography (ENG)
• transcranial Doppler (TCD)
• auditory brainstem response (ABR)
• pulsatility index (PI)
• mean flow velocity (MFV)
• posterior inferior cerebellar artery (PICA)

Acknowledgements

We would like to express our appreciation to all individuals who voluntary participated in this study. We thank Tiffany Gerik, Bryce Kennedy, and Dr. Gloria Galanes for reviewing and proofreading earlier version of this paper. We are thankful for the anonymous reviewers for their valuable comments. Part of this paper was presented 2011 American AudiologyNOW Convention in Chicago, USA.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.