“Eye Movement” Exam Outperforms MRI for Diagnosing Stroke

CHEAP, QUICK BEDSIDE “EYE MOVEMENT” EXAM OUTPERFORMS MRI FOR DIAGNOSING STROKE IN PATIENTS WITH DIZZINESS.

A Small study demonstrates possibilities of reducing unnecessary MRI tests and improving safety

In a small “proof of principle” study, stroke researchers at Johns Hopkins and the University of Illinois have found that a simple, one-minute eye movement exam performed at the bedside worked better than an MRI to distinguish new strokes from other less serious disorders in patients complaining of dizziness, nausea and spinning sensations.

Results of the study of 101 patients , who were already at higher than normal risk of stroke because of factors including high blood pressure or high cholesterol, were published online ahead of print on Sept. 17 in Stroke. The patients were all seen at OSF St. Francis Medical Center in Peoria, Ill.

The project, spearheaded by a Johns Hopkins neurologist in collaboration with colleagues at the University of Illinois in Peoria, found that the quick, extremely low-cost exam caught more strokes than the current gold standard of MRI, suggesting that if further research on broader populations confirms these results, physicians may have a way to improve care and avoid the high costs of MRI in some cases.

“The idea that a bedside exam could outperform a modern neuroimaging test such as MRI is something that most people had given up for dead, but we’ve shown it’s possible,” says David E. Newman-Toker, M.D., Ph.D., assistant professor of neurology at the Johns Hopkins University School of Medicine.

Dizziness is a common medical problem, Newman-Toker says, responsible for 2.6 million emergency room visits annually in the United States. While the vast majority of dizziness complaints are caused by benign inner-ear balance problems, about 4 percent are signals of stroke or transient ischemic attack (TIA, a condition that often warns of impending stroke in the coming days or weeks). Because more than half of patients with dizziness who are experiencing strokes show none of the classic stroke symptoms — one-sided weakness, numbness, or speech problems — emergency room physicians are estimated to misdiagnose at least a third of them, losing the chance for quick and effective treatment.

“We know that time is brain, so when patients having a stroke are sent home erroneously, the consequences can be really serious, including death or permanent disability,” says Jorge C. Kattah, M.D., chairman of neurology at OSF St. Francis Medical Center, who co-led the study.