Control of SARS-CoV-2 infection in rituximab-treated neuroimmunological patients
Marcel S. Woo, David Steins, Vivien Häußler, Matin Kohsar, Friedrich Haag, Birte Elias-Hamp, Christoph Heesen, Marc Lütgehetmann, Julian Schulze zur Wiesch, Manuel A. Friese
Abstract
Background!#!Diagnostic classification of central vs. peripheral etiologies in acute vestibular disorders remains a challenge in the emergency setting. Novel machine-learning methods may help to support diagnostic decisions. In the current study, we tested the performance of standard and machine-learning approaches in the classification of consecutive patients with acute central or peripheral vestibular disorders.!##!Methods!#!40 Patients with vestibular stroke (19 with and 21 without acute vestibular syndrome (AVS), defined by the presence of spontaneous nystagmus) and 68 patients with peripheral AVS due to vestibular neuritis were recruited in the emergency department, in the context of the prospective EMVERT trial (EMergency VERTigo). All patients received a standardized neuro-otological examination including videooculography and posturography in the acute symptomatic stage and an MRI within 7 days after symptom onset. Diagnostic performance of state-of-the-art scores, such as HINTS (Head Impulse, gaze-evoked Nystagmus, Test of Skew) and ABCD!##!Results!#!Machine-learning methods (e.g., MultiGMC) outperform univariate scores, such as HINTS or ABCD!##!Conclusions!#!Established clinical scores (such as HINTS) provide a valuable baseline assessment for stroke detection in acute vestibular syndromes. In addition, machine-learning methods may have the potential to increase sensitivity and selectivity in the establishment of a correct diagnosis.