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Background and Purpose: The aim of this study was to determine the prevalence of stroke and efficacy of bedside evaluation in diagnosing stroke in acute transient vestibular syndrome (ATVS)., Methods: We performed a prospective, single-center, observational study that had consecutively recruited 86 patients presenting with ATVS to the emergency department of Pusan National University Yangsan Hospital from January to December 2014. All patients received a constructed evaluation, including HINTS plus (head impulse, nystagmus patterns, test of skew, and finger rubbing) and brain magnetic resonance imagings. Patients without an obvious cause further received perfusion-weighted imaging. Multivariable logistic regression was used to determine clinical parameters to identify stroke in ATVS., Results: The prevalence of stroke was 27% in ATVS. HINTS plus could not be applied to the majority of patients because of the resolution of the vestibular symptoms, and magnetic resonance imagings were falsely negative in 43% of confirmed strokes. Ten patients (12%) showed unilateral cerebellar hypoperfusion on perfusion-weighted imaging without an infarction on diffusion-weighted imaging, and 8 of them had a focal stenosis or hypoplasia of the corresponding vertebral artery. The higher risk of stroke in ATVS was found in association with craniocervical pain (odds ratio, 9.6; 95% confidence interval, 2.0-45.2) and focal neurological symptoms/signs (odds ratio, 15.2; 95% confidence interval, 2.5-93.8)., Conclusions: Bedside examination and routine magnetic resonance imagings have a limitation in diagnosing strokes presenting with ATVS, and perfusion imaging may help to identify strokes in ATVS of unknown cause. Associated craniocervical pain and focal neurological symptoms/signs are the useful clues for strokes in ATVS., (© 2017 American Heart Association, Inc.)

Pupil-sparing inferior divisional oculomotor nerve palsy is rare and has not been described in Tolosa-Hunt syndrome (THS). A 24-year-old man with right supraorbital pain and binocular vertical diplopia for 2 weeks underwent full neuro-ophthalmolgical evaluations including brain magnetic resonance imaging (MRI). The patient showed right exo- and hypertropia with impaired depression and adduction of the right eye. The pupils were normal. Other findings of neurological examination and brain MRI were normal. The headache and ophthalmoplegia improved within 2 days of corticosteroid treatment. In view of the pupil sparing, the patient may have a lesion selectively involving the shorter branch of the oculomotor inferior division in the orbit. THS may manifest with pupil-sparing inferior divisional oculomotor palsy. [ABSTRACT FROM AUTHOR]