Editorial: Stroke and Balance Disorders

Arlindo C. Lima Neto ^1* Michael Strupp ² Alexander A Tarnutzer ³ Andreas Zwergal ² Emilio Domínguez-Durán ⁴ Camila de Giacomo Carneiro ⁵

• ¹ University of São Paulo, São Paulo, Brazil
• ² German Vertigo and Balance Center, LMU Munich University Hospital, Munich, Bavaria, Germany
• ³ Cantonal Hospital of Baden, Baden and University of Zurich, Zurich, Switzerland, Baden, Switzerland
• ⁴ Hospital Quiron Salud Infanta Luisa, Seville, Spain, Seville, Spain
• ⁵ Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil

In addition to the head impulse test, assessing positional and spontaneous nystagmus (SN) is essential for bedside testing in the ED (2,4). Wüthrich et al. conducted a systematic review of SN patterns from 39 studies, revealing that horizontal or horizontal-torsional SN is more common in peripheral etiologies (94.8% vs.43.4%, p<0.001), while torsional or vertical SN patterns are observed significantly more frequently in central disorders (15.1% vs. 2.6%, p<0.001).The HINTS+ test, while valuable, has limitations, particularly in the absence of SN during patient evaluation (3). To address this, Fracica et al. explored additional tools, such as smooth pursuit and saccadic eye movements, focusing on anterior and posterior circulation strokes. These tools may reveal highly localized findings that can distinguish between peripheral and central etiologies in some cases.Out-of-pattern symptoms may occur due to the anatomical complexity of the vasculature and pathways of the posterior fossa and inner ear (Fig. 1). For example, Koohi et al.