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Its discovery was awarded a Nobel Prize. We aimed to investigate the diagnostic accuracy of Caloric Testing when compared to the video head impulse test (vHIT) in differentiating between vestibular neuritis and vestibular strokes in acute dizziness.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Design<\/jats:title>\n                <jats:p>Prospective cross-sectional study (convenience sample).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Setting<\/jats:title>\n                <jats:p>All patients presenting with signs of an acute vestibular syndrome at the emergency department of a tertiary referral center.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Participants<\/jats:title>\n                <jats:p>One thousand, six hundred seventy-seven patients were screened between February 2015 and May 2020 for Acute Vestibular Syndrome (AVS), of which 152 met the inclusion criteria and were enrolled. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if they were younger than 18\u00a0years, if symptoms lasted\u2009&lt;\u200924\u00a0h or if the index ED visit was\u2009&gt;\u200972\u00a0h after symptom onset. Of the 152 included patients 85 completed testing. We assessed 58 vestibular neuritis and 27 stroke patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Main outcome measures<\/jats:title>\n                <jats:p>All patients underwent calorics and vHIT followed by a delayed MRI which served as a gold standard for vestibular stroke confirmation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The overall sensitivity and specificity for detecting stroke with a caloric asymmetry cut-off of 30.9% was 75% and 86.8%, respectively [negative likelihood ratio (NLR) 0.29] compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Caloric testing proved to be less accurate than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Contrary to classic teaching, asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We, therefore, recommend to abandon caloric testing in current practice and to replace it\u00a0with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-021-10667-7","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T11:04:18Z","timestamp":1625051058000},"page":"853-860","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Paradigm shift in acute dizziness: is caloric testing obsolete?"],"prefix":"10.1007","volume":"269","author":[{"given":"Miranda","family":"Morrison","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasia","family":"Korda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Zamaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franca","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco D.","family":"Caversaccio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas C.","family":"Sauter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Kalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-7811","authenticated-orcid":false,"given":"Georgios","family":"Mantokoudis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"10667_CR1","unstructured":"Barany R (1907) Physiologie und Pathologie (Funktions-Pr\u00fcfung) des Bogengang-Apparates beim Menschen: Klinische Studien: F. 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Eyeseetec company loaned the VOG goggles.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"There are no plans to disseminate the results of the research to study participants or the relevant patient community.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Dissemination to participants and related patient and public communities"}},{"value":"All enrolled patients gave written consent. This study was approved by the local ethics committee (IRB).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}