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Neurol."],"abstract":"<jats:p>Posterior circulation stroke (PCS) presents significant diagnostic challenges due to poorly localizing and non-specific symptoms, such as dizziness, nausea, and headache, which are often misattributed to benign conditions. This study introduces an innovative diagnostic tool that utilizes a machine learning algorithm-driven eye tracker to enhance early diagnosis of PCS. Our approach involves analyzing eye movements during three standard neurological eye examinations: the Dot Test, H Test, and Optokinetic Nystagmus (OKN) Test. The Discrete Radon Cumulative Distribution Transform (DRCDT) and nearest subspace (NS) classification methods were employed to distinguish between PCS patients and healthy controls by identifying specific eye movement patterns. Results demonstrate that the ensemble model combining the three tests achieved the highest sensitivity and accuracy, with a sensitivity of 96% and an accuracy of 88%, in diagnosing PCS. This study's findings underscore the potential of an eye-tracker-based diagnostic tool to support a more accurate and efficient diagnosis, particularly for non-neurology trained providers, which would improve patient outcomes with more timely and appropriate treatment. The proposed tool offers a practical solution to the limitations of current diagnostic methods, such as the need for calibration and reliance on highly trained specialists, and can be seamlessly integrated into clinical settings to support emergency medical services (EMS) and emergency department (ED) triage.<\/jats:p>","DOI":"10.3389\/fneur.2025.1632939","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T04:16:43Z","timestamp":1760415403000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Augmenting early stroke diagnosis with an eye-tracker"],"prefix":"10.3389","volume":"16","author":[{"given":"Mohamed Abul","family":"Hassan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Shifat-E-Rabbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad M.","family":"Aldridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Southerland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo K.","family":"Rohde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"B1","first-page":"192","article-title":"Posterior circulation ischemic stroke","volume":"112","author":"Go","year":"2015","journal-title":"Mo Med"},{"key":"B2","unstructured":"American Stroke Association\n          \n          2021"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2953","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.08.011","article-title":"e-NIHSS: an expanded National Institutes of Health Stroke Scale weighted for anterior and posterior circulation strokes","volume":"25","author":"Olivato","year":"2016","journal-title":"J Stroke Cerebrov Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"107541","DOI":"10.1016\/j.clineuro.2022.107541","article-title":"Posterior circulation stroke diagnosis in unselected group of acutely dizzy patients","volume":"224","author":"Kmetonyova","year":"2023","journal-title":"Clin Neurol Neurosurg"},{"key":"B5","first-page":"16","article-title":"\u201cA pilot study on camera-based neurological deficit detection,\u201d in ACM\/IEEE International Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE '20), December 16-18, 2020, Arlington, VA, USA","author":"Zhuang","year":"2020"},{"key":"B6","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1177\/17474930211046758","article-title":"Patterns of ischemic posterior circulation strokes: a clinical, anatomical, and radiological review","volume":"17","author":"Salerno","year":"2022","journal-title":"Int J Stroke"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3504","DOI":"10.1161\/STROKEAHA.109.551234","article-title":"HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging","volume":"40","author":"Kattah","year":"2009","journal-title":"Stroke"},{"key":"B8","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1136\/svn-2017-000079","article-title":"Eyes and stroke: the visual aspects of cerebrovascular disease","volume":"2","author":"Pula","year":"2017","journal-title":"Stroke Vasc Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1111\/acem.13830","article-title":"Avoiding misdiagnosis in patients with posterior circulation ischemia: a narrative review","volume":"26","author":"Gurley","year":"2019","journal-title":"Acad Emerg Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0266252","DOI":"10.1371\/journal.pone.0266252","article-title":"The HINTS examination and STANDING algorithm in acute vestibular syndrome: a systematic review and meta-analysis involving frontline point-of-care emergency physicians","volume":"17","author":"Nakatsuka","year":"2022","journal-title":"PLoS ONE"},{"key":"B11","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1177\/2396987319843701","article-title":"Posterior circulation stroke diagnosis using HINTS in patients presenting with acute vestibular syndrome: a systematic review","volume":"4","author":"Krishnan","year":"2019","journal-title":"Eur Stroke J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"772","DOI":"10.2183\/pjab.93.049","article-title":"What do eye movements tell us about patients with neurological disorders? 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