TeleAutoHINTS: A Virtual or Augmented Reality (VR/AR) System for Automated Tele-Neurologic Evaluation of Acute Vertigo

Abstract Annually, several million patients in the United States visit the emergency room (ER) with symptoms of vertigo or dizziness. Rapidly distinguishing between benign causes, such as inner ear disease, and more severe conditions, like strokes, necessitates performing and interpreting a three-step bedside head and eye movement assessment called HINTS (head impulse, nystagmus, and test of skew). This test is more accurate than state-of-the-art brain imaging, especially early in the disease’s course when there is a limited window for safely conducting lifesaving stroke interventions. A significant barrier to its widespread adoption is the shortage of experts trained to safely perform and interpret this test in the ER. This highlights the need for automated remote assessments. In response, we developed TeleAutoHINTS as a two-part solution: (1) a head-mounted display-based head and eye tracking platform, using Microsoft Hololens2, for automated tele-sensing and (2) an interconnected interface for real-time data visualization and analysis. We tested TeleAutoHINTS on three subjects to assess the feasibility of automated testing and evaluate the head and eye movement recordings. Preliminary results suggest that a head-mounted display-based remote self-assessment platform for acute vertigo diagnosis is technically feasible.