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Characteristics of S100B and Neuron Specific Enolase in Differentiating Acute Vertigo Cases with Central Cause; a Diagnostic Accuracy Study

Javad Mozaffari, Hassan Motamed, Kambiz Masoumi, Mohammad Ghasem Hanafi, Mohammad Ali Fahimi, Zahra Derakhshani, Farzaneh Ehyaie




Introduction: Differentiating central vertigo from peripheral ones poses a challenge to specialists. The present study aimed to examine the potential screening value of S100B and neuron-specific enolase (NSE) in this regard.

Methods: This prospective cross-sectional study recruited adult acute vertigo patients with suspected central causes visiting the emergency department (ED) in the first six hours since the onset of symptoms. The screening performance characteristics of S100B and NSE biomarkers in differentiating central vertigo cases were measured considering brain magnetic resonance imaging (MRI) as the reference test.

Results: 85 cases who met the criteria were enrolled to the study (82.3% female). The MRI of 21 (24.7%) cases had abnormal findings. The two groups were the same in terms of age, sex, and vital signs. Patients with abnormal brain MRI had significantly higher levels of S100B (p < 0.001) and NSE (p < 0.001). S100B and NSE had area under the receiver operating characteristic (ROC) curve of 90.3 (95% CI: 80.7 – 99.8) and 96.9 (95% CI: 93.7 – 100.0) in differentiating the central causes of acute vertigo, respectively.  At the cut-off point of above 119.68 pg/l, S100b had sensitivity of 90.00% (95% CI: 78.83 –95.86) and specificity of 92.00% (95% CI: 72.49 – 98.60).  The sensitivity and specificity of NSE at the cut-off point of above 18.12 ng/ml were 100.00% (95% CI: 93.14 – 100.00) and 89.47% (95% CI: 65.46 – 98.15), respectively.

Conclusion: The serum levels of S100B and NSE were significantly higher in patients with central vertigo, and could therefore be considered as accurate tools in screening acute vertigo cases with central causes in ED.


Vestibular neuronitis; biomarkers; S100B protein, human; phosphopyruvate hydratase; vertigo


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DOI: https://doi.org/10.22037/aaem.v8i1.513

DOI (PDF): https://doi.org/10.22037/aaem.v8i1.513.g682