Pavlin-Premrl Davor, Waterston John, McGuigan Sean, Infeld Bernard, Sultana Ron, O'Sullivan Richard, Gerraty Richard P
Department of Medicine, Monash University, Clayton, VIC, Australia.
Department of Medicine, Monash University, Clayton, VIC, Australia; Neurology Department, Alfred Hospital, Melbourne, VIC, Australia.
J Clin Neurosci. 2015 Mar;22(3):504-7. doi: 10.1016/j.jocn.2014.09.011. Epub 2014 Dec 20.
Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. We enrolled consecutive consenting patients arriving at a single emergency department with acute vertigo. There was no declared protocol for the emergency department staff. A standardized history and examination was conducted by the investigators. Observation for spontaneous nystagmus, its response to visual fixation, and testing the vestibulo-ocular reflex with the horizontal head impulse test were the chief examination components. MRI was obtained within 24 hours. Clinical criteria and MRI were used to reach the final diagnosis. The investigators' physical findings and final neurological diagnosis were compared with the initial emergency department examination findings and the referral diagnosis. There were 28 patients, 15 with vestibular neuritis, six with benign paroxysmal positional vertigo, one with stroke, suspected clinically, and three with migraine. In three the diagnosis remained uncertain. Spontaneous nystagmus was seen in all 15 patients with vestibular neuritis, fixation-suppressed in eight of 11 tested for this. The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo.
眩晕是急诊科就诊的常见原因。检测自发性眼球震颤可能是区分前庭神经炎与其他前庭疾病诊断的有用体征。我们旨在评估自发性眼球震颤在急性眩晕诊断中的作用。我们纳入了连续到达单个急诊科且患有急性眩晕并同意参与研究的患者。急诊科工作人员没有既定的方案。由研究人员进行标准化的病史询问和检查。观察自发性眼球震颤、其对视觉注视的反应以及通过水平头脉冲试验测试前庭眼反射是主要的检查内容。在24小时内进行磁共振成像（MRI）检查。使用临床标准和MRI得出最终诊断。将研究人员的体格检查结果和最终神经学诊断与急诊科最初的检查结果及转诊诊断进行比较。共有28例患者，其中15例患有前庭神经炎，6例患有良性阵发性位置性眩晕，1例临床上疑似中风，3例患有偏头痛。3例诊断仍不明确。所有15例前庭神经炎患者均可见自发性眼球震颤，其中11例接受此项测试的患者中有8例眼球震颤可被注视抑制。15例前庭神经炎患者中有12例头脉冲试验呈阳性。23例患者中有6例急诊科转诊诊断正确。检测自发性眼球震颤的能力在前庭疾病诊断中很有用，既有助于支持前庭神经炎的诊断，也有助于避免良性阵发性位置性眩晕的假阳性诊断。
