Tsang Benjamin K T, Chen Alex S K, Paine Mark
Department of Neurology, Sunshine Coast University Hospital, Sunshine Coast Region, Queensland, Australia.
Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2017 Dec;47(12):1352-1360. doi: 10.1111/imj.13552.
This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke (PCS) presenting as an AVS has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/Nystagmus/Test-of-skew) examination battery, yields a higher sensitivity for the diagnosis of PCS than even standard magnetic resonance imaging with diffusion-weighted imaging. However, most studies have only validated the utility of the HINTS examination when performed by experts, who interpret the most powerful component of HINTS, namely the head impulse test (HIT), considerably different to the novice. Several investigations useful in the differentiation of the AVS are becoming more accessible and portable, such as videooculography with Frenzel goggles and video head impulse testing (vHIT), which allows for the quantitative assessment of the HIT. In clinical practice, vHIT has already become accepted as standard of care in the evaluation of AVS.
这篇综述文章旨在提供一种基于证据的方法，用于评估在急性前庭综合征（AVS）背景下出现急性持续性、自发性眩晕的患者。将表现为AVS的后循环卒中（PCS）进行鉴别诊断，一直被视为参与急性护理的医生面临的一项重要诊断挑战。目前的证据表明，一种有针对性的病史采集和体格检查方法，重点是动眼神经检查，更具体地说是HINTS（头部脉冲/眼球震颤/斜视试验）检查组合，对于PCS的诊断，其敏感性甚至高于标准的磁共振成像和弥散加权成像。然而，大多数研究仅验证了专家进行HINTS检查的效用，专家对HINTS最有力的组成部分即头部脉冲试验（HIT）的解读，与新手有很大不同。一些对AVS鉴别诊断有用的检查正变得更易于获取和便于携带，比如使用弗伦泽尔护目镜的视频眼震图和视频头部脉冲测试（vHIT），它可以对HIT进行定量评估。在临床实践中，vHIT已被公认为是评估AVS的标准护理方法。
