Eggers Scott D Z, Kattah Jorge C
Department of Neurology, Mayo Clinic, Rochester, MN.
Department of Neurology, University of Illinois College of Medicine at Peoria.
Mayo Clin Proc Innov Qual Outcomes. 2020 Mar 9;4(2):216-222. doi: 10.1016/j.mayocpiqo.2019.12.003. eCollection 2020 Apr.
Evaluating the patient with acute constant vertigo or diplopia can be a daunting task for clinicians, who recognize that such symptoms can be the manifestation of potentially devastating disorders like stroke but may be uncomfortable eliciting and interpreting the key symptoms and subtle signs that distinguish dangerous from benign causes. We present a novel and highly instructive case of a patient with acute vertigo and binocular diplopia from a large skew deviation due to vestibular neuritis. As the case unfolds, text and video commentary guide the clinician through the important elements of the history, bedside examination, and laboratory evaluation necessary for accurate diagnosis in the acute vestibular syndrome. We demonstrate how to interpret nystagmus and properly perform the head impulse test and test of skew deviation and discuss the pitfalls of overreliance on imaging when evaluating patients with acute vertigo.
对临床医生来说，评估患有急性持续性眩晕或复视的患者可能是一项艰巨的任务，他们认识到这些症状可能是中风等潜在毁灭性疾病的表现，但在引出和解释区分危险与良性病因的关键症状和细微体征时可能会感到不自在。我们展示了一个新颖且极具启发性的病例，该患者因前庭神经炎导致大度数斜视而出现急性眩晕和双眼复视。随着病例的展开，文字和视频评论引导临床医生了解急性前庭综合征准确诊断所需的病史、床边检查和实验室评估的重要内容。我们展示了如何解释眼球震颤，正确进行摇头试验和斜视角试验，并讨论在评估急性眩晕患者时过度依赖影像学检查的陷阱。
