From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley.
Neurology. 2021 Jan 5;96(1):34-38. doi: 10.1212/WNL.0000000000010980. Epub 2020 Oct 1.
Patients with acute vestibular disorders are often a diagnostic challenge for neurologists, especially when the evaluation must be conducted remotely. The clinical dilemma remains: Does the patient have a benign peripheral inner ear problem or a worrisome central vestibular disorder, such as a stroke? The use of a focused history and the virtual HINTS (head impulse test, nystagmus evaluation, and test of skew) examination are key steps towards correctly diagnosing and triaging the acute vertiginous patient. When looking for signs of vestibulo-ocular dysfunction, there are important technological and practical considerations for an effective clinical interpretation.
急性前庭障碍患者常常给神经内科医生带来诊断上的挑战,尤其是在必须远程进行评估时。临床难题依然存在:患者是患有良性外周内耳问题,还是令人担忧的中枢性前庭障碍,如脑卒中?使用重点病史和虚拟 HINTS(摇头试验、眼震评估和偏斜试验)检查是正确诊断和分诊急性眩晕患者的关键步骤。在寻找前庭眼动功能障碍迹象时,有效临床解读需要考虑重要的技术和实际问题。