Schubert Michael C, Carter Nathaniel, Lo Sheng-Fu Larry
Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Front Neurol. 2021 Dec 20;12:814998. doi: 10.3389/fneur.2021.814998. eCollection 2021.
This case study describes transient downbeat nystagmus with vertigo due to a bilateral Bow Hunters Syndrome that was initially treated for 7 months as a peripheral benign paroxysmal positional vertigo. Normal static angiography and imaging studies (magnetic resonance, computed tomography) contributed to the mis-diagnosis. However, not until positional testing with the patient in upright (non-gravity dependent) was a transient downbeat nystagmus revealed with vertigo. The patient was referred for neurosurgical consult. Unfortunately, surgery was delayed due to suicidal ideation and hospitalization. Eventually, vertigo symptoms resolved following a C4-5 anterior cervical dissection and fusion. This case highlights the critical inclusion of non-gravity dependent position testing as an augment to the positional testing component of the clinical examination as well as the extreme duress that prolonged positional vertigo can cause.
本病例研究描述了一例因双侧“弓猎者综合征”导致的伴有眩晕的短暂性下跳性眼球震颤，该病例最初被当作外周性良性阵发性位置性眩晕治疗了7个月。正常的静态血管造影和影像学检查（磁共振成像、计算机断层扫描）导致了误诊。然而，直到让患者处于直立位（非重力依赖）进行位置测试时，才发现伴有眩晕的短暂性下跳性眼球震颤。患者被转诊至神经外科进行会诊。不幸的是，由于自杀念头和住院治疗，手术被推迟。最终，在进行了C4-5颈椎前路解剖和融合手术后，眩晕症状得以缓解。本病例强调了将非重力依赖位置测试作为临床检查位置测试部分的补充的重要性，以及长期位置性眩晕可能导致的极度痛苦。
