在急诊室捕捉眼球震颤：后循环卒中与急性前庭神经炎。
Capturing nystagmus in the emergency room: posterior circulation stroke versus acute vestibular neuritis.
机构信息
Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
Faculty of Medicine and Health, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia.
出版信息
J Neurol. 2023 Feb;270(2):632-641. doi: 10.1007/s00415-022-11202-y. Epub 2022 Jul 18.
OBJECTIVES
To compare acute nystagmus characteristics of posterior circulation stroke (PCS) and acute vestibular neuritis (AVN) in the emergency room (ER) within 24 h of presentation.
METHODS
ER-based video-nystagmography (VNG) was conducted, recording ictal nystagmus in 101 patients with PCS (on imaging) and 104 patients with AVN, diagnosed on accepted clinical and vestibular test criteria.
RESULTS
Patients with stroke in the brainstem (38/101, affecting midbrain (n = 7), pons (n = 19), and medulla (n = 12)), cerebellum (31/101), both (15/101) or other locations (17/101) were recruited. Common PCS territories included posterior-inferior-cerebellar-artery (41/101), pontine perforators (18/101), multiple-territories (17/101) and anterior-inferior-cerebellar-artery (7/101). In PCS, 44/101 patients had no spontaneous nystagmus. Remaining PCS patients had primary position horizontal (44/101), vertical (8/101) and torsional (5/101) nystagmus. Horizontal nystagmus was 50% ipsiversive and 50% contraversive in lateralised PCS. Most PCS patients with horizontal nystagmus (28/44) had unidirectional "peripheral-appearing" nystagmus. 32/101 of PCS patients had gaze-evoked nystagmus. AVN affected the superior, inferior or both divisions of the vestibular nerve in 55/104, 4/104 and 45/104. Most (102/104) had primary position horizontal nystagmus; none had gaze-evoked nystagmus. Two inferior VN patients had contraversive torsional-downbeat nystagmus. Horizontal nystagmus with SPV ≥ 5.8 °/s separated AVN from PCS with sensitivity and specificity of 91.2% and 83.0%. Absent nystagmus, gaze-evoked nystagmus, and vertical-torsional nystagmus were highly specific for PCS (100%, 100% and 98.1%).
CONCLUSION
Nystagmus is often absent in PCS and always present in AVN. Unidirectional 'peripheral-appearing' horizontal nystagmus can be seen in PCS. ER-based VNG nystagmus assessment could provide useful diagnostic information when separating PCS from AVN.
目的
比较 24 小时内就诊的后循环卒中（PCS）和急性前庭神经炎（AVN）患者在急诊室（ER）的急性眼震特征。
方法
对 101 例经影像学证实的 PCS 患者（38 例）和 104 例经公认的临床和前庭测试标准诊断为 AVN 的患者进行基于 ER 的视频眼震图（VNG）检查，记录发作性眼震。
结果
共招募了脑干（38/101，影响中脑（n=7）、脑桥（n=19）和延髓（n=12））、小脑（31/101）、两者（15/101）或其他部位（17/101）的卒中患者。常见的 PCS 部位包括后下小脑动脉（41/101）、脑桥穿支（18/101）、多部位（17/101）和前下小脑动脉（7/101）。在 PCS 中，44/101 例患者无自发性眼震。其余 PCS 患者有原发性水平（44/101）、垂直（8/101）和扭转（5/101）眼震。水平眼震在侧化 PCS 中 50%为同侧性，50%为对侧性。大多数有水平眼震的 PCS 患者（28/44）有单向“周围表现”眼震。32/101 例 PCS 患者有凝视诱发眼震。AVN 影响前庭神经的上、下或两者，分别为 104 例中的 55/104、4/104 和 45/104。大多数（102/104）有原发性水平眼震；均无凝视诱发眼震。2 例下前庭神经患者有对侧扭转性下斜性眼震。水平眼震伴 SPV≥5.8°/s，敏感性和特异性分别为 91.2%和 83.0%，可将 AVN 与 PCS 区分开来。无眼震、凝视诱发眼震和垂直扭转性眼震对 PCS 具有高度特异性（100%、100%和 98.1%）。
结论
PCS 中眼震常缺如，而 AVN 中眼震始终存在。PCS 中可见单向“周围表现”水平眼震。ER 基于 VNG 的眼震评估在将 PCS 与 AVN 区分开来时可能提供有用的诊断信息。
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