Koohi Nehzat, Male Amanda J, Kaski Diego
Department of Clinical and Movement Neurosciences, The UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
Front Neurol. 2023 Oct 5;14:1266778. doi: 10.3389/fneur.2023.1266778. eCollection 2023.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management.
To evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo.
Following routine ED care, patients with a primary complaint of dizziness, vertigo, light-headedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analyzed.
Of 71 consented patients (21-91 years; mean 56 years, ±16.7 years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (mean 48.85 years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88 years, mean 66 years, ±12.22, 5 females), and six with central positional nystagmus (age range 23-59 years, mean 41.67 years, ±15.78, 6 females).
Positional vertigo should be assessed with positional maneuvers such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity.
良性阵发性位置性眩晕（BPPV）是位置性眩晕最常见的病因。然而，位置性眩晕也可能由影响中枢前庭通路的疾病引起，如前庭性偏头痛。准确及时的诊断有助于进行有效的分诊和管理。
评估急诊科医生与急性眩晕专科医生对因位置性眩晕就诊于急诊科（ED）的患者所做出的诊断。
在急诊科进行常规护理后，以头晕、眩晕、头轻脚重或不稳为主要诉求的患者接受了急性眩晕专科医生的详细神经耳科评估。记录并分析了人口统计学数据和最终诊断结果。
在71名同意参与的患者中（年龄21 - 91岁；平均56岁，±16.7岁，40名女性），急诊科识别出13例位置性眩晕的外周病因患者（平均48.85岁，±16.19岁，8名女性）。急诊科医生诊治的位置性眩晕患者中均未发现中枢性位置性眼震。急性眩晕专科医生诊断出9例BPPV患者（年龄范围50 - 88岁，平均66岁，±12.22岁，5名女性），以及6例中枢性位置性眼震患者（年龄范围23 - 59岁，平均41.67岁，±15.78岁，6名女性）。
在急诊科应通过Dix - Hallpike和Roll试验等位置性手法对位置性眩晕进行评估，以识别外周和中枢性眼震特征。中枢性病因在年轻女性中更为常见，常伴有呕吐和/或运动敏感史。
