Capturing nystagmus in the emergency room: posterior circulation stroke versus acute vestibular neuritis.

Autor: Nham B; 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., Akdal G; Faculty of Medicine, Department of Neurology, Dokuz Eylül University, İzmir, Turkey.; Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey., Young AS; Faculty of Medicine and Health, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia., Özçelik P; Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey., Tanrıverdizade T; Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey., Ala RT; Faculty of Medicine, Department of Neurology, Dokuz Eylül University, İzmir, Turkey., Bradshaw AP; Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia., Wang C; 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., Men S; Faculty of Medicine, Department of Radiology, Dokuz Eylül University, İzmir, Turkey., Giarola BF; Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia., Black DA; Faculty of Medicine and Health, University of Sydney, Sydney, Australia., Thompson EO; Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia., Halmagyi GM; 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., Welgampola MS; Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia. miriam@icn.usyd.edu.au.; Faculty of Medicine and Health, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia. miriam@icn.usyd.edu.au.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2023 Feb; Vol. 270 (2), pp. 632-641. Date of Electronic Publication: 2022 Jul 18.
DOI: 10.1007/s00415-022-11202-y
Abstrakt: 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.
(© 2022. Crown.)
Databáze: MEDLINE
Externí odkaz: