眼球震颤模式在鉴别周围性和中枢性急性前庭综合征中的作用:一个重要的回顾。

IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY
Sun-Uk Lee, Alexander A Tarnutzer
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引用次数: 0

摘要

眩晕和头晕是急诊室最常见的症状之一,占所有紧急咨询的4%。其鉴别诊断的广泛性和这些症状的短暂性对治疗医生构成了重大挑战。在床边结合各种细微的眼动体征,对于符合急性前庭综合征诊断标准的急性头晕患者(即急性和长时间的眩晕或伴有恶心或呕吐、步态不平衡、运动不耐受和[非强制性]眼球震颤)区分外周性和中枢性原因非常成功。虽然提示(头-冲动-眼球震颤-偏差检验)算法的诊断准确性已被广泛研究,但对急性前庭综合征患者床边观察到的各种眼球震颤模式的价值知之甚少。在这里,我们回顾了自发性和触发性的眼球震颤模式,并讨论了它们的影响和局限性,包括原发性凝视水平、垂直和扭转型眼球震颤,偏心性凝视时的眼球震颤,以及由摇头、过度通气、体位测试、振动和Valsalva动作等刺激引发的眼球震颤。我们的结论是,眼球震颤模式在鉴别外周和中枢原因方面的作用很大程度上取决于所看到的模式和所进行的检查类型,这对扭转性和垂直自发性眼球震颤、下行性或向地性水平性和难治性位置性眼球震颤的中心原因具有很高的预测性。只有在水平摇头后的垂直性眼球震颤(“扭曲性”摇头眼球震颤)中,中心原因的预测值中等,因为它也可能发生在周围病例中,而振动性眼球震颤和valsalva性眼球震颤的预测值较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Usefulness of Nystagmus Patterns in Distinguishing Peripheral From Central Acute Vestibular Syndromes at the Bedside: A Critical Review.

Vertigo and dizziness are amongst the most frequent presenting symptoms in the emergency room, accounting for up to 4% of all emergency consultations. The broadness of their differential diagnosis and the often transient nature of these symptoms pose a significant challenge to the treating physician. Combining various subtle oculomotor signs at the bedside has been very successful in distinguishing peripheral from central causes in acutely dizzy patients meeting diagnostic criteria for the acute vestibular syndrome (i.e., acute and prolonged vertigo or dizziness accompanied by nausea or vomiting, gait imbalance, motion intolerance, and [not mandatory] nystagmus). While the diagnostic accuracy of the HINTS (Head-Impulse-Nystagmus-Test-of-Skew) algorithm has been studied extensively, less is known about the value of various nystagmus patterns seen at the bedside in patients with an acute vestibular syndrome. Here we review both spontaneous and triggered presenting nystagmus patterns and discuss their impacts and limitations, including primary-gaze horizontal, vertical, and torsional nystagmus, nystagmus during eccentric gaze, and nystagmus triggered by stimuli such as head-shaking, hyperventilation, positional testing, vibration, and the Valsalva maneuver. We conclude that the usefulness of nystagmus patterns in discriminating peripheral and central causes strongly depends on the pattern seen and the type of testing performed, being highly predictive of a central cause for torsional and vertical spontaneous nystagmus, downbeat, or apogeotropic horizontal and treatment-refractory positional nystagmus. The predictive value for central causes was moderate only for vertical nystagmus after horizontal head-shaking ("perverted" head-shaking nystagmus) since it can also occur in peripheral cases, while the predictive value was low for vibration-induced nystagmus and Valsalva-induced nystagmus.

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来源期刊
Journal of Clinical Neurology
Journal of Clinical Neurology 医学-临床神经学
CiteScore
4.50
自引率
6.50%
发文量
0
审稿时长
>12 weeks
期刊介绍: The JCN aims to publish the cutting-edge research from around the world. The JCN covers clinical and translational research for physicians and researchers in the field of neurology. Encompassing the entire neurological diseases, our main focus is on the common disorders including stroke, epilepsy, Parkinson''s disease, dementia, multiple sclerosis, headache, and peripheral neuropathy. Any authors affiliated with an accredited biomedical institution may submit manuscripts of original articles, review articles, and letters to the editor. The JCN will allow clinical neurologists to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism.
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