Format

Send to

Choose Destination
J Clin Neurosci. 2015 Mar;22(3):504-7. doi: 10.1016/j.jocn.2014.09.011. Epub 2014 Dec 20.

Importance of spontaneous nystagmus detection in the differential diagnosis of acute vertigo.

Author information

1
Department of Medicine, Monash University, Clayton, VIC, Australia.
2
Department of Medicine, Monash University, Clayton, VIC, Australia; Neurology Department, Alfred Hospital, Melbourne, VIC, Australia.
3
Department of Medicine, Monash University, Clayton, VIC, Australia; Clinical Trials and Research Centre, Epworth HealthCare, Richmond, VIC, Australia.
4
Neurosciences Institute, Epworth HealthCare, Richmond, VIC, Australia.
5
Emergency Department, Epworth HealthCare, Richmond, VIC, Australia.
6
Department of Medicine, Monash University, Clayton, VIC, Australia; Healthcare Imaging Services, Epworth HealthCare, Richmond, VIC, Australia.
7
Department of Medicine, Monash University, Clayton, VIC, Australia; Neurology Department, Alfred Hospital, Melbourne, VIC, Australia; Neurosciences Institute, Epworth HealthCare, Richmond, VIC, Australia; Victor Smorgon Epworth Education and Research Institute, Epworth HealthCare, Richmond, VIC, Australia. Electronic address: richard.gerraty@monash.edu.

Abstract

Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. We enrolled consecutive consenting patients arriving at a single emergency department with acute vertigo. There was no declared protocol for the emergency department staff. A standardized history and examination was conducted by the investigators. Observation for spontaneous nystagmus, its response to visual fixation, and testing the vestibulo-ocular reflex with the horizontal head impulse test were the chief examination components. MRI was obtained within 24 hours. Clinical criteria and MRI were used to reach the final diagnosis. The investigators' physical findings and final neurological diagnosis were compared with the initial emergency department examination findings and the referral diagnosis. There were 28 patients, 15 with vestibular neuritis, six with benign paroxysmal positional vertigo, one with stroke, suspected clinically, and three with migraine. In three the diagnosis remained uncertain. Spontaneous nystagmus was seen in all 15 patients with vestibular neuritis, fixation-suppressed in eight of 11 tested for this. The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo.

KEYWORDS:

Acute vestibular neuritis; Spontaneous ocular nystagmus; Vestibular diseases

PMID:
25537400
DOI:
10.1016/j.jocn.2014.09.011
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center