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

Pavlin-Premrl, Davor; Waterston, John; McGuigan, Sean; Infeld, Bernard; Sultana, Ron; O’Sullivan, Richard; Gerraty, Richard

doi:10.1016/j.jocn.2014.09.011

Cited by 20 publications

(36 citation statements)

References 11 publications

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“…Although our training program (6 h workshop, 10 proctored examinations, 1-month use in daily practice) is sufficient, we have not investigated if a shorter duration of training is enough. That said, there is evidence that emergency physicians usually do not test for nystagmus, so some training is clearly needed ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm

et al. 2017

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ObjectiveWe investigated the reliability and accuracy of a bedside diagnostic algorithm for patients presenting with vertigo/unsteadiness to the emergency department.MethodsWe enrolled consecutive adult patients presenting with vertigo/unsteadiness at a tertiary hospital. STANDING, the acronym for the four-step algorithm we have previously described, based on nystagmus observation and well-known diagnostic maneuvers includes (1) the discrimination between SponTAneous and positional nystagmus, (2) the evaluation of the Nystagmus Direction, (3) the head Impulse test, and (4) the evaluation of equilibrium (staNdinG). Reliability of each step was analyzed by Fleiss’ K calculation. The reference standard (central vertigo) was a composite of brain disease including stroke, demyelinating disease, neoplasm, or other brain disease diagnosed by initial imaging or during 3-month follow-up.ResultsThree hundred and fifty-two patients were included. The incidence of central vertigo was 11.4% [95% confidence interval (CI) 8.2–15.2%]. The leading cause was ischemic stroke (70%). The STANDING showed a good reliability (overall Fleiss K 0.83), the second step showing the highest (0.95), and the third step the lowest (0.74) agreement. The overall accuracy of the algorithm was 88% (95% CI 85–88%), showing high sensitivity (95%, 95% CI 83–99%) and specificity (87%, 95% CI 85–87%), very high-negative predictive value (99%, 95% CI 97–100%), and a positive predictive value of 48% (95% CI 41–50%) for central vertigo.ConclusionUsing the STANDING algorithm, non-sub-specialists achieved good reliability and high accuracy in excluding stroke and other threatening causes of vertigo/unsteadiness.

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Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm

et al. 2017

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“…Nystagmus in dizziness patients is important for differential diagnosis 29 . Stroke may be suspected if the patient has vertical nystagmus, torsional nystagmus, or direction‐changing nystagmus 30 .…”

Section: Discussionmentioning

confidence: 99%

Predictive model for diagnosing central lesions in emergency department patients with isolated dizziness who undergo diffusion‐weighted magnetic resonance imaging

Han

Kim

You

et al. 2021

Academic Emergency Medicine

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Objectives Only 5% to 10% of patients who visit the emergency department (ED) with isolated dizziness without neurologic abnormalities may have central lesions; however, it is important to distinguish central lesions through brain imaging. This study was conducted to create a nomogram to provide an objective medical basis for selectively performing magnetic resonance imaging (MRI) among patients with isolated dizziness. Methods This retrospective observational study enrolled patients who visited the ED of a tertiary hospital with isolated dizziness and underwent diffusion‐weighted MRI and subsequently consulted with the departments of neurology, neurosurgery, or otorhinolaryngology. Multivariable logistic regression analysis was performed to identify risk factors in patients diagnosed with central lesions to create a nomogram with the significant variables. Results Of the 1,078 patients who were screened, 119 were diagnosed with central lesions. Significant variables in the multivariable logistic regression analysis were albumin levels (odds ratio [OR] = 0.339, 95% confidence interval [CI] = 0.188 to 0.610, p = 0.0003), inorganic phosphate levels (OR = 0.891, 95% CI = 0.832 to 0.954, p = 0.0010), history of ischemic stroke (OR = 3.170, 95% CI = 1.807 to 5.560, p < 0.0001), presyncope (OR = 3.152, 95% CI = 1.184 to 8.389, p = 0.0216), and nystagmus (OR = 0.365, 95% CI = 0.237 to 0.561, p < 0.0001). The area under the receiver operating characteristic curve of the nomogram created with these variables was 0.7315 (95% CI = 0.6842 to 0.7788, p < 0.0001). Conclusions Albumin, inorganic phosphate, previous stroke, presyncope, and nystagmus were associated with the predictive diagnosis of central lesions among patients admitted to the ED with isolated dizziness. The novel nomogram created using these variables can help in objectively determining the need for MRI in patients presenting with isolated dizziness to the ED.

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“…Our patient had spontaneous horizontal pendular nystagmus which was not suppressed by visual fixation. It is pathognomonic of a central system pathology (6) . Considering this type of nystagmus, along with the patient's Porencephaly is an extremely rare disease of the central nervous system characterised by a solitary or multiple cavity in the brain parenchyma, filled with cerebrospinal fluid (3) .…”

Section: Discussionmentioning

confidence: 99%

Porencephaly as a rare cause of nystagmus

Ishak¹,

Ramli²,

Mohamad³

2020

Pediatr Med Rodz

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Nystagmus is a condition of involuntary oscillatory movement of the eyes that may present in various patterns. These different types of movement and direction of nystagmus along with associated signs and symptoms can give a clue as to the location of the site of lesion, and indicate possible aetiologies. In paediatric patients, most of the causes of nystagmus are infantile or congenital, and only a small percentage may be acquired. We describe the case of a boy with spontaneous nystagmus noted since he was 3 years old and having a learning disability without other otological or neurological problems. Magnetic resonance imaging of his brain showed a porencephalic cyst which is a very rare occurrence.

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

Cited by 20 publications

References 11 publications

Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm

Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm

Predictive model for diagnosing central lesions in emergency department patients with isolated dizziness who undergo diffusion‐weighted magnetic resonance imaging

Porencephaly as a rare cause of nystagmus

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