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

Publication date: March 2015 Source:Journal of Clinical Neuroscience, Volume 22, Issue 3 Author(s): Davor Pavlin-Premrl , John Waterston , Sean McGuigan , Bernard Infeld , Ron Sultana , Richard O’Sullivan , Richard P. Gerraty 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 24hours. 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 vesti...

Source: Journal of Clinical Neuroscience - February 16, 2015 Category: Neuroscience Source Type: research