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1.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
2.
Medicine (Baltimore) ; 99(17): e19866, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332650

RESUMO

The direction-changing bilateral gaze-evoked nystagmus (GEN) (BGEN) is a more specific sign for a gaze-holding deficit than unilateral GEN (UGEN) in a central lesion. We sought to clarify which cerebellar structure is responsible for the generation of BGEN compared with UGEN.We studied 47 cases of UGEN or BGEN associated with isolated unilateral cerebellar infarction in the territories of the cerebellar arteries diagnosed by brain magnetic resonance image (MRI) from June 2007 to April 2014. To identify the structures involved in the generation of BGEN, the overlapped lesions of the BGEN group were subtracted from those of UGEN group and vice versa.About half of the patients (25/47, 53%) showed BGEN and others showed UGEN. There was no difference in the interval from symptom onset to examination between 2 groups (1.3 days vs 2.5 days, P = .24). Thirty-five patients (35/47, 75%) with GEN also showed spontaneous nystagmus. Lesion subtraction analyses revealed that both of the patients with BGEN and UGEN had damage around the vermal pyramid, the uvula and the tonsil, parts of the biventer lobule, and the inferior semilunar lobule.Midline and lower cerebellar structures are related to both BGEN and UGEN in patients with unilateral cerebellar infarction. Regardless of unilateral or bilateral, GEN may represent damage of the gaze-holding neural integrator control system in human.


Assuntos
Infarto Encefálico/complicações , Cerebelo/anatomia & histologia , Nistagmo Patológico/etiologia , Idoso , Infarto Encefálico/fisiopatologia , Cerebelo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/fisiopatologia , Sistema de Registros/estatística & dados numéricos
3.
Invest Ophthalmol Vis Sci ; 61(3): 40, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32203983

RESUMO

Purpose: The purpose of this study was to report GNAT2-associated achromatopsia (GNAT2-ACHM) natural history, characterize photoreceptor mosaic, and determine a therapeutic window for potential intervention. Methods: Patients with GNAT2-ACHM were recruited from a single tertiary referral eye center (Moorfields Eye Hospital, London, UK). We performed longitudinal clinical evaluation and ophthalmic examination, and multimodal retinal imaging, including adaptive optics scanning light ophthalmoscopy, quantitative analysis of the cone mosaic, and outer nuclear layer (ONL) thickness, including cone densities evaluation in selected regions of interest and comparison with reported healthy controls. Results: All nine subjects (3 women) presented with nystagmus, decreased visual acuity (VA), light sensitivity, and highly variable color vision loss. One patient had normal color vision and better VA. Mean VA was 1.01 (±0.10) logarithms of the minimal angle of resolution (LogMAR) at baseline, and 1.04 (±0.10) LogMAR after a mean follow-up (range) of 7.6 years (1.7-12.8 years). Optical coherence tomography showed preservation of the foveal ellipsoid zone (EZ; n = 8; 88.9%), and EZ disruption (n = 1; 11.1%). Mean ONL thickness (range, ± SD) was 84.72 µm (28.57-113.33, ± 25.46 µm) and 86.47 µm (28.57-113.33, ± 24.65 µm) for right and left eyes, respectively. Mean cone densities (±SD) at 190 µm, 350 µm, and 500 µm from the foveal center, were 48.4 (±24.6), 37.8 (±14.7), and 30.7 (±9.9), ×103 cones/mm2, respectively. Mean cone densities were lower than these of unaffected individuals, but with an overlap. Conclusions: The cone mosaic in GNAT2-ACHM is relatively well preserved, potentially allowing for a wide therapeutic window for cone-directed interventions.


Assuntos
Defeitos da Visão Cromática/genética , Defeitos da Visão Cromática/patologia , Subunidades gama da Proteína de Ligação ao GTP/genética , Células Fotorreceptoras Retinianas Cones/patologia , Adolescente , Adulto , Criança , Testes de Percepção de Cores , Eletrorretinografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Nistagmo Patológico/diagnóstico , Oftalmoscopia , Imagem Óptica , Linhagem , Fenótipo , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
6.
World Neurosurg ; 136: 289-292, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32001401

RESUMO

BACKGROUND: Pineal lesions are common causes of dorsal midbrain syndrome and typically require surgical intervention in symptomatic patients. We describe a unique case of spontaneous resolution of dorsal midbrain syndrome resulting from a pineal gland cyst. CASE DESCRIPTION: A 23-year-old woman developed a supranuclear upgaze palsy, convergence-retraction nystagmus, and light-near dissociation from a pineal gland cyst (1.0 × 1.3 × 1.2 cm) with mild mass effect on the posterior surface of the tectum. Seven days after symptom onset, she had complete, spontaneous resolution of her symptoms, and examination returned to normal. Repeat magnetic resonance imaging demonstrated an unchanged pineal cyst with new T2/fluid attenuated inversion recovery hyperintensity along the mesial surface of the left thalamus. CONCLUSIONS: Dorsal midbrain syndrome resulting from a pineal cyst may spontaneously improve even without a significant change in lesion size. This suggests that observation may be an appropriate initial management strategy.


Assuntos
Cistos do Sistema Nervoso Central/complicações , Glândula Pineal , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/patologia , Transtornos Dissociativos/diagnóstico por imagem , Transtornos Dissociativos/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Nistagmo Patológico/diagnóstico por imagem , Nistagmo Patológico/etiologia , Transtornos da Motilidade Ocular , Glândula Pineal/diagnóstico por imagem , Remissão Espontânea , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Paralisia Supranuclear Progressiva/etiologia , Teto do Mesencéfalo/diagnóstico por imagem , Teto do Mesencéfalo/patologia , Adulto Jovem
7.
Artigo em Chinês | MEDLINE | ID: mdl-32086931

RESUMO

Vertical nystagmus is a vertical nystagmus caused by structural abnormalities and/or dysfunction of the central vestibular system and observed in situ in the center of the eyeball. There are two kinds of nystagmus (UBN) and downbeat nystagmus (DBN) according to the direction of nystagmus. The diagnosis of UBN is mainly made by naked eye or electronystagmography/viewer. It is a common neuro-ophthalmologic sign in the field of vestibular medicine. In this paper, the mechanism of vertical nystagmus formation and the location of lesions were briefly introduced, in order to provide help for the diagnosis and treatment of Vertigo.


Assuntos
Olho/patologia , Nistagmo Patológico/diagnóstico , Eletronistagmografia , Humanos , Vertigem
9.
Strabismus ; 28(1): 3-6, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31889465

RESUMO

Purposes: To establish a relation between pendular low amplitude high frequency (PLAHF) components and congenital retinal disorders.Methods: Patients who showed PLAHF components in their eye-movement recording between January 2016 to January 2019 were included. Best corrected visual acuity (BCVA), refraction, strabismus assessment, fundus photograph, spectral domain-optical coherence tomography (SD-OCT), full-field electroretinography (f-ERG), clinical ophthalmological examination, and gene tests were used to determine their clinical conditions, especially their retina conditions in all patients.Results: Among 136 patients there were 76 males and 60 females with mean age of 11.4.5 ± 4.5 years. Pure PLAHF waveforms were found in 38 patients (28%), the amplitude of the PLAHF was 2°±1.6° and frequency was 5-10 Hz. Superimposed PLAHF waveforms were found in 98 patients (72%). BCVA was worse than Log MAR1.0 in 94 patients (69%), between LogMar 0.5-1.0 (20/63-20/200) in 30 cases (22%); higher than LogMar 0.5 (20/63) in 12 cases (9%). Fifty-eight patients were diagnosed with exotropia and six patients with esotropia. Abnormal Fundus were found in 71 cases (52%), fovea hypoplasia was identified with OCT in 95 cases (70%) and retinal thinning in 92 cases (68%). Abnormal on-off VEP were found in 116 cases (85%). The f-ERG responses were reduced in all patients. In 46 patients, gene mutations were found to related to retinal disease, including 3 congenital stationary night blindness (CSNB), 14 achromatopsia (ACHM), 5 Aland Island eye disease (AIED), 7 Alstrom syndrome (AS), 11 Leber congenital amaurosis (LCA), 6 cone-rod dystrophy (CRD).Conclusions: Patients presenting with PLAHF usually had retinal disorders.


Assuntos
Nistagmo Patológico/diagnóstico , Distrofias Retinianas/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Eletronistagmografia , Eletrorretinografia , Feminino , Humanos , Lactente , Masculino , Nistagmo Patológico/fisiopatologia , Distrofias Retinianas/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
10.
World Neurosurg ; 134: 577-579, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790839

RESUMO

BACKGROUND: Spontaneous downbeat nystagmus is a finding that raises suspicions of a central nervous system disorder. Vermis and lower brainstem lesions are considered to be responsible, but the exact mechanism is still controversial. We observed a rare case of spontaneous downbeat nystagmus caused by an infratentorial meningioma. CASE DESCRIPTION: A 50-year-old woman was incidentally diagnosed with infratentorial tumor. Later, she suffered from oscillopsia and the symptom disturbed her daily life especially while driving. Magnetic resonance imaging showed a tumor of approximately 30 mm in diameter at the dorsal midline of the posterior fossa. The tumor was compressing the cerebellar vermis and was apparently responsible for the symptoms that affected her daily life; therefore, we decided to perform tumor removal. The postoperative course was uneventful, and the spontaneous downbeat nystagmus completely disappeared. CONCLUSIONS: Vertical nystagmus is a finding that raises suspicion of a central nervous system disorder, and requires detailed examination. In addition, in case of vertical nystagmus because of tumor compression of the vermis, removal of the tumor can be an effective treatment.


Assuntos
Neoplasias Infratentoriais/cirurgia , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgia , Nistagmo Patológico/etiologia , Encéfalo/patologia , Feminino , Humanos , Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/diagnóstico , Imagem por Ressonância Magnética/efeitos adversos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/cirurgia , Resultado do Tratamento
11.
Am J Ophthalmol ; 210: 3-7, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31730837

RESUMO

PURPOSE: To evaluate long-term outcomes of surgical treatment for abnormal head positioning (AHP) associated with infantile nystagmus syndrome (INS). DESIGN: Retrospective observational case series. METHODS: Review of 150 patients who underwent surgery for AHP associated with nystagmus. Outcomes included head positioning, duction limitations, and strabismus, and were evaluated several times postoperatively. Successful collapse of AHP was defined as being ≤10°. RESULTS: Thirty-one patients had surgery for AHP in the pitch (chin up/down) position, whereas 119 had surgery for a horizontal AHP. In addition, 54 underwent 50%-60% augmentation, 19 underwent 40% augmentation, 5 underwent less than 40% augmentation. Thirty-eight had surgical dose modified to correct strabismus, and 3 underwent surgery different from standard Kestenbaum procedures. Collapse of AHP: At the 1-3-week follow-up (n = 131), 125 patients (95%) had collapse of AHP. The percentage trended down at the 2-5-month (91%, n = 106) and 2-year follow-ups (83%, n = 57). However, at 5 and 10 years, it was 93% (n = 42) and 93% (n = 14), respectively, due to reoperation in a small minority. Over- and undercorrection: At 1-3 weeks, 5% of patients were overcorrected whereas 0% were undercorrected. Over- and undercorrection rates peaked at 2 years postoperatively. Ten years out, there were no overcorrections and 7% undercorrections. Four percent of patients required reoperation for overcorrection (mean 2.7 years) and 5% did for undercorrection (mean 3.9 years). CONCLUSION: Surgery for the head positioning associated with INS produces excellent outcomes throughout 10 years postoperatively. Overcorrection presents early and resolves either over time or with additional surgery. Undercorrection develops later and can persist despite reoperation.


Assuntos
Cabeça/fisiologia , Nistagmo Patológico/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Postura/fisiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Nistagmo Patológico/fisiopatologia , Estudos Retrospectivos , Estrabismo/cirurgia
12.
Infection ; 48(1): 137-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31606875

RESUMO

CASE DESCRIPTION: A 73-year-old male presented with new onset dizziness and a 22-kg weight loss due to antibiotic-induced nausea/vomiting. Due to gaze-evoked nystagmus (GEN), thiamine deficiency was suspected. Within 12 h after replacement, his GEN decreased. CONCLUSION: In patients with nutritional deprivation, new onset GEN should prompt further diagnostics and immediate thiamine supplementation to avoid disease progression.


Assuntos
Antibacterianos/efeitos adversos , Desnutrição/etiologia , Náusea/complicações , Deficiência de Tiamina/diagnóstico , Idoso , Humanos , Masculino , Náusea/induzido quimicamente , Nistagmo Patológico/induzido quimicamente , Deficiência de Tiamina/induzido quimicamente , Deficiência de Tiamina/terapia , Resultado do Tratamento
13.
Strabismus ; 28(1): 17-19, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31566469

RESUMO

Purpose: To describe Optical Coherence Tomography (OCT) findings of the macula in patients with nystagmus, mainly the relationship between spectral-domain OCT (SD-OCT) images and nystagmus in macular dysplasia.Methods: In this study, 17 cases (29 eyes) with congenital macular abnormalities in patients with albinism, macular heterotopias, congenital aniridia, foveal hypoplasia, congenital macular coloboma, and congenital retinoschisis were retrospectively analyzed. Patients underwent multimodal retinal imaging examinations including ultra-widefield fundus imaging, SD-OCT, autofluorescence, and visual field. When the pit was not clearly presented, SD-OCT imaging was centered at the expected foveal center.Results: In cases of oculocutaneous albinism SD-OCT showed the absence of the foveal pit and increased foveal thickness, with nystagmus. Their fundus revealed a lack of pigment in retinal pigment epithelium with visible large choroidal vessels. SD-OCT in congenital aniridia showed a planar fovea in the macula with the lack of a foveal pit and nystagmus. SD-OCT showed the absence of a foveal pit in foveal hypoplasia with nystagmus. In cases of monocular macular heterotopia, no nystagmus was found; the fellow eye had good vision and the macular morphology was usually normal. Nystagmus was not found in patients with congenital macular coloboma and congenital retinoschisis in this study.Conclusion: SD-OCT plays an important role in the diagnosis and prognosis of macular dysplasia in patients with nystagmus. Absence of a normal foveal pit is an OCT-imaging characteristic of macular dysplasia associated with nystagmus.


Assuntos
Nistagmo Patológico/etiologia , Displasia Retiniana/complicações , Adulto , Feminino , Humanos , Masculino , Imagem Multimodal , Nistagmo Patológico/diagnóstico , Imagem Óptica , Displasia Retiniana/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Testes de Campo Visual , Campos Visuais/fisiologia
14.
J Laryngol Otol ; 134(1): 86-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31843038

RESUMO

BACKGROUND: Periodic alternating nystagmus is a rare condition characterised by spontaneous horizontal nystagmus that periodically reverses direction, indicating an alteration of the velocity storage mechanism. Windmill nystagmus is a peculiar and rare variant of periodic alternating horizontal nystagmus with a superimposed periodic alternating vertical nystagmus. It is generally observed in blind patients. CASE REPORT: This paper presents the unique case of a normally sighted patient with a windmill nystagmus triggered by an episode of benign paroxysmal positional vertigo due to bilateral posterior canalolithiasis. Videonystagmography revealed an anticlockwise up-beating nystagmus followed by a clockwise down-beating nystagmus with a cycle lasting 2 minutes, followed by a brief burst of horizontal left-beating nystagmus. CONCLUSION: This case report represents the first observation of a new type of windmill nystagmus, probably provoked by a malfunction of the velocity storage mechanism, gaze-stabilisation and short-adaptation networks, with a loss of cerebellar inhibition.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Nistagmo Patológico/diagnóstico , Canais Semicirculares/fisiopatologia , Idoso de 80 Anos ou mais , Vertigem Posicional Paroxística Benigna/fisiopatologia , Feminino , Humanos , Nistagmo Patológico/fisiopatologia , Testes de Função Vestibular , Gravação em Vídeo
16.
Ugeskr Laeger ; 181(48)2019 Nov 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-31791457

RESUMO

Acute vestibular syndrome (AVS) is an acute-onset of continuous vertigo with no other neurological deficits. AVS is most often of peripheral origin - vestibular organ or nerve. However, in some cases AVS is caused by a posterior circulation stroke (PCS). Head impulse, nystagmus and test of skew (HINTS) can be used to differentiate peripheral causes of AVS from central causes. Within the first 48 hours after onset of symptoms, HINTS has a higher sensitivity of detecting PCS (96-100%) than an MRI (72-87%). We recommend using HINTS for acute dizzy patients.


Assuntos
Nistagmo Patológico , Acidente Vascular Cerebral , Vertigem , Humanos , Náusea , Nistagmo Patológico/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Vertigem/etiologia , Vômito
17.
J Pediatr Ophthalmol Strabismus ; 56: e79-e83, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31821513

RESUMO

Russell diencephalic syndrome is a condition in which infants become emaciated in the setting of a decreased or normal caloric intake as the result of a hypothalamic astrocytoma. The diagnosis may be delayed if providers initially attribute the symptoms to a behavioral disorder. The detection of nystagmus, which is present in many patients, may be a critical diagnostic clue. The authors describe two patients in whom the discovery of nystagmus months after the onset of emaciation led to the diagnosis of Russell diencephalic syndrome. [J Pediatr Ophthalmol Strabismus. 2019;56:e79-e83.].


Assuntos
Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Nistagmo Patológico/etiologia , Astrocitoma/diagnóstico , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Masculino , Nistagmo Patológico/diagnóstico , Síndrome
19.
BMC Ophthalmol ; 19(1): 257, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842796

RESUMO

BACKGROUND: Lithium salts have been commonly used for prophylaxis and treatment of bipolar disorder and have numerous side effects. However, there has been no report of skew deviation and downbeat nystagmus associated with lithium. Herein, we report the first case of lithium-induced skew deviation and downbeat nystagmus. CASE PRESENTATION: A 39 years-old woman presented with intermittent vertical diplopia and dizziness within 1-2 months. Ophthalmologic examination revealed downbeat nystagmus and 6 prism diopters of right hypertropia. Funduscopic examination showed mild incyclotorsion on right eye. However, ductions and versions were within normal range. Other neurological examinations were also normal. She had a history of bipolar disorder treated with daily 600-900 mg of lithium for past 6 years, and 2 months before the first visit, daily dose of lithium was increased to 1200 mg. We referred the patients to psychiatrist. Although the serum level of lithium was within the normal therapeutic range, her daily dose of lithium was reduced to 600 mg and then stopped. 6 days after cessation of lithium, down beat nystagmus and right hypertropia were completely resolved and symptoms did not recur over a year. CONCLUSION: Even within a normal therapeutic range, downbeat nystagmus and skew deviation can occur as side effect of lithium. Dehydration may contribute to the neurotoxicity of lithium.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Compostos de Lítio/efeitos adversos , Nistagmo Patológico/induzido quimicamente , Transtornos da Motilidade Ocular/induzido quimicamente , Adulto , Encéfalo/diagnóstico por imagem , Diplopia/fisiopatologia , Feminino , Humanos , Compostos de Lítio/administração & dosagem , Imagem por Ressonância Magnética , Nistagmo Patológico/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Visão Binocular/fisiologia
20.
J Int Adv Otol ; 15(3): 425-430, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31846924

RESUMO

OBJECTIVES: The aim of the present study was to evaluate the ability of head-shaking nystagmus (HSNy), evoked after the resolution of a vertigo spell, to predict an imminent crisis in the early stage of Meniere's disease (MD). MATERIALS AND METHODS: A total of 20 patients in the early stage of MD were included in the study. The head-shaking test (HST) was performed twice, during the first visit within 24 h of vertigo spell (T0) and 48 h later (T1). The onset of a new vertigo episode during the 2 weeks following the first visit was recorded in each patient's medical record. The sensitivity and specificity of HSNy toward predicting a new vertigo episode were calculated. RESULTS: At T0, an evoked ipsilesional HSNy in 15 (75%) patients was observed; in four of them, the HSNy had a biphasic component. The HSNy was present and persistent at T1 in 8 (42.1%) patients; among these cases, 6 patients had ipsilesional HSNy, and 2 patients a contralesional HSNy. None of the patients presented with a biphasic HSNy at T1. Seven (36.8%) patients experienced the recurrence of a vertigo crisis. Among these, 6 patients had ipsilesional HSNy at T1. Only 8 patients with ipsilesional HSNy at T0 did not have recurrence. The sensitivity of the ipsilesional HSNy in predicting the recurrence of vertigo in patients with MD was 100% at T0 and 85.7% at T1. The specificity was 46.6% and 100% at T0 and T1, respectively. CONCLUSION: The HST can be a useful test in the early stages of MD to predict a new vertigo attack.


Assuntos
Doença de Meniere/fisiopatologia , Nistagmo Patológico/diagnóstico , Vertigem/diagnóstico , Testes de Função Vestibular/estatística & dados numéricos , Adulto , Feminino , Cabeça/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Doença de Meniere/complicações , Pessoa de Meia-Idade , Nistagmo Patológico/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Sensibilidade e Especificidade , Vertigem/etiologia , Testes de Função Vestibular/métodos
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