Central Acute Vestibular Syndrome of Vascular Cause and Its Nystagmus Patterns

Abstract

Abstract:

The onset of acute vestibular syndrome (AVS) is characterized by rapid permanent vertigo, accompanying nausea, vomiting, spontaneous nystagmus, unsteady gait and intolerant head motion, these clinical symptoms last for more than 24 hours, the majority of AVS patients suffer for several days or weeks. Central AVS often originates from vascular causes, most of which are posterior circulation ischemic stroke. Even some patients with brain stem and cerebellar infarction present acute isolated vertigo, which is extremely challenging for diagnosis. With the development of researches about vestibular and eye movement physiology mechanism, bedside examination including vestibular, eye movement and posture balance system has become increasingly important. In addition to conventional neurology and otology examinations, nystagmus evaluation, which is based on the vestibular-eye reflex, contributes to rapid diagnosis of central AVS among vertigo patients. The present study elucidates the central AVS and nystagmus characteristics.

Key words: Central; Vertigo; Acute vestibular syndrome; Posterior circulation infarction; Nystagmus

摘要：

急性前庭综合征（acute vestibular syndrome，AVS）是以急性持续性眩晕起病，伴有恶心、呕吐，自发眼震，步态不稳，头动不能耐受等症状的临床综合征，持续时间超过24?h，大多为数天或数周。中枢性AVS以血管源性常见，其中大多数为后循环缺血性卒中，尤其部分脑干、小脑梗死常表现为急性孤立性眩晕，这类患者的诊断极具挑战性。随着前庭及眼动生理机制研究的深入，基于前庭、眼动及姿势平衡系统等方面的床旁检查重要性也日益凸显。眩晕患者的床旁检查，除了常规的神经科及耳科查体外，基于前庭-眼反射的各类眼震的评价极有助于快速诊断、识别中枢性AVS。本文对血管源性中枢性AVS的神经血管解剖基础、脑干和小脑卒中所致AVS的眼震特点等进行了综述归纳。

关键词: 中枢; 眩晕; 急性前庭综合征; 后循环梗死; 眼震

JU Yi, YANG Xu, ZHAO Xing-Quan. . Central Acute Vestibular Syndrome of Vascular Cause and Its Nystagmus Patterns [J]. Chinese Journal of Stroke, 2015, 10(05): 435-441.

鞠奕1，杨旭2，赵性泉1. 血管源性中枢急性前庭综合征及其眼震形式[J]. 中国卒中杂志, 2015, 10(05): 435-441.

References

1 Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging[J]. Stroke, 2009, 40:3504-3510.

2 Baloh RW, Kerber K. Baloh and Honrubia's Clinical Neurophysiology of the Vestibular System[M]. Oxford:Oxford University Press, 2010.

3 Veros K, Blioskas S, Karapanayiotides T, et al. Clinically isolated syndrome manifested as acute vestibular syndrome:Bedside neuro-otological examination and suppression of transient evoked otoacoustic emissions in the differential diagnosis[J]. Am J Otolaryngol, 2014, 35:683-686.

4 Francis DA, Bronstein AM, Rudge P, et al. The site of brainstem lesions causing semicircular canal paresis:an MRI study[J]. J Neurol Neurosurg Psychiatry, 1992, 55:446-449.

5 Lee JO, Park SH, Kim HJ, et al. Vulnerability of the vestibular organs to transient ischemia:implications for isolated vascular vertigo[J]. Neurosci Lett, 2014, 558:180-185.

6 Kim HJ, Lee SH, Park JH, et al. Isolated vestibular nuclear infarction:report of two cases and review of the literature[J]. J Neurol, 2014, 261:121-129.

7 Kim JS. Vertigo and gait ataxia without usual signs of lateral medullary infarction:a clinical variant related to rostral-dorsolateral lesions[J]. Cerebrovasc Dis (Basel, Switzerland), 1999, 10:471-474.

8 Lee H, Yi HA, Cho YW, et al. Nodulus infarction mimicking acute peripheral vestibulopathy[J]. Neurology, 2003, 60:1700-1702.

9 Shim DB, Song CE, Baek SJ, et al. A case of isolated cerebellar hemorrhage presenting as vestibular neuritis combined with contralateral benign paroxysmal positional vertigo[J]. Otolaryngol Head Neck Surg, 2011:0194599811425475.

10 Park HK, Kim JS, Strupp M, et al. Isolated floccular infarction:impaired vestibular responses to horizontal head impulse[J]. J Neurol, 2013, 260:1576-1582.

11 Ahn BY, Bae JW, Kim DH, et al. Pseudovestibular neuritis associated with isolated insular stroke[J]. J Neurol, 2010, 257:1570-1572.

12 Lee H, Sohn SI, Cho YW, et al. Cerebellar infarction presenting isolated vertigo frequency and vascular topographical patterns[J]. Neurology, 2006, 67:1178-1183.

13 Kim DU, Han MK, Kim JS. Isolated recurrent vertigo from stenotic posterior inferior cerebellar artery[J]. Otol Neurotol, 2011, 32:180-182.

14 Choi JH, Kim MJ, Lee TH, et al. Dominant vertebral artery occlusion during ipsilateral head tilt[J]. Neurology, 2011, 76:1679.

15 Noh Y, Kwon OK, Kim HJ, et al. Rotational vertebral artery syndrome due to compression of nondominant vertebral artery terminating in posterior inferior cerebellar artery[J]. J Neurol 2011, 258:1775-1780.

16 Kim DR, Lee HJ, Kim HJ, et al. Dynamic changes in the inner ear function and vestibular neural pathway related to the progression of labyrinthine infarction in patient with an anterior inferior cerebellar artery infarction[J]. Otol Neurotol, 2011, 32:1596-1599.

17 Kim JS, Cho KH, Lee H. Isolated labyrinthine infarction as a harbinger of anterior inferior cerebellar artery territory infarction with normal diffusion-weighted brain MRI[J]. J Neurol Sci, 2009, 278:82-84.

18 Lee H, Sohn SI, Jung DK, et al. Sudden deafness and anterior inferior cerebellar artery infarction[J]. Stroke, 2002, 33:2807-2812.

19 Lee H, Kim JS, Chung EJ, et al. Infarction in the territory of anterior inferior cerebellar artery spectrum of audiovestibular loss[J]. Stroke, 2009, 40:3745-3751.

20 Amarenco P, Rosengart A, DeWitt LD, et al. Anterior inferior cerebellar artery territory infarcts:mechanisms and clinical features[J]. Arch Neurol, 1993, 50:154-161.

21 Lee H, Yi HA, Baloh RW. Sudden bilateral simultaneous deafness with vertigo as a sole manifestation of vertebrobasilar insufficiency[J]. J Neurol Neurosurg Psychiatry, 2003, 74:539-541.

22 Amarenco P, Hauw JJ. Cerebellar infarction in the territory of the superior cerebellar artery:A clinicopathologic study of 33 cases[J]. Neurology, 1990, 40:1383-1383.

23 Pierrot-Deseilligny C, Milea D. Vertical nystagmus:clinical facts and hypotheses[J]. Brain, 2005, 128:1237-1246.

24 Choi JH, Jung NY, Kim MJ, et al. Pure upbeat nystagmus in association with bilateral internuclear ophthalmoplegia[J]. J Neurolog Sci, 2012, 317:148-150.

25 Kim JS, Moon SY, Choi KD, et al. Patterns of ocular oscillation in oculopalatal tremor. Imaging correlations[J]. Neurology, 2007, 68:1128-1135.

26 Habek M, Gabeli T, Pavliša G, et al. Central positioning upbeat nystagmus and vertigo due to pontine stroke[J]. J Clin Neurosci, 2011, 18:977-978.

27 Koga N, Ishikawa H. Clinical evaluation of primary position downbeat nystagmus[J]. Nippon Ganka Gakkai Zasshi, 2006, 110:468-472.

28 Nakamagoe K, Shimizu K, Koganezawa T, et al. Downbeat nystagmus due to a paramedian medullary lesion[J]. J Clin Neurosci, 2012, 19:1597-1599.

29 Tilikete C, Jasse L, Pelisson D, et al. Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor[J]. Neurology, 2011, 76:1650-1657.

30 Jeong SH, Kim EK, Lee J, et al. Patterns of dissociate torsional–vertical nystagmus in internuclear ophthalmoplegia[J]. Ann N Y Acad Sci, 2011, 1233:271-278.

31 Huh YE, Kim JS. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction:imaging correlations[J]. Brain, 2011, 134:3662-3671.

32 Kim HA, Lee H, Sohn SI, et al. Perverted head shaking nystagmus in focal pontine infarction[J]. J Neurol Sci, 2011, 301:93-95.

33 Baier B, Dieterich M. Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions[J]. Neurology, 2011, 76:361-365.

34 Huh YE, Koo JW, Lee H, et al. Head-shaking aids in the diagnosis of acute audiovestibular loss due to anterior inferior cerebellar artery infarction[J]. Audiol Neuro-otol, 2012, 18:114-124.

35 Yee RD. Downbeat nystagmus:characteristics and localization of lesions[J]. Trans Am Ophthalmol Soc, 1989, 87:984.

36 Jorns-Häderli M, Straumann D, Palla A. Accuracy of the bedside head impulse test in detecting vestibular hypofunction[J]. J Neurol Neurosurg Psychiatry, 2007, 78:1113-1118.

37 Newman-Toker DE, Kattah JC, Alvernia JE, et al. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis[J]. Neurology, 2008, 70:2378-2385.

38 Chen L, Lee W, Chambers BR, et al. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit[J]. J Neurol, 2011, 258:855-861.

39 Tarnutzer AA, Berkowitz AL, Robinson KA, et al. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome[J]. Canad Med Assoc J, 2011, 183:E571-E592.

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