头脉冲-眼震-眼偏斜试验在急性前庭综合征中的应用价值
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摘要
眩晕为神经内科和急诊科最常见的主诉之一,其中急性前庭综合征(AVS)的病因诊断对于众多医生一直是个难题。外周性和中枢性的AVS治疗预后相差大,漏诊和误诊甚至可导致严重后果。近几年文献表明头脉冲-眼震-眼偏斜试验(HINTS)在鉴别中枢性AVS中,敏感性可高达100%,特异性可达69%~96%。HINTS是一项易获得、敏感度和特异性均高的床旁检查技术,在神经科门诊和急诊科易于开展。本文将对HINTS试验的最新文献进行综述,为AVS的临床诊治提供参考。
引文
[1]中华医学会神经病学分会.眩晕诊治多学科专家共识[J].中华神经科杂志,2017,50(11):805-212.
[2]中国医药教育协会眩晕专业委员会,中国医师协会急诊医师分会.眩晕急诊诊断与治疗专家共识[J].中华急诊医学杂志,201 8,27(3):248-253.
[3]Bisdorff A.Vestibular symptoms and history taking[J].Handbook Clin Neurol,2016,137:83-90.
[4]Saber Tehrani AS,Kattah JC,Mantokoudis G,et al.Small strokes causing severe vertigo:frequency of false-negative MRIs and nonlacunar mechanisms[J].Neurology,2014,83(2):169-173.
[5]崔世磊,马中华,刘欣欣,等.基于头脉冲-眼震-扭转偏斜检查法的急性前庭综合征病因分析[J].中国耳鼻咽喉头颈外科,2015,22(5):239-243.
[6]Kattah JC,Talkad AV,Wang DZ,et al.HINTS to Diagnose Stroke in the Acute Vestibular Syndrome[J].Stroke,2009,40(1 1):3504-35 10.
[7]Ljunggren M,Persson J,Salzer J.Dizziness and the Acute Vestibular Syndrome at the Emergency Department:A Population-Based Descriptive Study[J].Eur Neurol,2017,79(1-2):5-12.
[8]Newman-Toker DE,Kerber KA,Hsieh YH,et al.HINTS Outperforms ABCD2 To Screen for Stroke in Acute Vestibular Syndrome[J].Ann Neurol,2013,20:987-996.
[9]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].CMAJ,2011,183(9):571-592.
[10]Tsang BKT,Chen ASK,Paine M.Acute evaluation of the acute vestibular syndrome:differentiating posterior circulation stroke from acute peripheral vestibulopathies[J].Int Med J2017,47.
[11]Kerber KA,Brown DL,Lisabeth LD,et al.Stroke among patients with dizziness,vertigo,and imbalance in the emergency department:a population-based study[J].Stroke,2006,32(4):2484-2487.
[12]Saber Tehrani AS,Coughlan D,Hsieh YH,et al.Rising annual costs of dizziness presentations to U.S.emergency departments[J].Acad Emerg Med,2013,20(7):689-696.
[13]Kim AS,Sidney S,Klingman JG,et al.Practice variation in neuroimaging to evaluate dizziness in the ED[J].Am J Emerg Med,2012,30(5):665-672.
[14]Newman-Toker DE.Missed stroke in acute vertigo and dizzi-ness:It is time for action,not debate[J].Ann Neurol,2016,79(1):27-31.
[15]Edlow JA,Gurley KL,Newman-Toker DE.A New Diagnostic Approach to the Adult Patient with Acute Dizziness[J].J Emerg Med,2018,1-13.
[16]Muncie HL,Sirmans SM,James E.Dizziness:Approach to Evaluation and Management[J].Am Family Physician,2017,95(3):154.
[17]W ai YC,Miriam G,Claudia F,et al.Comparison of the Bedside Head-Impulse Test with the Video Head-Impulse Test in a Clinical Practice Setting:A Prospective Study of 5 00Outpatients[J].Front Neurol,2016,7:58.
[18]Celebisoy N.Acute vestibular syndrome:clinical head impulse test versus video head impulse test[J].J Neurol,2018,1-4.
[19]Newman-Toker DE,Kattah JC,Alvernia JE,et al.Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis[J].Neurology,2008,70(24 Pt 2):2378-2385.
[20]王凯,严小艳,韩玉梁,等.床旁头脉冲实验阳性结果的前庭疾病病因分析[J].北京医学,2017,39(8):803-806.
[21]Newman-Toker DE,Saber Tehrani AS,Mantokoudis G,et al.Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness:toward an ECG for the eyes[J].Stroke,2013,44(4):1158.
[22]Huh YE,Kim JS.Bedside Evaluation of Dizzy Patients[J].J Clin Neurol,2013,9(4):203-213.
[23]Leigh RJ,Zee DS.Synthesis of the command for conjugate eye movements[M.In:Leigh RJ,Zee DS.The neurology of eye movements.4 th ed.New York:Oxford University Press,2006,261-314.
[24]桑文文,洪渊,杨旭.眩晕患者床旁检查[J].中国卒中杂志,2015,10(5):414-422.
[25]Baier B,Dieterich M.Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions[J].Neurology,2011,76(4):361.
[26]Spiegel R,Kirsch M,Rosin C,et al.Dizziness in the emergency department:an update on diagnosis[J].Swiss Med Weekly,2017,147:w14565.
[27]Cnyrim CD,Newman-Toker D,Karch C,et al.Bedside differentiation of vestibular neuritis from central"vestibular pseudoneuritis"[J].J Neurol Neurosurg Psychiatr,2008,79(4):458-460.
[28]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.
[29]Sergio C,Carlos M,Guillermo Z,et al.The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome[J].Front Neurol,2016,7(3).
[30]Choi JH,Kim HW,Choi KD,et al.Isolated vestibular syndrome in posterior circulation stroke:Frequency and involved structures[J].Neurol Clin Pract,2014,4(5):410-418.
[2]中国医药教育协会眩晕专业委员会,中国医师协会急诊医师分会.眩晕急诊诊断与治疗专家共识[J].中华急诊医学杂志,201 8,27(3):248-253.
[3]Bisdorff A.Vestibular symptoms and history taking[J].Handbook Clin Neurol,2016,137:83-90.
[4]Saber Tehrani AS,Kattah JC,Mantokoudis G,et al.Small strokes causing severe vertigo:frequency of false-negative MRIs and nonlacunar mechanisms[J].Neurology,2014,83(2):169-173.
[5]崔世磊,马中华,刘欣欣,等.基于头脉冲-眼震-扭转偏斜检查法的急性前庭综合征病因分析[J].中国耳鼻咽喉头颈外科,2015,22(5):239-243.
[6]Kattah JC,Talkad AV,Wang DZ,et al.HINTS to Diagnose Stroke in the Acute Vestibular Syndrome[J].Stroke,2009,40(1 1):3504-35 10.
[7]Ljunggren M,Persson J,Salzer J.Dizziness and the Acute Vestibular Syndrome at the Emergency Department:A Population-Based Descriptive Study[J].Eur Neurol,2017,79(1-2):5-12.
[8]Newman-Toker DE,Kerber KA,Hsieh YH,et al.HINTS Outperforms ABCD2 To Screen for Stroke in Acute Vestibular Syndrome[J].Ann Neurol,2013,20:987-996.
[9]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].CMAJ,2011,183(9):571-592.
[10]Tsang BKT,Chen ASK,Paine M.Acute evaluation of the acute vestibular syndrome:differentiating posterior circulation stroke from acute peripheral vestibulopathies[J].Int Med J2017,47.
[11]Kerber KA,Brown DL,Lisabeth LD,et al.Stroke among patients with dizziness,vertigo,and imbalance in the emergency department:a population-based study[J].Stroke,2006,32(4):2484-2487.
[12]Saber Tehrani AS,Coughlan D,Hsieh YH,et al.Rising annual costs of dizziness presentations to U.S.emergency departments[J].Acad Emerg Med,2013,20(7):689-696.
[13]Kim AS,Sidney S,Klingman JG,et al.Practice variation in neuroimaging to evaluate dizziness in the ED[J].Am J Emerg Med,2012,30(5):665-672.
[14]Newman-Toker DE.Missed stroke in acute vertigo and dizzi-ness:It is time for action,not debate[J].Ann Neurol,2016,79(1):27-31.
[15]Edlow JA,Gurley KL,Newman-Toker DE.A New Diagnostic Approach to the Adult Patient with Acute Dizziness[J].J Emerg Med,2018,1-13.
[16]Muncie HL,Sirmans SM,James E.Dizziness:Approach to Evaluation and Management[J].Am Family Physician,2017,95(3):154.
[17]W ai YC,Miriam G,Claudia F,et al.Comparison of the Bedside Head-Impulse Test with the Video Head-Impulse Test in a Clinical Practice Setting:A Prospective Study of 5 00Outpatients[J].Front Neurol,2016,7:58.
[18]Celebisoy N.Acute vestibular syndrome:clinical head impulse test versus video head impulse test[J].J Neurol,2018,1-4.
[19]Newman-Toker DE,Kattah JC,Alvernia JE,et al.Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis[J].Neurology,2008,70(24 Pt 2):2378-2385.
[20]王凯,严小艳,韩玉梁,等.床旁头脉冲实验阳性结果的前庭疾病病因分析[J].北京医学,2017,39(8):803-806.
[21]Newman-Toker DE,Saber Tehrani AS,Mantokoudis G,et al.Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness:toward an ECG for the eyes[J].Stroke,2013,44(4):1158.
[22]Huh YE,Kim JS.Bedside Evaluation of Dizzy Patients[J].J Clin Neurol,2013,9(4):203-213.
[23]Leigh RJ,Zee DS.Synthesis of the command for conjugate eye movements[M.In:Leigh RJ,Zee DS.The neurology of eye movements.4 th ed.New York:Oxford University Press,2006,261-314.
[24]桑文文,洪渊,杨旭.眩晕患者床旁检查[J].中国卒中杂志,2015,10(5):414-422.
[25]Baier B,Dieterich M.Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions[J].Neurology,2011,76(4):361.
[26]Spiegel R,Kirsch M,Rosin C,et al.Dizziness in the emergency department:an update on diagnosis[J].Swiss Med Weekly,2017,147:w14565.
[27]Cnyrim CD,Newman-Toker D,Karch C,et al.Bedside differentiation of vestibular neuritis from central"vestibular pseudoneuritis"[J].J Neurol Neurosurg Psychiatr,2008,79(4):458-460.
[28]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.
[29]Sergio C,Carlos M,Guillermo Z,et al.The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome[J].Front Neurol,2016,7(3).
[30]Choi JH,Kim HW,Choi KD,et al.Isolated vestibular syndrome in posterior circulation stroke:Frequency and involved structures[J].Neurol Clin Pract,2014,4(5):410-418.