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Abstract：
UNASSIGNED: For the assessment of patients presenting with acute prolonged vertigo meeting diagnostic criteria for acute vestibular syndrome (AVS), bedside oculomotor examinations are essential to distinguish peripheral from central causes. Here we assessed patterns of spontaneous nystagmus (SN) observed in AVS and its diagnostic accuracy at the bedside.
UNASSIGNED: MEDLINE and Embase were searched for studies (1980-2022) reporting on the bedside diagnostic accuracy of SN-patterns in AVS patients. Two independent reviewers determined inclusion. We identified 4,186 unique citations, examined 219 full manuscripts, and analyzed 39 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted and SN beating-direction patterns were correlated with lesion locations and lateralization.
UNASSIGNED: Included studies reported on 1,599 patients, with ischemic strokes (n = 747) and acute unilateral vestibulopathy (n = 743) being most frequent. While a horizontal or horizontal-torsional SN was significantly more often found in peripheral AVS (pAVS) than in central AVS (cAVS) patients (672/709 [94.8%] vs. 294/677 [43.4%], p < 0.001), torsional and/or vertical SN-patterns were more prevalent in cAVS than in pAVS (15.1 vs. 2.6%, p < 0.001). For an (isolated) vertical/vertical-torsional SN or an isolated torsional SN specificity (97.7% [95% CI = 95.1-100.0%]) for a central origin etiology was high, whereas sensitivity (19.1% [10.5-27.7%]) was low. Absence of any horizontal SN was more frequently observed in cAVS than in pAVS (55.2 vs. 7.0%, p < 0.001). Ipsilesional and contralesional beating directions of horizontal SN in cAVS were found at similar frequency (28.0 vs. 21.7%, p = 0.052), whereas for pAVS a contralesional SN was significantly more frequent (95.2 vs. 2.5%, p < 0.001). For PICA strokes presenting with horizontal SN, beating direction was ipsilesional more often than contralesional (23.9 vs. 6.4%, p = 0.006), while the opposite was observed for AICA strokes (2.2 vs. 63.0%, p < 0.001).
UNASSIGNED: (Isolated) vertical and/or torsional SN is found in a minority (15.1%) of cAVS patients only. When present, it is highly predictive for a central cause. A combined torsional-downbeating SN-pattern may be observed in pAVS also in cases with isolated lesions of the inferior branch of the vestibular nerve. Furthermore, in cAVS patients the SN beating direction itself does not allow a prediction on the lesion side.
UNASSIGNED: MEDLINE and Embase were searched for studies (1980-2022) reporting on the bedside diagnostic accuracy of SN-patterns in AVS patients. Two independent reviewers determined inclusion. We identified 4,186 unique citations, examined 219 full manuscripts, and analyzed 39 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted and SN beating-direction patterns were correlated with lesion locations and lateralization.
UNASSIGNED: Included studies reported on 1,599 patients, with ischemic strokes (n = 747) and acute unilateral vestibulopathy (n = 743) being most frequent. While a horizontal or horizontal-torsional SN was significantly more often found in peripheral AVS (pAVS) than in central AVS (cAVS) patients (672/709 [94.8%] vs. 294/677 [43.4%], p < 0.001), torsional and/or vertical SN-patterns were more prevalent in cAVS than in pAVS (15.1 vs. 2.6%, p < 0.001). For an (isolated) vertical/vertical-torsional SN or an isolated torsional SN specificity (97.7% [95% CI = 95.1-100.0%]) for a central origin etiology was high, whereas sensitivity (19.1% [10.5-27.7%]) was low. Absence of any horizontal SN was more frequently observed in cAVS than in pAVS (55.2 vs. 7.0%, p < 0.001). Ipsilesional and contralesional beating directions of horizontal SN in cAVS were found at similar frequency (28.0 vs. 21.7%, p = 0.052), whereas for pAVS a contralesional SN was significantly more frequent (95.2 vs. 2.5%, p < 0.001). For PICA strokes presenting with horizontal SN, beating direction was ipsilesional more often than contralesional (23.9 vs. 6.4%, p = 0.006), while the opposite was observed for AICA strokes (2.2 vs. 63.0%, p < 0.001).
UNASSIGNED: (Isolated) vertical and/or torsional SN is found in a minority (15.1%) of cAVS patients only. When present, it is highly predictive for a central cause. A combined torsional-downbeating SN-pattern may be observed in pAVS also in cases with isolated lesions of the inferior branch of the vestibular nerve. Furthermore, in cAVS patients the SN beating direction itself does not allow a prediction on the lesion side.
摘要：
■为了评估符合急性前庭综合征（AVS）诊断标准的急性长时间眩晕患者，床旁的眼球运动检查对于区分周围和中央原因至关重要。在这里，我们评估了在AVS中观察到的自发性眼球震颤（SN）的模式及其在床边的诊断准确性。
■搜索MEDLINE和Embase的研究（1980-2022年）报告了SN模式在AVS患者中的床旁诊断准确性。两名独立审稿人确定纳入。我们确定了4,186个独特的引文，审查了219份完整的手稿，分析了39项研究。研究对偏倚风险(QUADAS-2)进行了评级。提取诊断数据，并将SN搏动方向模式与病变位置和侧向化相关联。
■纳入了1,599名患者的研究报告，缺血性卒中（n=747）和急性单侧前庭病变（n=743）最常见。虽然水平或水平扭转SN在外周AVS（pAVS）中比在中央AVS（cAVS）患者中更常见（672/709[94.8％]vs.294/677[43.4%]，p<0.001)，扭转和/或垂直SN模式在cAVS中比在pAVS中更普遍(15.1与2.6%,p<0.001)。对于中央起源病因学的（孤立的）垂直/垂直扭转SN或孤立的扭转SN特异性（97.7%[95%CI=95.1-100.0%]）较高，而敏感性（19.1%[10.5-27.7%]）较低。cAVS中没有任何水平SN的现象比pAVS中更常见（55.2vs.7.0%,p<0.001)。cAVS中水平SN的单发和对照拍打方向的频率相似（28.0vs.21.7%,p=0.052),而对于pAVS，对比SN明显更频繁(95.2vs.2.5%,p<0.001)。对于具有水平SN的PICA笔划，跳动方向比对比方向更常见(23.9与6.4%,p=0.006),而AICA中风则相反（2.2vs.63.0%,p<0.001)。
■（孤立的）垂直和/或扭转SN仅在少数（15.1%）cAVS患者中发现。当存在时,它对核心原因具有很高的预测性。在前庭神经下支孤立病变的情况下，也可以在pAVS中观察到组合的扭转-下降SN模式。此外，在cAVS患者中，SN搏动方向本身不允许在病变侧进行预测。
■搜索MEDLINE和Embase的研究（1980-2022年）报告了SN模式在AVS患者中的床旁诊断准确性。两名独立审稿人确定纳入。我们确定了4,186个独特的引文，审查了219份完整的手稿，分析了39项研究。研究对偏倚风险(QUADAS-2)进行了评级。提取诊断数据，并将SN搏动方向模式与病变位置和侧向化相关联。
■纳入了1,599名患者的研究报告，缺血性卒中（n=747）和急性单侧前庭病变（n=743）最常见。虽然水平或水平扭转SN在外周AVS（pAVS）中比在中央AVS（cAVS）患者中更常见（672/709[94.8％]vs.294/677[43.4%]，p<0.001)，扭转和/或垂直SN模式在cAVS中比在pAVS中更普遍(15.1与2.6%,p<0.001)。对于中央起源病因学的（孤立的）垂直/垂直扭转SN或孤立的扭转SN特异性（97.7%[95%CI=95.1-100.0%]）较高，而敏感性（19.1%[10.5-27.7%]）较低。cAVS中没有任何水平SN的现象比pAVS中更常见（55.2vs.7.0%,p<0.001)。cAVS中水平SN的单发和对照拍打方向的频率相似（28.0vs.21.7%,p=0.052),而对于pAVS，对比SN明显更频繁(95.2vs.2.5%,p<0.001)。对于具有水平SN的PICA笔划，跳动方向比对比方向更常见(23.9与6.4%,p=0.006),而AICA中风则相反（2.2vs.63.0%,p<0.001)。
■（孤立的）垂直和/或扭转SN仅在少数（15.1%）cAVS患者中发现。当存在时,它对核心原因具有很高的预测性。在前庭神经下支孤立病变的情况下，也可以在pAVS中观察到组合的扭转-下降SN模式。此外，在cAVS患者中，SN搏动方向本身不允许在病变侧进行预测。
