Bruns' nystagmus revisited: A sign of stroke in patients with the acute vestibular syndrome
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BORIS DOI
Publisher DOI
PubMed ID
34176187
Description
OBJECTIVE
Gaze-evoked nystagmus (GEN) is a central sign in patients with the acute vestibular syndrome (AVS); however, discriminating between a pathological and a physiologic GEN is a challenge. Here we evaluate GEN in patients with AVS.
METHODS
In this prospective cross-sectional study, we used video-oculography (VOG) to compare GEN in the light (target at 15 degrees eccentric) in 64 healthy subjects with 47 patients seen in the emergency department (ED) who had AVS; 35 with vestibular neuritis and 12 with stroke. All patients with an initial non-diagnostic MRI received a confirmatory, delayed MRI as a reference standard in detecting stroke.
RESULTS
Healthy subjects with GEN had a time constant of centripetal drift >18s. VOG identified pathologic GEN (time constant ≤ 18s) in 33% of patients with vestibular strokes, specificity was 100%, accuracy was 83%. Results were equivalent to examination by a clinical expert. As expected, since all patients with GEN had a SN in straight-ahead position, they showed the pattern of a Bruns' nystagmus.
CONCLUSIONS
One third of patients with AVS due to central vestibular strokes had a spontaneous SN in straight-ahead gaze and a pathological GEN, producing the pattern of a Bruns' nystagmus with a shift of the null position. The localization of the side of the lesion based on the null was not consistent, presumably because the circuits underlying gaze-holding are widespread in the brainstem and cerebellum. Nevertheless, automated quantification of GEN with VOG was specific, and accurately identified patients in the ED with AVS due to strokes.
Gaze-evoked nystagmus (GEN) is a central sign in patients with the acute vestibular syndrome (AVS); however, discriminating between a pathological and a physiologic GEN is a challenge. Here we evaluate GEN in patients with AVS.
METHODS
In this prospective cross-sectional study, we used video-oculography (VOG) to compare GEN in the light (target at 15 degrees eccentric) in 64 healthy subjects with 47 patients seen in the emergency department (ED) who had AVS; 35 with vestibular neuritis and 12 with stroke. All patients with an initial non-diagnostic MRI received a confirmatory, delayed MRI as a reference standard in detecting stroke.
RESULTS
Healthy subjects with GEN had a time constant of centripetal drift >18s. VOG identified pathologic GEN (time constant ≤ 18s) in 33% of patients with vestibular strokes, specificity was 100%, accuracy was 83%. Results were equivalent to examination by a clinical expert. As expected, since all patients with GEN had a SN in straight-ahead position, they showed the pattern of a Bruns' nystagmus.
CONCLUSIONS
One third of patients with AVS due to central vestibular strokes had a spontaneous SN in straight-ahead gaze and a pathological GEN, producing the pattern of a Bruns' nystagmus with a shift of the null position. The localization of the side of the lesion based on the null was not consistent, presumably because the circuits underlying gaze-holding are widespread in the brainstem and cerebellum. Nevertheless, automated quantification of GEN with VOG was specific, and accurately identified patients in the ED with AVS due to strokes.
Date of Publication
2021-09
Publication Type
Article
Subject(s)
Keyword(s)
Bruns’ nystagmus Gaze-evoked nystagmus HINTS acute vestibular syndrome gaze-holding nystagmus
Language(s)
en
Contributor(s)
Zee, David S | |
Sauter, Thomas C | |
Wagner, Franca |
Series
European journal of neurology
Publisher
Wiley
ISSN
1468-1331
Access(Rights)
open.access