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Often, a carefully elicited history supported by a competent examination yields a correct diagnosis with a clear management path, without requiring further investigation. Episodic positional vertigo lasting seconds, with paroxysmal positional nystagmus confirming BPV, leading to a liberatory manoeuvre, is a cause for celebration. Acute vestibular syndrome, where isolated spontaneous vertigo is accompanied by typical peripheral nystagmus and an unequivocally positive bedside head impulse confirming vestibular neuritis is another. Conversely, there will be instances where the diagnosis has to be avidly pursued. When the patient with episodic positional vertigo has a negative Hallpike test, it will be necessary to perform a second, third or fourth assessment on a symptomatic day before BPV is proven. When the patient with an acute vestibular syndrome does not fulfil all “HINTs plus” criteria (positive head impulse, peripheral nystagmus, absent skew, normal hearing), alternate causes of acute vestibular syndrome such as brainstem stroke should be considered. A diffusion-weighted MRI scan should be undertaken, and it may be necessary to commence an antiplatelet therapy even when there is no clear infarction, especially in the presence of vascular risk factors. Patients with recurrent spontaneous vertigo lasting hours may have no historic features or examination findings pointing to whether the vertigo is due to endolymphatic hydrops or VM. Here, the clinician may need to use audio-vestibular tests to assist with differential diagnosis and plan to urgently assess the patient on a symptomatic day to help them determine whether they are dealing with VM or MD. There is a need for methods of capturing the ictal nystagmus that accompanies acute spontaneous vertigo in patients’ own environments as additional means of identifying the underlying vestibular disorder.