Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria.
Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria.
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DOI：
10.3233/ves-220201
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Magnusson M
中科院分区：
文献类型：
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作者：
Strupp M;Bisdorff A;Furman J;Hornibrook J;Jahn K;Maire R;Newman-Toker D;Magnusson M
本文描述了Bárány学会前庭疾病分类委员会定义的急性单侧前庭病变(AUVP)的诊断标准，AUVP是前庭神经炎的同义词。AUVP表现为急性前庭综合征，是由于急性单侧外周前庭功能丧失而没有急性中枢或急性听力学症状或体征的证据。这意味着AUVP的诊断是基于患者的病史、床边检查，如果必要的话，还需要进行实验室评估。主要症状是旋转或非旋转眩晕的急性或罕见的亚急性发作，并伴有不稳定、恶心/呕吐和/或视振荡。一个主要的临床症状是自发性的外周前庭眼球震颤，它是方向固定的，并通过去除视觉固定来增强，其轨迹与所涉及的半规管传入神经(通常是水平-扭转)相适应。该委员会将诊断标准分为四类：1.“急性单侧前庭病变”，2.“进化中的急性单侧前庭病变”，3.“可能的急性单侧前庭病变”和4.《急性单侧前庭病史》。具体的诊断标准如下：“急性单侧前庭病变”：a)持续旋转或非旋转眩晕的急性或亚急性发作(即急性前庭综合征)，强度从中到重度，症状持续至少24小时。B)自发性前庭外周性眼球震颤，其轨迹与所涉及的半规管传入相适应，一般为水平扭转，方向固定，并通过去除视觉注视而增强。C)与自发性眼球震颤的快相方向相反的一侧VOR功能降低的明确证据。D)没有证据表明有急性中枢神经、耳科或听力方面的症状。E)无急性中枢神经体征，即无中枢眼运动或中央前庭体征，尤其无明显斜视，无凝视诱发眼球震颤，无急性听力学或耳科体征。F)不能更好地解释另一种疾病或紊乱。“进化中的急性单侧前庭病变”：A)持续旋转或非旋转眩晕的急性或亚急性发作，持续症状超过3小时，但尚未持续至少24小时，患者就诊时；B)-F)如上所述。这一类别对于诊断原因与急性中枢性前庭综合征的鉴别、启动特定的治疗方法以及将患者纳入临床研究是有用的。“可能的急性单侧前庭病变”：与AUVP相同，只是单侧VOR缺失没有清楚的观察或记录。“急性单侧前庭病史”：a)持续至少24小时的急性或亚急性眩晕发作史，且强度缓慢下降。B)无同时出现急性听力学或中枢神经症状的病史。C)单方面降低VOR功能的明确证据。D)无同时出现急性中枢神经体征的病史，即无中枢眼运动或中央前庭体征，无急性听力学或耳部体征。E)不能更好地解释另一种疾病或紊乱。这一类别允许诊断表现为单侧外周前庭缺陷和急性前庭综合征病史的患者，这些患者在急性期后进行了良好的检查。值得注意的是，对AUVP没有明确的测试。因此，它的诊断需要排除中枢性病变以及其他各种外周前庭疾病。最后，这份共识文件将讨论AUVP的其他方面，如病因学、病理生理学和实验室检查，如果它们与分类标准直接相关。
This paper describes the diagnostic criteria for Acute Unilateral Vestibulopathy (AUVP), a synonym for vestibular neuritis, as defined by the Committee for the Classification of Vestibular Disorders of the Bárány Society. AUVP manifests as an acute vestibular syndrome due to an acute unilateral loss of peripheral vestibular function without evidence for acute central or acute audiological symptoms or signs. This implies that the diagnosis of AUVP is based on the patient history, bedside examination, and, if necessary, laboratory evaluation. The leading symptom is an acute or rarely subacute onset of spinning or non-spinning vertigo with unsteadiness, nausea/vomiting and/or oscillopsia. A leading clinical sign is a spontaneous peripheral vestibular nystagmus, which is direction-fixed and enhanced by removal of visual fixation with a trajectory appropriate to the semicircular canal afferents involved (generally horizontal-torsional). The diagnostic criteria were classified by the committee for four categories: 1. “Acute Unilateral Vestibulopathy”, 2. “Acute Unilateral Vestibulopathy in Evolution”, 3. “Probable Acute Unilateral Vestibulopathy” and 4. “History of Acute Unilateral Vestibulopathy”. The specific diagnostic criteria for these are as follows: “Acute Unilateral Vestibulopathy”: A) Acute or subacute onset of sustained spinning or non-spinning vertigo (i.e., an acute vestibular syndrome) of moderate to severe intensity with symptoms lasting for at least 24 hours. B) Spontaneous peripheral vestibular nystagmus with a trajectory appropriate to the semicircular canal afferents involved, generally horizontal-torsional, direction-fixed, and enhanced by removal of visual fixation. C) Unambiguous evidence of reduced VOR function on the side opposite the direction of the fast phase of the spontaneous nystagmus. D) No evidence for acute central neurological, otological or audiological symptoms. E) No acute central neurological signs, namely no central ocular motor or central vestibular signs, in particular no pronounced skew deviation, no gaze-evoked nystagmus, and no acute audiologic or otological signs. F) Not better accounted for by another disease or disorder. “Acute Unilateral Vestibulopathy in Evolution”: A) Acute or subacute onset of sustained spinning or non-spinning vertigo with continuous symptoms for more than 3 hours, but not yet lasting for at least 24 h hours, when patient is seen; B) - F) as above. This category is useful for diagnostic reasons to differentiate from acute central vestibular syndromes, to initiate specific treatments, and for research to include patients in clinical studies. “Probable Acute Unilateral Vestibulopathy”: Identical to AUVP except that the unilateral VOR deficit is not clearly observed or documented. “History of acute unilateral vestibulopathy“: A) History of acute or subacute onset of vertigo lasting at least 24 hours and slowly decreasing in intensity. B) No history of simultaneous acute audiological or central neurological symptoms. C) Unambiguous evidence of unilaterally reduced VOR function. D) No history of simultaneous acute central neurological signs, namely no central ocular motor or central vestibular signs and no acute audiological or otological signs. E) Not better accounted for by another disease or disorder. This category allows a diagnosis in patients presenting with a unilateral peripheral vestibular deficit and a history of an acute vestibular syndrome who are examined well after the acute phase. It is important to note that there is no definite test for AUVP. Therefore, its diagnosis requires the exclusion of central lesions as well as a variety of other peripheral vestibular disorders. Finally, this consensus paper will discuss other aspects of AUVP such as etiology, pathophysiology and laboratory examinations if they are directly relevant to the classification criteria.