抄録
Vertigo attacks with severe nausea and vomiting are frequently seen in emergency medical care. The present study was conducted to investigate whether bedside nystagmus observation might provide useful information for prediction of the clinical course during acute hospitalization and for determination of steroid administration in patients with peripheral vestibular disorders. We reviewed the electronystagmography (ENG) records of 38 patients with peripheral vestibular disorder who were hospitalized because of rotary vertigo, severe nausea, and/or vomiting. The patients were diagnosed as having acute peripheral vestibular disorder between January 2004 and February 2006 at the university hospital or its affiliates. Correlations between the withdrawal period duration of spontaneous nystagmus and the results of subsequent laboratory caloric testing by computerized ENG were examined. The 38 patients were divided into the short-decaying and long-lasting groups on the basis of the nystagmus duration. Half of the patients had the short-decaying type of nystagmus; their unidirectional spontaneous nystagmus disappeared within a few days. This group showed a female preponderance (male 2, female 17), recovered quickly from vertigo, and were out of bed within a few days. In contrast, the group with the long-lasting type of nystagmus showed no gender preponderance (male 9, female 10), and also a relatively high incidence of canal paresis on caloric testing (72.2%). Our results suggest that there are at least two types of peripheral vestibular disorders, which we designated as "benign paroxysmal spontaneous vertigo" and vestibular neuritis. We recognized the fact that daily short-time bedside observation of spontaneous nystagmus can provide prognostic information in patients with sudden vertigo at the very first visit. Steroid administration may be recommended when spontaneous nystagmus lasts more than 3 days, because vestibular neuritis would be strongly suspected in such cases.
