神经耳科学与神经眼科学进展——聚焦近三年的新进展

文献信息

中文摘要

背景： 眩晕、头晕和不稳是初级保健和急诊科（ED）最常见的就诊症状之一。临床诊断基于结构化的病史采集以及前庭系统和眼动系统的床旁检查，尤其关注中枢性眼动体征。近期指南，如关于急性眩晕和头晕的GRACE-3指南、床旁诊断算法的日益普及，以及在急诊和门诊环境中使用定量前庭和眼动测试，促进并标准化了对头晕患者的诊疗方法。本文综述神经耳科学和神经眼科学的最新进展，涵盖本刊2023年发表最新神经耳科学更新之后的时期。分别讨论新发急性、发作性和慢性前庭疾病，重点介绍疾病特征描述、诊断标准和治疗策略方面的进展。尽管在外周性、中枢性和功能性前庭疾病以及眼动障碍的病理生理学、病因学、遗传学和诊断标准方面已取得重大进展，但这些知识仍需转化为临床实践。系统性地培训医生以提高知识水平并改善其在临床实践中高水平应用不同测试的技能，被确定为面临的挑战。在治疗方面，仍然非常需要应用已批准疗法的先进临床试验。

英文摘要

Vertigo, dizziness, and imbalance are among the most frequent presenting symptoms in primary care and in the emergency department (ED). The clinical diagnosis is based on a structured patient history and bedside examination of the vestibular system and the ocular motor system, looking especially for central ocular motor signs. Recent guidelines, such as the GRACE-3 guideline on acute vertigo and dizziness, the increasing availability of bedside diagnostic algorithms, and the use of quantitative vestibular and ocular motor testing in both the ED-setting and in the outpatient center have facilitated and standardized the approach to the dizzy patient. Here we review recent developments in neuro-otology and neuro-ophthalmology, covering the period after the latest neuro-otology update was published in this journal in 2023. Both new-onset acute, episodic and chronic vestibular conditions are discussed separately, highlighting advancements in disease characterization, diagnostic criteria, and treatment strategies. While major progress has been made in terms of the pathophysiology, etiology, genetics, and diagnostic criteria of peripheral, central, and functional vestibular diseases as well as ocular motor disorders, this knowledge has to be transferred into clinical practice. Systematic teaching of doctors to increase knowledge and to improve skills in applying the different tests in clinical practice on a high level are identified challenges. In terms of treatment, there is still a very great need for state-of-the art clinical trials applying approved therapies.