Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs).
Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs.
A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs.
AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.
Copyright © 2020 by the American Academy of Pediatrics.
About The Expert
Giacomo Garone
Agnese Suppiej
Nicola Vanacore
Francesco La Penna
Pasquale Parisi
Lucia Calistri
Antonella Palmieri
Alberto Verrotti
Elisa Poletto
Annalisa Rossetti
Duccio Maria Cordelli
Mario Velardita
Renato d’Alonzo
Paola De Liso
Daniela Gioè
Marta Marin
Luca Zagaroli
Salvatore Grosso
Rocco Bonfatti
Elisabetta Mencaroni
Stefano Masi
Elena Bellelli
Liviana Da Dalt
Umberto Raucci
References
PubMed