Characteristics of Acute Nystagmus in the Pediatric Emergency Department

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 MencaroniStefano Masi, Elena Bellelli, Liviana Da Dalt, Umberto Raucci

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: 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).

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
JournalPediatrics
Volume146
Issue number2
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Ataxia/complications
  • Brain Neoplasms/complications
  • Central Nervous System Infections/complications
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cranial Nerve Diseases/complications
  • Demyelinating Diseases/complications
  • Dizziness/etiology
  • Emergency Service, Hospital
  • Female
  • Headache/etiology
  • Humans
  • Intracranial Hypertension/complications
  • Italy
  • Male
  • Migraine Disorders/complications
  • Nausea/etiology
  • Nystagmus, Pathologic/etiology
  • Poisoning/complications
  • Retrospective Studies
  • Strabismus/etiology
  • Vertigo/etiology
  • Vestibular Diseases/complications
  • Vomiting/etiology

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