Characteristics of Acute Nystagmus in the Pediatric Emergency Department

• DOI: 10.1542/peds.2020-0484
• Publication Date: 2020-07-30T12:25:25Z
• Authors: Giacomo Garone; Agnese Suppiej; Nicola Vanacore; Francesco La Penna; Pasquale Parisi; Lucia Calistri; Antonella Palmieri; Alberto Verrotti; Elisa Poletto; Annalisa Rossetti; Duccio Maria Cord...; 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
• Keywords: Male; Ataxia; Brain Neoplasms; Central Nervous System Infections; Child; Child, Preschool; Cohort Studies; Cranial Nerve Diseases; Demyelinating Diseases; Dizziness; Emergency Service, Hospital; Female; Headache; Humans; Intracranial Hypertension; Italy; Male; Migraine Disorders; Nausea; Nystagmus, Pathologic; Poisoning; Retrospective Studies; Strabismus; Vertigo; Vestibular Diseases; Vomiting; Vomiting; Migraine Disorders; Dizziness; Nystagmus, Pathologic; Cohort Studies; 03 medical and health sciences; Central Nervous System Infections; 0302 clinical medicine; Ataxia, Brain Neoplasms, Central Nervous System Infections, Child, Cranial Nerve Diseases, Demyelinating Diseases, Dizziness, Headache, Intracranial Hypertension, Nausea, nystagmus; Humans; Child; Aataxia; brain neoplasms; central nervous system infections; child; child, preschool; cohort studies; cranial nerve diseases; demyelinating diseases; dizziness; emergency service; hospital; female; headache; humans; intracranial hypertension; Italy; male; migraine disorders; nausea; nystagmus; pathologic; poisoning; retrospective studies; strabismus; vertigo; vestibular diseases; vomiting; Retrospective Studies; Brain Neoplasms; Poisoning; Headache; Nausea; Cranial Nerve Diseases; 3. Good health; Strabismus; Vestibular Diseases; Italy; Child, Preschool; Vertigo; Ataxia; Female; Intracranial Hypertension; Emergency Service, Hospital; Demyelinating Diseases

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.