Giacomo Garone1, Agnese Suppiej2,3, Nicola Vanacore4, Francesco La Penna5, Pasquale Parisi6, Lucia Calistri7, Antonella Palmieri8, Alberto Verrotti9, Elisa Poletto10, Annalisa Rossetti11, Duccio Maria Cordelli12, Mario Velardita13, Renato d'Alonzo14, Paola De Liso15, Daniela Gioè7, Marta Marin8, Luca Zagaroli9, Salvatore Grosso11, Rocco Bonfatti12, Elisabetta Mencaroni14, Stefano Masi7, Elena Bellelli5, Liviana Da Dalt10, Umberto Raucci5. 1. University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome Italy; giacomo.garone@opbg.net. 2. Neurophtalmology Programme, Padova Paediatric University Hospital, Padova, Italy. 3. Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy. 4. National Centre for Epidemiology, Surveillance, and Health Promotion, National Institutes of Health, Rome, Italy. 5. Pediatric Emergency Department and. 6. Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University and Sant'Andrea Hospital, Rome, Italy. 7. Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy. 8. Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Genova, Italy. 9. Department of Pediatrics, University of L'Aquila, L'Aquila, Italy. 10. Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy. 11. Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy. 12. Child Neurology Unit, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy. 13. Pediatric Operative Unit, Gravina Hospital, Caltagirone, Catania, Italy; and. 14. Pediatric Clinic, Santa Maria della Misericordia Hospital and Department of Surgical and Medical Sciences, Università Degli Studi di Perugia, Perugia, Italy. 15. Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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.
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.