后半规管良性阵发性位置性眩晕患者在体位诱发试验中的眼震特征分析

崔湘凝; 冯永; 梅凌云; 贺楚峰; 陆小净; 张华; 陈红胜

doi:10.13201/j.issn.1001-1781.2015.01.008

后半规管良性阵发性位置性眩晕患者在体位诱发试验中的眼震特征分析

- 1 中南大学湘雅医院耳鼻咽喉头颈外科(长沙, 410008);
- 2 上海交通大学医学院附属仁济医院耳鼻咽喉头颈外科
基金项目:
国家自然科学基金(No:81170923,No:81260160)

湖南省科技计划项目院士基金(No:2013FJ4110)

详细信息

通讯作者: 陈红胜,E-mail:chs_xy@163.com)

中图分类号: R764.3

收稿日期: 2014-09-11

The analysis of nystagmus in patients with posterior canal benign paroxysmal positional vertigoin positioning test

- 1 Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China;
- 2 Department of Otolaryngology-Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine

More Information

Corresponding author: CHEN Hongsheng, E-mail: chs_xy@163.com

Received Date: 11 September 2014

摘要

摘要: 目的:分析和总结后半规管良性阵发性位置性眩晕(BPPV)患者在体位诱发试验中的眼震特点,提高对后半规管BPPV的诊断和治疗。方法:回顾性分析175例确诊为后半规管BPPV患者的视频眼震图资料,分析该类BPPV患者在Dix-Hallpike试验、Roll试验和翻身试验中的眼震特征。结果:175例BPPV患者中,左后半规管BPPV 69例(39.4%),右后半规管BPPV 106例(60.6%)。Dix-Hallpike试验悬头位时,所有患者均记录到垂直向上的眼震,其中扭转成分指向患侧47例(26.9%),指向健侧100例(57.1%),余28例(16.0%)眼震无明显扭转成分;Dix-Hallpike试验坐位时,139例(79.4%)患者可见垂直向下的眼震,其中扭转成分指向患侧40例(22.9%),指向健侧68例(38.9%),无扭转成分者31例(17.7%),余36例(20.6%)患者无明显眼震,仅有短暂眩晕感或头晕感。在Roll试验中,12例右后半规管BPPV患者在头右转时出现带旋转成分的垂直上跳性眼震,5例左后半规管BPPV患者在头左转时出现带扭转成分的垂直上跳性眼震。在翻身试验中,左侧卧位变至右侧卧位时,出现垂直方向眼震的有74例(42.3%),30例上跳性眼震中有25例(83.3%)来自右后半规管BPPV,44例下跳性眼震中有36例(81.8%)来自左后半规管BPPV;在该试验中,垂直眼震方向与判断后半规管的左右侧别密切相关(P<0.01)。结论:Dix-Hallpike试验中后半规管BPPV患者的眼震扭转成分方向不定,其诊断主要依据垂直眼震的方向;Roll滚转试验中出现带垂直上跳性成分为主的旋转性眼震,提示后半规管BPPV可能;利用翻身试验可协助左右侧后半规管的定位诊断。
- 良性阵发性位置性眩晕 /
- 半规管 /
- 视频眼震图 /
- 眼震
Abstract: Objective: To analyze and summarize nystagmus of patients with posterior canal benign paroxysmal positional vertigo (BPPV) in positioning test,and to improve the diagnosis and treatment of posterior canal BPPV (PSC-BPPV). Method: The present study was conducted on 175 patients who had unilateral BPPV of the posterior semicircular canal (PSC). Their positional nystagmus recorded by videnonystagmography in Dix-Hallpike test,roll test and roll over test were analyzed to summarize the characteristics of nystagmus on nystagmograph of PSC-BPPV. Result: Of the 175 patients, lesion was located in the left PSC in 69 (39.4%) patients,the right PSC in 106(60.6%)patients. The nystagmus of patients with PSC-canalithiasis showed upward on the vertical phase of nystagmograph and orientated the different side on horizontal phase in the head hangging position. The horizontal phase pointed to the contralateral side in 47(26.9%) patients,the ipsilateral contralateral side in 100(57.1%) patients,no significant reverse ingredients in 28(16.0%) patients. When these patients returned to sit,139(79.4%) patients showed down beating positioning nystagmus, whereas 36 (20.6%) patients with no nystagmus only had a short vertigo or dizziness. The horizontal phase of the 139 patients pointed to the contralateral side in 40(22.9%) patients,the ipsilateral contralateral side in 68(38.9%) patients,no significant reverse ingredients in 31(17.7%) patients.In roll test,12 patients of the right PSC-BPPV presented an up-beating rotatory nystagmus when the head turned to right,and 5 patients of the left PSC-BPPV presented a down-beating rotatory nystagmus when the head turned to left.When the patients changed body from the left lateral position to the right lateral position in the roll over test, 74(42.3%) patientsshowed vertical positioning nystagmus.In 30 patients who presented an up-beating nystagmus, there were 25(83.3%) patientscame from the right PSC-BPPV. In 44 patients who presented a down-beating nystagmus, there were 36(81.8%) patientscame from the left PSC-BPPV. The direction of the vertical nystagmus was highly correlated with the judgment about the side of the PSC-BPPV in roll over test (P<0.01).Conclusion: The patient with PSC-canalithiasis showed an uncertain direction in torsional nystagmus in Dix-Hallpike test,the diagnosis was mainly concern with the vertical nystagmus. When we found a rotatory nystagmus with much more up-beating nystagmus in roll test,it might be PSC-BPPV.We also can use the roll over test to diagnose the location of the otolith in which side of the PSC-BPPV.
- benign paroxysmal positional vertigo /
- semicircrular canal /
- videonystagmography /
- nystagmus

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