良性阵发性眩晕患儿视频头脉冲试验结果分析

陈建勇; 杨军; 张勤; 汪玮; 马孝宝; 梅玲; 沈佳丽; 沈敏; 陈向平

doi:10.13201/j.issn.1001-1781.2019.03.012

良性阵发性眩晕患儿视频头脉冲试验结果分析

- 上海交通大学医学院附属新华医院耳鼻咽喉头颈外科上海交通大学医学院耳科学研究所上海市耳鼻疾病转化医学重点实验室(上海, 200092)
基金项目:
国家自然科学基金面上项目 (No:81470689)

上海交通大学科技创新专项资金多学科交叉项目 (No:ZH2018ZDA11)

详细信息

通讯作者: 杨军,E-mail:yangjun@xinhuamed.com.cn

中图分类号: R764.3

收稿日期: 2018-11-05

An analysis of the results of video head impulse test in benign paroxysmal vertigo of childhood

- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine; Institute of Ophthalmology, School of Medicine, Shanghai Jiaotong University; Shanghai key Laboratory of Ear and Nose Disease Transformation, Shanghai, 200092, China

More Information

Corresponding author: YANG Jun, E-mail: yangjun@xinhuamed.com.cn

Received Date: 05 November 2018

摘要

摘要: 目的:分析良性阵发性眩晕(BPVC)患儿的视频头脉冲试验(vHIT)结果,探讨BPVC的可能发病机制,以及vHIT在儿童BPVC诊断中的临床价值。方法:36例BPVC患儿均进行头颅CT或MRI、脑电图、纯音测听、声导抗和vHIT检查。以vHIT增益值、增益不对称比和代偿性扫视眼动波(显性或隐性)作为研究的终点指标,分析BPVC患儿3对半规管功能异常情况。随机选取11例正常儿童作为正常对照组,对比分析两组间vHIT结果的差异。结果:①正常对照组vHIT各项指标均未见异常;BPVC组有9例(25.0%)异常,其中3例表现为增益值降低,4例表现为不对称比的异常,2例出现显性扫视波。②BPVC组水平左侧、水平右侧、左前、右后、右前、左后6个半规管的平均增益值和标准差分别为1.03±0.14、1.01±0.15、1.13±0.31、1.18±0.36、1.21±0.33和1.14±0.30,正常对照组分别为1.14±0.15、1.18±0.09、1.16±0.30、1.18±0.40、1.34±0.26和1.30±0.20,两组间水平半规管增益值差异均有统计学意义(P<0.05),余各半规管的增益值差异均无统计学意义(P>0.05)。③BPVC组双侧水平、左前右后、右前左后三对共轭半规管不对称比分别为0.04±0.07、0.06±0.04和0.06±0.04,正常对照组分别为0.02±0.02、0.04±0.03和0.04±0.04,差异均无统计学意义(P>0.05)。结论:BPVC的发病机制尚不清楚,存在一定比率的外周前庭功能异常。相比较冷热试验及其他前庭功能检查,vHIT试验相对简单且易于操作,可用于检测儿童6个半规管的功能异常情况,为评估BPVC患儿的外周前庭功能障碍提供一些潜在的临床信息。
- 儿童 /
- 眩晕 /
- 视频头脉冲试验
Abstract: Objective:This study was to analyze the results of video head impulse test (vHIT) of benign paroxysmal vertigo of childhood (BPVC) in order to determine the potential value of vHIT in the diagnosis and treatment for BPVC and to discuss its possible pathogenesis of BPVC.Method:Thirty-six children with BPVC were enrolled.No hearing loss and skull abnormality were found in these children as assessed by pure tone audiometry, acoustic impedance, CT or MRI scan.The vHIT was carried out, and main outcome measures were the gain of vestibulo-ocular reflex, gain asymmetry, and refixation saccades.Eleven healthy children were selected as normal control who came to our hospital for doing a routine checkup and have no history of dizziness.The differences of vHIT results between these two groups were analyzed.Result:①The vHIT results in control group were normal.In all BPVC subjects, abnormalities were detected in 9 patients (25.0%), including vHIT gains decline in 3 patients, abnormal symmetry in 4 patients, and abnormal isolated overt saccades in 2 patients.②The average saccadic gain in different canals of BPVC group was 1.03±0.14, 1.01±0.15, 1.13±0.31, 1.18±0.36, 1.21±0.33, 1.14±0.30 in left horizontal, right horizontal, left anterior, right posterior, right anterior, left posterior canal, respectively;while in normal group, it was 1.14±0.15, 1.18±0.09, 1.16±0.30, 1.18±0.40, 1.34±0.26, 1.30±0.20, respectively.Significant statistical difference was found only in horizontal canals between these two groups (P<0.05).③Asymmetry of the three pairs of conjugated semicircular canals was 0.04±0.07 (horizontal canal), 0.06±0.04 (left anterior and right posterior canal), 0.06±0.04 (right anterior and left posterior canal) in BPVC group, respectively;while in control group, it was 0.02±0.02, 0.04±0.03, 0.04±0.04, respectively.There was no statistical difference between the two groups (P>0.05).Conclusion:A certain proportion of abnormal peripheral vestibule function in children with BPVC was found.vHIT is a "child friendly", relatively easy-to-use, and simple tool to evaluate each of the 6 semicircular canals, which may offer some potential clinical information for assessing the vestibule dysfunction for BPVC.
- child /
- vertigo /
- video head impulse test

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参考文献(18)

[1]	GRUBER M, COHEN-KEREM R, KAMINER M, et al.Vertigo in children and adolescents:characteristics and outcome[J].Sci World J, 2012, 2012:1-6.
[2]	HEADACHE CLASSIFICATION COMMITTEE OFTHE INTERNATIONAL HEADACHE SOCIETY (IHS).The International Classification of Headache Disorders, 3rd edition (beta version)[J].Cephalalgia, 2013, 33:629-808.
[3]	MACDOUGALL H G, WEBER K P, MCGARVIE LA, et al.The video head impulse test:diagnostic accuracy in peripheral vestibulopathy[J].Neurology, 2009, 73:1134-1141.
[4]	JAHN K, LANGHAGEN T, SCHROEDER A S, et al.Vertigo and dizziness in childhood-update on diagnosis and treatment[J].Neuropediatrics, 2011, 42:129-134.
[5]	ABU-ARAFEH I, RUSSEL G.Paroxysmal vertigo as a migraine equivalent in children:apopulation-based study[J].Cephalalgia, 2010, 15:22-25.
[6]	THYRA L A, SEBASTIAN S, NICOLE R, et al.Migraine-related vertigo and somatoform vertigo frequently occur in children and are often associated[J].Neuropediatrics, 2013, 44:55-58.
[7]	FINKELHOR B K, HARKER L A.Benign paroxysmal vertigo of childhood[J].Laryngoscope, 2010, 97:1161-1163.
[8]	LANZI G, BALOTTIN U, FAZZI E, et al.Benign paroxysmal vertigo of childhood:a long-term follow-up[J].Cephalalgia, 1994, 14:458-460.
[9]	SALAMI A, DELLEPIANE M, MORA R, et al.Electronystagmography finding in children with peripheral and central vestibular disorders[J].Int J Pediatr Otorhinolaryngol, 2006, 70:13-18.
[10]	GIOACCHINI F M, ALICANDRI C M, KALECI S, et al.Prevalence and diagnosis of vestibular disorders in children:a review[J].Int J Pediatr Otorhinolaryngol, 2014, 78:718-724.
[11]	张莉, 刘冰, 刘海红, 等.ABR与儿童良性阵发性眩晕的相关性[J].中华耳科学杂志, 2015, 13 (3):416-418.
[12]	CHANG C H, YOUNG Y H.Caloric and vestibular evoked myogenic potential tests in evaluating children with benign paroxysmal vertigo[J].Int J Pediatr Otorhinolaryngol, 2007, 71:495-499.
[13]	LIN K Y, HSU Y S, YOUNG Y S.Brainstemlesion in benign paroxysmal vertigo children:Evaluated by a combined ocular and cervical vestibular-evoked myogenic potential test[J].Int J Pediatr Otorhinolaryngol, 2010, 74:523-527.
[14]	侯凌霄, 陈太生, 徐开旭, 等.视频头脉冲试验评估突发性聋伴眩晕患者的前庭上下神经损伤范围[J].中华耳鼻咽喉头颈外科杂志, 2015, 50 (9):718-723.
[15]	BENJAMIN K, BERNARD E, JULIE L, et al.Benign paroxysmal vertigo of childhood:long-term outcome[J].Cephalalgia, 2010, 31:439-443.
[16]	MARCELLI V, RUSSO A, CRISTIANO E, et al.Benign paroxysmal vertigo of childhood:A 10-year observational follow-up[J].Cephalalgia, 2015, 35:538-544.
[17]	HALBERSTADT A L, BALABAN C D.Serotonergic and nonserotonergic neurons in the dorsal raphe nucleus send collateralized projections to both the vestibular nuclei and the central amygdaloid nucleus[J].Neuroscience, 2006, 140:1067-1077.
[18]	DIETERICH M, RANDT T.Episodic vertigo related to migraine (90cases):vestibular migraine[J]?J Neurol, 1999, 256:333-338.