Further exploration of the classification and clinical value of head-shaking nystagmus
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摘要: 目的 探讨摇头性眼震(head-shaking nystagmus，HSN)在前庭外周疾病中的分型与临床价值。方法 回顾分析198例存在HSN的前庭外周损伤疾病患者的临床资料。应用视频眼震图(video nystagmograph，VNG)分别进行自发性眼震(spontaneous nystagmus，SN)，HSN，冷热试验(caloric test，CT)检查，观察患者SN强度、方向，HSN强度、方向、分型，CT的单侧半规管功能减退(unilateral weakness，UW)值、眼震优势(direction preponderance，DP)值。结果 198例前庭外周损伤疾病患者中男105例、女93例，年龄14~87岁，平均(49.1±14.4)岁。包括前庭神经炎(vestibular neuritis，VN)患者137例，梅尼埃病(meniere’s disease，MD)12例，突发性聋伴眩晕(sudden deafness，SD)41例，伴眩晕的Hunt征8例。其中急性期患者116例，HSN呈减退型68例(58.6%)、恢复型4例(3.4%)、双相型5例(4.3%)、不变型38例(32.8%)、倒错型1例(0.9%)。非急性期82例，HSN减退型51例(62.2%)、恢复型3例(3.6%)、双相型9例(11.0%)、不变型19例(23.2%)。双相型HSN中，Ⅰ相减退型眼震强度通常大于Ⅱ相恢复型，差异有统计学意义(P < 0.01)。HSN分型与病程、DP值均无相关性。HSN强度与病程、DP值分别呈负相关(r=-0.320，P < 0.001)和正相关(r=0.364，P < 0.001)。不变型的眼震强度与摇头前的自发眼震强度分别为(8.0±5.7)°/s、(8.5±6.4)°/s，摇头前后眼震强度的差异无统计学意义。结论 HSN可呈现5种类型，是一种特定频率(中频)的潜在SN，同理SN也是各种不同频率单侧前庭损伤的共有体征。HSN强度能够动态反映前庭代偿过程，对前庭外周疾病损伤频率测评及前庭康复具有临床指导意义。Abstract: Objective To investigate the classification of head shaking nystagmus(HSN) and its clinical value in vestibular peripheral diseases.Methods Clinical data of 198 patients with peripheral vestibular disorders presenting with HSN were retrospectively analyzed. Video Nystagmograph(VNG) was applied to detect spontaneous nystagmus(SN), HSN, and Caloric Test(CT). The intensity and direction of SN and HSN as well as the unilateral weakness(UW) and direction preponderance(DP) values in caloric test was analyzed in patients.Results Among the 198 patients with vestibular peripheral disease, there were 105 males and 93 females, with an average age of(49.1±14.4) years (range: 14-87 years). One hundred and thirty seven patients were diagnosed as Vestibular Neuritis(VN), 12 as Meniere's Disease(MD), 41 as sudden deafness(SD) and 8 as Hunt's syndrome accompanied by vertigo. Among them, there were 116 patients in the acute phase, including 68 cases(58.6%) with decreased HSN, 4 cases(3.4%) with increased HSN, 5 cases(4.3%) with biphasic HSN, 38 cases(32.8%) with unchanged HSN, and 1 case(0.9%) with perverted HSN. There were 82 cases in the non-acute phase, 51 cases(62.2%) with decreased HSN, 3 cases(3.6%) with increased HSN, 9 cases(11.0%) with biphasic HSN, and 19 cases(23.2%) with unchanged HSN. In biphasic HSN, the intensity of phase I nystagmus was usually greater than that of phase II, and the difference was statistically significant(P < 0.01). There was no correlation between HSN type and course of disease or DP value. The intensity of HSN was negatively correlated with the course of disease(r=-0.320, P < 0.001) and positively correlated with DP value(r=0.364, P < 0.001), respectively. The intensity of unchanged nystagmus and spontaneous nystagmus were(8.0±5.7) °/s and(8.5±6.4)°/s, respectively. There was no statistically significant difference in the intensity of nystagmus before and after shaking the head.Conclusion HSN can be classified into five types and could be regarded as a potential SN within a specific frequency range (mid-frequency). Similarly, SN could also be considered as a common sign of unilateral vestibular impairment at different frequencies. HSN intensity can reflect the dynamic process of vestibular compensation, and is valuable for assessing the frequency of damage in peripheral vestibular diseases and monitoring the progress of vestibular rehabilitation.
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表 1 急性期患者与HSN分型
例 病例 总数 减退型 恢复型 双相型 不变型 倒错型 向健侧 向患侧 向健侧 向患侧 向健侧 向患侧 向健侧 向患侧 VN 92 54 0 2 1 2 0 32 1 0 MD 5 2 2 0 0 0 0 1 0 0 SD 18 8 1 0 1 2 1 4 0 1 Hunt综合征 1 1 0 0 0 0 0 0 0 0 合计 116 65 3 2 2 4 1 37 1 1 
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表 2 非急性期患者与HSN分型
例 病例 总数 减退型 恢复型 双相型 不变型 倒错型 向健侧 向患侧 向健侧 向患侧 向健侧 向患侧 向健侧 向患侧 VN 45 26 1 0 1 3 1 9 4 0 MD 7 3 1 0 0 0 0 1 2 0 SD 23 13 1 0 2 4 1 2 0 0 Hunt综合征 7 6 0 0 0 0 0 1 0 0 合计 82 48 3 0 3 7 2 13 6 0
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表 3 HSN类型、强度与病程、冷热试验DP、UW相关性分析
项目 病程 DP UW HSN类型 -0.106
(P>0.05)0.057
(P>0.05)/ HSN强度 -0.320
(P < 0.01)0.364
(P < 0.01)0.040
(P>0.05)
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