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1.
Summary The vestibular ganglia in 11 temporal bones from subjects with known premortem unilateral Meniere's disease were studied for evidence of increased fibrosis. Tissue sections were treated with Gomori's trichrome stain and were examined independently by each of seven persons experienced in histological study. The averaged ratings for the amount of fibrous tissue in the vestibular ganglia showed no significant differences for ears with Meniere's disease, the opposite uninvolved ears, and the controls.This work was supported by Grant 5 RO1 NSO5881 from the National Institute of Neurological and Communicative Disorders and Stroke  相似文献   

2.
Objective: Gait initiation is a transient procedure between orthostatic posture and steady-state locomotion and includes anticipatory anteroposterior (AP) and lateral movements. Commands for this task are located in some levels of brain stem, which modulates activity of central pattern generator in the spinal cord. The purpose of this work was to explore the role of the vestibular system in this voluntary stepping. Methods: Six patients with chronic bilateral vestibular loss (BVL) were measured by means of a large force plate (70 cm×120 cm ) and the displacement of the center of pressure (COP) during gait initiation was calculated. Measurement parameters comprised maximum distance (MD), velocity (MV) in the AP and lateral direction as well as for pre-, first- and second-step stages, and the angle of the COP trajectory. Results: For all stages, BVL patients registered lower values for both MD and MV in the AP direction than did normal subjects. In the lateral direction, however, neither MD nor MV in BVL patients showed any difference from those of normals. The step angle of the COP trajectory was obviously reduced. Conclusion: These results suggest that in the AP direction, the vestibulospinal pathway can influence the locomotor related neural circuits, including the central pattern generator and supraspinal levels, by means of modifying the velocity and step length in order to stabilize the trunk. On the other hand, the control mechanism in the lateral direction may be different from that in the AP direction.  相似文献   

3.
目的 探讨迷路后径路前庭神经切断术治疗难治性梅尼埃病的手术安全性、可靠性、术后疗效。 方法 回顾性分析75例单侧难治性梅尼埃病患者行经迷路后径路前庭神经切断术的临床资料。 结果 75例患者平均病程(53.11±43.87)个月,术前500 Hz、1 000 Hz、2 000 Hz、4 000 Hz平均听阈(63.71±16.85)dB HL。听力分期Ⅱ期2例,Ⅲ期34例,Ⅳ期39例。Ⅱ期2例患者为内淋巴囊减压术后复发患者。术后颅内感染1例(1.3%)、脑脊液漏4例(5.3%)、暂时性面瘫1例(1.3%)、切口感染2例(2.6%)、切口脂肪液化3例(3.9%)。无颅内出血及术后即刻全聋的病例。术后眩晕疗效评定73例患者为A级,2例患者为B级。 结论 经迷路后前庭神经切断术疗效确切,风险与并发症可控,可显著改善患者生活质量。  相似文献   

4.
 目的探讨联合应用前庭自旋转(Vestibular autorotation test, VAT)和冷热试验对早期梅尼埃病和前庭性偏头痛的临床鉴别诊断价值。方法选取24例早期梅尼埃病非急性发作期(Meniere disease,MD)患者和22例前庭性偏头痛(Vestibular migraine,VM)患者进行VAT和冷热试验检查,均为单耳发病,均先行VAT检测后行冷热试验。VAT检测观察水平增益、水平相移、垂直增益、垂直相移、非对称性5项参数,其中任意一项及以上异常即评定为前庭功能异常;后行冷热试验观察记录半规管轻瘫值(canal paresis,CP)和热气试验最大慢相角速度(SPVmax)。对两组患者的VAT和冷热试验的结果进行比较,分析统计学差异。结果VAT结果显示24例MD组16例(66.7%)前庭功能异常,其中增益增高1例次、降低8例次,增益部分增高部分降低1例次,相移延迟有12例次,非对称性异常有5例次;22例VM组中12例(54.5%)前庭功能异常,其中增益增高6例次、降低1例次,相移延迟有10例次。两组数据比较,增益增高和降低检出率有统计学差异(P<0.05)。冷热试验显示24例MD组中CP阳性14例(58.3%),SPVmax均值10.5°±9.5°/S;22例VM组CP阳性4例(18.2 %),SPVmax均值34.7°±17.9°/S。 两组CP和SPVmax均值比较有显著统计学差异(P<0.05)。结论在两组疾病的非急性发作期,VAT测试提示MD患者以4~6 Hz增益降低,VM患者以2~4 Hz增益增高为主要特征;冷热试验提示MD患者多表现为单侧水平半规管功能减退,而VM患者表现为亢进或者正常;二者的结合具有高低频互补作用,可以提高早期MD和VM的鉴别诊断。  相似文献   

5.
目的 探讨前庭诱发肌源性电位(VEMP)对前庭下神经炎的诊断价值。方法 回顾分析我科眩晕门诊18例前庭下神经炎的临床资料,尤其是VEMP检测结果。结果 18例患者中,15例表现为旋转性眩晕,3例为平衡障碍,所有患者纯音测听、冷热试验及眼性前庭诱发肌源性电位(oVEMP)正常而颈性前庭诱发肌源性电位(cVEMP)异常。其中14例cVEMP检查不能引出,4例振幅低下。3个月后复诊10例患者症状消失,复查cVEMP 9例恢复正常,1例振幅低下;半年复诊18例患者症状全部消失,复查cVEMP只有2例振幅低下,其余均恢复正常。结论 VEMP检查对前庭下神经炎的精准诊断及判断预后有重要临床价值,值得临床推广。  相似文献   

6.
梅尼埃病与偏头痛性眩晕的听-前庭功能比较   总被引:1,自引:0,他引:1  
目的探讨梅尼埃病与偏头痛性眩晕的听功能及前庭功能状态的不同特点,进行比较分析,为二者的鉴别诊断提供帮助。方法回顾性分析2007年5月至2008年9月山东省立医院眩晕门诊52例梅尼埃病患者与36例偏头痛性眩晕患者的临床资料,全部患者均在急性期或亚急性期行纯音测听、视频眼震电图、冷热试验、前庭诱发的肌源性电位检查,部分梅尼埃病及全部偏头痛性眩晕患者行高刺激率听性脑干反应检查,对二者的听力与前庭功能检查结果进行比较分析。结果梅尼埃病患者共52例,男24例,女28例,年龄14-70岁,平均45.8岁。纯音测听异常52例,均为单侧感音神经性聋。视频眼震电图检查示中枢性异常眼动10例。冷热试验异常37例,均为单侧半规管反应低下。前庭诱发的肌源性电位检查异常31例。行高刺激率听性脑干反应检查共32例,5例异常。偏头痛性眩晕患者共36例,男8例,女28例,年龄16-62岁,平均43.6岁。纯音测听异常9例,均为单侧轻至中度感音神经性聋。视频眼震电图检查示中枢性异常眼动17例。冷热试验异常8例,均为单侧半规管反应低下。前庭诱发的肌源性电位检查异常18例,高刺激率听性脑干反应检查异常22例。经统计学分析,二者纯音测听、中枢性眼动检查、冷热试验及高刺激率听性脑干反应的检查结果差异有显著性。结论与梅尼埃病相比,偏头痛性眩晕患者纯音测听及冷热试验异常较少见,中枢性服动检查及高刺激率听性脑干反应异常率较高。在结合患者病史及临床表现的基础上.以上检查可为二者的鉴别提供辅助参考。  相似文献   

7.
前庭神经切断术后的前庭代偿观察   总被引:1,自引:1,他引:1  
目的观察前庭神经切断术后的前庭代偿过程。方法对1998-2005年10例前庭神经切断术后患者.观察自发性眼震和平衡失调的持续时间,并对4例术前、后眼震电图进行对比观察。结果患者术后均出现快相向健侧的水平性眼震,持续4~7天消失,平衡失调恢复时间为一月至一年不等,年龄越大持续时间越长。4例进行眼震电图检查的患者,3例前庭功能均丧失,1例热水试验出现反向眼震。结论前庭代偿是前庭神经切断术后患者康复的必然过程,前庭康复训练可缩短前庭代偿的时间。  相似文献   

8.
Summary Immunofluorescent staining techniques were performed on a series of cryostat sections of the vestibular ganglion taken during ganglionectomy from a patient with Menière's disease. The direct technique using FITC-labelled antiserum proved the presence of immunoglobulins in the patient's blood vessels and endoneural connective tissue. Preincubation with unlabelled antiserum blocked this reaction. An additional positive reaction of ganglion cells was demonstrated by incubating tissue with the patient's serum. These findings prove antibodies in the patient's serum against the autologous ganglion cells. The vestibular ganglion from a patient with dizziness following a skull base fracture served as a control specimen. No autoimmune reaction was found in the ganglion cells when incubation was carried out with the patient's serum. A positive reaction in the blood vessels and connective tissue was less pronounced. The findings of the present study underline the occurrence of immunological reactions in the vestibular ganglion of patients with Menière's disease. A subsequent degeneration of ganglion cells could provoke clinical Menière's attacks.  相似文献   

9.
Summary The morphology of the vestibular nerve was studied in three fresh nerve specimens obtained by surgery from two patients with Ménière's disease and one patient with tinnitus after an attack of sudden deafness.The number of nerve fibres appeared light microscopically normal. The vestibular ganglion cells of the Ménière-specimens showed, as a characteristic finding advanced vesiculation of the cytoplasm. This change was confirmed by electron microscopy and the vacuoles appeared to consist of widened endoplasmic reticulum cisternae. Numerous primary lysosomes and lipofuscin granules were observed in all vestibular ganglion cells but their number appeared increased in the specimens from Ménière-patients. Some of the vestibular ganglion cells of these patients showed a filamentous appearance and the number of glycogen granules seemed reduced in all of them. All vestibular ganglion cells observed were unmyelinated. The degenerative changes observed might explain the typical elevation of the threshold for vestibular stimulation in Ménière's disease.We thank Miss Pirkko Leikas for skillful technical assistance.  相似文献   

10.
利用螺旋CT三维图像对梅尼埃病患者前庭小管外口的研究   总被引:1,自引:0,他引:1  
目的 通过螺旋CT三维重建技术观察梅尼埃病患者前庭小管外口,研究其宽度的大小与该病发生的内在联系。方法 分别观察比较梅尼埃病患者和正常受试者。对颞骨岩部范围进行容积扫描,采用后颅窝内面观、表面法进行三维重建。在三维方向上旋转切割后图像,直接测量前庭小管外口最大直径。结果 所有受试者三维图像上前庭小管外口均显示清晰,梅尼埃病患者前庭小管外口宽度与正常耳组间的差异具有非常显著性意义。单侧梅尼埃病患者病耳与非病耳前庭小管外口宽度的差异无显著性意义。结论 前庭小管发育不良为梅尼埃病的病理解剖学基础,并且常常累及双耳。  相似文献   

11.
Summary In patients with peripheral vestibular deficiencies, the testing of posture or posturography can give specific information about any compensation obtained in the vestibulospinal reflex (VSR). We have used the statokinesimetric parameter of length in this study. Nearly 50% of the patients with unilateral vestibular hypofunction as well as those patients with paroxysmal positional vertigo (PPV) show abnormal results. These findings indicate deficient compensation at the vestibulospinal level, which is independent of any compensation already achieved at the vestibulo-ocular level. The tests used for the latter, such as positioning and rotational tests, are unable to provide information about the degree of compensation reached in the VSR. The examinations used in the different modalities of sensory interaction can show the presence of influences of ocular fixation and changes of head position. We have observed three types of deviant interaction. Our posturographic data have allowed us to assess functional situations in a more precise way. Any rehabilitation exercises used should be adapted according to these data.Supported by a grant from the Nationaal Fonds voor Geneeskundig Wetenschappelijk Onderzoek  相似文献   

12.
Summary The central projections of fibers from the vestibular nerve were studied in 19 chinchillas after horseradish peroxidase labelling. In addition, the limits of the vestibular nuclei and the anatomical characteristics of their neurons were also studied. All five vestibular nuclei received primary afferents, but there were extensive areas of them that received very little or no projections at all, such as the rostral part of the superior vestibular nucleus, the dorsocaudal part of the lateral vestibular nucleus, the caudal half of the medial vestibular nucleus and the caudalmost aspect of the dorsal vestibular nucleus.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988  相似文献   

13.
《Acta oto-laryngologica》2012,132(10):1053-1056
Conclusion. In patients with Ménière's disease and persisting vertigo attacks after vestibular neurectomy (VNx) MRI of the vestibulocochlear nerve can identify residual vestibular nerve fibres that could be responsible for the vertigo attacks. Objective. To test if MRI of the vestibulocochlear nerve can corroborate the presence of residual vestibular nerve fibres in patients with persisting vertigo attacks and residual vestibular function after VNx. Materials and methods. Vestibulocochlear nerve bundles of seven post-VNx unilateral Ménière's patients were imaged using 1.5 Tesla MRI with steady state free precession (SSFP) sequences. Reformatted MR images orthogonal to the vestibulocochlear nerve axis in internal auditory canal were compared on the VNx and intact sides. Vestibular function was assessed with caloric tests, three-dimensional head impulse tests and vestibular evoked myogenic potentials. Of the seven patients only one was asymptomatic (totally free of vertigo); six had continued to experience vertigo attacks, albeit not as long or as severe as before VNx. Results. On the VNx side, MRI showed intact facial and cochlear nerves in all seven patients. In the six symptomatic patients, although superior and inferior vestibular nerve bulk and signal were reduced, residual bulk suggestive of inferior vestibular nerve was evident, correlating with evidence of residual posterior canal function on impulsive testing in all six symptomatic patients. In the asymptomatic patient, superior and inferior vestibular nerves were absent on MRI and impulsive testing revealed no residual posterior canal function.  相似文献   

14.
眩晕是外周前庭疾病的主要表现之一,发病原因涉及多个学科,临床诊治较为困难。随着前庭功能检查技术的发展、对前庭疾病研究的不断深入,相关科研成果与日剧增并广泛应用于临床。近年来,随着前庭疾病国际分类标准制定和发布,各类前庭疾病诊断标准相继出台,治疗前庭疾病的药物、手术的相关规范日趋完善,加之前庭康复技术的飞速发展,使得对前庭疾病的诊疗越来越规范和精准。  相似文献   

15.
The parameters for vestibular dysfunction were modified after our own studies. This index includes the degree of vertigo present, spontaneous nystagmus, dysfunction of the vestibulospinal reflexes and caloric and postrotatory side differences. The index is applicable for defining the extent of a lesion, follow-up, defining its stage and the results of therapy. Introduction of the modified vestibular index is proposed for use in clinical diagnosis. Classification of vestibular neuronitis into groups A, B and C is suggested on the basis of the reversibility of spontaneous nystagmus after caloric stimulation.  相似文献   

16.
单侧前庭功能低下患者计时平衡试验及静态姿势描记   总被引:5,自引:1,他引:5  
目的观察单侧前庭功能低下(unilateral vestibular hypofunction,UVH)患者的计时平衡试验和静态姿势描记,探讨两种方法的临床应用价值。方法65例UVH患者和92例健康志愿者进行如下静态直立试验:①标准Romberg试验;②双脚平行分开直立试验;③强化Romberg试验(踵趾足位站立);④单足直立试验。每种测试条件下分别睁眼和闭眼站立,用秒表记录①~④试验中维持平衡的时间,同时用静态姿势描记记录①、②条件下的身体晃动平均速度。结果①计时平衡试验:UVH组采取踵趾位和单足站立时,维持平衡时间较对照组降低,差异均有统计学意义(P值均〈0.001);②静态姿势描记:采用标准Romberg位和双脚分开站立,UVH组和对照组相比,睁眼时2组身体晃动平均速度差异无统计学意义(P值分别是0.118和0.110)。而闭眼时UVH组身体晃动平均速度较对照组增加,2组差异均有统计学意义(P值均〈0.001);③对于UVH组和对照组,无论睁眼或闭眼,采用双脚分开站立时,身体晃动平均速度均较标准Romberg位时降低,差异有统计学意义(P值〈0.05或〈0.001);④踵趾位和单足站立时的各计时结果与其标准Romberg站立和双足分开站立时的各身体晃动平均速度间未发现有统计学意义。结论评估UVH患者平衡功能时,踵趾位和单足直立计时平衡试验是对静态姿势描记试验的补充,两种方法可在临床中结合应用;进行静态姿势描记试验时,应考虑足位因素对测试结果的影响。  相似文献   

17.
十年来,我国对前庭系统疾病的基础和临床研究取得了较大的进展。本文对前庭疾病的计算机图像技术,遗传学,神经递质,检查,诊断和治疗等方面进行综述。  相似文献   

18.
甘油对梅尼埃病患者前庭诱发的肌源性电位的影响   总被引:1,自引:0,他引:1  
目的通过梅尼埃病患者前庭诱发的肌源性电位(vestibulare voked myogenic potential,VEMP)在甘油试验前后的变化情况,了解本项检查在梅尼埃病诊断中的意义。方法对明确诊断为梅尼埃病的10例患者进行甘油试验,比较甘油试验前后前庭诱发的肌源性电位的变化。甘油试验VEMP观察时间段选择两点,服用甘油前及服用甘油后3小时的振幅变化作为指标。结果8例单侧梅尼埃病,其中5例振幅改善(2例振幅增加,3例振幅从无到有),3例甘油试验后VEMP的振幅变差。2例双侧梅尼埃病,1例甘油试验后VEMP振幅从无到有,1例VEMP振幅改善。结论梅尼埃病患者甘油试验后,VEMP变化有以下三种情况:①从无到有;②引出的振幅降低;③引出的振幅提高。甘油试验纯音听力检查结合VEMP的甘油试验有助于梅尼埃病的诊断。  相似文献   

19.
眼动功能定量分析在前庭疾病中鉴别诊断的意义   总被引:2,自引:0,他引:2  
目的探讨眼动功能定量分析检查在鉴别不同类型前庭疾病中的作用.方法本文收集181例眼动功能定量分析资料,其中正常组40例,突发性聋组46例,药物中毒性眩晕组26例,梅尼埃病组48例,听神经瘤组21例,分别进行扫视、跟随及视动试验定量分析检查.结果周围性前庭病变各项检查与正常组比较无统计学差异;听神经瘤组扫视试验潜伏期延长,达246ms+66ms,较正常组190ms+25ms明显延长,跟随试验各项指标均示异常,视动性检查最大慢相速度及平均慢相速度减慢,分别为18.4°/s±6.4°/s和16.0°/s±6.0°/s,较正常组22.6°/s±8.8°/s和20.3°/s±8.7°/s减慢.结论提示眼动功能定量分析检查对鉴别前庭周围性和中枢性病变有一定参考价值.  相似文献   

20.
R E Blessing  P Pedersen  W W Schlenter 《HNO》1990,38(11):396-398
Frenzel's spectacles have been essential tools for the clinical examination of the vestibular system since 1925. However, they may lead to false-negative results because they enable the patient to fixate, or to false-positive results because they induce pseudospontaneous nystagmus. Both pitfalls originate from direct illumination of the patient's eyes, and we propose a new design using indirect illumination.  相似文献   

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