150例眩晕患者临床分析

目的 探讨眩晕患者的病因、病变部位及前庭功能检测的特点.方法对2001～2002年我院门诊病房共计150例眩晕患者行纯音测听、声导抗、听性脑干反应（ABR）、耳蜗电图、眼震电图（ENG）、颅脑CT、颈部动脉多普勒超声检查等,并对结果进行分析.结果诊断为梅尼埃病30例,占20%,突发性聋伴眩晕19例,占12.7%,前庭神经炎4例,占2.7%,耳毒性药物中毒10例,占6.7%,良性阵发性位置性眩晕56例,占37.3%,听神经瘤1例,椎-基底动脉供血不足25例,占16.6%,脑供血不足5例,占3.3%.中枢性眩晕31例患者ENG显示眼辩障碍试验有过冲20例,自发性眼震18例,视动性眼震试验双侧不对称25例,视跟踪试验Ⅲ型曲线6例,双温试验轻瘫2例,麻痹15例.周围性眩晕119例患者ENG结果显示眼辩障碍试验有过冲42例,自发性眼震4例,视动性眼震34例,视跟踪试验Ⅰ型曲线80例,双温试验轻瘫42例.结论本组150例眩晕患者中,周围性眩晕发病率比中枢性高.周围性眩晕患者中纯音测听高频听力下降为主,ABR正常.中枢性眩晕患者中高刺激率听性脑干反应异常对听神经瘤有一定的诊断价值.中枢性眩晕患者双温试验异常率低,而周围性眩晕患者异常率偏高,说明迷路病变与周围件眩晕发病有关.     

前庭学

941024椎一基底动脉供血不足的眼姚电图表现/毋哲生…了新疆医学一1993,23(3)。一142~143 对90。例眩晕病人做了眼震电图检查,确诊为椎一基底动脉供血不足性眩晕170例。在眼震电图中扭颈试验阳性为椎一基底动脉供血不足的特征性表现。当椎一基底动脉供血不足主要发生在内听动脉时,扭颈试验出现水平旋转性眼震,冷热试验可出现单侧或双侧前庭功能低下。当供血障碍累及脑干、小脑时,扭颈试验多出现水平旋转性眼震,也可出现垂直性眼震,同时可有凝视试验阳性、视测距障碍试验阳性、跟踪试验l型曲线和视动试验不对称等中枢性改变。参5(原提要)9410…     

眼性前庭诱发肌源电位与眩晕诊断

眩晕是临床常见病和多发病,多由半规管或耳石器病变、前庭神经传入通路异常、大脑皮层颞上回前庭皮质区病变或受刺激引起.此外,颈椎病、椎基底动脉供血不足也能诱发眩晕.由于病因繁多,发病机制不明,眩晕的定位定性诊断一直是困扰临床医生的难题之一.目前常用的前庭功能检查方法主要有:眼震电图(electronystagmography,ENG)、眼震视图( videonystagmography,VNG)、转椅试验、姿势图和前庭诱发肌源电位(vestibular-evoked myogenic potentials,VEMP)等.其中VEMP因在球囊和椭圆囊功能评估中的独特作用,在眩晕临床诊治中受到越来越多的关注.     

良性阵发性位置性眩晕的诊断

回顾分析95例良性阵发性位置性眩晕(BPPV)诊断方法,并评价有效的检查和检查程序安排。应用的检查方法有:①病史及专科检查,脑干诱发电位;②检查自发性或位置性眼球震颤(PN)用Frenzel眼镜观察眼震电图(ENG)记录,并作视动眼震检查,作Dix-Hallpike位置试验;③Bithermal冷热试验;④旋转试验;⑤前庭习服锻炼(VHT)动作。试验标准:①DHM出现短暂的PN伴眩晕;②ENG在一个或多个位置上记录到眼震伴眩晕;③VHT一组动作中至少一个操作中出现PN。上列三项任一阳性可确诊。结果:95例中67例有典型的诱发性眩晕史,28例症状描述不典型。     

中耳渗液对前庭迷路的影响

眩晕在儿童不常见,但近年有所增多。有提出咽鼓管功能障碍、有或无中耳渗液,是儿童前庭机能障碍或眩晕的常见原因。本文研究中耳渗液对前庭的影响。一组患中耳渗液一年以上、无中耳感染的儿童100例,年龄4～7岁,平均6.3岁。由父母填表提供患儿平衡失调症状,均作神经学检查及鼓膜、纯音测听、鼓室图、眼震电图(ENG)等检查,与50名正常儿童及25名鼓膜切开放管后干耳的儿童相比较。结果:3例因中耳急性感染除外,余97例纯音测听语言听阈为20～45dB,平均28.9dB;鼓室图均为B型或C型;均为双侧性,仅2例双耳轻重不等;ENG显示35例(36%)有自发性水平性眼震,22例(22.7%)有位置性眼震,12例(12.4%)以上两眼震均有,ENG总异常率为69例(71%)。自发性眼震均单向     

眼震电图对老年头晕病人有诊断价值吗？

为了明确眼震电图(ENG)对六十五岁以上老年头晕病人的诊断价值,对96位健康无症状的志愿者和149例头晕患者行ENG检查,包括随意扫视试验、平稳跟踪试验、视动性眼震、位置性眼震的冷热试验。所     

眩晕和眼震电图的评价

眼震电图(ENG)的优点和用途已被公认,它正愈益广泛地应用于耳鼻咽喉科和神经耳科的诊断。本文作者根据在一所大学医院前庭门诊工作4年的经验,认为ENG对眩晕或头晕患者作为常规诊查法在诊断中往往不能提供重要依据,它的临床重要性似被夸大了。在头两年中,作者用双导的103A型ENG描记仪常规地进行记录。检查项目包括自发性眼震、位置性眼震和冷热试验。经验表明,ENG并     

眼震电图记录中垂直眼震的诊断价值

充分利用眼震电图(ENG)凝视试验可获更多信息,有助于区别前庭中枢和末梢病变。一般依靠水平导诊断疾病,垂直导不被重视仅用于鉴别水平导程上叠加的眨眼波。在全暗室瞬眼测试或观察眼睑可排除眨眼波,仍可能掩盖垂直眼震。下面报告一病例来证实此观点。24岁女病人因咽痛就诊后出现眩晕,不能除外急性迷路炎。用Tracoustic RN 260行常规ENG     

静态姿势图在眩晕类疾病诊断中的应用

目的探讨静态姿势图在眩晕类疾病诊断中的应用价值.方法对415例眩晕患者进行静态姿势图（SPG）和眼震电图（ENG）检测,比较分析其临床意义.结果静态姿势图异常和眼震电图半规管轻瘫分别为205例（49.4%）和215例（51.8%）,差异无显著性意义,两者综合分析异常者达到287例（69.2%）.结论静态姿势图在各类眩晕病症诊断中具有重要临床意义,联合应用眼震电图可以提高诊断效率.     

起立性低血压:血压与眼震的关系

起立性低血压患者大部分自述眩晕,但在当时记录血压与眼震的极少。作者对一例糖尿病并有多种合并症在起立时出现明显眼震的患者,在记录血压的同时应用眼震电图(ENG)记录眼震并进行分析。患者男,62岁,有浮动感、头痛和左侧面瘫,浮动感多在立位时出现,而在卧位时减轻,发作时有呕吐。经听力、前庭检查,变     

Investigating the causes of vertigo in breast cancer survivors

The vertigo symptom in breast cancer survivors has rarely been mentioned. The aim of this study was to investigate the causes of vertigo in breast cancer survivors with vertigo. From May 1997 to April 2003, 36 consecutive female breast cancer survivors with vertigo underwent a battery of tests including physical examination, neurological examination, serum lipid profile, plain chest radiograph, whole body bone scan, liver sonography, audiometry, electronystagmography (ENG) and MRI scan. Based on these tests, the causes of vertigo were attributed to peripheral labyrinthine origin in 14 patients (39%) and central origin in 22 patients (61%) consisting of 11 cases of vascular insufficiency, eight of hyperlipidemia and three of posterior fossa metastases (8%). The latter included one case of cerebellopontine angle and two of cerebellum, accompanied by extracranial systemic metastases, e.g., of the lung, bone or liver. In conclusion, vertigo in breast cancer survivors warrants concern, especially in those with extra-cranial systemic metastasis accompanied by headache. In addition to 8% occurrence of posterior fossa metastasis, other possible causes for vertigo in breast cancer survivors consist of vascular insufficiency, hyperlipidemia and labyrinthine lesion.     

甘油试验眼震电图对梅尼埃病的早期诊断价值

目的 为了对梅尼埃病能够早期诊断，早期治疗，预防出现耳聋及反复发作眩晕。方法 对来诊的６２８例眩晕患者进行甘油试验及眼震电图检查。结果 共确定梅尼埃病患者１１０例，其中无典型三征者９６例（占８７．３％）有典型三征者１４例（占１２．７％）。结论 梅尼埃病早期仅以症状断有一定困难，而甘油试验和眼震电图检查，可为梅尼埃病早期诊断提供客观依据。     

位置性眩晕的临床诊疗分析

目的 探讨位置性眩晕的临床诊断、治疗的更佳方案。方法 回顾性研究分析233例表现为位置性眩晕患者的临床特点及治疗效果。结果 233例中226例良性阵发性位置性眩晕(BPPV),中枢性眩晕6例(Arnold-Chiari 畸形1例、多发性硬化2例、小脑腔隙性梗塞2例、小脑出血1例),颈部寰枢椎脱位1例。后半规管BPPV 182例经复位法治疗,治愈129例(70.88%),改善39例(21.43%),无效14例(7.70%)。其他类型半规管BPPV 44例,治愈24例(54.54%),改善13例(29.55%),无效7例(15.91%)。Arnold-Chiari 畸形采用神经外科手术治疗治愈,寰枢椎脱位采用颈部牵引、多发性硬化和小脑腔隙性梗塞及小脑出血神经科保守治疗,症状缓解。结论 准确诊断和系统治疗是治疗位置性眩晕的关键。     

Association between leukoaraiosis and saccadic oscillation

OBJECTIVE: To use an audiovestibular test battery to evaluate patients with leukoaraiosis in order to investigate the relationship between vertigo and dizziness and leukoaraiosis. DESIGN: Retrospective study. SETTING: Tertiary university hospital. Patients A total of 18 elderly patients with vertigo and dizziness and with leukoaraiosis confirmed by magnetic resonance imaging (hereafter, leukoaraiosis group), and another 18 age- and sex-matched patients with vertigo and dizziness but without leukoaraiosis (hereafter, nonleukoaraiosis group) were enrolled in this study. MAIN OUTCOME MEASURES: Each patient underwent a battery of audiovestibular tests, including audiometry and electronystagmography (ENG). RESULTS: In the leukoaraiosis group, ENG examination showed slow pursuit movements in 72% of patients, slowing of saccadic eye movements in 28%, abnormal optokinetic nystagmus test results in 44%, and canal paresis or caloric areflexia in 56% of cases. Compared with the nonleukoaraiosis group, 50%, 17%, 44%, and 61% of cases exhibited nonsignificant differences in slow pursuit movements, slowing of saccadic eye movements, abnormal optokinetic nystagmus test results, and abnormal caloric test results, respectively. However, saccadic oscillation had an occurrence rate of 72% in the leukoaraiosis group in contrast with a 22% rate in the nonleukoaraiosis group, revealing a significant statistical difference. CONCLUSIONS: Saccadic oscillations in the ENG examination indicated leukoaraiosis on the magnetic resonance imaging scan, with a sensitivity of 72% and a specificity of 78%. We therefore recommend using ENG examination to screen elderly individuals with leukoaraiosis.     

Electronystagmographic (ENG) findings in paroxysmal positional vertigo (PPV) as a sign of vestibular dysfunction

In 285 patients, the observed nystagmus during episodes of PPV was compatible with excitation of the posterior semicircular canal. In these cases, divided in two groups, routine ENG recordings were retrospectively reviewed. In Group A (n = 241), the ENG was performed during the time the vertigo could be elicited; in Group B (n = 44), during the time it could not. In Group A: 1) the velocity of positional nystagmus (not the paroxysmal) was less than 6 degrees/s in 93% of cases; 2) there was no statistical difference of positional nystagmus and post-caloric preponderance of opposite directions, with 66% of cases having symmetrical responses; 3) the velocity of positional nystagmus and the post-caloric preponderance were higher than in Group B. It is concluded that: (i) in most cases no concomitant vestibular dysfunction could be detected; (ii) there was a tendency to restore right-left asymmetricity when the episodes subsided; (iii) ENG recordings were not pathognomonic and did not localize the affected side; (iv) there were ENG findings suggestive of concomitant involvement of other vestibular sensors (canals), in a small number of cases.     

Vestibular involvement in myringitis bullosa

OBJECTIVE: Cochlear involvement manifested by sensorineural or mixed-type hearing loss (HL) has been reported to occur in 30-67% of patients suffering from myringitis bullosa (MB). The goal of this study was to investigate the incidence and nature of vestibular involvement in MB. MATERIAL AND METHODS: All adult patients presenting to Hadassah University Hospital with MB between 2000 and 2002 were evaluated for inner ear involvement. Audiometry, tympanometry and electronystagmography (ENG) were performed within the first 48 h after presentation. The affected ears were examined on a regular basis and audiometric studies were repeated every other day. ENG was not repeated but a detailed questionnaire was administered and a thorough physical examination performed to rule out persistent vestibular dysfunction. RESULTS: Thirteen patients (17 ears) were diagnosed as suffering from MB. All 13 patients reported HL in the affected ears and 7 (54%) reported a sensation of vertigo at presentation. Audiometric tests revealed HL in all 17 affected ears: sensorineural HL in 2, mixed-type HL in 12 and conductive HL in 3. ENG was normal in only two cases, both of whom did not suffer from vertigo. Four patients with no vestibular symptoms whatsoever had an abnormal electronystagmogram. All seven patients who complained of vertigo had an abnormal electronystagmogram and recovered fully after treatment. All but two patients recovered their auditory function. CONCLUSIONS: Not only is the cochlear part of the inner ear affected in patients suffering from MB, but the vestibular part as well. Sensorineural HL and vestibular abnormalities should both be considered as manifestations of MB.     

Clinical investigation on hypotensive patients with vertigo

The aim of this study was to investigate the characteristic of hypotensive patients with vertigo. Twenty hypotensive patients with rotatory vertigo, 15 hypotensive subjects without vertigo, and 15 mitral valve prolapse subjects without vertigo underwent a battery of tests including audiometry, electronystagmography (ENG), and vestibular evoked myogenic potential (VEMP) test. The abnormal rates in terms of audiometry, eye tracking, optokinetic nystagmus, visual suppression, and caloric tests were 15, 35, 35, 10, and 42% for the first group; 13, 20, 33, 0, and 0% for the second group; and 7, 13, 60, 0, and 3% for the third group, respectively. Comparison of the first group with the other two control groups revealed that significant difference existed only in the abnormality of caloric responses. Fifteen (75%) of 20 hypotensive patients with vertigo having abnormal ENG results, asymmetric caloric responses, or delayed VEMPs were attributed to vertigo of central origin, possibly from ischemic disorder. In contrast, five patients (25%) had neither central signs in ENG nor abnormal VEMPs, but showing bilateral normal or hyperactive caloric responses were classified as autonomic dysfunction. After 3 months of medication, all patients with autonomic dysfunction had their vertigo and autonomic symptoms subsided, whereas 27% of the patients with ischemic disorder had vertigo persisted, showing a significant difference. In conclusion, hypotensive patients with vertigo could be due to either direct autonomic dysfunction or ischemic disorder mediated by autonomic deficits.     

Quantitative vestibular function testing in elderly patients with dizziness

Electronystagmography was used to examine 103 elderly patients complaining of dizziness. This series of tests included tests for pathologic nystagmus, saccades, smooth pursuit, and optokinetic nystagmus, as well as bithermal caloric testing and rotational testing. One or more specific diagnoses were identified in 100 patients (86.2%), with the two most common diagnoses being benign positional vertigo (30 patients, or 25.9%) and cerebrovascular disorders (25 patients, or 21.6%). An abnormality was found on ENG in 75 (65%) of the patients tested, the most common of these being a unilateral hypoexcitability to caloric stimulation. In most cases, the ENG data was used to support a presumptive diagnosis that was based on the patient's history and examination, although in 4 cases ENG provided the critical diagnostic information by identifying decreased caloric and rotational responses in patients with nonspecific dizziness and dysequilibrium.     

Electronystagmographic findings and recovery of cochlear and vestibular function in patients suffering from sudden deafness with a special reference to the effect of anticoagulation

The study included 80 patients treated for sudden deafness over the last 5-7 years. Case history, laboratory findings, pure-tone audiogram and electronystagmography (ENG) findings were noted. If any abnormalities had been recorded in ENG studies, the studies were redone. ORL status was redefined and audiograms were obtained in all patients. When becoming ill, the 80 patients had not differed from the normal population in common cardiovascular risk factors. None of them had had signs of viral infection (paired serum samples had been taken at 2-week intervals; routine examinations had been done for common viral antigens). As many as 31 of the 80 patients with acute hearing loss had had abnormalities such as spontaneous nystagmus (PN), hypoexcitability (HE) and directional preponderance (DP) in the bithermal caloric tests (+44 degrees C, + 30 degrees C) of their ENG studies. Twenty of the 31 patients still had abnormal ENG studies after 5-7 years. Only 1 subject had positional nystagmus, and none had subjective vertigo. Patients with an abnormal ENG study showed a poor recovery of the speech reception threshold, whereas those with a normal ENG study showed slightly significant (p less than 0.05) recovery.