良性发作性位置性眩晕抗抑郁焦虑治疗疗效分析

目的探讨良性发作性位置性眩晕患者抗焦虑抑郁治疗疗效。方法我院2009—2012年收治病程>2周的良性发作性位置性眩晕患者58例,随机分为治疗组和对照组,治疗组进行常规眩晕治疗(药物及手法复位)+氟哌塞顿美利曲辛治疗,对照组进行常规眩晕治疗。2组患者在初诊时、治疗2周后分别进行DHI量表评分测定。结果治疗组DHI量表分值明显低于对照组,眩晕症状改善明显优于对照组。结论良性发作性位置性眩晕患者常伴随抑郁焦虑情绪,针对性进行抗抑郁焦虑治疗有益于改善患者眩晕症状。     

氟哌噻吨美利曲辛对良性阵发性位置性眩晕成功复位后残余头晕的影响

目的观察氟哌噻吨美利曲辛对良性阵发性位置性眩晕成功管石复位后残余头晕的影响。方法 60例良性阵发性位置性眩晕成功管石复位后发生残余头晕的患者随机分为对照组及观察组,对照组28例,观察组32例。对照组给予内科常规治疗,观察组在内科治疗的基础上加用氟哌噻吨美利曲辛治疗。于治疗前及治疗后第7天、第14天评估眩晕障碍量表(DHI)评分、医院焦虑抑郁量表(HADS)评分及前庭症状指数(VSI)。结果治疗后第7天及第14天,观察组DHI总分及各子项评分、HADS评分及VSI均低于对照组(P0.05)。结论氟哌噻吨美利曲辛可以通过抗焦虑、抗抑郁作用,改善良性阵发性位置性眩晕成功复位后的残余头晕症状,改善患者生活质量。     

良性阵发性位置性眩晕手法复位后残余头晕研究进展

良性阵发性位置性眩晕（BPPV）是前庭周围性眩晕中最常见的原因,经相应的手法复位治疗,绝大多数患者的眩晕症状消失,部分患者在成功复位后仍有残余头晕（RD）,给患者的健康相关生活质量带来诸多困扰,RD产生的原因尚未完全明确,本文总结了国内外学者近年来报道的有关RD的发生率、相关影响因素,并归纳了RD常用的评估方法和治疗手段,以期为BPPV患者RD的规范化及个体化治疗提供参考。     

良性阵发性位置性眩晕手法复位后残余头晕研究进展

良性阵发性位置性眩晕(BPPV)是前庭周围性眩晕中最常见的原因,经相应的手法复位治疗,绝大多数患者的眩晕症状消失,部分患者在成功复位后仍有残余头晕(RD),给患者的健康相关生活质量带来诸多困扰,RD产生的原因尚未完全明确,本文总结了国内外学者近年来报道的有关RD的发生率、相关影响因素,并归纳了RD常用的评估方法和治疗手段,以期为BPPV患者RD的规范化及个体化治疗提供参考。     

耳石复位法治疗良性阵发性位置性眩晕

目的 探讨良性阵发性位置性眩晕(BPPV)耳石复位法的疗效.方法 应用Epley手法、Barbecue翻滚法和Semont手法对110例BPPV患者进行治疗.结果 110例患者经上述手法复位治疗后眩晕症状均完全消失或改善,治愈率94.5% ,总有效率100%,无明显不良反应.结论 手法复位治疗BPPV患者是一种非常有效的方法,它能有效的缩短病程,减轻患者痛苦,其方法简单、易行且费用低,可以在临床广泛使用.     

良性阵发性位置性眩晕的耳石复位治疗

目的探讨良性阵发性位置性眩晕(BPPV)耳石复位法的疗效。方法应用Epley手法、Barbecue翻滚法和Semont手法对12例BPPV患者进行治疗。结果12例患者经上述手法复位治疗48h后眩晕症状均完全消失,无明显不良反应,分别随访3～11个月无再发。结论耳石复位法治疗BPPV有效、简便、安全,可作为BPPV的首选治疗方法。     

良性发作性位置性眩晕患者残余头晕的危险因素分析

目的 研究良性发作性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者治愈后残余头晕的发生率和持续时间以及残余头晕的危险因素.方法 连续性前瞻性收集确诊的284例BPPV患者,在颗粒复位后随访3个月,统计患者残余头晕的发生率和持续时间；应用Logistic回归分析其残余头晕的危险因素.结果 (1) 284例被确诊的BPPV患者纳入研究,其中55.63％(158/284)在治愈后有残留头晕症状.245例患者完成了3个月的随访,30 d残余头晕率为13.67％(38/278),60 d残余头晕率为9.29％ (25/269),90d残余头晕率为7.75％(19/245).残余头晕组的平均年龄(岁)明显大于无头晕组(61.46±9.38与56.93±7.62,t =2.121,P=0.015).此外,女性残余头晕的发生率稍高于男性[62.41％ (88/141)与37.59％(53/141),x2=7.984,P=0.005].(2)对残余头晕患者危险因素进行Logistic回归分析发现,治疗前眩晕的持续时间是残余头晕的独立危险因素(OR=2.988,95％ CI 1.688～5.292,P=0.000).结论 (1)BPPV颗粒复位后一半以上的患者残留有头晕症状,多在1个月内自然消失.(2)手法复位治疗前眩晕的持续时间是眩晕后头晕的独立危险因素.     

360°旋转复位与Epley手法复位治疗后半规管良性阵发性位置性眩晕的比较

目的:比较360°旋转复位与Epley手法复位治疗后半规管良性阵发性位置性眩晕的临床疗效。方法:69例后半规管良性阵发性位置性眩晕患者被随机分入研究组(35例,接受360°旋转复位治疗)和对照组(34例,接受Epley手法复位治疗)。比较2组患者的疗效以及痊愈后的残留症状。结果:研究组和对照组患者在接受1次治疗后即可获得治愈的患者所占比例分别为91.4%(32/35)和88.2%(30/34),需要接受2次治疗才能达到治愈的患者所占比例分别为8.6%(3/35)和11.8%(4/34),但2组之间的差异均无统计学意义(P值均0.05)。研究组治愈后有残留症状(包括头晕、行走不稳、颈部不适)的患者所占比例为17.1%(6/34),显著低于对照组患者[29.4%(10/35)](P0.05)。结论:360°旋转复位与Epley手法复位治疗后半规管良性阵发性位置性眩晕的疗效相似,但前者的残留症状更少,有助于提高患者的生活质量,且操作更加简便、舒适度更优,显示出较高的临床应用价值。     

良性阵发性位置性眩晕残留症状的影响因素

目的 探讨良性阵发性位置性眩晕（BPPV）患者耳石复位后残留症状的影响因素。方法 本 研究为前瞻性研究，共收集42例门诊确诊BPPV的患者在发病时和耳石复位成功1周后的一般情况，以 及眩晕残障量表（DHI）、医院焦虑抑郁量表（HADS）和眼肌前庭诱发肌源性电位检查（oVEMP）的结果。按 照复位成功后有无残留症状进行分组比较，Logistic回归分析残留症状的影响因素。结果 41例患者完 成随访，发现12例（29.3%）患者耳石复位成功后出现残留症状。残留症状组平均年龄和病程均大于无残 留症状组（P＜ 0.05）；残留症状组oVEMP患侧的振幅在耳石复位后有明显增高（P＜ 0.05）；残留症状组的 DHI-E（情绪）和HADS总分均高于无残留症状组（P ＜ 0.01）。进行Logistic回归分析发现BPPV发病时的 情绪状态是复位后残留症状的独立危险因素（P＜0.05）。结论 BPPV复位后残留症状受多方面因素影响， 抑郁与焦虑情绪是主要影响因素，BPPV发病时心理情绪干预能预防或改善残留症状的发生。     

改良式耳石复位法联合益气聪明汤治疗良性阵发性位置性眩晕疗效观察

目的 探讨改良式耳石复位法联合益气聪明汤治疗良性阵发性位置性眩晕(BPPV)的疗效.方法 56例BPPV患者随机分为对照组(耳石复位法)和治疗组(改良式耳石复位法联合益气聪明汤),随访1 a,观察治疗效果.结果 经上述方法治疗后,眩晕症状完全消失或明显改善.对照组治愈率81.5%,有效率100%,复发率22.2%;治疗...     

良性阵发性位置性眩晕与前庭性偏头痛患者焦虑抑郁状态比较研究

目的 比较良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）患者和前庭性偏头痛 （vestibular migraine，VM）患者焦虑、抑郁的发生率和特点。 方法 收集2016年9月-2017年9月诊断为BPPV和VM患者各50例。对两组患者进行眩晕残障量表 （dizziness handicap inventory，DHI）和医院焦虑抑郁量表（hospital anxiety and depression scale，HADS）评 定，比较两组基线资料和DHI 、HADS评分的差异。 结果 治疗前BPPV组存在明显眩晕残障者32例（64%），存在焦虑抑郁者15例（30%），治疗后分 别为3例（6%）和2例（4%），差异有统计学意义（P＜0.001和P =0.001）；治疗前VM组存在明显眩晕 残障者38例（76%），存在焦虑抑郁者为28例（56%），治疗后分别为12例（24%）和8例（16%），差异 均有统计学意义（均P＜0.001）。治疗前VM组DHI[55.00（44.00～70.00）vs 31.00（20.00～45.00），P ＜0.001]和HADS评分[13.50（6.00～20.00）vs 6.00（3.75～10.00），P =0.001]高于BPPV组，其中DHI评 分中情感、躯体和功能3个分项的评分也均高于BPPV组，差异均有统计学意义。治疗后VM组DHI[22.00 （12.00～34.00）vs 0（0～4.00），P＜0.001]和HADS评分[7.50（2.00～10.50）vs 0（0～3.00），P＜0.001] 仍高于BPPV组，其中DHI评分中情感、躯体和功能3个分项的评分也均高于BPPV组，差异均有统计学 意义。 结论 VM患者焦虑抑郁严重程度高于BPPV患者，两组经治疗后焦虑抑郁的发生率均有显著下降。     

Unexplained dizziness does not resolve in time

Only few patients with dizziness are referred to a medical specialist, who is sometimes unable to come to a conclusive cause of the dizziness. We have no information about the course of unexplained dizziness, from the literature or from our own population. We therefore undertook this follow-up study to assess the outcome of patients with unexplained dizziness, after assessment in a multidisciplinary outpatient clinic. In 292 patients (out of our total cohort of 2,244 patients), a diagnosis could not be established. The median dizziness handicap inventory (DHI) score at the diagnostic visit was 30. We sent them a questionnaire and the DHI. After a median follow-up of 62?months (range 24?C105 months), 113 of the 189 responders (60?%) reported to still suffer from dizziness, 46 patients had moderate impairments, and 16 patients indicated that they were severely impaired by their dizziness. The DHI only slightly decreased (from median 30 to 26). In 1?% of the cases, an organic explanation for the dizziness was ultimately found during follow-up by other health-care workers. Patients who have been assessed in a multidisciplinary dizziness clinic, and in whom no explanatory cause for the dizziness has been found, have a high risk of persisting impairments.     

中医刁氏技法治疗梅尼埃病眩晕症状的DHI量表评估

目的观察中医刁氏技法对治疗梅尼埃病患者眩晕症状的影响。方法将16例梅尼埃病患者分为对照组和实验组,对照组予银杏叶注射液加西药倍他司汀(口服)治疗,实验组在上述药物治疗基础上予中医刁氏技法治疗。两组均在治疗前及治疗1d后应用眩晕残障程度评定量表(DHI)对临床症状进行评价。结果治疗前,实验组和对照组的DHI评分差异无统计学意义(P=0.412)。治疗1d后,实验组DHI评分(7.33±5.48)显著低于对照组(48.33±21.70)(P=0.000)。两组患者在治疗期间及治疗结束后皆无明显不适反应。结论中医刁氏技法治疗梅尼埃病的眩晕症状可能有效。     

Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs

OBJECTIVE: To determine the longitudinal relationship between beliefs about the consequences of dizziness and handicap levels in dizzy patients, and the effect of therapy on beliefs. METHODS: Symptoms, beliefs, and handicap were assessed at baseline and 6 months follow up in 76 primary care patients complaining of dizziness or vertigo, of whom 33 were assigned to treatment (i.e., vestibular rehabilitation). RESULTS: At baseline most patients believed that dizziness would have negative consequences such as falling, fainting, or losing control. Handicap levels at follow-up were predicted by baseline beliefs that dizziness would have negative consequences. Significant reduction in negative beliefs at follow-up was observed in the patients who received treatment, whereas there was no reduction in negative beliefs in the untreated patients. CONCLUSIONS: Negative beliefs about the consequences of dizziness sustain long-term restriction of activity, and can be modified by therapy.     

Residual Dizziness after Successful Repositioning Treatment in Patients with Benign Paroxysmal Positional Vertigo

Background and purpose

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Although the repositioning maneuver dramatically improves the vertigo, some patients complain of residual dizziness. We evaluated the incidence and characteristics of persistent dizziness after successful particle repositioning and the clinical factors associated with the residual dizziness.

Methods

We performed a prospective investigation in 49 consecutive patients with confirmed BPPV. The patients were treated with a repositioning maneuver appropriate for the type of BPPV. Success was defined by the resolution of nystagmus and positional vertigo. All patients were followed up until complete resolution of all dizziness, for a maximum of 3 months. We collected data on the characteristics and duration of any residual dizziness and analyzed the clinical factors associated with the residual dizziness.

Results

Of the 49 patients, 11 were men and 38 were women aged 60.4±13.0 years (mean ±SD), and 30 (61%) of them complained of residual dizziness after successful repositioning treatment. There were two types of residual dizziness: continuous lightheadedness and short-lasting unsteadiness occurring during head movement, standing, or walking. The dizziness lasted for 16.4±17.6 days (range=2-80 days, median=10 days). A longer duration of BPPV before treatment was significantly associated with residual dizziness (p=0.04).

Conclusions

Residual dizziness after successful repositioning was observed in two-thirds of the patients with BPPV and disappeared within 3 months without specific treatment in all cases. The results indicate that early successful repositioning can reduce the incidence of residual dizziness.     

Electronystagmography study in patients with the insufficiency of vertebrobasilar artery after betahistine treatment

The aim of the study was objective assessment of the results of betahistyne treatment in patients with chronic insufficiency of the vertebrobasilar artery system by means of elektronystagmography (ENG). The patients had mostly vertigo and/or dizziness, headache, ear buzzing and disequilibrium sensations. In 46 patients clinical, audiological and ENG examinations were carried out. All symptoms decreased in frequency after the treatment. Vertigo and/or dizziness improvement was noted in 58.5% patients of cases, headache decreased in 56.5% of cases, ear buzzing decreased in 42.8% and hearing improved in 22.2%. Before treatment 76% of patients had pathologic changes in ENG, after treatment improvement of ENG was noted in all tests, particularly in 17 cases (48.6%). This was most frequent in spontaneous nystagmus (83%), positional test (85%), caloric test (83%), and optokinetic test (71%). Comparison of complaints and ENG findings before and after treatment showed improvement both in symptoms and signs. Betaserc was effective in the treatment of patients with vertebrobasilar system insufficiency both in subjective opinions of patients and in objective assessment by ENG.     

Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo

ObjectiveTo investigate whether residual dizziness after successful treatment in patients with benign paroxysmal positional vertigo (BPPV) was associated with autonomic dysfunction.MethodsFifty-eight consecutive patients with BPPV who had successful canal repositioning procedures (CRPs) and showed no nystagmus or positional vertigo at the next follow-up visit were enrolled and divided into two groups with and without residual dizziness. We performed a standardized autonomic function test.ResultsOf the 58 patients, 25 (43%) complained of residual dizziness after successful CRPs, in which postural lightheadedness when righting from sitting, or short-lasting nonspecific dizziness that occurred during head movement or walking were common complaints. Orthostatic hypotension (OH) occurred in 11 patients (19%). Incidence of OH was significantly higher in patients with residual dizziness at the next follow-up than those without residual dizziness (40% and 3%, p = 0.000). Compared to patients without residual dizziness, patients with residual dizziness had larger falls in systolic BP during the valsalva maneuver and head-up tilt test. However, cardiovagal parasympathetic function was not different between the patients with and without residual dizziness.ConclusionIn BPPV, residual dizziness after successful treatment may be associated with sympathoneural autonomic dysfunction.SignificanceThis investigation could be useful in understanding the mechanism of residual dizziness in patients with BPPV.     

Simulator based rehabilitation in refractory dizziness

Patients with chronic vestibular symptoms are common in neurological practice but the most effective treatment remains an open question. The purpose of our study was to conduct a controlled, between-group comparison of patients' responses to a customised exercise regime (Group C, for customised) versus treatment additionally incorporating simulator based desensitisation exposure (Group S, for simulator) integrating whole-body or visual environment rotators. Forty chronic peripheral vestibular patients who had previously undergone conventional vestibular rehabilitation without notable improvement were randomly assigned into Group C or S. Individuals attended therapy sessions twice weekly for eight weeks and were provided with a customised home programme. Response to treatment was assessed at four-week intervals with dynamic posturography, vestibular time constants, and questionnaires concerning symptoms, symptom-triggers and emotional status. At final assessment posturography and subjective scores had significantly improved for both groups, although Group S showed greater improvement. A statistically significant improvement for visual vertigo symptom scores was noted only for Group S (p < 0.01; total improvement 53.5 %). Anxiety and depression levels significantly decreased for both groups; improvements were significantly correlated particularly to improvements in visual vertigo (SCQ) (p < 0.01; r = 0.53 and r = 0.57, respectively). Significant differences were noted between groups (p = 0.02) for posturography scores. Vestibular time constants showed no notable change in either group. Conclusions: Both groups improved but exposure to simulator motion gave overall better results. These effects were also observed in psychological symptoms and partly relate to simulator effects on visual vertigo symptoms. Visual motion and visuo-vestibular conflict situations should be incorporated in the rehabilitation of patients with refractory dizziness.     

Anxious,introverted personality traits in patients with chronic subjective dizziness

Objectives

Chronic subjective dizziness (CSD) is a neurotologic disorder of persistent non-vertiginous dizziness, unsteadiness, and hypersensitivity to one's own motion or exposure to complex visual stimuli. CSD usually follows acute attacks of vertigo or dizziness and is thought to arise from patients' failure to re-establish normal locomotor control strategies after resolution of acute vestibular symptoms. Pre-existing anxiety or anxiety diathesis may be risk factors for CSD. This study tested the hypothesis that patients with CSD are more likely than individuals with other chronic neurotologic illnesses to possess anxious, introverted personality traits.

Methods

Data were abstracted retrospectively from medical records of 40 patients who underwent multidisciplinary neurotology evaluations for chronic dizziness. Twenty-four subjects had CSD. Sixteen had chronic medical conditions other than CSD plus co-existing anxiety disorders. Group differences in demographics, Dizziness Handicap Inventory (DHI) scores, Hospital Anxiety and Depression Scale (HADS) scores, DSM-IV diagnoses, personality traits measured with the NEO Personality Inventory — Revised (NEO-PI-R), and temperaments composed of NEO-PI-R facets were examined.

Results

There were no differences between groups in demographics, mean DHI or HADS-anxiety scores, or DSM-IV diagnoses. The CSD group had higher mean HADS-depression and NEO-PI-R trait anxiety, but lower NEO-PI-R extraversion, warmth, positive emotions, openness to feelings, and trust (all p < 0.05). CSD subjects were significantly more likely than comparison subjects to have a composite temperament of high trait anxiety plus low warmth or excitement seeking.

Conclusion

An anxious, introverted temperament is strongly associated with CSD and may be a risk factor for developing this syndrome.     

孤立性眩晕起病的后循环缺血性脑卒中患者临床分析

目的探讨后循环缺血性脑卒中的患者中最初仅表现为孤立性眩晕的患者的临床特点。方法回顾性分析阜新市中心医院2018-08—2019-08以孤立性眩晕起病的后循环缺血性脑卒中患者13例,对13例以孤立性眩晕起病的后循环缺血性脑卒中患者的危险因素、临床表现、磁共振特点及预后进行回顾性分析。结果13例患者的发病危险因素主要以糖尿病、高血压及脑血管病为主,大部分患者存在吸烟或饮酒的不良嗜好,仅1例患者无任何危险因素;所有患者均表现为头晕或眩晕,典型旋转性眩晕患者占69%,非旋转性眩晕(头晕)占31%,伴随症状中以呕吐和走路不稳更为常见,还有部分患者会有出汗、头痛及排便等情况;13例患者均行磁共振检查,DWI均出现责任病灶,其中小脑梗死8例,其余均为脑干梗死;13例患者均给予双重抗血小板、强化降脂及改善脑供血治疗,大部分患者预后良好;3例患者病情逐渐进展,预后不佳,其中死亡1例。结论后循环缺血性脑卒中患者若最初仅表现为孤立性眩晕容易误诊,早期应及时行磁共振检查,早诊断,早治疗。