震动眼震试验在眩晕诊断中的应用

目的:观测震动眼震(VIN)在眩晕诊断中的临床意义。方法:健康志愿者30例作为对照组,单侧前庭周围性疾病眩晕缓解期患者67例为实验组,分别进行震动试验(VT)和摇头试验(HST),观察眼震诱发情况。眩晕患者同时还进行冷热试验(CT)。结果:实验组VT中52例(77.6%)出现VIN,主要是水平眼震,其中44例VIN方向朝向健侧,梅尼埃病和前庭神经元炎患者分别有2例、6例VIN方向朝向患侧;引出摇头眼震(HSN)46例(68.7%),CT存在一侧半规管反应减退(UW)54例(80.6%)。对照组均无VIN和HSN。结论:VIN试验具有较高的敏感性,能够为评定前庭损伤侧别提供有益信息,安全性强、患者无痛苦、简便、易于推广,适合各级眩晕门诊的快速筛查。     

眩晕中医分型的血液流变性和血脂血糖变化

目的:观察眩晕中医分型的血液流变性、血脂和血糖的变化.方法:将434例眩晕患者分为肝阳上亢、痰浊中阻、肾精不足、气血亏虚4型,观察不同中医分型的眩晕患者的血液流变性、血脂和血糖的变化.结果:肝阳上亢、痰浊中阻、肾精不足型眩晕患者全血粘度、血沉、纤维蛋白原、血栓干重、甘油三酯和血糖等指标升高,血清高密度脂蛋白胆固醇则降低(P＜0.05),痰浊中阻型患者的红细胞压积、血清总胆固醇升高(P＜0.05);而气血亏虚型患者RBC压积降低,血沉增快(P＜0.05).各型之间尤以痰浊中阻型患者的全血粘度与RBC压积增加较其它各型有统计学意义(P＜0.05);肾精不足型患者血糖增加有统计学意义(P＜0.05);气血亏虚型患者全血粘度与RBC压积降低、血沉增快有统计学意义(P＜0.05).结论:眩晕患者与正常人的血液流变性、血脂和血糖水平呈现统计学差异,不同中医分型眩晕患者的上述指标亦有所不同.     

关注眩晕疾病

眩晕是一种因空间定向紊乱引起的运动错觉,其病因涉及临床各科,相关检测技术繁多,鉴别诊断复杂,治疗方法 多样,因此,关注眩晕疾病的研究,规范诊断流程已成为当务之急.     

腹针治疗颈性眩晕的临床观察

目的:观察腹针与传统针灸治疗颈性眩晕的疗效。方法:将40例确诊为颈性眩晕的病人随机分为腹针组与传统针灸组,治疗后对两组病人症状进行积分评估,疗效的对比,在不同时间点(针灸5次后与针灸10次后)进行不同的症状改善情况对比。结果:观察两组患者的有效率,虽然腹针组的有效率高于传统针灸组,但无统计学意义,说明两种方法都有效;从两组的治疗前后症状的积分的改善情况的对比,P<0.01,腹针组症状改善优于传统针灸组;从治疗后不同时间点的有效率看,眩晕症状的改善,腹针组快于传统针灸组,而后伸不适却是传统针灸组改善快于腹针组。结论:两种方法在治疗颈性眩晕时同样有效,腹针组在症状改善方面优于传统针灸组。     

Intratympanic gentamycin in severe Méniére's disease

From 1982 to 1987, 20 patients with disabling attacks of vertigo and severe hearing loss due to unilateral Meniere's disease were treated with local intratympanic gentamycin. In 18 patients control of vertiginous attacks was achieved. Hearing deteriorated in 8 patients. In spite of complete control of attacks a disabling ablation type of unsteadiness and dizziness affected 7 patients. Two patients required additional treatment after 5–8 months remission. Intratympanic gentamycin seems to be a less useful method of treating severe unilateral Meniere's disease than previously stated. It is, however, a possible alternative to surgical labyrinthectomy with a fair chance of residual hearing preservation.     

Vestibular disorders following head injury in children

One hundred and ninety-nine child patients with blunt head injury were examined. Spontaneous and/or positional nystagmus (greater than or equal to 7 degrees/s) was observed immediately after trauma in 46% of cases, 6-12 months (average 10.2 months) later in 20%, and 2-8 years (average 4.7 years) later in 18%. Central ENG disturbances were found immediately after trauma in 43% of cases, 6-12 months later in 24%, and 2-8 years later in 12%. Only 1.5% of the child patients suffered from vertigo more than 6 months after trauma. The results of the study led to the conclusion that head injuries cause about as many similar objective vestibular lesions in children as in adults but fewer subjective symptoms.     

Three-dimensional analysis of nystagmus in benign paroxysmal positional vertigo. New insights into its pathophysiology

Nystagmus is a rhythmical rotation of the eyeball. Its characteristics can be defined mathematically by the axis of rotation and the angular velocity around this axis. We analysed the axis of rotation for the nystagmus in benign paroxysmal positional vertigo (BPPV) to elucidate its pathophysiology. Thirteen patients with typical unilateral BPPV participated in the present study. The axis of rotation for the nystagmus was calculated from images recorded on digital videotape with an infrared CCD camera, using an algorithm that we developed. The patients' responsiveness to Semont's liberatory maneuver was also assessed. The results showed that patients could be assigned to one of two groups based on the rotation axis of the nystagmus. In one group of patients (n = 7; Group A), the axis of rotation was almost vertical to the plane containing the posterior semicircular canal (PSC) on the presumed affected side. In the other group of patients (n = 6; Group B), it was clustered around the naso-occipital axis. These results suggest that in the patients in Group A the responsible lesion is confined to the PSC, whereas the pathogenesis underlying the conditions in those in Group B is considered to be more complicated. This speculation was reinforced by the difference in responsiveness to Semont's liveratory maneuver. All of the patients in Group A showed remission of vertigo within 10 days (mean, 2.4 days) after onset of treatment using Semont's liberatory maneuver, whereas the patients in Group B required much longer periods of time for remission to occur (mean, 25.7 days). Our findings lead to the conclusion that by considering the spatial orientation of individual semicircular canals, in the patients in Group B the pathophysiology is not confined to the PSC, but most probably all three semicircular canals are involved. Received: 16 January 2002, Received in revised form: 22 May 2002, Accepted: 6 June 2002 Correspondence to Yujiro Hayashi, MD     

交感神经在兔椎动脉被膜节段性分布的实验研究

目的旨在利用辣根过氧化物酶（horseradish peroxidase，HRP）逆行示踪技术对新西兰免进行实验，以明确交感神经纤维在椎动脉被膜上的分布规律，为临床颈性眩晕的分型提供实验依据，有助于对颈性眩晕的评估和治疗。方法选用20只新西兰兔，C2、C5左右侧各5只。将30％HRP5μl注于椎动脉外膜表面．48h后灌注处死，切取颈上神经节（SCG）、颈下神经节（ICG）（或星状神经节），TMB法成色反应，观察HRP标记细胞分市情况。结果实验侧同水平节段交感神经节发现以中、小细胞为主的HRP标记细胞。结论椎动脉被膜的交感神经分布具有节段性及同侧性的分布特点。     

DSA与椎基底动脉供血不足性眩晕的病因研究

目的观察椎基底动脉供血不足性眩晕患者数字减影主动脉弓及全脑血管造影显示的血管结构异常的类型、比例及其分布。方法观察对象为临床拟诊为椎基底动脉供血不足性眩晕的患者，全部进行数字减影主动脉弓及全脑血管造影检查，分析血管结构异常的类型、好发部位以及受累血管数目。结果参加实验57例患者，1例患者因左椎动脉不能进入而放弃。1例在行主动脉弓造影时并发大面积脑梗死手术中止。进入结果分析55例。经检查发现共有39例（39／55，70．90％）患者存在颈及颅内血管结构异常，单纯前循环病变6例（6／55，10．90％）：后循环病变33例（33／55，60％），其中合并有前循环异常的复合病变9例（16．36％），累及两争或两争以上血管的共24例（24／55，43．64％），以椎动脉合并其他血管狭窄最为常见；其余16例（16／55，29．09％）造影未见血管结构异常。结论各种类型的血管结构异常是椎基底动脉供血不足性眩晕的主要病因，诊断椎基底动脉供血不足眩晕的金标准应为数字减影血管造影。     

管石复位法治疗良性阵发性位置性眩晕的影响因素分析

目的观察管石复位法治疗良性阵发性位置性眩晕的长期效果，探讨影响治疗预后的相关因素。方法回顾性分析59例后半规管良性阵发性位置性眩晕患者治疗和随访结果．并对管石复位法治疗成功的良性阵发性位置性眩晕患者进行多因素COX回归分析。结果59例患者中有54例（91．5％）治愈。治愈的54例患者在随访中有21例（38．9％）复发，其中有10例患者伴有半规管轻瘫。对患者的性别、年龄、发病时间、病因、半规管功能等指标进行多因素分析，只有半规管轻瘫一项指标进入COX模型，说明半规管轻瘫是影响治疗预后的因素。结论半规管轻瘫是影响BPPV患者管石复位法治疗预后的影响因素。