偏头痛性眩晕的神经耳科学表现

目的研究偏头痛相关的眩晕（migrainous vertigo，MV）的临床特点，了解听觉与前庭系统受累的情况以及功能障碍的范围和程度，判断偏头痛相关眩晕是中枢性抑或外周性眩晕。方法22例急性（5例）或亚急性（17例）MV检查包括神经一耳科学检查、自发性眼震和位置性眼震记录以及听力学检查。结果22例患者男6例，女16例。15例次有偏头痛，17例次有运动病，15例次有偏头痛或运动病家族史，1例次有视觉先兆，7例次对运动敏感（身体运动或改变头位出现眩晕），4例次畏光，6例次畏声，5例次失眠、情绪影响易引起眩晕发作，2例次与月经期关系密切。眩晕持续数分钟到1天。纯音测听异常9例，均为轻至中度感音神经性聋。高刺激率听性脑干反应双侧异常3例，单侧异常10例。主观垂直视觉检查均正常。前庭诱发的肌源性电位异常14例（13例为患侧低振幅，1例为患侧P13波潜伏期延长）。前庭双温检查异常3例；中枢性异常眼动11例，其中视动性眼震低增益9例，1例扫视过冲，1例摇头试验出现垂直眼震，同时高刺激听性脑干反应异常者10例，1例正常。4例患者有位置性眩晕，但均不符合良性阵发性位置性眩晕的诊断。结论偏头痛性眩晕应作为外周或中枢性眩晕的一种常规鉴别诊断的疾病，可为中枢性或外周性眩晕。

Neurootological manifestation of migrainous vertigo

Objective To analyzed the characteristics of migrainous vertigo (MV),a kind of paroxysmal vertigo,in order to demonstrate the extent of damage and dysfunction in MV and to judge whether MV is peripheral or central vertigo.Methods Twenty-two cases of acute(5 cases)or subacute (17 cases) MV were examined with oto-neutological tests,spontaneous nystagmus,positional nystagmus and auditory tests.Results There were 6 males and 16 females.Among those patients,15 had migraine,17 motion sickness,15 family history of migraine or motion sickness,1 visual aura,7 motion intolerance( vertigo from head movement and body movement),4 photophobia,6 phonophobia and 5 vertigo from insomnia and emotion.There were likely to have vertigo in menstrual period in 2 cases.The duration of vertigo lasted from minutes to days.For pure-tone audiometric,9 were normal which from mild to moderate hearing loss.Three cases had abnormal high frequency ABR bilaterally and 10 abnormal unilaterally.Subjective visual vertical were normal in all of the cases.Vestibular evoked myogenic potentials were abnormal in 14 cases (13 had low amplitude and 1 had longer latency of P13 wave).Bithermal caloric test was abnormal in 3 cases and 11 had abnormal ocular movement (9 with low gain of optokinetic nystagmus,1 with overshoot in saccade and 1 with vertical nystagmus after head shaking),in which 10 had abnormal high frequency ABR and 1 was normal.Conclusions MV could be peripheral or central vertigo and MV should be included in the differentiation of peripheral and central vertigo.