前庭性偏头痛患者前庭功能变化情况及临床特点分析

目的总结分析前庭性偏头痛患者前庭功能变化情况及临床特点。方法选取2015年1月—2017年5月沧州市中心医院收治的符合纳入及排除标准的前庭性偏头痛34例作为观察组,同期在该院进行健康体检的健康体检者34例作为对照组。观察比较两组纯音测听、声导抗检查结果及冷热试验、颈肌性前庭诱发电位检查(cervical vestibular myogenic potential, cVEMP)、摇头试验结果,并对前庭性偏头痛患者临床特点进行分析。结果观察组低频听阈异常、高频听阈异常与声导抗异常发生率均明显高于对照组,差异有统计学意义(P0.05)。观察组冷热试验、cVEMP、摇头试验结果异常或阳性率均明显高于对照组,差异有统计学意义(P0.05)。前庭性偏头痛34例前庭症状持续时间:1 min为2例(5.9%)、1～5 min为6例(17.6%)、5 min～1 h为7例(20.6%)、1 h～1 d为15例(44.1%)、1 d为4例(11.8%)。前庭性偏头痛34例均出现眩晕,发作时伴随症状包括偏头痛21例(61.8%)、畏光18例(52.9%)、畏声17例(50.0%)、视觉先兆12例(35.3%)。结论前庭系统作为人体重要空间感知器官,对维持人体正常姿势与保持平衡具有重要意义。前庭功能损伤可加重前庭性偏头痛患者临床症状,并增加其并发症发生,临床应予以重视。     

确诊型前庭性偏头痛42例临床特征及相关检测结果分析

目的:分析确诊型前庭性偏头痛(dVM)的临床特征及相关检测结果,优化dVM诊断标准。方法:按照Bárány学会诊断标准,纳入就诊于我院的d VM患者42例,对其临床资料进行回顾性分析。结果:本组患者年龄为24～68岁,平均(48.9±11.9)岁;男女比例为1:4.3。38.1%(16例)为头运动诱发眩晕,61.9%(26例)为自发性眩晕;64.3%(27例)d VM患者发作持续时间>1 h;73.8%(31例)为无先兆偏头痛,52.4%(22例)的患者偏头痛起病早于前庭症状;81.0%(34例)患者有畏光、畏声的表现;50.0%(21例)有晕动症,26.2%(11例)患者伴听力受损,温度试验后33.3%(14例)患者伴单侧半规管功能减低,同时有40.5%的患者伴温度试验不耐受。30.9%(13例)的dVM患者中枢眼动异常,38.1%(16例)免疫相关指标异常患者,其中血清甲状腺抗体阳性10例(62.5%)。结论:dVM以女性多见,眩晕多呈自发发作,症状持续时间多>1 h,偏头痛起病多早于前庭症状,发作时多伴畏光畏声;晕车史及双温试验不耐受亦不少见。     

前庭性偏头痛

眩晕和偏头痛是神经科常见的主诉,眩晕患者中偏头痛的发生率很高,偏头痛患者也极易出现眩晕症状。随着研究的深入,临床医生对眩晕相关偏头痛的认识逐渐深入,但其发病机制仍不明确。本文就前庭性偏头痛的历史、发展、发病机制、临床表现、诊断及鉴别诊断、治疗予以综述。     

前庭康复治疗前庭性偏头痛的疗效分析

目的 评价前庭康复治疗前庭性偏头痛的疗效。方法 选取2021年4月—2023年5月商河县人民医院门诊就诊的42例由耳内前庭功能障碍引发的偏头痛患者为研究对象,以随机数表法分为两组,各21例。对照组给予药物治疗,观察组在对照组的治疗基础上辅助前庭康复治疗,对比两组患者的治疗效果、眩晕症状改善情况和眩晕残障程度。结果 观察组偏头痛患者的康复治疗有效率为95.24%,高于对照组的71.43%,差异有统计学意义(χ²=4.286,P<0.05)。治疗后观察组患者眩晕平均发作(3.14±0.28)次,每次持续(4.08±0.28)min,均小于对照组的(4.25±0.65)次和(5.62±0.66)min,差异有统计学意义(P均<0.05)。治疗前两组眩晕残障(Dizziness Handicap Inventory, DHI)量表评分较高,差异无统计学意义(P>0.05);治疗后观察组患者的DHI评分低于对照组,差异有统计学意义(P<0.05)。结论 前庭康复辅助药物治疗可有效缓解患者的偏头痛症状,促进脑活动恢复,降低其眩晕残障程度,改善患者情感及...     

前庭性偏头痛——从诊断到治疗

偏头痛与眩晕或头晕存在密切关系。在2013年"国际头痛学会"制订的"第三版国际头痛疾病分类—β测试版"中,首次在附录中增加了"前庭性偏头痛(vestibular migraine,VM)"的诊断,并制定了详细的诊断标准。本文将对"前庭性偏头痛"的诊断标准、临床表现、鉴别诊断和治疗等做一简要综述。     

多模态功能磁共振成像在前庭性偏头痛的研究进展

偏头痛的特征是反复发作的头痛,尤其是头痛在受到光、声音和其他感觉刺激后,其敏感性增强,因此更普遍地被接受为与神经过敏性相关的一种疾病.前庭症状在偏头痛中尤为常见,不仅对晕动病易感性增强,部分偏头痛患者还经历了与其他先兆偏头痛不同的眩晕或共济失调发作,因此将头痛引起的发作性前庭症状称为前庭性偏头痛(vestibular ...     

前庭性偏头痛57例误诊临床剖析

目的分析前庭性偏头痛的临床特点及误诊原因,提高诊断率。方法对2016年9月—2018年1月我院收治并误诊为其他疾病的前庭性偏头痛57例的临床资料进行回顾性分析。结果本组均在外院首诊并误诊,误诊时间10～70 d,平均25.75 d,误诊为良性阵发性位置性眩晕36例,梅尼埃病13例,后循环缺血8例。57例均出现5～12次中度到重度的前庭症状发作,且均存在日常活动后头痛症状加重的情况。后完善相关检查,结合临床资料,均确诊为前庭性偏头痛,予盐酸氟桂利嗪口服及改变生活作息治疗1个月,其中44例症状明显减轻,发作次数明显减少;6例症状消失;5例症状无明显改善;2例失访。随访3个月,34例症状未复发;11例出现1次偏头痛症状发作,但较轻微,持续时间均未超过1 h,无前庭症状;3例出现1次偏头痛及前庭症状发作,持续时间均24 h;1例症状无明显改善;8例失访。结论前庭性偏头痛临床表现缺乏特异性,且个体差异较大,临床医师应加强对该病的认识和警惕,以避免或减少误诊。     

前庭性偏头痛分期诊断的研究进展

前庭性偏头痛（vestibular migraine,VM）是以发作性眩晕/头晕为主要表现的常见前庭疾病。临床上对VM分期具有主观性,缺乏规范。准确判别发作期、间歇期或慢性持续期是VM临床诊疗及开展病理生理研究的基础。从发作时间和频率、症状体征、量表评分、影像检查及血液检测等方面综合分析VM的发病规律和病理本质,有助于对VM进行客观的分期诊断。     

前庭康复对前庭偏头痛患者大脑自发性神经活动影响的静息态功能磁共振研究

目的采用静息态功能磁共振成像评价前庭康复(vestibular rehabilitation,VR)训练对前庭偏头痛(vestibular migraine,VM)患者脑部自发神经活动的影响,探索VR训练在VM治疗中的神经病理机制.材料与方法纳入首次诊断并在6个月内未经VR训练的VM患者14例,分别在VR训练1个月前后...     

前庭性偏头痛患者基于体素的脑灰质体积研究

目的 采用基于体素的形态分析法(voxel-based morphological analysis,VBM)分析前庭性偏头痛(vestibular migraine,VM)患者大脑灰质体积改变区域,以期提供临床病理生理方面的新思路.材料与方法 严格按照纳入标准及排除标准,招募了17例VM患者及20例健康对照组.所有受...     

Migraine and vestibular symptoms--identifying clinical features that predict "vestibular migraine"

Background.— Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms—VS) often co‐exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians. Objective.— To determine common clinical features that may be associated with “vestibular migraine” (VM). Methods.— We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM. Results.— Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), “light‐headedness” (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur). Conclusions.— Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.     

Flunarizine, the vestibular system and migraine

The vestibular function was extensively investigated in 75 patients suffering from migraine. Pathological findings were present in 62 patients (82.6%). With the exception of position nystagmus, vestibular abnormalities were not related to migraine characteristics. Fifty-six patients were treated with flunarizine 10 mg daily for three months. A favourable effect on headache was obtained in 44 patients (78.5%). Flunarizine therapy influenced significantly gaze nystagmus and position nystagmus. The latter tended to be related to anti-migraine efficacy. Other electronystagmographic parameters were not substantially influenced. The authors assume that the vestibular abnormalities in migraine are side phenomena, the clinical relevance of which, at least during the headache-free phase, is not yet well understood.     

脑电图、经颅多普勒检测技术在前庭性偏头痛诊断中的应用价值

目的探讨脑电图(EEG)、经颅多普勒(TCD)检测技术在前庭性偏头痛(VM)诊断中的应用价值。方法选取我院2016年8月至2019年8月收治的116例VM患者作为研究组,另选取同期116名健康体检者作为对照组。两组均进行EEG、TCD检测,并对临床检查结果进行分析。结果研究组EEG异常率、TCD异常率均明显高于对照组(P<0.05)。EEG+TCD联合检测的异常率明显高于单项检测(P<0.05)。结论EEG+TCD联合检测可提高VM的诊断率,并为治疗方案的选择提供指导依据。     

Vestibulo-ocular reflex abnormalities in patients with migraine

OBJECTIVE: To investigate the high-frequency vestibulo-ocular reflex (VOR) in patients with migraine, with and without dizziness and aura. BACKGROUND: Migraine is a common cause of dizziness. Although many vestibular testing abnormalities have been documented in migraine patients, high-frequency VOR abnormalities have not been reported. METHODS: Thirty-nine consecutive patients with migraine were studied with the vestibular autorotation test (VAT). The patients were subclassified as having migraine headache only, migraine with visual aura, migraine with dizziness, or migraine with visual aura and dizziness. RESULTS: Only a high vertical phase in the 4 to 5 Hz range was correlated with migraine (correlation coefficients: .356, P=.03). Further analysis revealed that an abnormal 4 to 5 Hz vertical phase result also was positively correlated with migraine with aura and dizziness (correlation coefficients: .392). CONCLUSION: The results suggest that patients with migraine may have an abnormal vertical VOR at higher head movement frequencies. Migraine patients with visual aura and dizziness are even more likely to have this abnormality.     

Demographic and clinical characteristics of patients with episodic migraine versus chronic daily headache

We compared data from 243 patients with episodic migraine (EM) and 132 patients with chronic daily headache (CDH). We divided the matter group into those with tension-type headache only (CDH Type 1) and those with headaches having migrainous features (CDH Types 2+3) and compared each with the EM group and all three groups with one another. CDH Type l patients differed from those in the other groups by virtue of gender (more often male) and mean age at headache onset (older). The CDH Types 2+3 and EM groups differed only in that the former were more likely to have undergone a brain-imaging study. These data suggest that CDH Type 1 may represent a distinct headache syndrome, while CDH Types 2+3 closely resemble episodic migraine.     

甲磺酸倍他司汀联合盐酸氟桂利嗪治疗前庭性偏头痛的临床效果

目的 观察甲磺酸倍他司汀联合盐酸氟桂利嗪治疗前庭性偏头痛的临床效果.方法 选择2018年2月至2020年10月我院收治的100例前庭性偏头痛患者为研究对象,按治疗方式的不同将其分为对照组和观察组,每组50例.对照组采取甲磺酸倍他司汀治疗,观察组采取倍他司汀联合盐酸氟桂利嗪治疗.比较两组的临床效果.结果 观察组的头痛、眩晕发作次数、累积发作时间以及疼痛强度评分均优于对照组,差异具有统计学意义(P<0.05).两组患者的不良反应总发生率无显著差异(P>0.05).治疗后,两组患者的PSQI、WHOQOL-BREF评分及血清CGRP、5-HT水平均较治疗前明显改善,且观察组优于对照组,差异具有统计学意义(P<0.05).观察组的治疗总有效率高于对照组,差异具有统计学意义(P<0.05).结论 甲磺酸倍他司汀联合盐酸氟桂利嗪治疗前庭性头痛能有效改善患者偏头痛及眩晕等临床症状,提高其睡眠质量和生活质量,且安全性良好,值得临床推广应用.     

耳内镜下鼓膜修补术对外伤性鼓膜穿孔患者气骨导差及预后的影响

目的  观察耳内镜下鼓膜修补术治疗外伤性鼓膜穿孔患者的效果及其对患者气骨导差的影响。方法  纳入2019年1月~2021年2月本院收治的40例外伤性鼓膜穿孔患者,在充分告知本研究设计思路后,均开展耳内镜下鼓膜修补术,观察患者治疗效果、听力情况(对比患者术前、术后1月及术后3月气导听阈和气骨导差情况)及疼痛程度[术前、术后1 d、出院时,采用视觉模拟评分法(VAS)]。结果  40例外伤性鼓膜大穿孔患者经耳内镜下鼓膜修补术治疗后,显效28例,有效10例,无效2例,治疗总有效率95.00%。40例患者经耳内镜鼓膜修补术治疗后,与术前相比,术后1月及术后3月气导听阈、气骨导差均较低,差异有统计学意义(P < 0.001);与术前相比,术后1 d、出院时,患者VAS评分均下降,术前、术后1 d及住院时3个时间段患者VAS评分的差异有统计学意义(P < 0.001);术前与术后1 d患者VAS评分的差异无统计学意义(P > 0.05),与术前相比,出院时患者VAS评分较低,差异有统计学意义(P < 0.05)。结论  外伤性鼓膜穿孔患者采取耳内镜下鼓膜修补术,手术治疗效果显著,利于术后听力恢复,缓解疼痛程度,建议在临床外伤性鼓膜穿孔患者中大范围开展。