CT、MRI和磁共振动脉成像对后循环缺血性眩晕的诊断价值

目的 探讨CT、MRI和磁共振动脉成像(magnetic resonance angiography,MRA)对后循环缺血性眩晕的诊断价值.方法 采用GE Light Speed 4层或1 6层螺旋CT扫描仪、Signa Excite3.0T超导磁共振成像设备对32例后循环缺血性眩晕患者行CT、MRI和MRA检查,并对...     

椎基底系统血流缓慢所致头晕和眩晕

局部缺血性脑病,包括椎基底系供血不足(VBI)在老年人中较为常见。这些病人中75%以上以头晕和眩晕为主要症状。作者用核磁共振(MRI)方法检查了患有头晕或眩晕的老年病人,观察其椎基底系是否有血流缓慢现象(SBF)。选102例主诉头晕或眩晕的病人,年龄大于50岁。根据MRI结果分为有无SBF的A、B两组。对照组57例病人,年龄大于50岁。无前庭症状,都因头痛做过MRI。作者也检查了32例小于50岁病人,其中13例主诉有前庭症状。全部病人都进行了MRI检查。眼震电图作为神     

前庭自旋转试验在位置性眩晕患者中的检测

目的 通过对位置性眩晕患者进行前庭自旋转试验(Vestibular autorotation test,VAT)检查,探讨VAT用于鉴别中枢性和外周性位置性眩晕的作用.方法 回顾性分析140例位置性眩晕患者的临床资料,均无耳聋、耳鸣或前庭功能低下.患者资料包括病史,专科检查,视频眼震电图(videonystagmography,VNG),VAT,头颅磁共振(MRI),位置试验,手法复位治疗.结果 138例良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV),VAT参数水平增益正常,部分患者的垂直向下的眼震(positional down beating nystagmus,pDBN)通过手法复位消失,经MRI排除其他疾病.2例颅底凹陷综合征(Arnold-Chiari malformation,ACM)通过头颅MRI得到确诊,其VAT水平增益增高,手法复位后pDBN不消失.结论 VAT可用以辅助BPPV的鉴别诊断.     

后循环缺血单发性眩晕与偏头痛性眩晕的鉴别诊断

目的：通过2组病例分析,探讨后循环缺血单发性眩晕（PCIV）与偏头痛性眩晕（MV）的鉴别诊断。方法：选取眩晕门诊MV患者60例和PCIV患者64例,分析其临床的特征性表现。检查方法包括：后循环缺血（PCI）的高危因素检查、眼动检查和高刺激率听性脑干反应（ABR）检查及头颅MRI。结果：64例PCIV患者,血压异常29例;血脂或（和）血糖异常14例;血管超声异常37例;突然起身眼前发黑或头晕14例;高刺激ABR异常22例;4例头颅MRI异常（腔隙梗死）。60例MV患者,运动病45例,运动敏感20例,畏光或（和）畏声32例,偏头痛45例,眼动异常16例,MRI异常3例,高刺激ABR异常40例。高刺激ABR在PCIV和MV的阳性率分别为34%（22/64）,67%（40/60）。结论：MV平均年龄小于PCIV患者。MV患者女性发病多于男性（2.75∶1.00）,PCIV性别比例差异减小（1.46∶1.00）。MV的运动病、运动敏感、发作时畏光或（和）畏声是与PCIV的重要鉴别点;PCIV的主要特点包括血压、血脂或（和）血糖异常、动脉硬化等。前庭功能检查不能作为鉴别的依据;头颅MRI对于鉴别诊断有一定的帮助,高刺激ABR不能作为PCIV与MV的鉴别点,但对与其他类型眩晕的鉴别有一定意义。前庭功能检查无助于PCIV与MV的鉴别诊断。     

老年人眩晕的病因分析

目的探讨老年人眩晕与脑血管缺血的关系.方法综合分析老年眩晕110例的ENG、TCD及眼底动脉硬化程度.结果110例中前庭功能减退占27.3%,ETⅡ型以上曲线占80.9%,OKN不对称占59.1%,TCD显示90%的患者脑血管缺血,眼底动脉硬化占97.3%,耳聋占88.2%.结论老年人眩晕不能以某一特定的诊断作为终结,应该多因素综合考虑老年人生理性退行性变.脑血管缺血性改变是引致老年人眩晕的重要因素.     

前庭阵发症的临床特点及疗效观察

目的：探讨前庭阵发症（vestibular paroxysmia ,VP）的临床特点,观察其药物治疗效果。方法回顾性分析32例诊断为VP患者的临床资料,分析其眩晕发作特点、纯音听阈（pure－tone audiometry PTA）、听性脑干反应（ABR）、头颅磁共振（MRI）及前庭功能等检查结果。给予卡马西平或奥卡西平治疗3个月后评估其疗效。结果32例V P患者均以反复发作的短暂性眩晕为主要临床表现,24例（75．0％）患者在转头或转身时诱发眩晕发作,24例（75．0％）患者伴平衡障碍或自身感觉的不平衡感;11例（34．38％）患者 PT A阈值上升;所有患者的颅脑MRI均显示前庭蜗神经存在神经血管交互压迫（neurovascular cross －compression ,NVCC）现象;行 ABR检测的30例患者中有24例（80．00％）异常,其中I－III波间期延长（＞2．2 ms）者19例（63．33％）,其病程较I－III波间期正常者长,但差异无统计学意义（ P＝0．231）。所有患者经抗癫痫药物治疗1个月,失访1例,症状无改善者4例,其余27例患者均继续治疗3个月,停药6个月后与治疗前比较,其眩晕发作频率明显减少（ P＜0．05）,眩晕的严重程度亦明显减轻（P＜0．05）。结论 VP以反复发作的短暂性眩晕为主要临床表现,常见诱发因素有头位或体位变动;MRI均提示有NVCC现象,多数患者ABR I－III波间期延长,部分患者PTA阈值上升;卡马西平或奥卡西平能有效控制眩晕症状,在试验性治疗中有重要意义。     

高刺激率听性脑干反应诊断椎基动脉短暂缺血性眩晕

对34例椎基动脉短暂缺血性眩晕患者应用51次/秒高刺激率听性脑干反应检查,发现波Ⅲ、波Ⅴ潜伏期、波Ⅰ～Ⅲ间期和波Ⅰ～Ⅴ间期,比正常人和其他眩晕患者延长。提示此法可作为椎基动脉短暂缺血性眩晕的诊断方法。     

168例眩晕患者临床特征分析

目的:探讨眩晕患者的常见病因及临床特点.方法:询问168例眩晕患者的病史,并行纯音测听、红外视频眼震电图、Dix-Hallpike试验、颈椎X摄片、头颅CT和(或)MRI以及多普勒超声等检查,对相关结果进行统计学分析.结果:所有患者中周围性眩晕134例(79.8%),其中良性阵发性位置性眩晕(BPPV)66例,梅尼埃病30例,突发性聋24例,前庭神经炎5例,中耳炎并迷路炎5例,耳带状疱疹2例,耳毒性药物中毒2例;前庭中枢性眩晕26例(15.5%),其中椎基底动脉短暂性脑缺血(包括颈椎病)20例,听神经瘤2例,脑梗死3例,抑郁症1例;原因不明8例(4.8%).结论:眩晕患者以周围性眩晕多见,其中BPPV发病率最高,详细采集病史和分析眩晕发作的特点,尤其是眩晕持续时间及听力变化是鉴别、诊断眩晕疾病的重要依据.     

突发聋和梅尼埃病鼓室灌注疗效与内耳MRI显影相关性

目的 研究突发聋和梅尼埃病鼓室灌注疗效与内耳MRI显影的相关性.方法 17例患者(突发聋13例,梅尼埃病4例)给予鼓室插管并注射钆造影剂,术后1 h、1 d、6d行MRI连续扫描,1周后复查电测听,评估眩晕改善情况,分析钆剂是否透入内耳和症状改善的相关性.结果 17例中9例(突发聋5例,梅尼埃病4例)在插管注入钆剂后1 h到6 d的MRI检查中出现内耳高信号.另8例MRI未显影者听力没有进步.结论 鼓室灌注造影剂能透入内耳者药物也能透入,治疗效果亦较好.     

基于头脉冲-眼震-扭转偏斜检查法的急性前庭综合征病因分析

目的　分析头脉冲-眼震-扭转偏斜（head impulse,nystagmus,test of skew,HINTS）检查法在急性前庭综合征（acute vestibular syndrome,AVS）定位诊断中的价值,观察AVS的病因分布。方法　选取急诊就诊的眩晕持续＞6 h的AVS患者,收集临床资料,完成HINTS床旁检查、颅脑MRI DWI像及前庭功能检查,并进行为期1年的随访修正诊断。结果　①2012～2013年以眩晕就诊于北京同仁医院神经内科急诊患者,符合入组标准的AVS患者53例;②前庭中枢源性AVS共20例,前庭外周源性AVS24例,9例患者不能确定病变部位,HINTS检查法对于鉴别前庭中枢源性AVS的敏感性100%（20/20）,特异性69%（20/29）;③后循环缺血（posterior circulation ischemia,PCI）组7例,其余46例患者定义为非PCI（nPCI）组,比较发现PCI组年龄（68.3±9.2）岁,显著高于nPCI组（47.6±15.9）岁,P =0.002;PCI组患者均有1个以上脑卒中危险因素,nPCI组仅10.9%（5/46）有1个以上危险因素,P =0.0。结论  急性前庭综合征可见于各个年龄阶段,其中前庭中枢源性并不少见,应该推广HINTS检查法在临床鉴别诊断中的应用;对于眩晕症状持续超过6 h的急性前庭综合征患者,如果伴有多重动脉粥样硬化危险因素,要高度警惕后循环缺血性脑血管病的可能。     

Results of cerebellopontine space imaging by magnetic resonance during one year

The authors present the results of a retrospective study concerning 231 magnetic resonance imaging (MRI) of the cerellopontine space requested by the otologists of the department between September 1996 and September 1997. The motives of imaging were sensorineural hearing loss (44%), vertigo and unsteadiness (25.5%), tinnitus (16.5%) and other (13%). The MRI was abnormal in 18% of the cases and the diagnosis of acoustic schwannoma was made in 10% of the cases.     

Etiology of vertigo in children

OBJECTIVE: To detect the most common causes of vertigo in children. METHODS: Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. RESULTS: Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo. CONCLUSIONS: A peripheral type of vertigo was found in most cases. Diagnostic approach in vertigo in children should include a detailed history and clinical examination in conjunction with a test battery of audiological and neurotologic tests. When a central cause of vertigo is suspected an MRI or CT scan should be ordered.     

Magnetic resonance imaging in the diagnosis of temporal bone and skull base lesions

Six patients are presented in whom total reliance on magnetic resonance imaging (MRI) interpretations would have resulted in less than ideal treatment. The misleading information on magnetic resonance imaging could be divided into two types; as follow: type I were those in which there was no signal but nonosseous pathology was present, and in type II an abnormal signal was present but misinterpreted. In three of these patients (cases, 2, 3, and 5), information gained from more traditional means (history, physical examination, audiologic and vestibular testing, and computed tomography) led to proper treatment, whereas, in two patients (cases 4 and 6), treatment exceeded that required by the disease process. In one patient (case 1), ideal therapy resulted, despite a negative magnetic resonance imaging study, when a small intracanalicular tumor was found fortuitously during a translabyrinthine vestibular nerve section for vertigo. Although magnetic resonance imaging provides excellent supplemental information to more traditional means of diagnosis, it cannot be used entirely in their place. As gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) becomes more readily available, as the resolution of magnetic resonance imaging improves, and as we gain more familiarity with this diagnostic modality, misleading information from these studies should decrease.     

Saccades and smooth pursuit eye movements in central vertigo

In order to analyze the diagnostic efficiency of saccadic and pursuit eye movements compared to findings from brain magnetic resonance imaging in patients with central vertigo, 108 patients were selected from 580 dizzy patients as cases of suspected central origin; the saccadic and pursuit eye movements were evaluated by electronystagmography and findings were compared to information from magnetic resonance imaging. The study of oculomotor movements in patients suspected of having a central lesion revealed a 83.3% sensitivity and 21.2% specificity. Restricting consideration to severe alterations in eye movements as indicative of a central origin, this test gives a 71.4% sensitivity and 50.0% specificity. In conclusion, the study of alterations in oculomotor movements, in patients with suspected central lesions, proved to be a test with good sensitivity also compared with results of magnetic resonance imaging.     

Disabling positional vertigo (DPV): syndrome of vestibulo-cochlear organ impairment during vascular compression of the vestibulo-cochlear nerve (VCS)

In 1984 Jannetta et al. introduced a new term-disabling positional vertigo (DPV). DPV is a term used to describe syndrome of cochleo-vestibular organ impairment during vascular compression syndrome of eight cranial nerve. They introduced this term to distinct this syndrome from other established vertigo syndromes on the basis of recognized in angio - MRI exam compression of VIII nerve by vessel and clinical and electrophysiological criteria. Existence of DPV syndrome is still not universally accepted, because it is difficult to diagnose vertigo as vascular compression syndrome of the eight cranial nerve when there are no specific finding to detect this syndrome. Only Moller proposed specific ABR abnormalities as a criterion in DPV diagnosis (prolongation of I - III interval). The authors performed retrospective analysis of 28 patients (16 female, 12 men, average age 43) with recognized on basis angio - MRI vascular compression syndrome of eight cranial nerve. Contrasted magnetic resonance imaging identified a vascular loop near to cochleo - vestibular nerve in all 28 cases. All patients were performed pure tone audiometry, DPOAE, ABR and ENG exam. The most common symptoms were unilateral tinnitus (89% cases), unilateral hearing loss (86%) and dizziness (61%). The most frequent abnormalities in above mentioned exams were sensorineural hearing loss in pure tone audiometry (92%). ABR data were interpreted with respect to Mollerís criteria and asymmetry of the I - III, III - V and I - V interval and prolongation of V waves in the auditory brainstem response was found in 36% cases. Abnormal changes in electronystagmography were found: absence (10%) or weakness (36%) of caloric response. The differential diagnosis of DPV syndrome are discussed. We could not find any specific clinical findings valuable for DPV diagnosis. There is no significantly more weakness or absence of caloric response of vestibular organ in patients with DPV. Disabling positional vertigo is the syndrome which should be considered in differential diagnosis in every case of vertigo.     

Changes in endolymphatic hydrops after vestibular neurectomy observed in magnetic resonance imaging – A pilot study

ObjectivesThe aim was to evaluate endolymphatic hydrops in patients with Ménière's disease before and after vestibular neurectomy to verify if the endolymphatic space dilatation, observed in magnetic resonance imaging, regressed within several months after surgery.MethodsMagnetic resonance imaging was performed after intravenous gadolinium injection in four patients with unilateral definite Ménière's disease before and eight months after vestibular neurectomy. Clinical symptoms, audiovestibular tests, and endolymphatic hydrops in magnetic resonance imaging were evaluated.ResultsEndolymphatic hydrops was visualized in preoperative magnetic resonance imaging in three out of four analyzed patients. In the remaining one, an asymmetrical contrast enhancement in the affected ear was found. After the vestibular neurectomy, all four patients presented a complete resolution of vertigo episodes and improved functional level. Significant postoperative hearing deterioration was found in two patients. In the follow-up magnetic resonance imaging, no reduction of the endolymphatic hydrops was visualized. A reduction of asymmetrical contrast enhancement in one patient was found.ConclusionsMagnetic resonance imaging of the inner ear is a helpful diagnostic tool for Menière's disease. Vestibular neurectomy is an effective treatment for intractable vertigo; however, there is no endolymphatic hydrops regression evidence within several months after the surgery. Therefore, further studies with a long follow-up period and repeated magnetic resonance imaging are needed to assess the vestibular neurectomy's impact on endolymphatic hydrops. Nevertheless, magnetic resonance imaging supports the clinical diagnosis of Ménière's disease and may help understand its pathophysiology.     

Eye movements and imaging in vestibular migraine

Background and objectiveMigrainous dizziness is one of the most frequent complaints. Dizziness associated with migraine may be the result of abnormal eye movements. Brain imaging and changes in eye movements may explain the dizziness and highlight possible pathophysiological substrates in migraine dizziness. Our aim is to evaluate eye movement using videonystagmography (VNG) and video head impulse test (vHIT) and to study the occipital lobe metabolic profile in vestibular migraine patients (VM).Materials and methodsThere were 2 groups enrolled in the study; the first group consisted of 25 vestibular migraine patients (VM) according to the recent criteria of Barany society. The second group consisted of 20 age matched healthy subjects. Both groups underwent the following: (1) A detailed history, VNG test protocol, vHIT in three planes. (2) Magnetic resonance imaging (MRI) for the brain and inner ear using 1.5 T magnet and proton magnetic resonance spectroscopy (H1-MRS).ResultsSixty eight percent of the patients complained of spontaneous vertigo and 28% complained of positional vertigo. Non-paroxysmal positional nystagmus was recorded in 92% during their dizzy spell. The brain MRI was unremarkable in 72% of the cases. Chemical shift in the occipital lobe was found in 92% of VM. Lactate peaks were statistically significant related with the presence of non-paroxysmal positional nystagmus.ConclusionsA statistically significant relationship exists between non-paroxysmal positional nystagmus and presence of lactate peaks in the occipital lobe in VM patients.     

Acute vertigo following cervical manipulation

OBJECTIVE/HYPOTHESIS: Either licensed American chiropractors or traditional Chinese herbalists may produce vertiginous attack in a patient after cervical manipulation. The purpose of the study was to present our experience in treating these patients to determine the risk of this procedure. STUDY DESIGN: A retrospective study from May 1999 to April 2002. METHODS: Nine patients (one man and eight women) with acute vertigo after cervical manipulation were admitted and underwent a battery of audiometric and vestibular tests, accompanied by magnetic resonance imaging and magnetic resonance angiography examination. RESULTS: The mean interval for the onset of acute vertigo after cervical manipulation was within 1 day (17 h). Electronystagmography revealed multiple central signs. Magnetic resonance angiography scan also disclosed abnormality in the vertebral artery such as occlusion, stenosis, or slow blood flow in three patients. After treatment with dextran, relief of vertigo without neurological deficits was experienced in all nine patients. CONCLUSIONS: When there are multiple central signs in electronystagmography results or slow blood flow of the vertebral artery is displayed in neck on Doppler sonography or magnetic resonance angiography scan, the therapeutic benefits of cervical manipulation cannot be expected to outweigh its potential risk for the morbidity of cervical vessels.     

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.     

以孤立性眩晕为临床表现的颅内炎性脱髓鞘2例报道

目的 分析2例表现为孤立性眩晕的颅内炎性脱髓鞘病的临床特点,提高临床医生对其认识,为中枢性和周围性孤立性眩晕患者的诊疗提供帮助。方法 对2例表现为孤立性眩晕患者的病史、体格检查、辅助检查及治疗过程进行分析总结。结果 2例患者均表现为急性孤立性眩晕,1例患者有上呼吸道感染史,1例患者可诱发出无疲劳性位置性眼震。2例患者的神经系统、听力及前庭功能检查均未见异常,头颅MRI示：脑干或小脑可见异常信号。使用激素冲击治疗,2例患者预后较好。结论 急诊孤立性眩晕疾病需尽早排除中枢性疾病。