良性阵发性位置性眩晕成功手法复位后短期残余头晕的发生情况及预测因素研究

目的：探讨良性阵发性位置性眩晕（BPPV）患者成功手法复位后1周残余头晕（RD）的发生情况及相关危险因素。方法：对首次就诊成功手法复位的223例BPPV患者进行为期1周的随访,在首诊（W0）及一周（W1）时进行眩晕/头晕视觉模拟量表（VAS）、头晕残障量表（DHI）评估,并在W0行GAD-7、PHQ-9、HAMA及HAMD-17等神经心理学量表评估。W1时头晕VAS大于1分判定为存在RD。比较伴有及不伴有RD组之间人口学及临床指标的差异,调查患者成功手法复位后短期生活质量的影响因素。结果：成功手法复位的BPPV患者1周时RD的发生率为50.67%（113/223）。伴有RD组首诊时头晕残障量表（DHI）评分明显高于不伴有RD组（P=0.009）,差异主要体现在功能性分值（DHIF）（17.38±8.67与14.91±9.39,P=0.044）和情绪性分值（DHIE）（7.25±6.77与5.35±6.26,P=0.032）上,而年龄、性别、眩晕持续时间,焦虑抑郁评分在两组间无明显差别。多因素Logistic回归分析发现,首诊时DHI>30分（OR=2.149,95%CI 1.257~3.673,P=0.005）是RD的独立预测因素。线性回归发现,RD是BPPV患者成功手法复位后1周时生活质量的主要影响因素（P=0.001,95% CI for β=8.826~15.056）。结论：近一半的BPPV患者成功手法复位后1周存在RD;首诊时DHI总分大于30分可以预测短期手法复位后RD的发生。     

特发性良性阵发性位置性眩晕复位后残余头晕与脑血管反应性的关系

目的 探讨特发性良性阵发性位置性眩晕（BPPV）患者在复位成功后残余头晕（RD）的发生与脑血管反应性（CVR）的关系。方法 记录117例特发性BPPV患者的眩晕残障评定量表（DHI）评分,复位成功后应用经颅多普勒血流分析仪通过屏气试验（BHI）测定CVR,观察1周内患者RD的发生情况,根据是否存在RD将117例患者分为...     

Brandt-Daroff习服训练联合黛力新治疗良性阵发性 位置性眩晕管石复位后残余头晕的疗效

目的:观察Brandt-daroff习服训练联合黛力新治疗良性阵发性位置性眩晕(BPPV)管石复位后残余头晕的疗效。方法:BPPV成功管石复位后发生残余头晕的患者96例随机分为4组:对照组(常规内科治疗),训练组(Brandt-Daroff习服训练),药物组(黛力新治疗),联合组(Brandt-Daroff习服训练联合黛力新治疗),每组24例。治疗前后采用医院焦虑抑郁量表(HADS)、眩晕残障量表(DHI)、前庭症状指数(VSI)对患者进行评分比较。结果:治疗前各组HADS、VSI、DHI评分差异无统计学意义(P0.05)。治疗7、14 d后,3组HADS、VSI、DHI评分均低于对照组(均P0.05)。治疗7、14 d后,联合组HADS、VSI、DHI评分均低于训练组及药物组(均P0.05)。治疗7 d后,药物组HADS评分低于训练组(P0.05);治疗14 d后,训练组DHI评分低于药物组(P0.05)。结论:Brandt-Daroff习服训练、黛力新均能减轻BPPV成功管石复位后残余头晕症状,联合治疗较单一治疗更有效。     

耳石症患者手法复位后残余头晕的危险因素研究

目的 探讨耳石症患者手法复位后残余头晕的危险因素,为临床提供参考。方法 回顾性分析2020年7月至2022年7月内蒙古自治区人民医院收治的115例耳石症手法复位患者的临床资料,根据手法复位后是否有残余头晕分为有残余头晕组（20例）和无残余头晕组（95例）。比较两组患者的临床资料,分析耳石症患者手法复位后发生残余头晕的独立危险因素。结果 有残余头晕组患者有睡眠障碍、合并高血压、合并动脉硬化症及复位后无药物治疗占比均高于无残余头晕组,复位前眩晕残障量表（DHI）评分、复位前医院焦虑抑郁量表（HADS）评分均高于无残余头晕组（均P<0.05）;两组患者合并糖尿病占比、起病时间及临床症状比较,差异均无统计学意义（均P>0.05）。多因素Logistic回归分析显示,有睡眠障碍、合并高血压、合并动脉硬化症、复位后无药物治疗、复位前DHI评分高及复位前HADS评分高是耳石症患者手法复位后发生残余头晕的独立危险因素（均P<0.05）。结论 有睡眠障碍、合并高血压、合并动脉硬化症、复位后无药物治疗、复位前DHI评分高及复位前HADS评分高是耳石症患者手法复位后发生残余头晕的独立危险因...     

低频经颅磁刺激治疗阵发性位置性眩晕患者成功手法复位后残余头晕的疗效观察

目的观察低频重复经颅磁刺激(rTMS)治疗良性阵发性位置性眩晕患者成功手法复位后残余头晕的疗效。 方法采用随机数字表法将72例良性阵发性位置性眩晕成功手法复位后残余头晕患者分为对照组和治疗组。对照组患者在成功手法复位后，嘱其注意保持头部姿势，避免大幅度或剧烈转动头部，未给予其它药物或特殊干预；治疗组患者在成功手法复位后给予rTMS治疗。在手法复位成功后当天和第1周、第2周及第4周时分别应用头晕评价量表（DHI）、活动平衡信心量表（ABC）、汉密尔顿焦虑（HAMA）量表、皮肤交感反应（SSR）检查对2组患者疗效进行评定，同时记录、比较2组患者残余头晕持续时间。 结果在治疗4周期间2组患者DHI、HAMA评分、SSR潜伏时及SSR波幅均进行性下降，ABC评分则进行性增加。对照组患者在治疗第1周时，其DHI、ABC、HAMA评分、SSR潜伏时及SSR波幅较治疗前有改善趋势，但差异均无统计学意义(P>0.05)；在治疗第2周及第4周时，上述指标与组内治疗前差异均具有统计学意义(P<0.05)。治疗组患者DHI、ABC、HAMA评分、SSR潜伏时及SSR波幅在治疗第1周时分别为（30.52±1.43）分、（56.51±7.39）分、（11.38±3.52）分、(1.11±0.47)ms和(1.83±0.33)mV,第2周时分别为（15.46±3.65）分、（78.33±12.10）分、（8.64±3.32）分、(0.73±0.36)ms和(1.41±0.32)mV，第4周时分别为（8.66±2.37）分、（89.52±13.48）分、（4.65±1.68）分、(0.31±0.28)ms和(1.01±0.24)mV,均较治疗前及对照组相应时间点结果明显改善(P<0.05)。另外治疗组患者残余头晕平均持续时间［（18.45±6.47）d］明显短于对照组水平［（35.36±6.47）d］，组间差异具有统计学意义(P<0.05)。 结论低频rTMS干预能显著减轻BPPV患者经手法复位后残余头晕症状，缩短残余头晕持续时间，改善患者生活质量，该疗法值得临床推广、应用。     

下气汤治疗良性阵发性位置性眩晕手法复位后残留头晕症状

目的:评价下气汤治疗良性阵发性位置性眩晕复位后残留头晕症状的临床疗效。方法:将180例良性阵发性位置性眩晕复位后残留头晕症状的患者,随机分为中药组、西药组及对照组,每组各60例,中药组予以下气汤治疗,西药组予以氟哌噻吨美利曲辛10.5mg qd口服,对照组未予其他治疗,3组其余治疗相同,疗程均为2周;治疗前后分别进行眩晕残障量表(DHI)及眩晕病中医症候积分量表测定。结果:3组治疗后眩晕残障量表评分及眩晕病中医症候积分均较治疗前减少,中药组积分减少最明显,而对照组减少不明显。结论:下气汤治疗良性阵发性位置性眩晕复位后残留头晕症状疗效好,且无不良反应。     

非典型眼震表现的良性阵发性位置性眩晕中西医结合治疗

目的:探讨中西医结合治疗非典型眼震表现的良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者的临床疗效。方法:随机将36例非典型眼震表现的良性阵发性位置性眩晕患者分为对照组和治疗组,每组各18例。对照组给予手法复位及一般内科支持治疗,治疗组在对照组治疗基础上结合中医辨证治疗。治疗2周后,分别对2组患者的疗效、眩晕残障程度评定量表(DHI评分)进行比较,并在3个月内随访患者的复发情况。结果:治疗2周后治疗组、对照组的有效率分别为94.45%和61.12%,差异有统计学意义。治疗组眩晕残障程度DHI评分(11.25±2.88),对照组眩晕残障程度DHI评分(19.72±5.31),差异有统计学意义。随访3个月后治疗组复发率为16.67%,对照组复发率为38.89%,差异有统计学意义。结论:应用手法复位结合中医辨证疗法治疗非典型眼震表现的良性阵发性位置性眩晕,可以提高患者临床疗效,改善眩晕残障严重程度并减少手法复位后的复发率。     

血浆内皮素和降钙素基因相关肽测定在颈性眩晕诊断和治疗评估中的意义

目的 检测颈性眩晕患者血浆内皮素(ET)和降钙素基因相关肽(CGRP)水平,分析其在诊断和治疗评估中的意义。方法 选取济南市第四人民医院2017年9月至2019年9月收治的颈性眩晕患者33例为观察组,选取同一时间段内33名健康人群为对照组。观察组患者进行颈前路手术治疗,于对照组体检时和观察组术前、术后2、6、12及24周测定其血浆ET和CGRP,并进行比较。分析ET和CGRP与《头晕残障量表》(DHI评分)及《颈性眩晕症状与功能疗效评价表》(眩晕评分)的相关性。结果 术前,观察组患者的血浆ET高于对照组(P<0.05),CGRP水平低于对照组(P<0.05)。术后2、6、12及24周,观察组患者的ET水平明显下降,逐渐接近正常值,但均高于对照组;CGRP水平明显升高,但均低于对照组(P<0.05)。与术前相比,观察组患者的DHI评分明显下降(P<0.01),眩晕评分明显升高(P<0.01)。Pearson相关性分析显示,DHI评分与ET成正相关(r=0.981,P=0.003),与CGRP成负相关(r=-0.898,P=0.038);眩晕评分与ET成负相关...     

良性阵发性位置性眩晕患者抑郁焦虑状态评估

目的探讨良性阵发性位置性眩晕(BPPV)患者管石手法复位(CRP)治疗前后抑郁焦虑状态的变化。方法选择我院2014年1~11月期间确诊并施行CRP的单侧原发性BPPV患者52例(病例组)和同期于我院查体的健康体检者58例(对照组)。采用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和眩晕障碍量表(DHI)分别对病例组CRP治疗前、后和对照组的抑郁焦虑状态进行评估,比较各组评分结果,并探讨DHI与HAMD、HAMA之间的相关性。结果 (1)病例组中HAMD、HAMA得分异常者(HAMD≥8;HAMA≥7)分别有38.46%(20/52)和48.08%(25/52)。治疗前HAMD、HAMA、DHI及其分量表得分均显著高于治疗后和对照组(P<0.05);治疗后HAMD、HAMA得分与对照组比较无显著差异(P>0.05);治疗后DHI及其分量表得分与对照组比较均有显著差异(P<0.05)。(2)DHI与HAMD、HAMA得分之间呈线性相关(r=0.427,0.556;均P<0.05)。HAMD、HAMA得分越高者其DHI得分也越高,反之亦然。结论 (1)BPPV患者可合并抑郁焦虑,CRP能显著改善患者眩晕症状和情绪状态。(2)三种量表评分具有相关性,联合应用可能有助于BPPV患者的综合评估和治疗。     

SRM-Ⅳ眩晕诊疗系统治疗良性阵发性位置性眩晕的疗效观察

目的分析SRM-Ⅳ眩晕诊疗系统治疗对良性阵发性位置性眩晕(BPPV)患者主客观症状、生活质量和复发率的影响。方法选取BPPV患者113例,采用随机数字表法分为A组、B组分别56例、57例,B组予以传统手法复位治疗1周,A组采用SRM-Ⅳ眩晕诊疗系统治疗1周,评估两组治愈时间、治疗有效率、主客观症状[眩晕调查问卷(UCLA-DQ)、运动敏感度指数量表(MSQ)]、舒适度(主观舒适度问卷)、生活质量[眩晕障碍量表(DHI)]、并发症发生率、复发率。结果 A组治愈时间短于B组,而1次性治疗有效率、第2次治疗有效率高于B组(P0. 05); A组治疗后1周、1个月、3个月UCLA-DQ中眩晕频率与眩晕程度及MSQ评分均低于B组,舒适度评分高于B组,而DHI评分低于B组,差异均有统计学意义(P0. 05); A组治疗后1周并发症发生率低于B组(P 0. 05),两组治疗后1个月、3个月复发率比较差异无统计学意义(P0. 05)。结论 SRM-Ⅳ眩晕诊疗系统治疗BPPV可有效改善患者主客观症状,提高其一次性治疗有效率及生活质量,且舒适度高,复位并发症明显减少,值得在临床推广实践。     

Risk factors for residual dizziness in patients successfully treated for unilateral benign posterior semicircular canal paroxysmal positional vertigo

ObjectiveThe risk factors for residual dizziness (RD) after successful treatment of benign paroxysmal positional vertigo (BPPV) are poorly characterized. We determined the risk factors for RD in patients with benign unilateral posterior semicircular canal paroxysmal positional vertigo (pc-BPPV) after successful treatment.MethodsWe conducted a prospective study of patients diagnosed with unilateral pc-BPPV between March 2015 and January 2017. Bone mineral density (BMD) was measured by dual-energy X-ray bone mineral densitometry. Participants underwent bithermal caloric testing (C-test) using videonystagmography and a canalith repositioning procedure (CRP). The occurrence of RD was the primary outcome. The participants underwent follow-up 1 week, 1 month, and 1 year after successful CRP, consisting of outpatient visits, questionnaires, and telephone interviews.ResultsWe assessed 115 participants with unilateral pc-BPPV (31 men and 84 women) who were 53.2 ± 8.8 years old. RD occurred in 60 (52.2%) participants. The participants who experienced RD were older, had vertigo for longer before treatment, and were more likely to show a positive C-test and significant BMD loss.ConclusionsWe found that a significant reduction in BMD (T-score  < −1 standard deviation), a positive C-test, and older age are independently associated with RD in patients with pc-BPPV after successful CRP.     

Effects on physicians' sick-listing practice of an administrative reform narrowing sick-listing benefits

Objective. To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. Design. Retrospective study of computerized medical records. Setting. A primary health care centre in Malmö, Sweden. Subjects. A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years.Main outcome measures. Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). Results. Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. Conclusions. Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.     

良性阵发性位置性眩晕残余症状的康复治疗

目的:探讨良性阵发性位置性眩晕(BPPV)残余症状的康复治疗疗效。方法:BPPV患者128例,随机分为对照组和研究组各64例,对照组进行常规治疗,研究组进行综合性康复治疗。比较2组患者治疗有效率、症状持续时间、眩晕障碍量表(DHI)评分、医院焦虑抑郁量表(HADS)评分。结果:与对照组比较,研究组治疗有效率更高(P0.05),研究组颈部不适、头晕、走路不稳症状持续时间更短(P0.05);干预前,2组DHI评分差异无统计学意义(P0.05),干预后,2组DHI评分明显降低,但与对照组比较,研究组DHI评分降低更明显(P0.05);干预前,2组HADS-T、HADS-A评分差异无统计学意义(P0.05),干预后,HADS-T、HADS-A评分明显降低,与对照组比较,研究组HADS-T、HADS-A评分降低更明显(P0.05);与对照组比较,研究组血流动力学指标更低(P0.05)。结论:对BPPV患者进行综合性康复治疗指导,可改善患者临床症状,提高生活质量,缓解焦虑抑郁情绪,维持正常血流动力学指标。     

Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial

Purpose: To evaluate short-term effects of balance Vestibular Rehabilitation Therapy (VRT) on balance, dizziness symptoms and quality of life of the elderly with chronic Benign Paroxysmal Positional Vertigo (BPPV).

Method: In this randomized, single-blind and controlled trial, older adults with chronic BPPV were randomized into two groups, the experimental group (n?=?7, age: 69 (65–78) years) and the control group (n?=?7, age: 73 (65–76) years). Patients in the experimental group underwent balance VRT (50?min per session, two times a week) and Canalith Repositioning Maneuver (CRM) as required, for 13 weeks. The control group was treated using only CRM as required. Standing and dynamic balance, dizziness symptoms and quality of life were measured at the baseline, and at one, five, nine and thirteen weeks.

Results: There were no between-group differences in dizziness, quality of life and standing balance over the 13 weeks. Significant differences were observed in dynamic balance measures between groups (p?< 0.05 for most tests) through assessments. In intragroup analysis, both groups showed improvements in all measurements except no improvement was found in majority of the dynamic balance tests in the control group.

Conclusions: The patients who received additional balance VRT demonstrated better results in dynamic balance than those who received only CRM.

• Implications for Rehabilitation

• The findings that balance VRT in addition to CRM improves dynamic balance in elderly people with BPPV should be useful in guiding rehabilitation professionals’ clinical decision making to design interventions for seniors suffering from BPPV;

• Improvements in tests of dynamic balance suggest that the risk of adverse consequences of BPPV in the elderly such as falls and fractures can be potentially reduced through implementation of CRM in conjunction with balance VRT;

• Lack of additional improvement in Visual Analogue Scale of dizziness and Dizziness Handicap Index suggests that addition of balance VRT does not influence dizziness symptomatology, per se, and CRM alone is effective to ameliorate vertiginous symptoms and potentially improve quality of life.

     

The point prevalence of dizziness or vertigo in migraine--and factors that influence presentation

Objective.— To ascertain and characterize the point prevalence of dizziness or vertigo in migraineurs presenting for routine appointments at a specialty headache clinic. Background.— Migraine, dizziness, and vertigo are all common in the general population, affecting 13%, 20‐30%, and 5‐10% respectively. Thereby, chance concurrence of migraine with either dizziness or vertigo would be expected in roughly 4% of the general population. It is the authors' clinical impression that severe attacks of migraine are far more commonly associated with these complaints than chance would predict. Methods.— This is a prospective, cross‐sectional study of 462 consecutive patients who presented for consultation at a specialty headache clinic over a 4‐month period of time. During routine check‐in procedures, patients were asked to report their headache pain on a 1‐10 Likert scale. Patients were also asked to report if they were currently experiencing dizziness or vertigo. Responses to these questions were recorded along with vital signs. Diagnosis of migraine with or without aura was made by headache medicine specialists in accordance with International Classification of Headache Disorders – second edition criteria. Chi‐square analysis was used to examine the prevalence of vertigo or dizziness in subjects with varying intensity of headache, and by history of aura. Results.— Of the 425 evaluable subjects, 28% experienced aura. Subjects' average age was 43.8 years (range 15 to 76 years); 89.5% were female. At the time of evaluation, 72.4% of subjects reported some degree of ongoing headache pain and 15.7% reported concurrent dizziness or vertigo. The prevalence of dizziness or vertigo was twice as high (24.5% vs 12.1%) in migraine with aura compared to migraine without aura (P < .01), and prevalence increased with age (P < .05). There was a strong correlation between migraine pain and subjective complaint of vertigo (P < .001). When migraine pain was present at an intensity of 7 or greater (on a scale of 1‐10), almost half of the subjects (47.5%) reported concomitant dizziness or vertigo. Conclusions.— Subjective complaints of dizziness or vertigo appear to be relatively common accompaniments of migraine, particularly migraine with aura, and prevalence increases with age. Disequilibrium symptoms have a strong and positive association with the severity of migraine pain. With co‐occurrence higher than expected by chance, the relationship either reflects comorbidity or these symptoms may be part of the migraine presentation. With a point prevalence of 15.7%, and factors that link expression both to the intensity of migraine pain and to migraine aura, the authors believe that the true relationship may prove to be the latter.     

Balance performance and self-perceived handicap among dizzy patients in primary health care

OBJECTIVE: To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. DESIGN: Retrospective study of computerized medical records. SETTING: A primary health care centre in Malm?, Sweden. SUBJECTS: A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years. MAIN OUTCOME MEASURES: Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). RESULTS: Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. CONCLUSIONS: Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.