良性阵发性位置性眩晕发病与复发相关危险因素分析

良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）是所有眩晕疾病中最 常见的类型,主要表现为短暂的旋转样感觉,由头位改变（相对于重力作用方向）诱发。其病因尚不 明确,可能与头部外伤、各种内耳疾病等有关,耳石复位是有效的治疗方法,尽管BPPV患者无论治疗 与否疾病缓解率较高,但是仍有复发情况存在。本文结合近年国内外发表的文献对良性阵发性位置 性眩晕发病与复发相关的危险因素进行探讨。     

良性阵发性位置性眩晕

良性阵发性位置性眩晕（benign paroxysmal positional vetigo,BPPV）系指当头部快速移动至某一特定的位置时,所激发的短暂的阵发性眩晕与水平型或旋转眼震,眼震具有潜伏期、短暂性和疲劳性特点,属位置性眼震Ⅲ型.由于良性阵发性位置性眩晕为自限性疾病,绝大多数可以自愈,故被称为良性眩晕,迁延不愈甚少.     

良性阵发性位置性眩晕

良性阵发性位置性眩晕(BPPV)的临床特点表现为头部位置变化所引起的短暂性、发作性眩晕和眼球震颤。BP-PV的发病机理有嵴顶石学说和管石学说。BPPV症状的严重程度、持续时间和频率与所累及的半规管及结石碎片的位置有关。不同类型的BPPV可以通过观察体位诱发试验中出现的眼球震颤特点来诊断。BPPV可在保守治疗时自行缓解。管石复位法能将结石碎片从半规管转移到前庭,从而快速消除症状。     

良性阵发性位置性眩晕诊疗系统对良性阵发性位置性眩晕诊疗效果的临床研究

目的 观察良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）诊疗系统对BPPV的诊疗效果。 方法 选取2010年6月至2012年12月就诊于武警总医院耳鼻咽喉头颈外科中美眩晕病研究所门诊和病房BPPV患者120例,随机分为BPPV诊疗系统组和手法复位组各60例,比较两种治疗方法对BPPV的诊疗效果。 结果 BPPV组间诊断符合率为100%（Kappa检验值1.000）。BPPV诊疗系统组的次日有效率为96.7%,1周有效率为100%,而BPPV手法组次日有效率为88.3%,1周有效率为91.7%,两组组间比较差异无显著性（P=0.057）。 结论 BPPV诊疗系统对BPPV诊断准确,治疗效果好,有助于实现对BPPV高效标准化的诊断和治疗。     

良性位置性阵发性眩晕误诊23例临床分析

目的分析良性位置性阵发性眩晕的临床特点及误诊原因,提高神经内科医生对此病的认识。方法回顾性分析23例患者的临床资料。结果23例患者分别在外院及本院误诊,其主要临床表现为在改变头位时出现阵发性头晕、恶心、呕吐及变位性眼震试验阳性;主要经耳石复位治疗后痊愈率达91.3%。结论对收住神经内科的眩晕患者,按颈椎病、椎-基底动脉供血不足等缺血性脑血管病治疗后眩晕无缓解者,要想到此病的可能。     

良性阵发性位置性眩晕

良性阵发性位置性眩晕是最常见的周围性眩晕,除部分继发于头部外伤、病毒性迷路炎、梅尼埃病和内耳手术后等病因外,大多数均无明确病因。在发病机制上,"半规管结石学说"已得到了大多数学者认可。诊断主要依靠典型的病史、阳性体位诱发试验和眼震的方向。大多数患者经耳石复位法等非手术治疗可取得满意疗效,少数保守治疗效果不理想的患者可行手术治疗。     

中国家族性良性阵发性位置性眩晕临床分析

目的了解中国家族性良性位置性眩晕(benign paroxysmal positional vertigo,BPPV)家系临床特点,提高对BPPV家族性可能的遗传病因认识。方法回顾分析我院诊断的1个家族性BPPV家系,并检索维普电子期刊全文数据库1989~2016年间收录我国的家族性BPPV家系的研究文献,分析中国家族性BPPV的临床特点。结果我院诊断1家系及文献检索出的2个家族性BPPV家系,共计3个家系,包括患者23例,其中男性10例,女性13例,起病年龄最小者7岁,最大者70岁,病程明确者为6 m至36 y,平均病程6.5 y。3个家系中先证者及其他患者均表现为头部位置突然变化后诱发的眩晕,伴视物旋转、恶心、呕吐,Roll-Test滚转试验或Dix-Hallpike试验可诱发眼震,经手法复位及相关药物治疗后患者头晕症状好转,均表现为家族成员多发性,且已排外其他原因所致眩晕,依据BPPV的4条诊断标准,上述成员均为诊断明确的BPPV,根据临床表现为家族聚集性BPPV,考虑诊断为家族性良性阵发性位置性眩晕,但均未检测目前国外已报道的2个与良性阵发性位置性眩晕相关的基因位点(良性复发性眩晕1(Benign Recurrent Vertigo 1,BRV1)定位在6p,BRV2定位在22q12)。结论家族遗传性可能为中国良性阵发性位置性眩晕的罕见病因,目前遗传机制尚不明确,需引起重视及进一步研究。     

良性阵发性位置性眩晕患者脑干听觉诱发电位分析

目的探讨脑干听觉诱发电位(BAEP)对良性发作性位置性眩晕的诊断价值。方法对51例良性发作性位置性眩晕者进行BAEP检查,并以47名正常健康受试者作对照。结果 (1)良性阵发性位置性眩晕组BAEP异常率为49.02%;(2)与对照组相比,病例组右侧Ⅰ-Ⅴ峰间潜伏期延长,有统计学差异(P<0.05);(3)病例组左右两侧相比,右侧Ⅰ、Ⅲ、Ⅴ波潜伏期延长,有统计学差异(P<0.05)。结论 BAEP对于良性发作性位置性眩晕的诊断有一定价值。     

良性阵发性位置性眩晕临床特征与预后

目的 探讨良性阵发性位置性眩晕（benign p aroxysmal p ositional v ertigo,BPPV）的临床特征以及预后 情况。 方法 收集2009年7月-2015年6月在首都医科大学附属北京天坛医院门诊或住院确诊并经复位治疗 痊愈的BPPV患者1046例。所有患者于2015年12月进行随访以了解预后状况,所有数据应用SPSS 22.0 进行统计分析。 结果 ①BPPV多见于女性,发病高峰年龄为50～60岁,女男比例为2∶1。②BPPV复发率为27.20%, Logistic回归多因素分析发现伴有梅尼埃病的患者复发的风险是不伴有梅尼埃病患者的15.567倍（P ＜0.001）;有偏头痛的患者复发的风险是没有偏头痛的患者的3.003倍（P＜0.01）;伴有高血压和高脂 血症的患者复发的风险分别是不伴有高血压和高脂血症患者的1.554倍和1.457倍（P＜0.05）。 结论 BPPV多见于中年患者,女性多于男性,受累半规管中后半规管型BPPV占绝大多数。梅尼埃病、 偏头痛、高血压、高脂血症可能为BPPV复发的危险因素。     

良性阵发性位置性眩晕患者伴发焦虑抑郁状况分析

目的探讨良性阵发性位置性眩晕(BPPV)患者伴发焦虑抑郁状态情况及危险因素分析。方法选择该院2018年1月至2020年4月被诊断为良性阵发性位置性眩晕的患者98例,并招募100例年龄、性别、受教育程度相匹配的健康体检人群作为对照组,受试人群均接受汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估。结果 BPPV组焦虑和抑郁的患病率均高于对照组(P0.05)。BPPV患者中,38例(38.78%)有焦虑倾向,10例(10.2%)被诊断焦虑症;对照组中6例(6%)有焦虑倾向,2例(2%)诊断焦虑症。BPPV患者中,27例(27.55%)可能抑郁,10例(10.2%)被诊断抑郁症,2例(2.04%)被诊断重度抑郁;对照组中5例(5%)可能抑郁,1例(1%)被诊断抑郁症。女性、发作频率较高、病程长是影响BPPV患者焦虑和抑郁程度的危险因素(P0.05)。结论 BPPV患者发生焦虑和抑郁的概率较高。尤其是女性、发作频率高、病程长的患者。因此,需要早期对BPPV患者的精神障碍进行评估和干预。     

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. Typical symptoms and signs of BPPV are evoked when the head is positioned so that the plane of the affected semicircular canal is spatially vertical and thus aligned with gravity. Paroxysm of vertigo and nystagmus develops after a brief latency during the Dix-Hallpike maneuver in posterior-canal BPPV, and during the supine roll test in horizontal-canal BPPV. Positioning the head in the opposite direction usually reverses the direction of the nystagmus. The duration, frequency, and symptom intensity of BPPV vary depending on the involved canals and the location of otolithic debris. Spontaneous recovery may be expected even with conservative treatments. However, canalithrepositioning maneuvers usually provide an immediate resolution of symptoms by clearing the canaliths from the semicircular canal into the vestibule.     

Residual Dizziness after Successful Repositioning Treatment in Patients with Benign Paroxysmal Positional Vertigo

Background and purpose

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Although the repositioning maneuver dramatically improves the vertigo, some patients complain of residual dizziness. We evaluated the incidence and characteristics of persistent dizziness after successful particle repositioning and the clinical factors associated with the residual dizziness.

Methods

We performed a prospective investigation in 49 consecutive patients with confirmed BPPV. The patients were treated with a repositioning maneuver appropriate for the type of BPPV. Success was defined by the resolution of nystagmus and positional vertigo. All patients were followed up until complete resolution of all dizziness, for a maximum of 3 months. We collected data on the characteristics and duration of any residual dizziness and analyzed the clinical factors associated with the residual dizziness.

Results

Of the 49 patients, 11 were men and 38 were women aged 60.4±13.0 years (mean ±SD), and 30 (61%) of them complained of residual dizziness after successful repositioning treatment. There were two types of residual dizziness: continuous lightheadedness and short-lasting unsteadiness occurring during head movement, standing, or walking. The dizziness lasted for 16.4±17.6 days (range=2-80 days, median=10 days). A longer duration of BPPV before treatment was significantly associated with residual dizziness (p=0.04).

Conclusions

Residual dizziness after successful repositioning was observed in two-thirds of the patients with BPPV and disappeared within 3 months without specific treatment in all cases. The results indicate that early successful repositioning can reduce the incidence of residual dizziness.     

变位试验结合手法复位诊治良性发作性位置性眩晕

目的:探讨变位试验诊断良性发作性位置性眩晕(BPPV)及耳石手法复位的疗效。方法:回顾性分析50例BPPV患者的资料,对所有患者进行全面病史采集,行变位试验(Roll试验和Dix-hallpike试验)判定BPPV的类型及侧别,对后半规管BPPV(PC-BPPV)患者采用Epley手法复位,对水平半规管BPPV(HC-BPPV)管石症患者采用Barbecue翻滚法复位,对水平半规管嵴顶结石症患者采用Gufoni疗法、Casani解脱法和Barbecue翻滚法复位。结果:随访3周时治愈42例(84%),有效49例(98%),无效1例(2%),且无明显不良反应。结论:根据典型病史及变位试验可判断BPPV的类型及侧别。手法复位治疗BPPV效果显著、简便、安全,适于临床推广。     

耳石复位对主观性良性阵发性位置性眩晕的疗效观察

目的探讨手法复位对主观性良性阵发性位置性眩晕(S-BPPV)的临床疗效。方法通过变位试验(Roll试验和Dix-hallpike试验)对50例诊断S-BPPV患者进行分型及侧别判定,对可能的后半规管S-BPPV患者采用Epley手法复位,对水平半规管S-BPPV患者采用Barbecue翻滚法复位,对混合型S-BPPV患者采用Epley手法联合Barbecue翻滚法复位,连续治疗3周,观察临床疗效及不良反应。结果 3周后随访时治愈38/50例(76%),有效46/50例(92%),无效4/50例(8%),无严重不良反应。结论根据典型病史及变位试验可判断S-BPPV的类型及侧别,给予相应的手法复位治疗效果显著、简便、安全,适于临床推广。     

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Background and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV).MethodsWe retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver.ResultsTorsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082).ConclusionsSHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.     

体位限制预防BPPV复发的随机对照临床研究

目的 评价体位限制预防良性阵发性位置性眩晕(BPPV)近期复发的疗效.方法 将2018年3月至2019年2月在朝阳医院西区神经内科门诊就诊的217例单侧后半规管BPPV患者随机分为观察组和对照组.记录两组患者的一般资料,如年龄、性别、发病时间、伴随疾病及是否给予甲磺酸倍他司汀治疗.观察组Epley手法复位后采用床头抬高...     

良性阵发性位置性眩晕与前庭性偏头痛患者焦虑抑郁状态比较研究

目的 比较良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者和前庭性偏头痛 （vestibular migraine,VM）患者焦虑、抑郁的发生率和特点。 方法 收集2016年9月-2017年9月诊断为BPPV和VM患者各50例。对两组患者进行眩晕残障量表 （dizziness handicap inventory,DHI）和医院焦虑抑郁量表（hospital anxiety and depression scale,HADS）评 定,比较两组基线资料和DHI 、HADS评分的差异。 结果 治疗前BPPV组存在明显眩晕残障者32例（64%）,存在焦虑抑郁者15例（30%）,治疗后分 别为3例（6%）和2例（4%）,差异有统计学意义（P＜0.001和P =0.001）;治疗前VM组存在明显眩晕 残障者38例（76%）,存在焦虑抑郁者为28例（56%）,治疗后分别为12例（24%）和8例（16%）,差异 均有统计学意义（均P＜0.001）。治疗前VM组DHI[55.00（44.00～70.00）vs 31.00（20.00～45.00）,P ＜0.001]和HADS评分[13.50（6.00～20.00）vs 6.00（3.75～10.00）,P =0.001]高于BPPV组,其中DHI评 分中情感、躯体和功能3个分项的评分也均高于BPPV组,差异均有统计学意义。治疗后VM组DHI[22.00 （12.00～34.00）vs 0（0～4.00）,P＜0.001]和HADS评分[7.50（2.00～10.50）vs 0（0～3.00）,P＜0.001] 仍高于BPPV组,其中DHI评分中情感、躯体和功能3个分项的评分也均高于BPPV组,差异均有统计学 意义。 结论 VM患者焦虑抑郁严重程度高于BPPV患者,两组经治疗后焦虑抑郁的发生率均有显著下降。