前庭性偏头痛和后循环脑梗死患者眼震电图结果分析

目的 比较并描述前庭性偏头痛(vestibular migraine,VM)患者和后循环梗死(posterior circulation infarction,PCI)患者视频眼震电图参数特点.方法 本研究为横断面研究,收集2018年11月-2019年11月首都医科大学附属北京天坛医院神经内科住院的PCI患者和神经内科...     

前庭性偏头痛患者的临床特点及眼震电图研究

目的 探讨前庭性偏头痛(VM)临床特点及不同条件诱发的眼震特点.方法 收集VM患者、无眩晕和偏头痛的健康对照组各100例,记录各组研究对象的临床资料,利用视频眼震图仪(VNG)观察VM患者于不同诱发条件下眼震电图的特点.结果 VM以围绝经期女性高发,62例表现为自发性眩晕,29例位置性眩晕,2例自发性眩晕与位置性眩晕共...     

偏头痛患者的眼震电图特征

偏头痛患者的眼震电图特征石明牛好敏尹蓉杨晓苏杨期东偏头痛患者眼震电图（ＥＮＧ）变化，文献报道较少。现报告我院１３４例偏头痛患者ＥＮＧ检查结果如下。临床资料本组男５１例，女８３例，年龄２２～４６岁，病程１～１０年，其中１～３年３６例，３～５年４０例，５...     

前庭中枢性及周围性眩晕患者视频眼震图参数特点分析

目的 探讨前庭中枢性眩晕和前庭周围性眩晕患者视频眼震图（videonystagmography,VNG）的参数特点。 方法 收集2011年3～12月首都医科大学附属北京天坛医院神经内科住院的69例后循环缺血所致前庭中枢性眩晕患者和眩晕会诊中心就诊的108例前庭周围性眩晕（梅尼埃病12例、良性阵发性位置性眩晕96例）患者的临床资料,分析并比较其VNG参数特点和临床特征。 结果 69例前庭中枢性眩晕患者和108例前庭周围性眩晕患者相比,临床特点：男性多见（P<0.001）,年龄更大（P=0.009）,病程更短（P<0.001）,更多出现视物成双（P<0.001）、偏身麻木无力（P<0.001）、言语不利（P<0.001）等症状,较少出现耳蜗症状（P=0.021）,眩晕持续时间更长（P<0.001）,发病多与体位改变无关（P<0.001）;VNG参数特点：视跟踪异常（40.6% vs 0.9%,P<0.001）、定标试验异常（13.0% vs 0.0%,P<0.001）、视动试验异常（10.1% vs 0.0%,P=0.003）、凝视试验异常（10.1% vs 0.0%,P=0.003）、自发性眼震（8.7% vs 0.0%,P=0.007）或位置性眼震（8.7% vs 0.0%,P=0.007）发生比例前庭中枢性眩晕组高于前庭周围性眩晕组;而变位试验阳性（14.5% vs 74.1%,P<0.001）前庭中枢性眩晕组低于前庭周围性眩晕组。 结论 VNG参数特点能客观地反映前庭中枢性眩晕和前庭周围性眩晕患者的眼震情况,结合临床特征有助于前庭系统性眩晕的定位诊断。     

眼震电图对神经系统疾病的诊断价值

眼震电图对前庭神经系统的末梢、中枢病变的定位较敏感,尤其对脑血管病、脱髓鞘疾病及变性病的亚临床症状期,可在MRI、CT 尚未见异常时即有改变,且其异常改变可随某些疾病的转归而变化,故可用于多种神经系统疾病的早期诊断,疗效观察,推测预后,具有重要价值。本文综述了眼震电图对神经系统疾病的临床应用。     

视频眼震电图在后循环缺血性眩晕诊断中的应用

目的探讨视频眼震电图（VNG）在以眩晕为主诉的后循环缺血患者诊断中应用价值。方法运用VNG技术检查68例以眩晕为主诉的后循环缺血患者，观察视眼动系统反应、自发性眼震、冷热试验、位置性眼震，并以40例正常健康老年人为对照。结果后循环缺血性眩晕组中有自发性眼震18例（26．5％），位置性眼震31例（45，6％），显著高于对照组（P〈0.05）。视眼动系统检查共56例（82．3％）出现1项或多项异常，表现为扫视试验32例（47.1％）异常，视跟踪试验Ⅲ型改变24例、Ⅳ型改变5例共29例（42．6％）异常，均显著高于对照组（P〈0．01）。视动试验有8例（11．8％）出现视动性眼震或视动眼震减弱。温度试验单侧减弱异常28例（41．2％），优势偏向异常16例（23.5％），总慢相角速度降低7例（10.3％），均显著高于对照组（P〈0.05）。结论VNG在后循环缺血性眩晕诊断中有重要意义。     

早期帕金森病患者视频眼震电图分析

目的采用眼震电图检查方法对早期帕金森病眼球运动异常进行定量分析。方法选取31例HY分期不大于2期的帕金森病患者作为病例组,其中HY1期6例,1.5期16例,2期9例。同时选取31例无中枢神经系统、周围前庭系统及眼部疾病的受试者作为对照组。对病例组和对照组进行视频眼震电图检查,检查内容包括凝视检查、自发眼震检查、扫视检查、平稳跟踪检查及视动性眼震检查等。对检查结果分别进行两组间的比较。结果与对照组相比,病例组扫视速度降低,在个别扫视角度上的速度差异有统计学意义(P0.05);左向扫视时,病例组准确度异常的发生率为21.1%,对照组为10.8%,右向扫视时,病例组、对照组准确度异常的发生率分别为18.8%和8.1%,均有极显著差异(P0.01);病例组平稳跟踪试验速度增益明显低于对照组(P0.05);而视动性眼震、自发及凝视性眼震在两组之间无统计学差异(P0.05)。结论早期帕金森病患者眼球运动存在异常,主要表现在扫视和平稳跟踪运动中。眼震电图检查结果可以为帕金森病的早期诊断提供重要的依据。     

头脉冲-眼震-眼偏斜试验在急性前庭综合征中的应用价值

眩晕为神经内科和急诊科最常见的主诉之一,其中急性前庭综合征(AVS)的病因诊断对于众多医生一直是个难题。外周性和中枢性的AVS治疗预后相差大,漏诊和误诊甚至可导致严重后果。近几年文献表明头脉冲-眼震-眼偏斜试验(HINTS)在鉴别中枢性AVS中,敏感性可高达100%,特异性可达69%~96%。HINTS是一项易获得、敏感度和特异性均高的床旁检查技术,在神经科门诊和急诊科易于开展。本文将对HINTS试验的最新文献进行综述,为AVS的临床诊治提供参考。     

上跳性眼震与下跳性眼震

上跳性眼震(UBN)表现为原位凝视时的向上眼震或矛盾性向下凝视,下跳性限震(DBN)表现为向下凝视出现的快速跳动性跟震,与器质性中枢损害相关.UBN、DBN可相互转换.氯硝安定、融氯芬、加巴贲丁等可减轻UBN、DBN.毒扁豆碱可使DBN加重.     

血管源性中枢急性前庭综合征及其眼震形式

急性前庭综合征（acute vestibular syndrome,AVS）是以急性持续性眩晕起病,伴有恶心、呕吐,自发眼震,步态不稳,头动不能耐受等症状的临床综合征,持续时间超过24?h,大多为数天或数周。中枢性AVS以血管源性常见,其中大多数为后循环缺血性卒中,尤其部分脑干、小脑梗死常表现为急性孤立性眩晕,这类患者的诊断极具挑战性。随着前庭及眼动生理机制研究的深入,基于前庭、眼动及姿势平衡系统等方面的床旁检查重要性也日益凸显。眩晕患者的床旁检查,除了常规的神经科及耳科查体外,基于前庭-眼反射的各类眼震的评价极有助于快速诊断、识别中枢性AVS。本文对血管源性中枢性AVS的神经血管解剖基础、脑干和小脑卒中所致AVS的眼震特点等进行了综述归纳。     

拉莫三嗪辅助治疗前庭性偏头痛的临床效果及对血清神经递质水平的影响

目的 探讨拉莫三嗪辅助治疗前庭性偏头痛的临床效果及对血清神经递质水平的影响。方法 选择本院2018年4月-2019年7月接诊的前庭性偏头痛患者85例,通过随机数表法分为观察组45例和对照组40例,对照组给予盐酸氟桂利嗪胶囊治疗,观察组给予盐酸氟桂利嗪胶囊联合拉莫三嗪治疗,均连续治疗2个月,并比较2组临床疗效、眩晕情况、血清神经递质水平的变化及不良反应。结果 治疗2个月后观察组总有效率明显高于对照组(91.11% vs 72.50%)(P<0.05); 观察组眩晕发作次数、每次眩晕严重程度均明显低于对照组,眩晕持续时间明显短于对照组[(2.05±0.47)vs(2.94±0.61)次/月,(2.43±0.63)vs(3.59±0.88)分,(8.76±1.74)vs(10.09±2.11)h](P<0.05); 观察组血清降钙素基因相关肽(CGRP)、P物质(SP)、内皮素-1(ET-1)水平明显低于对照组[(56.75±8.01)vs(66.42±9.65)ng/L,(162.30±15.42)vs(184.21±17.27)ng/L,(72.30±11.38)vs(88.27±13.47)pg/mL](P<0.05); 2组不良反应总发生率无明显差异[13.33% vs 12.50%](P>0.05)。结论 在氟桂利嗪基础上联合拉莫三嗪辅助治疗前庭性偏头痛的疗效显著,可有效改善血清神经递质表达水平,缓解临床症状,安全性好     

前庭性偏头痛基因学研究进展

前庭性偏头痛是临床常见的良性复发性眩晕疾病,因其反复发作的临床特点、在人群中的高发病率以及较差的药物治疗反应,严重影响了患者生活质量.作为一种遗传性疾病,前庭性偏头痛的基因学研究对揭示其发病机制、开发诊断标记物及新型治疗手段有着重要的作用.现对前庭性偏头痛的基因学研究进展加以综述,以期为今后前庭性偏头痛的临床诊疗提供参...     

Resistance exercise relieves symptoms of vestibular migraine patients with MRI diagnosis: A randomized parallel-controlled single-blind clinical trial

To investigate the efficacy of resistance exercise on symptoms of vestibular migraine (VM) among migraine patients, a total of 385 VM patients were recruited, among whom 312 were eligible to participate in the current study. Patients were randomly allocated into either resistance exercise or relaxation control groups, and received respective interventions two times per week for 12 weeks. Patients were followed up at two and four months, respectively, to evaluate treatment effects. Primary outcomes included Dizziness Handicap Inventory (DHI), the number of vertiginous attacks in the previous week and Vertigo Severity Scale (VSS). Secondary endpoints included depression and anxiety symptoms, which were measured using the scores of the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Serum concentrations of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), were also assessed. Resistance exercise was slightly more pronounced in alleviating VM symptoms than relaxation control at two-month follow-up. While at four-month follow-up, the extents of the symptom attenuation were obviously better in the resistance exercise group than the relaxation control, in terms of VSS and DHI scores, as well as BDI and BAI scores. Serum levels of both TNF-α and IFN-γ were also significantly lower in patients in the resistance group than those in the relaxation control group. Our study favors an exercise-oriented treatment scheme in rehabilitating therapy for patients suffering from VM, and sheds light on the molecular mechanism potentially involving TNF-α and IFN-γ related inflammation pathways.     

Vestibular migraine: a critical review of treatment trials

Vestibular migraine (VM), also known as migraine-associated vertigo, is a common cause of dizziness in adults. We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990–2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.     

Episodic vertigo related to migraine (90 cases): vestibular migraine?

A retrospective study was conducted on 90 patients with episodic vertigo that could be related to migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the International Headache Society (IHS) for basilar migraine, the diagnosis was substantiated by disease course, medical efficacy in treating (ergotamines) and preventing (metoprolol, flunarizine) attacks, ocular motor abnormalities in the symptom-free interval, and careful exclusion of the most relevant differential diagnoses, such as transient ischemic attacks, Menière’s disease, and vestibular paroxysmia. The following clinical features were elaborated. The initial manifestation could occur at any time throughout life, with a peak in the fourth decade in men and a “plateau” between the third and fifth decades in women. The duration of rotational (78%) and/or to-and-fro vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as vertigo associated with auditory symptoms in only 16%. Vertigo was not associated with headache in 32% of the patients. In the symptom-free interval 66% of the patients showed mild central ocular motor signs such as vertical (48%) and/or horizontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate positional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with other forms of migraine were found in 52%. Thus, migraine is a relevant differential diagnosis for episodic vertigo. According to the criteria of the IHS, only 7.8% of these patients would be diagnosed as having basilar migraine. However, to ensure that at least those presenting with monosymptomatic episodic vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term “vestibular migraine.” Received: 22 September 1998 Received in revised form: 3 March 1999 Accepted: 16 March 1999