水平半规管良性阵发性位置性眩晕三例

水平半规管良性阵发性位置性眩晕三例周传理李建华我们从１９９５年２月到１９９６年１２月共遇到３例水平半规管良性阵发性位置性眩晕，报道于下。例１女，４９岁。因反复发作旋转性眩晕于１９９５年２月３日来诊。１个多月前１次午餐后弯腰低头时突发眩晕，呕吐３、４次...     

改良李氏复位法和Semont法治疗后半规管良性阵发性位置性眩晕疗效对比研究

目的探讨采用改良李氏复位法和Semont管石解脱法治疗后半规管良性阵发性位置性眩晕的疗效。方法将2015年10月至2016年4月收治的80例确诊为原发性后半规管良性阵发性位置性眩晕的患者随机分为两组,分别采用改良李氏复位法及Semont法进行复位治疗,评定其疗效,随访3个月。结果改良李氏复位法40例,随访1周后总有效率92.5%(37/40),随访3个月后总有效率87.5%(35/40),复发2例(5%);Semont法40例,随访1周后总有效率90%(36/40),随访3个月后总有效率85%(34/40),复发3例(7.5%)两组比较差异无统计学意义(P>0.05)。结论改良李氏复位法治疗后半规管良性阵发性位置性眩晕疗效确切,疗效与Semont管石解脱法相近(P>0.05),且操作更简洁,过程迅速,可在临床应用。     

Brandt-Daroff康复练习治疗水平半规管良性阵发性位置性眩晕

目的探讨Brandt-Daroff康复练习对23例水平半规管良性阵发性位置性眩晕患者的疗效。方法选取2007年3月~2013年12月间23例水平半规管良性阵发性位置性眩晕患者,包括2例主观性良性阵发性位置性眩晕和21例客观性水平半规管良性阵发性位置性眩晕患者,嘱患者进行Brandt-Daroff练习。结果 23例患者练习1周后,痊愈12例,9例症状减轻,2例无效;2周后复诊,痊愈17例,5例症状明显减轻,1例无效。结论 Brandt-Daroff康复练习治疗水平半规管良性阵发性位置性眩晕取得良好的疗效。     

焦虑对良性阵发性位置性眩晕复位治疗效果的影响

目的探讨焦虑对良性阵发性位置性眩晕患者复位治疗效果的影响。方法选取2015年7月~2016年12月在我院神经内科眩晕中心接受诊疗的870例良性阵发性位置性眩晕患者。所有患者接受汉密尔顿焦虑量表评分,根据其评分分为伴焦虑组和无焦虑组,两组患者均接受手法复位治疗,在治疗后1周和3个月进行随访,评价其疗效及复发情况。结果无焦虑组手法复位1周、3个月时有效率明显高于伴焦虑组(P0.05)。无焦虑组手法复位3个月后复发率明显低于伴焦虑组(P0.05)。结论焦虑情绪影响良性阵发性位置性眩晕患者复位治疗的效果,伴有焦虑的患者手法复位的有效率降低,复发率增加。     

管石复位法治疗良性阵发性位置性眩晕的影响因素分析

目的观察管石复位法治疗良性阵发性位置性眩晕的长期效果，探讨影响治疗预后的相关因素。方法回顾性分析59例后半规管良性阵发性位置性眩晕患者治疗和随访结果．并对管石复位法治疗成功的良性阵发性位置性眩晕患者进行多因素COX回归分析。结果59例患者中有54例（91．5％）治愈。治愈的54例患者在随访中有21例（38．9％）复发，其中有10例患者伴有半规管轻瘫。对患者的性别、年龄、发病时间、病因、半规管功能等指标进行多因素分析，只有半规管轻瘫一项指标进入COX模型，说明半规管轻瘫是影响治疗预后的因素。结论半规管轻瘫是影响BPPV患者管石复位法治疗预后的影响因素。     

主观性良性阵发性位置性眩晕的临床表现和治疗

目的 探讨主观性良性阵发性位置性眩晕临床表现和治疗.方法 回顾性分析2003年1月至2006年9月诊治的12例主观性良性阵发性位置性眩晕患者的临床表现和治疗结果,与24例客观性后半规管良性阵发性位置性眩晕比较.结果 主观性良性阵发性位置性眩晕临床表现为由头位改变诱发的短暂眩晕发作,而Dix-Hallpike诱发试验未见相应的眼震,主观性良性阵发性位置性眩晕发作的潜伏期(-x±s,下同)为(4.42±2.02)s,持续时间(-x±s,下同)为(8.67±4.31)s,而客观性后半规管良性阵发性位置性眩晕组分别为(3.20±1.18)s和(14.75±4.97)s,差异均有统计学意义(t=2.30,P＜0.05;t=3.61,P＜0.01).主观性良性阵发性位置性眩晕组首次治疗成功率为91.7%(11/12),客观性后半规管良性阵发性位置性眩晕首次治疗成功率为79.2%(19/24),两者差异无统计学意义;所需的颗粒复位手法次数主观性良性阵发性位置性眩晕组为(1.75±1.08)次(-x±s,下同),客观性后半规管良性阵发性位置性眩晕组为(3.38±1.06)次,差异具有统计学意义(t=4.32,P＜O.01).随访5～29个月,主观性良性阵发性位置性眩晕组2例复发,客观性后半规管良性阵发性位置性眩晕组7例复发,两者差异无统计学意义.结论 主观性良性阵发性位置性眩晕与客观性后半规管良性阵发性位置性眩晕相比,前者眩晕发作潜伏期长、持续时间短,治疗所需的循环数更少,前者治疗结果优于后者.     

手法复位治疗良性阵发性位置性眩晕36例

目的 评价体位治疗在良性阵发性位置性眩晕（BPPV）的应用价值。方法 回顾性分析36例原发性或继发性BPPV的临床资料,后半规管BPPV采用改良Epley手法或Semont手法复位,水平半规管采用Barbecue翻滚疗法复位治疗,评价其治疗效果。结果 33例后半规管BPPV患者应用改良Epley手法或Semont手法复位,有效率为93.9%。3例水平半规管BPPV患者采取Barbecue翻滚法复位后症状均明显改善。结论 手法复位治疗良性阵发性位置性眩晕方法简单,疗效可靠,治愈率高。     

手法复位联合甲磺酸倍他司汀治疗后半规管良性阵发性位置性眩晕的临床观察

目的 观察手法复位联合甲磺酸倍他司汀(敏使朗)治疗后半规管良性阵发性位置性眩晕的临床效果.方法 手法复位联合敏使朗治疗后半规管良性阵发性位置性眩晕观察1周内治疗有效率、3个月内、6个月内的复发例数及复发率.结果 手法复位联合敏使朗治疗1周有效率、3个月复发例数及复发率与对照组无统计学差异,治疗6个月两组复发例数及复发率有显著差异,具有统计学意义.结论 手法复位联合长期服用敏使朗治疗将明显降低患者复发率.     

360°滚转复位法治疗良性阵发性位置性眩晕

目的明确在后半规管平面360°旋转患者对治疗典型的后半规管良性阵发性位置性眩晕是否有效。方法回顾分析了46例后半规管良性阵发性位置性眩晕患者,其中25例采用三维滚轮360°滚转复位法进行复位治疗,21例采用Epley手法复位治疗,对其疗效进行比较。结果采用三维滚轮360。滚转复位法治疗的患者中第一次治疗后有23例患者（92％）治愈,2例患者经过第二次治疗治愈;采用Epley手法复位的患者中第一次治疗后有19例患者（91.5％）治愈,2例患者经过第二次治疗治愈。应用X^2检验（α=0.05,X^2=0.1173,P=0.7319）二者的差异没有统计学意义。结论三维滚轮360°滚转复位法能有效的治疗后半规管良性阵发性位置性眩晕,其成功率及效果与Epley法一致,且操作简便、舒适度优于传统方法。     

应用SRM-Ⅳ进行速度阶梯试验的可行性分析

目的全自动化良性阵发性位置性眩晕诊断治疗系统是用于良性阵发性位置性眩晕诊断和治疗的全自动化设备。该设备还可以作为转椅进行速度阶梯试验,探讨使用全自动化良性阵发性位置性眩晕诊断治疗系统进行速度阶梯试验检查结果的可靠性。方法武警总医院眩晕病研究所就诊的眩晕患者48例和正常对照者20例,随机先后使用传统转椅及全自动化良性阵发性位置性眩晕诊断治疗系统进行速度阶梯试验,计算双侧半规管不对称比。Stata软件t检验比较统计数据。结果2种检测方法不对称比的差异无统计学意义。结论全自动化良性阵发性位置性眩晕诊断治疗系统既可以用于良性阵发性位置性眩晕的诊断和复位治疗,又可以进行水平半规管功能检测,临床应用效果可靠.     

后半规管良性阵发性位置性眩晕患者复位中眼震分析

目的 分析后半规管良性阵发性位置性眩晕(posterior semicircular canal benign paroxysmal positional vertigo,PC-BPPV)患者复位中的眼震,探讨BPPV可能的发病机制.方法 2007年12月至2008年4月眩晕门诊就诊的66例PC-BPPV患者,详细记录病史、体位试验及复位中不同位置眼震的情况,对PC-BPPV患者可能发病机制进行探讨.结果 变位试验完伞符合贵阳会议诊断标准的66例PC-BPPV患者,采用改良Epley复位,视频眼震记录技术记录复位中四个位置的眼震方向及强度,24例患者复位中出现的眼震均为垂直扭转向上眼震;21例除第一个位置出现上向扭转眼震,其余三个位置眼震阴性;7例变位试验初诊PC-BPPV的患者在第二次复位中出现强烈水平眼震;14例患者复位的第二或第三个位置出现下向垂直眼震.由复位中不同位置出现的眼震分析,66例确诊为PC-BPPV的患者,52例复位中的表现符合管石及嵴顶耳石症理论,占78.8%.结论 除了目前公认的管石症及嵴顶耳石症理论外,推测部分PC-BPPV可能与耳石器官及球囊椭圆囊神经病变有关.     

Particle repositioning maneuver for benign paroxysmal positional vertigo

The recent demonstration of free-floating particles in the endolymph of the posterior semicircular canal in patients with benign paroxysmal positional vertigo (BPPV)¹ has renewed interest in the physiology and treatment of this entity. The particle repositioning maneuver (PRM) relocates the free-floating particles from the posterior semicircular canal back into the utricle, relieving the patient of bothersome, often long-standing vertigo. This report represents a prospective study of 27 consecutive patients seen with a diagnosis of BPPV. Eighty-four percent of the patients treated with the particle repositioning maneuver who had no other associated pathology were cured or significantly improved with this new technique. Two patients who failed conservative management went on to surgical intervention with the posterior semicircular canal occlusion. The authors find the particle repositioning maneuver effective for many patients with benign positional vertigo and recommend it as the first-line treatment modality for BPPV.     

同时性后半规管与水平半规管性良性位置性眩晕

目的：探讨同时性后半规管与水平半规管性良性位置性眩晕（混合性良性位置性眩晕）的诊治方法。方法：联合应用Epley手法和Barbecue翻滚法对4例患者进行治疗，两次治疗间隔1d。结果：4例患者眩晕症状完全消失，随访至今无复发。结论：混合性良性位置性眩晕兼有后半规管与水平半规管性良性位置性眩晕的临床表现，联合采用Epley手法和Barbecue翻滚法治疗该病是可行的。     

Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo

CONCLUSION: Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. OBJECTIVE: To analyse the video-oculographic findings of positional tests in patients with BPPV. MATERIAL AND METHODS: Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix-Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. RESULTS: Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix-Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.     

Persistent vertigo following particle repositioning maneuvers: an analysis of causes

OBJECTIVE: To analyze the causes of persistent vertigo following treatment with particle repositioning maneuvers (PRMs) in patients with benign paroxysmal positional vertigo. DESIGN: Prospective study of outcomes in patients with benign paroxysmal positional vertigo. STUDY SETTING: Outpatient clinic of a tertiary care referral center. PATIENTS: A sample of 90 consecutive patients with documented benign paroxysmal positional vertigo of the posterior semicircular canal who had persistent vertigo after at least 3 sessions of PRMs during a period of 2 weeks. INTERVENTION: Particle repositioning using a modified Epley maneuver. MAIN OUTCOME MEASURE: Persistent vertigo following at least 3 sessions of PRMs over a period of 2 weeks. RESULTS: Seven patients showed partial or no improvement following treatment. The causes subsequently determined included coincident horizontal canal positional vertigo (2 cases), Ménière's disease (2 cases), persistent posterior canal benign paroxysmal positional vertigo in association with cervical spondylosis (2 cases), and a posterior fossa meningioma (1 case). CONCLUSIONS: Patients with persistent or frequently recurring positional vertigo following treatment with PRMs should undergo detailed investigation to exclude coincidental pathology for which specific treatment is required. In patients in whom no coincident pathology requiring therapy is identified, treatment options other than the PRM already instituted should be considered.     

Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.

OBJECTIVE: The purpose of this study was to determine the effectiveness of a new physical maneuver in the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. STUDY DESIGN: Case review. SETTING: Outpatient clinic. PATIENTS: The diagnosis of apogeotropic horizontal canal benign paroxysmal positional vertigo was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal apogeotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were three men and five women ranging in age from 31 to 73 years (average, 49.2 yr). INTERVENTIONS: All patients were treated with a repositioning maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the anterior arm of the horizontal canal. The maneuver favors their shifting into the posterior arm of the canal. Patients were reexamined immediately after the treatment and underwent Gufoni's liberatory maneuver for the geotropic variant of horizontal canal benign paroxysmal positional vertigo. MAIN OUTCOME MEASURE: The treatment outcome was considered as responsive when, after one repositioning maneuver, nystagmus shifted from apogeotropic to geotropic. RESULTS: The repositioning maneuver resulted in a transformation from the apogeotropic variant into a geotropic variant of horizontal canal benign paroxysmal positional vertigo in all patients. CONCLUSION: This maneuver represents a simple and effective approach to the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. It favors the shifting of the canaliths from the anterior into the posterior arm of the horizontal canal from where they can migrate into the utricle with Gufoni's maneuver.     

Effectiveness of the particle repositioning maneuver in subtypes of benign paroxysmal positional vertigo

OBJECTIVES: To assess the efficacy of the particle repositioning maneuver (PRM) in patients presenting with idiopathic benign paroxysmal positional vertigo (BPPV) compared with those with evidence of additional peripheral vestibulopathies. METHODS: Retrospective administration of the Dizziness Handicap Inventory (DHI) to 41 patients with primary BPPV and 31 patients with secondary BPPV to subjectively evaluate their symptoms before and after the PRM. RESULTS: Both groups indicated a marked improvement in symptoms after the PRM. Only two patients reported an increase in their symptoms after the PRM and both had secondary BPPV. CONCLUSIONS: The PRM was found to be highly effective in all forms of BPPV, but careful history and judicious testing may identify patients requiring additional intervention to relieve their symptoms.     

耳石复位法治疗半规管良性阵发性位置性眩晕的临床研究

目的：评价耳石复位法治疗良性阵发性位置性眩晕（BPPV）疗效。方法：回顾分析2002年1月～2005年6月间治疗的230例BPPV患者的临床资料。根据半规管耳石假说,随机分成治疗组122例,对照组108例,分别接受耳石复位法和一般对症治疗。治疗结束后2周复查并评定疗效。结果：治疗组88例眩晕和眼震于治疗后立即或在2周内逐渐消失,18例改善,16例无效,治愈率72．1％,总有效率86．9％。对照组51例立即或在2周内逐渐消失,23例改善,34例无效,治愈率47．2％,总有效率68．5%。两组疗效相比差异有统计学意义。结论：鉴于耳石复位法治疗无明显禁忌证,方法简单,无痛苦和不良反应,一次性治疗疗效高,短期（1～3个月）随访无复发,因此认为该法可作为BPPV门诊治疗的首选方法。     

不同类型良性阵发性位置性眩晕的诊断和治疗

目的探讨不同类型良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的诊断和治疗方法。方法对我科2004年4月-2006年3月就诊的BPPV病人131例．应用红外线视频眼动记录分析变位试验诱发的眼震特点，进行分型、定侧，并采用相应的耳石复位技术治疗。结果（1）后半规管BPPV94例（71．8％），随机分组采用Epley管石复位法和Semont管石解脱法各47例。（2）水平半规管BPPV29例（22．1％），水平向地性眼震者16例，另13例为水平背地性眼震者，自行或采用Gufoni疗法后转换为水平向地性9例，方向不能转换4例。采用barbecue翻滚和／或强迫侧卧体位疗法。（3）前半规管BPPV6例（4．6％），采用Epley管石复位法。（4）混合型BPPV2例（1．5％），行上述相应半规管的疗法。1周后随访总有效率85．5％（112／131），3个月后92.4％（121／131）。结论BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别不同半规管及不同发病机理类型，并选择合适的耳石复位技术治疗。