病毒性前庭神经炎31例误诊分析

目的探讨病毒性前庭神经炎眩晕与椎-基底动脉供血不足眩晕二者临床不同特点。方法对125例眩晕患者的病历资料进行回顾性分析,从其中筛选出31例有明确病毒感染者作为A组,同期94例无病毒感染的椎-基底动脉供血不足/TIA作为B组,两组对比。结果 31例病毒感染患者前庭周围性眩晕发生率低于前庭中枢性眩晕;椎-基底动脉供血不足/TIA表现周围性眩晕亦极少。A组经颅多普勒(TCD)异常率低(22.6%),B组异常率高(77.7%)。结论病毒感染后前庭中枢性眩晕容易与椎-基底动脉供血不足/TIA眩晕相混淆。TCD对于二者有较好的鉴别意义,应是首选检查手段。     

中枢性眩晕

眩晕是神经内科疾病常见症状,常由于前庭神经系统病变引起。前庭康复治疗是其主要治疗手段之一。主要针对中枢前庭神经系统病变,如偏头痛相关性头晕、颅脑外伤、脑干卒中、椎基底动脉供血不足以及小脑变性等疾病的临床特点、诊断及康复治疗等问题进行探讨。     

前庭中枢性眩晕诊断手段的进展

眩晕是机体对空间关系的定向感觉障碍,是一种运动幻觉或运动错觉,病人感外境或自身旋转、移动或摇晃。眩晕常由前庭周围和前庭中枢的病变引起,前庭中枢包括脑干的前庭神经核及其与小脑、中脑、大脑的联系通路。由前庭中枢病变引起的眩晕称中枢性眩晕。常见的病因有脑干或小脑的梗塞、出血、脱髓鞘、炎症、变性、先天性疾病,后颅窝的肿瘤、动静脉畸形以及椎基底动脉系统短暂缺血发作等。随着各种诊断方法和诊断仪器的发展,它们逐渐渗透到神经耳科领域,使前庭中枢性眩晕的诊断日趋明确。     

头晕或眩晕患者超声检测椎动脉异常变化相关性分析

头晕、眩晕是一种神经科的常见临床症状,可见于周围前庭病变,全身系统疾病以及中枢性疾病包括椎-基底动脉疾病等。彩色多普勒超声成像不但能显示颅外段椎动脉的走行,还能提供其血流动力学相关信息。本文目的在于探讨椎动脉异常变化与头晕、眩晕的相关性,从而为临床提供一定的参     

天麻和丁咯地尔治疗椎基底动脉供血不足性眩晕的临床观察

我院2004—07／2006—07采用天麻素联合丁咯地尔治疗椎基底动脉供血不足（VBI）性眩晕50例，疗效满意，现报道如下。 1对象和方法 1．1对象患者149例均以眩晕为好发症状，符合椎基底动脉供血不足性眩晕诊断标准，排除脑干、小脑、枕叶梗死或美尼尔综氏病的患者。随机分为：天麻联合丁咯地尔组50例，男21例，女29例，年龄46～81岁，视物旋转28例，眼球水平性震颤12例，合并高血压31例。     

伴单侧外周前庭受损的头晕/眩晕患者的临床分析

目的:探讨伴单侧外周前庭受损(UPVD)的头晕/眩晕患者的病因学、临床特征及相关危险因素。方法:连续收集我院神经科门诊就诊的伴UPVD的头晕/眩晕患者148例为病例组,同期收集我院健康体检门诊年龄、性别相匹配的187例健康人为对照组。收集2组研究对象的基线资料,分析伴UPVD的头晕/眩晕患者的病因及伴发疾病分布,应用多元Logistic回归分析伴UPVD的头晕/眩晕患者的独立危险因素。结果:148例伴UPVD的头晕/眩晕患者年龄9~86岁,男:女约为1:2。可以头晕(74.3%)或眩晕(25.7%)起病,分原发性(23.0%)和继发性/伴发性(77.0%)。原发性伴UPVD的头晕/眩晕患者包括急性原发单侧前庭病、发作性原发单侧前庭病、慢性原发单侧前庭病;继发/伴发性伴UPVD的头晕/眩晕患者包括良性阵发性位置性眩晕、持续性姿势-感知性头晕、可能的迷路卒中、慢性缺血性单侧前庭病可能、内耳缺血性发作性前庭病变可能、前庭性偏头痛、梅尼埃病、前庭神经元炎及迷路震荡。多元Logistic回归分析提示高血压、高脂血症是伴UPVD的头晕/眩晕患者的独立危险因素(P<0.05)。结论:神经科门诊伴UPVD的头晕/眩晕患者常伴有动脉粥样硬化危险因素。病因诊断较为困难,病因不明最为多见,其次多因伴发良性阵发性位置性眩晕、持续性姿势-感知性头晕和可能的迷路卒中而就诊。     

天麻和丁咯地尔治疗椎基底动脉供血不足性眩晕的临床观察

我院2004-07/2006-07采用天麻素联合丁咯地尔治疗椎基底动脉供血不足(VB I)性眩晕50例,疗效满意,现报道如下。1对象和方法1.1对象患者149例均以眩晕为好发症状,符合椎基底动脉供血不足性眩晕诊断标准[1],排除脑干、小脑、枕叶梗死或美尼尔综氏病的患者。随机分为:天麻联合丁咯地尔组50例,男21例,女29例,年龄46~81岁,视物旋转28例,眼球水平性震颤12例,合并高血压31例,冠心病11例,糖尿病13例,颈椎病25例;天麻素组50例,男22例,女28例,年龄45~78岁,视物旋转22例,眼球水平震颤8例,合并高血压16例,糖尿病11例,颈椎病21例;丁咯地尔组49例,男21例,…     

数字减影脑血管造影术对伴发眩晕的后循环缺血患者血管异常病因分析

目的 通过数字减影脑血管造影术(DSA)对伴发眩晕的后循环缺血(PCI)患者的头颈部血管进行检查,分析其血管异常病因,掌握其发病规律.方法 对138例伴发眩晕的PCI患者入院后给予详细的影像学检查,包括MRI、DSA,分析患者血管异常与PCI的因果关系.结果 138例患者,诊断为椎基底动脉系统短暂性缺血发作者89例、椎基底动脉系统脑梗死49例,综合所有的影像学检查结果分析,椎基底动脉血管异常者86例,考虑与PCI病因有关,有12例患者明确有心脏痛心房颤动,考虑与后循环脑梗死病因有关,其余40例患者病因不明确.结论伴发眩晕的PCI患者的血管异常病因为:①椎基底动脉系统血管变异;②椎基底动脉系统血管狭窄或闭塞导致的后循环出现低灌注状态或脑梗死.     

椎基底动脉供血不足性眩晕与血管结构异常

背景:近年来国外有研究报道称血管结构异常是椎基底动脉供血不足眩晕发病的主要形态学基础,但国内极少有关于椎基底动脉供血不足的血管结构异常的报道。目的:观察椎基底动脉供血不足性眩晕患者血管结构异常的数字减影血管造影表现及临床意义。设计:病例分析。单位:南京医科大学附属无锡第二医院(无锡市第二人民医院)神经内科及南华大学附属怀化医院神经内科。对象:2003-08/2004-05在南华大学附属怀化医院神经内科就诊及2004-10/2005-05在南京医科大学附属无锡第二医院(无锡市第二人民医院)神经内科就诊、以发作性眩晕,恶心或呕吐症状的门诊及住院患者57例。方法:对两年来收治的57例椎基底动脉供血不足性眩晕患者行数字减影主动脉弓及全脑血管造影:采用股动脉穿刺逆行血管造影法,以预灌装针筒形式供应的Optiray(安射力)非离子型造影剂行主动脉弓造影。数字减影机从多角度显示双侧颈动脉、椎动脉,范围包括颈总动脉起始至颈内动脉虹吸弯,由2位神经科医生分别进行测量和评价。主要观察指标:主动脉弓、颈内动脉及椎基底动脉系统血管结构异常的类型、分布及比例。结果:参加实验57例患者,1例患者因左椎动脉不能进入而放弃。1例在行主动脉弓造影时并发大面积脑梗死手术中止。进入结果分析55例。经检查发现共有71%(39/55)患者存在颈及颅内血管结构异常,单纯前循环病变占11%(6/55);后循环病变占60%(33/55),其中合并有前循环异常的复合病变9例(16%),累及两条或两条以上血管的共24例(24/55,44%),以椎动脉合并其他血管狭窄最为常见;其余16例(16/55,29%)造影未见血管结构异常。结论:各种类型的血管结构异常是椎基底动脉供血不足性眩晕的主要病因,诊断椎基底动脉供血不足眩晕的金标准应为数字减影血管造影。     

TCD对头晕或眩晕患者脑血管病变的分析

目的分析神经科门诊头晕或眩晕患者颅内外血管狭窄发生频率,以及狭窄血管的分布情况,探讨导致头晕或眩晕的动脉狭窄原因。方法对2001年1月~2001年12月神经科门诊筛选主诉为头晕或眩晕,且无其他神经系统局灶体征者1676例。应用经颅多普勒超声(TCD)检测颅内Willis环及颅外颈部血管。结果(1)202例有脑血管的狭窄,血管狭窄的发生率为202/1676(12.10%)。其中,单纯颈动脉系统血管病变的发生率45.05%,高于单纯椎基底动脉系统32.18%(P<0.01);(2)椎动脉狭窄者占11.88%,其中,单侧椎动脉病变占79.167%,左右无明显差别;3.锁骨下动脉狭窄者占32.673%,其中伴盗血综合征者为28.79%。结论临床上不能仅仅简单的把单纯头晕或眩晕患者诊断为功能性疾病或椎基底动脉供血不足。     

The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial

OBJECTIVE: To compare the canalith repositioning procedure (CRP) with a sham maneuver for the treatment of benign paroxysmal positional vertigo. PATIENTS AND METHODS: We recruited 50 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination (Dix-Hallpike maneuver). Patients were randomized to either the CRP (n = 24) or a sham maneuver (n = 26). Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS: The mean duration of follow-up was 10 days for both groups. Resolution of symptoms was reported by 12 (50%) of the 24 patients in the CRP group and by 5 (19%) of the 26 patients in the sham group (P = .02). The results of the Dix-Hallpike maneuver were negative for positional nystagmus in 16 (67%) of 24 patients in the CRP group and in 10 (38%) of 26 patients in the sham group (P = .046). CONCLUSION: The CRP is effective treatment of benign paroxysmal positional vertigo, and this procedure can be performed by general internists on outpatients with this disorder.     

前半规管良性阵发性位置性眩晕患者的诊断和 治疗分析

目的:探讨前半规管良性阵发性位置性眩晕(anterior canal benign paroxysmal positional vertigo,AC-BPPV)患者的眼震和管型受累特征。方法:回顾性收集AC-BPPV患者20例的临床资料,在眼震视图下行Dix-Hallpike试验,根据其眼震特征对其诊断,并采用Yacovino法对其进行手法复位治疗。结果:①本组20例患者中,左侧前半规管受累10例(50.0%),右侧前半规管受累5例(25.0%),侧别不能明确判定者5例(25.0%)。②眼震特征:Dix-Hallpike试验:单侧下跳性眼震11例(55.0%),单侧下跳伴扭转性眼震1例(5.0%),双侧下跳性眼震5例(25.0%),一侧下跳、另一侧下跳伴扭转性眼震2例(10.0%),双侧扭转伴下跳性眼震1例(5.0%)。坐起时出现眼震逆转5例(25.0%)。③Yacovino手法复位:首次手法复位治愈12例(60.0%),有效7例(35.0%),无效1例(5.0%)。1周后复查痊愈15例(75.0%),有效4例(20.0%),无效1例(5.0%)。结论:AC-BPPV患者在Dix-Hallpike试验中诱发出的眼震多样,单侧多见。多数为下跳眼震不伴有扭转成分,部分患者双侧Dix-Hallpike试验均能诱发出眼震;Yacovino法手法复位治疗常常效果较好。     

Horizontal Direction‐Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31‐month clinical course of a 41‐year‐old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left‐beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.     

眩晕中心门诊1419例患者的病因分层研究

目的总结眩晕中心门诊患者的疾病病因规律,为眩晕/头晕的精确诊疗提供依据。 方法从2016年1~12月期间空军总医院眩晕中心门诊诊治的6450例次病例中,选择具有全科医师工作经历并长期从事眩晕诊疗和研究的某专家团队诊治的眩晕/头晕患者1419例作为研究对象,按患者性别和年龄进行病因分层的构成比分析。采用χ²检验比较不同性别病因分层的构成比差异。 结果（1）眩晕/头晕患者前9位病因为良性阵发性位置性眩晕（BPPV）占38.55%（547/1419）、前庭性偏头痛（VM）占21.92%（311/1419）、前庭神经炎（VN）占7.89%（112/1419）、梅尼埃病（MD）占6.20%（88/1419）、精神性眩晕（PV）占4.65%（66/1419）,高血压占3.24%（46/1419）、后循环缺血（PCI）占2.54%（36/1419）、突发性耳聋伴眩晕（SD）占1.48%（21/1419）、冠状动脉粥样硬化性心脏病（CHD）占0.85%（12/1419）。按眩晕分类前庭外周性眩晕占56.03%（795/1419）,中枢性眩晕占24.59%（349/1419）,非前庭系统全身疾病所致眩晕/头晕占10.50%（149/1419）,不明原因眩晕/头晕占8.88%（126/1419）。（2）患者年龄9~90岁,按年龄病因分层,排在前4位的为：<18岁组BPPV（0.42%,6/1419）、晕动病（0.42%,6/1419）、VM（0.35%,5/1419）、VN（0.21%,3/1419）,共26例;18~44岁组为BPPV（11.35%,161/1419）、VM（7.26%,103/1419）、VN（2.47%,35/1419）、MD（1.20%,17/1419）,共412例;45~59岁组为BPPV（15.01%,213/1419）、VM（8.25%,117/1419）、MD（3.38%,48/1419）、VN（2.68%,38/1419）,共548例;60~74岁组为BPPV（10.36%,147/1419）、VM（4.79%,68/1419）、高血压（2.11%,30/1419）、VN（2.11%,30/1419）,共343例;75~90岁组为PCI（2.54%,36/1419）、BPPV（1.41%,20/1419）、VM（1.27%,18/1419）、VN（0.42%,6/1419）,共90例。（3）患者男:女为1:1.79。按性别病因分层,PV和不明原因以女性多见（χ²=4.02,P=0.044;χ²=29.94,P<0.001）,高血压和PCI以男性多见,差异具有统计学意义（χ²=17.90,21.32,P均<0.001）。 结论眩晕/头晕表现复杂、诊断困难,涉及多个传统学科,眩晕中心门诊与其他专科门诊的眩晕/头晕病因构成及年龄和性别分层规律有所不同,整合不同学科、不同纬度获得的统计信息,有助于提高专科医师和全科医师眩晕/头晕的精确诊疗水平。     

社区门诊头晕患者80例临床分析

目的:总结社区门诊眩晕患者的常见病因及临床特点。方法:回顾性分析2012年01月至2013年01月社区门诊首发眩晕患者80例并随访观察12个月的临床资料。结果:本组80例患者的临床诊断及其病因构成比依次为:47.5%(38/80)为周围性眩晕,其中84.2%(32/38)为良性阵发性位置性眩晕(BPPV),10.5%(4/38)为梅尼埃病(MD);20.0%(16/80)为前庭中枢性;28.8%(23/80)为系统性疾病性头晕;2.5%(2/80)为精神障碍性;1.3%(1/80)为其他原因性头晕。BPPV中女性占90.6%(29/32)。结论:社区门诊眩晕的最常见类型是周围性眩晕,而BPPV是周围性眩晕最常见的病因,且以女性多见;大多数以眩晕为主要特点的疾病都具有特征性的症状,这对提示疾病诊断具有重要的意义。     

Migrainous Vertigo: Results of Caloric Testing and Stabilometric Findings

Background.— Association between migraine and vertigo has been widely studied during the last years. A central or peripheral vestibular damage may occur in patients with migrainous vertigo. Despite much evidence, at present the International Headache Society classification does not include a specific category for migrainous vertigo. Objectives.— To assess the prevalence of central and peripheral vestibular disorders and postural abnormalities in patients diagnosed as affected by definite migrainous vertigo according to Neuhauser. Methods.— Thirty patients with migraine and acute vertigo lasting from minutes to hours underwent a full otoneurological screening for spontaneous, positional, and positioning nystagmus with head‐shaking and head‐thrust (Halmagyi) tests, an audiometric examination, and videonystagmography with bithermal stimulation according to Freyss. Videonystagmographic findings were compared with those of 15 migraineurs without lifetime vertigo (group M). Next day, a static posturography was performed; posturographic results have been compared with those of a second control group of 30 healthy patients matched for age and sex (group C). Results.— In total, 14 subjects with migrainous vertigo showed otovestibular disorders; 6 subjects showed impaired vestibulo‐oculomotor reflexes (20%). Five more patients had bilateral increased responses (16.6%). Five patients showed signs of central brainstem or cerebellar disorders for altered pursuit or saccades or positional direction changing nystagmus. Stabilometric results returned higher values of Length and Surface above all when testing was performed in eyes closed conditions compared with the normal control group. The subgroup of 14 subjects with migrainous vertigo and vestibular abnormalities performed poorly in stabilometric exams and seemed to rely more on visual cues in balance control than the subgroup of 16 subjects with migrainous vertigo but without abnormalities. Discussion.— Our results indicate that vestibular functional damage may occur in all vestibular pathways; central and peripheral signs are equally represented. Our data are not inconsistent with the hypothesis that a vestibulo‐spinal dysfunction is the causal factor for the posturographic results. Moreover, the Visual Romberg Index is significant for increased visual cue dependence in migraineurs.     

Effects of Restrained Cervical Mobility on Involuntary Eye Movements

Abstract

The presumed connection between cervicogenic dizziness, cervical evoked involuntary eye movements and intervertebral joint blocks of the high cervical spine serves as a starting point for the manual therapist in treating patients suffering from neck pain, headache and dizziness. Cervical evoked involuntary eye movements are of diagnostic importance and proprioceptive cervical positional nystagmus is seen as pathognomic for high cervical intervertebral joint blocks. In a period of two years, 157 patients with neck pain, headache and dizziness were referred to and examined in our department. Thirty eight patients were diagnosed as having functional vertebrobasilar insufficiency and 17 patients presented with benign paroxysmal positional vertigo. These 55 patients were excluded from the study. The remaining 102 patients were included in the study. Passive functional tests of cervical motion segments OCC-C1, C1 through C4 according to Van der EI and Dvorák and Dvorák and the test for cervical evoked involuntary eye movements according to Oosterveld were carried out on the last group. In 84 of the 102 patients (82%) the passive functional tests of OCC-C1, C1 through C4 were evaluated as positive for one or more cervical motion segments in one rotational direction; in 18 of the 102 patients (18%) as positive in two rotational directions. In 13 of 102 patients (13%) the cervical evoked involuntary eye movements were evaluated as present for proprioceptive cervical positional nystagmus (mean latency: 4 sec.; frequency: decreasing); in 89 patients (90%) as absent. In 12 of the 13 patients (92.3%) intervertebral joint blocks were present at four levels of the high cervical spine OCC-C1, C1 through C4. There was a significant correlation between the number and level of the blocked cervical motion segments and the presence of the proprioceptive cervical positional nystagmus (Kendall's tau-b = 0.59; p < 0.05). The results of this study are not comparable with those reported in other studies because of differences in the methods and judgement of the cervical evoked involuntary eye movements (ENG versus visual observation using Frenzel's spectacles) and the function of the high cervical spine (no specific information versus manual diagnostic information per cervical motion segment). The findings suggest the need for further research.     

Five per cent of the time it works 100 per cent of the time: the erroneousness of the P value

Abstract

Background and Aim: Dizziness or vertigo is a frequent complication of whiplash injury and reported in 40% -80% of cases. The term dizziness covers a wide range of symptoms. Characteristics of the neuro-otological signs in patients with whiplash associated disorders (WAD) remains a subject of debate. It has been reported that whiplash injury is a cause of benign paroxysmal positional vertigo (BPPV). The aim of the present study was to document the incidence of BPPV in whiplash-patients referred for manual therapy. Methods: All patients with whiplash injuries referred by a physician (60%) or by a medical specialist (40%), were examined following a standard protocol (history-taking and neuro-otological assessment). A key diagnostic manoeuvre for BPPV is the Dix and Hallpike positional test. Subjects: In a five-year period, 368 patients were referred. Based on four inclusion criteria, 273 patients were included in the study. All gave their informed consent. Statistical Analysis: Non-parametric statistics are used, based on the measurement level of the tests (dichotomous and ordinal level). Results: BPPV was suspected as a result of history-taking in 96 (35%) of 273 patients. A positive Dix and Hallpike response was seen in 68 (25%) of 273 patients; 56 of these patients were assessed as typical (positional vertigo and rotatory nystagmus) and 12 patients as atypical (positional dizziness and no rotatory nystagmus). Conclusion: The incidence of suspected BPPV is anamnestically 35% and clinically 25%. There is a discrepancy between neuro-otological signs and symptoms. The prognosis of BPPV is considered good with peripheral and central adaptation within 6 to 12 weeks. No spontaneous recovery occurred in our patients. Discussion: The results of this study highlight the need for the manual therapist to differentiate between patients with whiplash with a clinical entity (for example, [suspected] BPPV) and patients with whiplash injury without a clinical entity. Therapeutic implications for both groups of whiplash patients are given.     

Initial evaluation of vertigo

Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Meniere's disease cause most cases of vertigo; however, family physicians must consider other causes including cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms. Once it is determined that a patient has vertigo, the next task is to determine whether the patient has a peripheral or central cause of vertigo. Knowing the typical clinical presentations of the various causes of vertigo aids in making this distinction. The history (i.e., timing and duration of symptoms, provoking factors, associated signs and symptoms) and physical examination (especially of the head and neck and neurologic systems, as well as special tests such as the Dix-Hallpike maneuver) provide important clues to the diagnosis. Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging.