感觉门控P50在特发性BPPV成功复位后残余头晕中的应用

目的 探讨特发性良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）成功复位后出现残余头晕的患者感觉门控P50特点。方法 选择2018年6月至2019年11月就诊于大连市第三人民医院符合入组条件的确诊为BPPV并成功行手法复位后的患者60例,根据治疗7天后有无残余头晕（residual dizziness,RD）分为RD组和无RD组,行感觉门控电位P50检测,记录S1-P50及S2-P50的潜伏期、波幅及S2-P50/S1-P50波幅比值,进行统计学分析。结果 与无RD组相比,RD组S1-P50波幅减低,潜伏期延长,S2-P50波幅增高,潜伏期延长（P<0.05）;RD组S2/S1比值高于无RD组,差异具有统计学意义（P<0.05）。结论 感觉门控P50可以客观评价BPPV成功复位后残余头晕患者感觉门控功能缺损情况,提示患者可能存在情绪障碍,为临床治疗提供方向。     

Anxious,introverted personality traits in patients with chronic subjective dizziness

Objectives

Chronic subjective dizziness (CSD) is a neurotologic disorder of persistent non-vertiginous dizziness, unsteadiness, and hypersensitivity to one's own motion or exposure to complex visual stimuli. CSD usually follows acute attacks of vertigo or dizziness and is thought to arise from patients' failure to re-establish normal locomotor control strategies after resolution of acute vestibular symptoms. Pre-existing anxiety or anxiety diathesis may be risk factors for CSD. This study tested the hypothesis that patients with CSD are more likely than individuals with other chronic neurotologic illnesses to possess anxious, introverted personality traits.

Methods

Data were abstracted retrospectively from medical records of 40 patients who underwent multidisciplinary neurotology evaluations for chronic dizziness. Twenty-four subjects had CSD. Sixteen had chronic medical conditions other than CSD plus co-existing anxiety disorders. Group differences in demographics, Dizziness Handicap Inventory (DHI) scores, Hospital Anxiety and Depression Scale (HADS) scores, DSM-IV diagnoses, personality traits measured with the NEO Personality Inventory — Revised (NEO-PI-R), and temperaments composed of NEO-PI-R facets were examined.

Results

There were no differences between groups in demographics, mean DHI or HADS-anxiety scores, or DSM-IV diagnoses. The CSD group had higher mean HADS-depression and NEO-PI-R trait anxiety, but lower NEO-PI-R extraversion, warmth, positive emotions, openness to feelings, and trust (all p < 0.05). CSD subjects were significantly more likely than comparison subjects to have a composite temperament of high trait anxiety plus low warmth or excitement seeking.

Conclusion

An anxious, introverted temperament is strongly associated with CSD and may be a risk factor for developing this syndrome.     

Relationship of physical distress to dizziness in patients with fibromyalgia

Conclusions: The feelings of dizziness and unsteadiness of the patients with fibromyalgia supposed specifically amplified by the hypersensitivity mechanism of CSS (central sensitivity syndrome) of them. The severity of subjective pain and physical distress according to the questionnaires were not correlated with the objective body sway on the stabilometer. Objectives: Fibromyalgia manifests primarily as chronic pain of the entire body, but is also often associated with a variety of physical symptoms including dizziness and unsteadiness. This study assessed whether objective measures of body sway and unsteadiness of them are associated with their subjective dizziness findings. Method: Subjects were 24 patients diagnosed with fibromyalgia, but one patient who had the past history of sudden deafness was excluded. The 23 patients were assessed by a stabilometer as the objective measures of body sway, and JFIQ (Japanese version of the fibromyalgia impact questionnaire), DHI (dizziness handicap inventory) and ABC (activities-specific balance confidence) as the subjective questionnaires. Results: The significant correlations were shown between the scores of JFIQ and DHI, JFIQ and ABC, and DHI and ABC. Then, the body sway index of stabilometer environmental area was significantly correlated with DHI score. However, the stabilometer index was not correlated neither with JFIQ or ABC.     

Quantification of hearing loss in patients with posterior semicircular canal dehiscence

Conclusion: Patients with posterior semicircular canal dehiscence (PSCD) have low frequency conductive hearing loss similar to patients with superior semicircular canal dehiscence (SSCD) secondary to a pathologic third window. Objectives: PSCD can result in conductive hearing loss, but the magnitude of this hearing loss remains to be quantified. Patients with SSCD have been shown to have low frequency conductive hearing loss. The underlying pathophysiology of hearing loss from PSCD and SSCD is similar and related to a pathologic third window. Method: A PubMed search was completed for a meta-analysis of patients with PSCD. Articles with quality audiograms were obtained. Air conduction thresholds for ears with posterior semicircular canal dehiscence were compared to the opposite ear as well as normal control data. Results: Eight articles with 21 patients with PSCD and quality audiograms were included. Two patients had bilateral PSCD and one of those was excluded because hearing thresholds were at the limit of the audiometer. Patients with posterior semicircular canal dehiscence have statistically significant lower air conduction thresholds in frequencies at and below 2000 Hz.     

Spectrum of autonomic dysfunction in orthostatic dizziness

ObjectiveTo investigate the frequency and detailed spectrum of autonomic dysfunction in patients with orthostatic dizziness (OD).MethodsOver 20 months, 217 consecutive patients with OD as a presenting symptom of orthostatic intolerance were enrolled. The distribution and severity of autonomic dysfunction were measured by the composite autonomic severity score (CASS), which was derived from a standard autonomic function test including Finapres for recording of the beat-to-beat blood pressure. Sympathetic indexes (SIs) were calculated from the Valsalva maneuver (VM).ResultsApproximately 83% of patients showed at least one abnormal autonomic testing result. We classified OD into 11 groups according to the patterns of autonomic dysfunctions. The most common pattern was generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions (n = 60). Patients with delayed OH had larger BP increases during late phase II of the VM (p = 0.04), showed greater phase IV overshoot (p = 0.04), and had a smaller pressure recovery time increase (p = 0.02) than patients with classic OH. Each SI showed the strongest correlation with the CASS adrenergic subscores.ConclusionsOD can present with a board spectrum of autonomic dysfunctions.SignificanceThis investigation could be useful in understanding the pattern and mechanism of autonomic dysfunction associated with OD.     

慢性主观性头晕病机探讨与常见证候分析

目的:探讨慢性主观性头晕(CSD)的病机与证候分布。方法:采集125例CSD头晕患者的一般资料、中医四诊信息,对年龄、性别、症状、证候、证素进行统计学描述、分析。结果:CSD患者以青中年为主,男女比例1.0∶1.6。男女平均年龄、年龄分布差异均无统计学意义(P>0.05)。核心症状除头晕沉、头痛、自觉走路不稳或晃动等,尚包含眠差、急躁、心烦等精神症状及易疲乏、健忘、心慌等躯体症状。证候以阴虚证、痰热证、瘀热证常见,三组证候年龄分布、证候性别分布差异具有显著统计学意义(P<0.01)。与阴虚证相比,痰热证、瘀热证皆以≤44岁青年人居多(P<0.05),与瘀热证相比,阴虚证以45~59岁中年人较多(P<0.05),在≥60岁年龄段,三组证候分布差异无统计学意义(P>0.05);阴虚证、瘀热证以女性为主(P<0.05),痰热证以男性为主(P<0.05)。结论:CSD病位在心,为形神共病,神病为主导。邪扰神躁、清窍不利、形神失和为其主要病机,阳躁不宁、火热内扰是其发病基础。常见证候不外虚实之分,实证责之因郁化热、阳动神躁,虚证责之阴虚热扰、阳旺神浮。临证治疗CSD,当分析病因,明晰体质,随证施治,总以恢复脏腑气化,神安形合为根本目标。     

Multiple occult intracranial diseases diverted diagnosis of glioma in a patient

Dizziness is an atypical symptom of the nervous system. Many neurological disorders can manifest as dizziness. When patients have multiple neurological disorders, the most obvious diagnosis is often considered, and diseases that are potentially more deadly are overlooked. Here, we report the case of a man aged in his early 50s with dizziness who was found to have four neurological disorders. A series of treatments failed to resolve the condition. A review of this case highlights that when a patient’s symptoms are not typical, a comprehensive examination and evaluation is required to determine the etiology, and imaging may reveal further minor problems.     

老年主动脉夹层患者神经系统表现的临床分析

目的总结老年主动脉夹层(AD)患者神经系统症状的特点。方法选择189例老年AD患者,其中A型105例,B型84例,对其临床资料进行回顾性分析。结果 189例患者中,54例(28.57%)出现神经系统症状,最常见症状为头晕16例,占8.47%,其次晕厥14例,占7.41%,昏迷7例,占3.70%,一侧下肢感觉障碍6例,占3.17%,截瘫3例,占1.59%。12例诊断为脑梗死。与B型AD比较,A型AD患者更易出现神经系统症状(40.95%vs 13.10%,P<0.01),晕厥的发生显著高于B型患者(13.33%vs 0%,P<0.01)。结论神经系统症状常见于老年AD患者,尤其是A型患者,可能与脑缺血有关。