以位置性眩晕及水平眼震为首发表现的小脑占位病变(附1例报告及文献复习)

目的探讨主要症状为位置性眩晕及水平眼震的小脑占位病变患者的临床及病灶分布特征,以提高临床医生对该少见病的认识。方法回顾性分析2016年12月诊治的1例以位置性眩晕及位置性眼震为首发症状的小脑占位病变患者的临床资料及疾病诊治经过,并结合文献复习进行总结。结果患者男性,75岁,以反复眩晕、恶心、呕吐、活动后加重2个月就诊,查体发现水平翻滚试验可见水平背地眼震,首次查头颅CT平扫未见明显异常,诊断右侧水平半规管帽石症,给予Gufoni手法复位治疗无明显效果。4周后患者出现意识淡漠,复查头颅CT显示梗阻性脑积水,头颅CT增强示右侧小脑小结占位病变,先后行侧脑室外引流及小脑肿瘤切除术,术后病理为弥漫大B细胞淋巴瘤。结合既往报道的文献13例和本研究的1例共计14例小脑占位引起的位置性眩晕及水平眼震患者中,有9例初诊为良性阵发性位置性眩晕;肿瘤主要位于小脑小结、舌叶及四脑室底部等小脑中线部位。结论小脑中线部位的占位病变可以表现为位置性眩晕/眼震,临床医生需注意识别,以免漏诊。

Cerebellar Tumor Presenting with Positional Vertigo and Horizontal Nystagmus: One Case Report and Literature Review

Aim To investigate the clinical and topographical features among patients with cerebellar tumor manifesting with positional vertigo and horizontal nystagmus,which is a rare disease.Methods The clinical data of one patient manifesting with positional vertigo and horizontal nystagmus was retrospectively analyzed with previous related cases,the patient was admitted to our hospital in December 2016 and was finally diagnosed with cerebellar tumor.Results A 75-year-old man was admitted to our hospital for suffering from 2-month episodic dizziness,nausea and vomiting,which was aggravated after head movement.Neurological examination showed apogeotropic horizontal nystagmus in Roll test and the initial cranial CT was negative.Therefore,the patient was considered to be right horizontal semicircular canal cupulolithiasis.Repeated Gufoni repositioning maneuver was in vain.Four weeks later,the patient appeared to be apathetic and re-examined cranial CT indicated obstructive hydrocephalus.Enhanced cranial CT showed neoplasm located in right cerebellar nodulus.An extra ventricular drainage and tumor resection were performed successively.The pathology confirmed that the lesion was diffuse large B cell lymphoma.In the previous studies,9 out of 14 patients,who manifested with positional vertigo and horizontal nystagmus,were initially misdiagnosed for benign paroxysmal positional vertigo (BPPV).But they were eventually diagnosed cerebellar tumor involving the midline cerebellar structures around the nodulus,uvula and the fourth ventricle.Conclusion Clinicians should be aware that patients with neoplasm located in midline cerebellar structures might be presented with positional vertigo and (or) nystagmus.