水平半规管良性阵发性位置性眩晕的诊断

目的探讨水平半规管良性阵发性位置性眩晕（BPPV）的诊断。方法自2003年1月至2006年9月，本眩晕中心共确诊为水平半规管BPPV（HSC BPPV）患者46例。诊断依据为典型的病史及用红外视频眼震电图仪记录患者在Dix—Hallpike试验和滚转试验中的眼震结果，并排除其他疾病。研究HSC BPPV的眼震特点。结果441例诊断为BPPV患者中，46例（10．43％）为水平半规管BPPV。其中38例（82．61％）为单侧病变，5例（10．87％）患者合并同侧后半规管病变，3例（6．52％）为双侧病变。35例患者通过两种试验诱发出水平眼震，11例患者仅通过滚转试验诱发出水平眼震。25例患者眼震方向向地，13例患者眼震方向背地，3例患者眼震方向不固定，5例患者各种手法诱发出同一方向的眼震。29例患者在双侧手法中出现眼震，17例患者在一侧手法中出现眼震。结论HSC BPPV眼震为完全水平性且多为快相向地。通常受累耳在双侧手法中均可出现眼震，以向患侧为重。一侧水平半规管和后半规管可同时受累。滚转试验在HSC BPPV检查中比Dix—Hallpike试验更加敏感。Dix—Hallpike试验结合滚转试验可使更多的HSCBPPV患者得到确诊．

Diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo

Objective To analyse the video-oculographic findings of positional tests in patients with horizontal semicircular canal paroxysmal positional vertigo (HSC BPPV). Methods Forty six patients were enrolled in this prospective study. The diagnosis was base history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during Dix-Hallpike and roll testing, and the exclusion of other disorders. Results Of 441 patients with BPPV diagnosed in our center, 46(10.43%) had HSC involvement. Of them, 38 (82.61%) patients had unilateral lesions, 5(10.87%) were associated with ipsilateral PSC BPPV, 3 (6.52%) patients had bilateral lesions. Thirty-five patients were confirmed both in Dix-Hallpike test and roll test, 11 were confirmed only in roll test. Geotropic nystagmus was seen in 25 patients in Dix-Hallpike test and roll test, while apogeotropic nystagmus in 13 patients. The direction of nystagmus could not be ascertained clinically in 3 patients and the direction of nystagmus was the same during right and left positional test in 5 patients. Seventeen patients were provoked nystagmus in unilateral maneuver and 29 patients in bilateral maneuver. Conclusion Patients of HSC BPPV with horizontal direction-changing positional nystagmus and geotropic nystagmus are more common. Always, nystagmus was provoked by bilateral maneuver, but was more serious on the lesion side. HSC BPPV can coexist with ipsilateral PSC BPPV. The roll test is more sensitive to horizontal semicircular canal benign paroxysmal positional vertigo.