前庭神经炎的颈-眼诱发肌源电位临床研究

 目的 评估前庭神经炎(vestibular neuritis,VN)的临床分类及前庭上神经(superior vestibular nerve,SVN)和下神经(inferior vestibular nerve,IVN)的受累情况。方法 选择本院60例诊断为前庭神经炎的患者(前庭神经炎组)和30例健康人(健康对照组)行颈肌前庭诱发肌源电位(ervical vestibular evoked myogenic potential,cVEMP)、眼肌前庭诱发肌源电位(ocular vestibular evoked myogenic potential,oVEMP)、前庭双温试验检查。双温试验用于评估水平半规管,oVEMP用于评估椭圆囊及前庭上神经功能,cVEMP用于评估球囊及前庭下神经功能。结果 前庭神经炎组中,前庭上神经炎46例,前庭下神经炎12例,全前庭神经炎2例,VEMPs异常率较对照组明显增高,两组相比异常率差异有统计学意义(P＜0.05)。前庭上神经患者患侧oVEMP潜伏期与健康对照组比较,差异无统计学意义,振幅及不对称比差异有统计学意义,而健侧与健康对照组比较,差异无统计学意义,双温试验与健康对照组差异有统计学意义;前庭下神经炎患者oVEMP潜伏期及振幅与健康对照组差异均无统计学意义;前庭下神经炎患者oVEMP振幅及不对称比与对照组比较,差异无统计学意义。前庭双温试验CP值与前庭神经无明显相关。前庭双温试验前庭cVEMP异常的患者oVEMP及前庭双温试验结果正常时代表前庭下神经。结论 前庭神经炎主要表现前庭上神经炎,部分可累及前庭下神经,cVEMP和oVEMP及双温试验提供更详细的前庭神经损伤定位。

Cervical and ocular vestibular-evoked myogenic potentials in acute vestibular neuritis

Objective To evaluate the classification of vestibular neuritis (VN) and involvement of the superior vestibular nerve (SVN) and inferior vestibular nerve (IVN).Methods Sixty patients diagnosed with vestibular neuritis in our department and 30 normal persons as healthy control group were included in our study.Ocular vestibular-evoked myogenic potential (oVEMP) test,cervical vestibular-evoked myogenic potential (cVEMP) test and caloric test were carried out in all the patients and healthy control group.Caloric test was used to measure the horizontal semicircular canal,oVEMPs were used to measure the function of the utricular and superior vestibular nerve,while cVEMPs were used to evaluate the function of the saccule and inferior vestibular nerve.Results VN selectively involved the superior vestibular nerve in 46 patients,affected the inferior vestibular nerve in twelve and damaged both superior and inferior vestibular nerve branches in two.The abnormal extraction rate of VEMPs of vestibular neuritis group was higher than in control group,and the difference was statistically significant.There was no significant difference in the latency of oVEMPs between patients in superior vestibular nerve group and healthy control group,whereas the amplitude and asymmetry ratio were significantly different.There was no significant difference between the healthy side and the healthy control group,but the difference was statistically significant in caloric test.However,there was no significant difference in the latency and amplitude of oVEMPs between patients in inferior vestibular nerve group and healthy control group.There was no correlation between the CP value of caloric test and the vestibular nerve.Patients with abnormal cVEMPs and normal oVEMPs and caloric test represented the inferior vestibular nerve.Conclusions Vestibular neuritis mostly involves the superior portion of the vestibular nerve.cVEMPs,oVEMPs and caloric test can provide more detailed localization of vestibular nerve damage.