良性阵发性位置性眩晕的眼震图研究

Positioning diagnosis of benign positional paroxysmal vertigo by VNG

目的:探讨视频眼震图(VNG)在良性阵发性位置性眩晕(BPPV)中的应用价值。方法:回顾126例BPPV患者的VNG资料,分析总结各型BPPV在Dix-Hallpike和滚转试验中VNG上的眼震特点。结果:126例BPPV患者中,后半规管BPPV(PSC-BPPV)98例(77.8%),水平半规管BPPV(HSC-BPPV)17例(13.5%),前半规管BPPV(ASC-BPPV)5例(3.9%),混合型BPPV6例(4.8%);28例PSC-BPPV记录到反转相眼震。VNG上显示PSC和ASC管石症Dix-Hallpike悬头位垂直相眼震分别向上、向下,水平相眼震均向对侧,回到坐位时眼震反向。HSC-BPPV滚转试验向两侧转头均可诱发出眼震,眼震与转头方向相同时,可判断为HSC管石症,以能够诱发较强眼震的转头侧为患侧;眼震与转头方向相反时,则为HSC嵴顶结石症,以能够诱发较弱眼震的转头侧为患侧。结论:VNG能够客观地记录BPPV患者的眼震情况,准确判断耳石所在的半规管,并且保存了眼震数据资料,可以进一步指导临床实践,值得推广。

Objective：To analyze the value of positioning diagnosis of VNG （Videonystagmograph） in patients with benign paroxysmal positional vertigo（BPPV）. Method： One hundred and twenty-six patients with BPPV were enrolled in this retrospective study. Their positional nystagmus recorded by VNG in Dix-Hallpike and roll tests were analyzed to summarize the characteristics of nystagmus on nystagmograph of various BPPV. Result： Of 126 patients with BPPV diagnosed in our center, the posterior semicircular canals（PSC） were involved in 98 patients （77.8 %） ,whereas the horizontal semicircular canal（HSC） and anterior semicircular canal（ASC） were involved in 17 （13.5%） and 5 （3.9%）, respectively. Six patients （4.8%） confirmed combined-BPPV had HSC-BPPV and ipsi lateral PSC-BPPV. Twenty-eight patients with PSC-BPPV had reversal phase on nystagmograph. The nystagmus of patients with P/ASC-canalithiasis showed upward/downward on the vertical phase of nystagmograph and orien tated the opposite side on horizontal phase in the head hangging position, and the nystagmus reversed when re turned to sit. Nystagmus on horizontal phase could be provoked when the head turned to both sides of the roll tests in patients with HSC-BPPV. If the nystagrnus and the head-turning shared the same direction, then HSC eanalithiasis was confirmed, and the direction of the head-turning which provoked the stronger nystagmus indicates the lesion side. If the nystagmus and the head-turning had the opposite direction, then HSC-cupulolithiasis was confirmed, and the direction of the head turning which provoked the weaker nystagmus indicates the lesion side. Conclusion： Positional nystagmus can be recorded objectively using VNG, According to which positioning the semi- circular canal involved would be easier and more accurate. The recording conserved also could be helpful for clinical diagnosis and repositioning of BPPV.