良性阵发性位置性眩晕126例误诊分析

Misdiagnosis Analysis of 126 Patients with Benign Paroxysmal Positional Vertigo

目的探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的误诊原因,提出防范误诊措施,以提高诊治水平。方法回顾性分析我院2008年1月～2011年1月首诊误诊为其他疾病的126例BPPV临床资料。结果本组特发性BPPV 84例,继发性BPPV 42例,早期误诊为后循环缺血54例,颈性眩晕32例,突发性耳聋6例,前庭神经元炎5例,梅尼埃病、耳带状疱疹各3例,其他药物或治疗不良反应23例。126例均经详细询问病史及Dix-Hallpike变位试验和(或)滚转试验检查,并行耳石手法复位治疗。本组眩晕症状均缓解,首次复位治愈率72.2%(91/126),观察随访3～24个月,总治愈率94.4%(119/126),复发率5.6%。结论良性阵发性位置性眩晕为常见周围性眩晕,在眩晕患者诊治过程中,应注重病史采集和变位试验检查,以降低BPPV的误诊率。

Objective To explore the misdiagnosis causes of benign paroxysmal positional vertigo（BPPV） and to improve diagnosis and treatment.Methods The clinical data of 126 patients not diagnosed as having BPPV at first during January 2008 to January 2011 in our hospital were retrospectively analyzed.Results 84 patients with BPPV were spontaneous,42 were secondum.54 patients were misdiagnosed as having ischemia of retral circulation,32 as having cervical vertigo,6 as having deafness,5 as having vestibular neuronitis,3 as having meniere disease,3 as having herpes zoster auricularis,and 23 as having adverse reaction of treatment.The 126 patients were inquired of disease history,and underwent Dix-Hallpike positioning test and（or） roll test and manipulative reduction.The symptoms were alleviated and initial success rate was 72.2%.During 3-24 month follow-ups,total success rate was 94.4%（119/126）,and recurrence rate was 5.6%.Conclusion BPPV is a common disease of vestibular vertigo.Therefore,we should pay attention to history taking and positioning nystagmus examination before diagnosis of vertigo,and reduce misdiagnosis rate of BPPV.