前庭阵发症51例患者临床特征分析

Clinical features of 51 patients with vestibular paroxysmia

目的探讨前庭阵发症（vestibular paroxysmia，VP）的临床特征。方法回顾性分析2009年1月至2011年4月诊治的51例VP患者的临床特征，并评价抗癫痫药的治疗效果。结果51例VP患者男女比例为1：1．55，病程为10d至20年，所有患者均以短暂眩晕发作为主要表现，其中46例（90．2％）可在静息时发作，37例（72．5％）可在转头或转身时发作，3min过度换气试验中13例（25．5％）诱发出短暂眩晕，Fukuda试验中15例（29．4％）阳性；脑干听觉诱发电位中40例（78．4％）表现异常，Ⅰ-Ⅲ波峰间期〉2．2ms患者共26例（51．0％）；42例（82．4％）患者在影像学表现有神经血管交互压迫（NVCC），单侧NVCC患者37例，双侧NVCC患者5例，共47耳，其中Ⅰ型23耳（48．9％），Ⅱ型5耳（10．6％），Ⅲ型17耳（36．2％），IV型2耳（4．3％）；治疗3个月后眩晕发作频率明显降低[3（2，7）次／月与15（9，30）次／月，Z=-6．156，P〈0．01]，发作的持续时间明显缩短[2（1，4）s与12（6，20）s，Z=-6．066，P〈0．01]，眩晕视觉模拟评分明显下降[（1．86±0．57）分与（5．83±1．12）分，t=1．984，P〈0．01]。结论VP临床上以自发性反复短暂性眩晕发作为特征，3min过度换气试验有助于诊断，脑干听觉诱发电位检查以Ⅰ-Ⅲ波峰间期延长为特点，NVCC以Ⅰ、Ⅲ型常见，应用抗癫痫药可取得较好疗效。

Objective To explore the clinical features of vestibular paroxysmia （VP）. Methods The clinical features of 51 patients with VP from January 2009 to April 2011 were analyzed retrospectively. The treatment effectiveness of antiepileptics was evaluated. Results The ratio of male to female was 1 ： 1.55 in the 51 patients with VP and the course of disease was 10 days to 20 years. In 46 patients （90. 2% ） the attacks occurred at rest, whereas 37 patients （72. 5% ） were precipitated by a head turn or a body turn. Three minutes hyperventilation-induced vertigo was found in 13 patients （25.5%） and Fukuda test was positive in 15 patients （ 29.4% ）. Forty patients （ 78.4% ） were abnormal in brainstem auditory evoked potentials （BAEP） and the interpeak latency of wave Ⅰ-Ⅲ was prolonged than 2. 2 ms in 26 patients （51.0%）. There were 47 ears had neurovascular cross-compression （NVCC） , which were unilateral in 37 patients and bilateral in 5 patients, with type Ⅰ in 23 ears（48.9% ）, type Ⅱ in 5 ears（10. 6% ）, type Ⅲ in 17 ears（36. 2% ） and type Ⅳ in 2 ears（4. 3% ）. Three month-treatment led to a significant reduction in the attack frequency（3 （2,7） per month vs 15 （ 9,30 ） per month, Z = - 6. 156, P 〈 0. 01 ）, in the attack duration （2 （1,4） s vs 12 （6,20） s, Z = -6. 066, P 〈 0. 01 ）, and a reduction in the visual analogue scale of vertigo （ 1.86 ±0. 57 vs 5.83 ±1.12, t = 1. 984, P 〈 0. 01 ）. Conclusions Brief vertigo attacks at rest is the character of VP. Three minutes hyperventilation-induced vertigo is helpful for the diagnosis of VP. The prolongation of the interpeak latency of wave Ⅰ-Ⅲ in BAEP is the character of VP. NVCC widely existed in the patients with VP and types Ⅰ and type Ⅲ was more common. Using antiepileptics, a better treatment effectiveness can be obtained.