位置性眩晕的临床诊疗分析

Clinical analysis of positional vertigo

目的探讨位置性眩晕的临床诊断、治疗的更佳方案。方法回顾性研究分析233例表现为位置性眩晕患者的临床特点及治疗效果。结果 233例中226例良性阵发性位置性眩晕(BPPV),中枢性眩晕6例(ArnoldChiari畸形1例、多发性硬化2例、小脑腔隙性梗塞2例、小脑出血1例),颈部寰枢椎脱位1例。后半规管BPPV182例经复位法治疗,治愈129例(70.88%),改善39例(21.43%),无效14例(7.70%)。其他类型半规管BPPV44例,治愈24例(54.54%),改善13例(29.55%),无效7例(15.91%)。Arnold-Chiari畸形采用神经外科手术治疗治愈,寰枢椎脱位采用颈部牵引、多发性硬化和小脑腔隙性梗塞及小脑出血神经科保守治疗,症状缓解。结论准确诊断和系统治疗是治疗位置性眩晕的关键。

Objective To investigate the better schema of diagnosis and treatment for positional vertigo. Methods The clinical features and treatment effectiveness of 233 positional vertigo patients were reviewed. Results In 233 cases, there were 226 benign paroxysmal positional vertigo, 1 atlantoaxial dislocation, and 6 central vertigo, including 1 Arnold-Chiari malformation, 2 multiple-sclerosis lesions, 2 cerebellar lacunar infarction, and 1 cerebellar hemor- rhage. Within 182 cases of posterior semicircular canal BPPV, 129 cases were cured （70.88%）, 39 cases improved （21.43%）, and 14 cases ineffective （7.70%） after the manipulative treatment. In 44 cases of other types of semicir- cular canal BPPV, there were 24 cured cases （ 54.54% ）, 13 improved cases （ 29.55% ）, and 7 ineffective cases （ 15.91% ）. The patient of Arnold-Chiari malformation was cured by neurosurgery. The atlantoaxial dislocation case was treated with neck traction and the patients with multiple-sclerosis lesions and cerebellar lacunar infarct or haemor- rhage were improved by neurological treatment. Conclusions Proper diagnosis and treatment is the key to treat posi- tional vertigo.