双侧后半规管良性阵发性位置性眩晕的诊治思路

Diagnosis and treatment of benign paroxysmal positional vertigo involving bilateral posterior semicircular canal

目的探讨双侧后半规管良性阵发性位置眩晕(BPPV)的诊治思路。方法回顾性分析2012年1月至12月我院神经内科眩晕专病门诊诊治的、双侧Dix-Hallpike诱发试验均出现扭转、向上、向地性眼震患者的临床资料,总结其诊治思路。结果 20例BPPV患者在Dix-Hallpike诱发试验时双侧均出现扭转、向上、向地性眼震发作,进一步行平躺试验和低头试验,其中6例患者平躺试验时出现垂直向上眼震发作而低头试验无眼震发作,判断为双侧后半规管BPPV,给予两侧颗粒手法复位后患者眩晕症状缓解;其余14例患者在平躺试验和低头试验时仍表现为扭转、向上性眼震发作,但此时二者眼震的扭转方向相反,判断为眼震带扭转、向上成分的单侧水平半规管BPPV,给予一侧Barbecue手法复位后患者眩晕症状消失。结论对Dix-Hallpike诱发试验双侧出现扭转、向上、向地性眼震发作的患者,不应贸然诊断为双侧后半规管BPPV,应排除眼震出现扭转、向上成分的单侧水平半规管BPPV。

Objective To explore the diagnosis and treatment of benign paroxysmal positional vertigo(BPPV)with bilateral posterior canal involved.Methods The clinical data of BPPV patients,who were diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012to December 2012,were retrospectively analyzed.The patients had bilateral torsional upbeating geotropic nystagmus as showed by Dix-Hallpike test.The diagnosis and treatment strategies were summarized. Results Twenty patients presented bilateral torsional upbeating geotropic nystagmus in Dix-Hallpike test;further investigation by lean and bow test showed that six patients manifested with vertical upbeating nystagmus in lean test and no nystagmus was found in the bow test;then they were diagnosed as having bilateral posterior canal BPPV and were treated by bilateral particle repositioning maneuver.Whereas the torsional upbeating nystagmus remained in the other 14patients in both lean and bow test,but the torsional direction of nystagmus was reversed,so these patients were diagnosed as having unilateral horizontal canal BPPV and their symptoms disappeared after treated by unilateral Barbecue maneuver.Conclusion Diagnosis of bilateral posterior canal BPPV should not be hastily made in patients showing bilateral torsional upbeating geotropic nystagmus in DixHallpike test unless unilateral horizontal canal BPPV is ruled out.