对Ménière综合征与Lerm oyez综合征的认识偏差导致误诊误治

Misdiagnosis and mistherapy due to an error in judgment on Ménière syndrome and Lerm oyez syndrome

Ménière综合征与 L ermoyez综合征为不同疾病 ,亦不可认为后者是前者的临床变异型。根据文献资料 ,两者是有区别的。前者 (即 Ménière综合征 )的病理基础在内耳迷路 ,故眩晕与耳呜、耳聋可同时出现 ;而后者 (即 L ermoyez综合征 )的病理基础在脑干的前庭核至颞叶皮质 ,一般先有眩晕 ,后有耳鸣和听力障碍故称中枢性眩晕 (核性眩晕 ) ,听力和平衡障碍虽可同时出现 ,但多数病例呈分离现象。如有垂直性眼震 。

Ménière syndrome and Lermoyez syndrome are two different diseases. The latter could not be regarded as a clinical variation of the former. According to the literature, there are differences between these two disorders. For Ménière syndrome, the pathological basis is on labyrinth of inner ear, so vertigo, tinnitus and deafness could appear at the same time. Whereas the pathologic alterations of the latter exist in vestibular nuclei of brain stem and in temporal cortices. For this reason, vertigo usually occurs first and then is followed by tinnitus and dysaudia. This is called nuclear vertigo. Although dysaudia and paraequilibrium could happen simultaneously, there is a dissociation in most of the cases. If vertical nystagmus is found, it is more likely this is a case of nuclear vertigo.