视频头脉冲试验在眩晕疾病诊断中的初步应用

Preliminary application of video head impulse test in the diagnosis of vertigo

目的:通过分析眩晕患者视频头脉冲试验(vHIT)的特点,探讨视频记录眼球运动的头脉冲试验在眩晕疾病诊断中的应用。方法:眩晕患者95例,依据临床诊断分为外周性眩晕(47例)和中枢性眩晕(48例),记录所有患者6个半规管vHIT的扫视眼动结果(阳性或阴性)和增益值,分析不同眩晕患者vHIT结果的特点,对比两组患者vHIT结果的差异。结果:外周性眩晕患者vHIT:梅尼埃病22例(23耳),vHIT结果异常21耳(91.3%);听神经瘤4例、耳部带状疱疹2例、迟发性膜迷路积水5例、突聋伴眩晕6例、前庭功能低下8例,所有患侧耳vHIT的结果均表现出扫视眼动阳性或(和)增益值异常;其中1例耳部带状疱疹患者经治疗后扫视眼动消失,增益值恢复正常;外周性眩晕患者vHIT结果异常率为95.7%(45/47)。中枢性眩晕患者包括后循环缺血7例,脑梗6例,头晕为主伴眩晕17例,其他中枢性眩晕18例,vHIT异常率为72.9%(35/48),明显低于外周性眩晕患者(P<0.05)。结论:vHIT操作简单,无不良反应,记录6个半规管的前庭眼反射高频特性,反映不同眩晕疾病前庭眼反射受影响的情况,能帮助鉴别诊断外周性眩晕和中枢性眩晕,是临床眩晕疾病非常实用的一项检查方法。

Objective：To investigate clinical application of head impulse test with video recording eye movements in the diagnosis of vertigo.Method：The video head impulse test（vHIT）was used to measure the eye saccades and velocity gain in 95 patients with vertigo which were divided into two groups,peripheral vertigo（47cases）and central vertigo（48cases）;the characteristics of eye saccades and velocity gain of six semicircular canals in different patients with vertigo were analyzed,and were compared between the two groups.Result：The vHIT result in patients with peripheral vertigo：in 22patients（23affected ears）with Meniere′s disease,21 ears were abnormal（91.3%）;the vHIT results in 4patients with vestibular schwannoma,2patients with vestibular neuritis,5patients with delayed endolymphatic hydrops,6patients with sudden hearing loss accompanied vertigo,and 8patients with vestibular dysfunction,were abnormal with correct saccades and/or lower velocity gain of vHIT.The abnormal vHIT results were also found in 35 of 48patients（72.9%）with central vertigo,which including posterior cerebral circulation ischemia（7patients）,cerebral infarction/stroke（6patients）,and dizziness with vertigo（17patients）and others（18patients）.Abnormal rate of vHIT in patients with peripheral vertigo was 95.7%（45/47）,which was significantly higher than that（72.9%）in patients with central vertigo.Conclusion：It is easy to perform the vHIT which without adverse reactions.We can record high-frequency characteristics of vestibularocular reflex among six semicircular canals through vHIT.The vHIT results which show the function of vestibular ocular reflex in different diseases with vertigo,can help discriminate peripheral vertigo from central vertigo,and it is a practical assessment method for vertigo.