床旁头脉冲实验阳性结果的前庭疾病病因分析

Causes analysis of vestibular diseases with positive head impulse test

目的研究床旁头脉冲实验阳性(head impulse test,HIT)患者的前庭系统疾病的病因构成。方法连续纳入我院神经内科门诊收治的105例HIT阳性的患者。根据临床特点、眩晕床旁检查、前庭功能检查和影像学检查的结果,综合分析HIT阳性的病因构成。结果 105例HIT阳性患者中,单侧HIT阳性78例,双侧HIT阳性27例;前庭外周性疾病76例(72%),包括前庭神经炎35例,双侧前庭病13例,梅尼埃病12例,突发性耳聋伴眩晕7例,前庭神经鞘瘤4例,迟发性膜迷路积水4例,上半规管裂1例。前庭中枢性疾病15例(14%),包括后循环梗死5例,多发性硬化4例,颅底畸形3例,多系统萎缩2例,脑干肿瘤1例,未明确病因者14例(13%)。15例HIT阳性的前庭中枢性疾病患者头颅MR均提示异常,其中11例呈双侧HIT阳性,出现神经系统缺损症状者12例,中枢性眼震6例,视跟踪异常4例,凝视性眼震4例,眼偏斜实验阳性2例,前庭自旋转试验提示前庭中枢性异常13例。结论 HIT实验阳性多数提示前庭外周性疾病。HIT实验阳性不能完全排除前庭中枢性疾病,尤其是双侧HIT阳性,需结合其他的临床资料进行综合分析。

Objectives To investigate the causes of vestibular diseases with positive bedside head impulse test （HIT）. Methods This was an open and prospective study conducted at the neurology clinic of 305 Hospitals, in which 105 patients with positive head impulse test were enrolled. The causes were comprehensively analyzed by analyzing the clinical data, bedside vertigo examinations, vestibular function tests and image examinations. Results Among 105 patients, 78 （85%） showed unilateral positive HIT and 27 （15%） with bilateral positive HITs. Of them 76 cases were diagnosed as peripheral vestibular diseases, including 35 cases of vestibular neuritis,13 cases of bilateral vestibulopathy, 12 cases of Meniere＇ s disease, 7 cases of sudden deafness with vertigo, 4 cases of vestibular schwannoma, 4 cases of delayed endolymphatic hydrops and 1 case of superior semicircular canal dehiscence syndrome; 15 cases were diagnosed as cen- tral vestibular diseases, including 5 cases of posterior circulation infarct, 4 cases of multiple sclerosis, 3 cases of basilar impression malformation, 2 cases of multiple system atrophy, 1 case of brainstem tumor, and 14 cases with unknown causes. All 15 cases of central vestibular diseases, of them 11 with bilateral positive HIT had abnormal cerebral MR. Among the 15 patients, 12 had neurological function impairment, 6 had central nystagmus, 4 had abnormal smooth pursuit, 4 had gaze-evoked nystagmus, 2 had positive test of skew,13 had abnormal vestibular autorotation test. Conclusion Positive HIT is mostly resulted from peripheral vestibular diseases, other causes include central vestibular diseases, especially when bilateral HIT was positive.