前庭下神经炎10例临床分析

Clinical analysis of ten cases of inferior vestibular neuritis

目的分析前庭下神经炎的临床特点。方法分析10例我科眩晕门诊收集的前庭下神经炎患者的临床资料,综合病史、症状、体征及影像学、听力学、冷热试验、眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)及颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)检查结果,予以诊断。结果 10例患者眩晕发作特点均符合前庭下神经炎表现,颅脑CT或MRI检查正常,排除中枢病变,听力学及冷热试验、oVEMP结果正常,cVEMP异常,均表现为单测消失。所有患者均给予抗眩晕、改善微循环、营养神经、病因学、激素等治疗,并在发病3~4天后指导患者行Cawthorne-Cooksey前庭康复训练,半年后症状均消失。结论前庭下神经炎属于前庭神经炎的一个亚型,VEMP检查可辅助诊断。对临床怀疑前庭神经炎的患者应常规行VEMP检查,以利于明确诊断及评估病变范围Cawthorne-Cooksey前庭康复训练可做为临床上治疗前庭下神经炎的一种治疗方法,特别对改善患者药物治疗后遗留的慢性眩晕有一定疗效。

OBJECTIVE To analyse the clinical features of inferior vestibular neuritis. METHODS The clinical data of 10 patients in vertigo clinic of our hospital were analyzed. All the patients were diagnosed as inferior vestibular neuritis based on a comprehensive analysis of medical history, symptom, inspection and radiological test auditory test, caloric test, ocular vestibular evoked myogenic potential（oVEMP） and cervical vestibular evoked myogenic potential（cVEMP）. RESULTS The clinical features of 10 patients with vertigo were consistent with the characteristics of vestibular neuritis. The central lesions were excluded with craniocerebral CT or MRI. The results of auditory test, oVEMP and caloric test were normal, while the result of cVEMP is abnormal. All patients were given anti vertigo, improving microcirculation, etiology and hormone therapy and were guided to use Cawthorne-Cooksey vestibular rehabilitation training 3-4 days after onset. After half a year, the symptoms disappeared. CONCLUSION Inferior vestibular neuritis is a subtype of vestibular neuritis. VEMP is a useful test in diagnosis of inferior vestibular neuritis. VEMP should be routinely performed for patients with vestibular neuritisin to establish the diagnosis and evaluate the extent of the lesion. Cawthorne-Cooksey vestibular rehabilitation training can be used as a clinical treatment of inferior vestibular neuritis, especially for the improvement of chronic vertigo after drug treatment.