前庭性偏头痛患者的临床特点及眼震电图研究

Study of electronystagmogram and clinical characteristics of patients with vestibular migraine

目的探讨前庭性偏头痛(VM)临床特点及不同条件诱发的眼震特点。方法收集VM患者、无眩晕和偏头痛的健康对照组各100例,记录各组研究对象的临床资料,利用视频眼震图仪(VNG)观察VM患者于不同诱发条件下眼震电图的特点。结果 VM以围绝经期女性高发,62例表现为自发性眩晕,29例位置性眩晕,2例自发性眩晕与位置性眩晕共存,3例头部活动诱发性眩晕,2例视觉诱发性眩晕,其他类型2例。眩晕持续时间从数秒到数天不等,以1~24 h为主,86例眩晕发作时存在先兆症状。23例表现为先兆性偏头痛,59例无先兆性偏头痛,18例偏头痛性症状。56例伴恶心、呕吐,17例伴耳鸣、听力下降。61例VM发作存在以压力、睡眠不足为主的诱发因素。VM组63例出现异常眼震,其中视动性眼震(OKN)次数显著高于对照组(P<0.05),变位眼震的各项指标与对照组比较无明显差异(P>0.05),变位眼震以坐位-右仰悬头位、坐位-左侧卧位的发生率较高,变温眼震CP值(不对称比)有明显差异(P<0.05)。结论 VM临床表现复杂多样,其诊断标准仅为眩晕与偏头痛的症状学组合,缺乏客观评价依据。眼震的出现提示患者可能存在外周前庭与中枢前庭功能损害,可应用眼震电图作为其诊断的辅助检查。

Objective To investigate the clinical features of vestibular migraine and the characteristics of nystagmus induced by different conditions.Methods One hundred patients with VM and 100 healthy controls without vertigo and migraine were collected.The clinical data of the subjects in the above groups were recorded,and the video nystagmogram(VNG) was used to observe the characteristics of VM patients under different induced conditions.Results The incidence of VM was high in perimenopausal women,62 cases showed spontaneous vertigo,29 cases of positional vertigo,2 cases of spontaneous vertigo coexisted with positional vertigo,3 cases of head movement induced vertigo,and 2 cases of visually induced vertigo,2 cases of other types.Vertigo lasted from a few seconds to several days,mainly 1-24 hours,86 cases of vertigo had aural symptoms at the onset of vertigo.There were 23 cases of migraine with aura,59 cases of migraine without aura and 18 cases with migraine symptoms.Fifty-six cases were accompanied by nausea and vomiting,17 cases were accompanied by tinnitus and hearing loss.61 cases of VM episodes had predisposing factors such as stress and lack of sleep.There were 63 cases of VM group had abnormal nystagmus,the number of OKN nystagmus was significantly higher than that of the control group(P<0.05).There were no significant differences in the indicators of positioning nystagmus compared with the control group(P>0.05).The higher incidence were site-right head hanging position and site-left lying position,and the CP value(asymmetry ratio) of variable temperature nystagmus is significantly different(P<0.05).Conclusion The clinical manifestations of VM are complex and diverse,and its diagnostic criteria are only the symptomatic combination of vertigo and migraine,and there is no objective evaluation basis.The appearance of nystagmus suggests that the patient may have damage to the peripheral vestibular and central vestibular function,so electronystagmus can be used as an auxiliary examination for its diagnosis.