持续性姿势-知觉性头晕的神经影像学研究现状

Neuroimaging research status of persistent postural-perceptual dizziness

持续性姿势-知觉性头晕(persistentpostural-perceptualdizziness,PPPD)作为临床常见的慢性头晕疾病,以持续性头晕、不稳感,或非旋转性眩晕为主要症状,并且在姿势改变、主动/被动运动及暴露于复杂的视觉环境时可能导致症状加重。目前认为PPPD的发生可能与姿势控制再适应失败、皮质多感觉整合异常有关,但是其具体的病理生理机制尚不明确。近年来,随着神经影像学技术在眩晕疾病领域的不断应用,发现PPPD患者在处理前庭多感觉和空间定位觉相关的大脑结构、功能和连通性下降,而与处理视觉的功能及连通性增强。同时,各种精神因素(如焦虑、抑郁、神经质等)以及触发因素可能参与调节PPPD患者脑内结构,这有助于解释研究之间存在的结果差异。上述神经影像学的发现有助于PPPD的早期诊断与治疗。因此,本文通过对PPPD神经影像学研究情况进行综述,为解释PPPD的病理生理学机制提供参考。

Persistent postural-perceptual dizziness(PPPD)is a common clinical chronic dizziness disease,with persistent dizziness,instability,or non-rotational vertigo as the main symptom.It may be aggravated by postural changes,active/passive movements,and exposure to complex visual environments.At present,it is believed that the occurrence of PPPD may be related to the failure of postural control readaptation and abnormal cortical multisensory integration,but the specific pathophysiological mechanism is not clear.In recent years,with the continuous application of neuroimaging technology in the field of vertigo diseases,it has been found that in patients with PPPD,the brain structure,function,and connectivity related to vestibular multisensory and spatial orientation are decreased,while the function and connectivity related to visual processing are enhanced.At the same time,various psychiatric factors(such as anxiety,depression,and neuroticism)as well as triggers may be involved in regulating the brain structure of people with PPPD,which helps explain the differences in outcomes between studies.The above neuroimaging findings are helpful for the early diagnosis and treatment of PPPD.Therefore,this paper reviews the neuroimaging studies of PPPD to provide a reference for explaining the pathophysiological mechanism of PPPD.