Asawavichiangianda S, Fujimoto M, Mai M, Desroches H, Rutka J
Department of Otolaryngology, Chulalongkorn University, Bangkok, Thailand.
Acta Otolaryngol Suppl. 1999;540:27-33.
In a series of studies, the phenomenon of head-shaking nystagmus (HSN) was assessed in 50 control subjects and 1364 consecutive dizzy patients who underwent formal electronystagmography (ENG) at the Toronto Hospital Center for Advanced Hearing and Balance Testing. HSN was compared in a series of 30 patients who underwent conventional electro-oculography (EOG) vs magnetic (scleral) coil eye movement recordings. Clinical correlation of HSN to other parameters of the ENG test battery was performed in another sub-series of 300 patients with known diagnoses. HSN was identified in 31.7% of dizzy patients vs 24% of control subjects. No significant difference in its manifestation was noted between active vs passive head-shaking tests or on EOG vs magnetic (scleral) coil eye movement recordings. When compared to other aspects of the ENG test battery, HSN was neither specific nor sensitive for vestibular dysfunction. It nevertheless correlated well with the presence of a caloric reduction and with increasing R/L excitability differences on ENG testing. When present, HSN was characteristically monophasic in 76.8%, biphasic in 22.7% and triphasic in 0.5% of subjects. The initial direction of HSN generally obeyed Ewald's second law, but the reverse was noted in 27% with monophasic and 17.6% of patients with biphasic HSN. In the subseries of 300 patients with known diagnoses, the presence of HSN was statistically significant (p < 0.05) in patients with peripheral vestibular dysfunction vs psychogenic dizziness. Its presence was also significant in well-documented peripheral vestibular disorders such as Meniere's disease (p < 0.01), vestibular neuronitis (p < 0.05) and acoustic neuroma (p < 0.05). Localization of the disease involvement based on the initial direction of HSN was especially unpredictable in patients with Meniere's disease. The significance and usefulness of the head-shake test in the otoneurological evaluation of the dizzy patient is further commented on.
在一系列研究中，对50名对照受试者以及在多伦多医院高级听力与平衡测试中心接受正式眼震电图（ENG）检查的1364例连续性眩晕患者的摇头性眼震（HSN）现象进行了评估。对30例行传统眼电图（EOG）检查的患者与行磁性（巩膜）线圈眼动记录的患者的HSN进行了比较。在另一组300例已知诊断的患者亚组中，对HSN与ENG测试组其他参数进行了临床相关性分析。在眩晕患者中，HSN的检出率为31.7%，对照受试者为24%。主动与被动摇头试验之间或EOG与磁性（巩膜）线圈眼动记录之间，HSN的表现无显著差异。与ENG测试组的其他方面相比，HSN对前庭功能障碍既不具有特异性也不具有敏感性。不过，它与ENG测试时热量降低的存在以及左右兴奋性差异增加密切相关。出现HSN时，76.8%的受试者表现为单相，22.7%为双相，0.5%为三相。HSN的初始方向通常遵循埃瓦尔德第二定律，但单相HSN中有27%以及双相HSN患者中有17.6%出现相反情况。在300例已知诊断的患者亚组中，外周前庭功能障碍患者与精神性眩晕患者相比，HSN的存在具有统计学意义（p<0.05）。在梅尼埃病（p<0.01）、前庭神经炎（p<0.05）和听神经瘤（p<0.05）等有充分记录的外周前庭疾病中，HSN的存在也具有显著意义。基于HSN初始方向对疾病累及部位进行定位，在梅尼埃病患者中尤其不可预测。进一步讨论了摇头试验在眩晕患者耳神经学评估中的意义和实用性。
