Fetter M
Department of Neurology, Eberhard-Karl-University, Tübingen, Germany.
J Neurol. 2000 May;247(5):335-42. doi: 10.1007/s004150050599.
Vertigo and dizziness are common complaints encountered in clinical practice. The patient's history and a thorough otoneurological evaluation are essential for identifying the specific pathology behind the patient's complaints. If the patient reports an illusion of movement (vertigo), this most likely indicates an imbalance within the vestibular system. A sensation of rotatory movement together with a spontaneous nystagmus suggests a lesion involving the semicircular canals, while an illusion of linear movement indicates a disturbance of the otoliths. Nystagmus of central origin or caused by a peripheral vestibular lesion can usually be distinguished by other features in the history or on clinical examination. While peripheral vestibular lesions usually lead to a mixed horizontal-torsional or vertical-torsional nystagmus, a pure vertical or pure torsional nystagmus is always caused by a central lesion. With simple bedside tests such as head-shaking nystagmus and rapid head impulses deficits in labyrinthine function can clearly be detected. For a more thorough investigation of vestibular function at the level of individual semicircular canals and the otoliths, modern techniques are now available such as three-dimensional eye movement vector analysis for the evaluation of individual semicircular canal function, measurement of the subjective visual vertical for utricular, and click-evoked myogenic potentials for saccular testing.
眩晕和头晕是临床实践中常见的主诉。患者的病史和全面的耳神经学评估对于确定患者主诉背后的具体病理情况至关重要。如果患者报告有运动错觉（眩晕），这很可能表明前庭系统存在失衡。旋转运动的感觉加上自发性眼球震颤提示病变累及半规管，而线性运动错觉则表明耳石受到干扰。中枢性起源或由外周前庭病变引起的眼球震颤通常可以通过病史中的其他特征或临床检查来区分。外周前庭病变通常会导致混合性水平-扭转或垂直-扭转眼球震颤，而单纯的垂直或单纯的扭转眼球震颤总是由中枢病变引起的。通过简单的床边测试，如摇头性眼球震颤和快速头部脉冲，可以清楚地检测到迷路功能缺陷。为了更全面地研究各个半规管和耳石水平的前庭功能，现在有了现代技术，如用于评估单个半规管功能的三维眼动矢量分析、用于椭圆囊的主观视觉垂直测量以及用于球囊测试的点击诱发肌源性电位。
