Brandt T, Dieterich M
Department of Neurology, Ludwig-Maximilians University, Munich, Germany.
Neurorehabil Neural Repair. 2000;14(1):1-12. doi: 10.1177/154596830001400101.
We present a clinical classification of central vestibular syndromes according to the three major planes of action of the vestibulo-ocular reflex: yaw, roll, and pitch. The plane-specific syndromes are determined by ocular motor, postural, and perceptual signs. Yaw plane signs are horizontal nystagmus, past pointing, rotational and lateral body falls, deviation of perceived straight-ahead to the left or right. Roll plane signs are torsional nystagmus, skew deviation, ocular torsion, tilts of head, body, and perceived vertical in a clockwise or counterclockwise direction. Pitch plane signs are upbeat/downbeat nystagmus, forward/backward tilts and falls, deviations of the perceived horizon. The thus defined vestibular syndromes allow a precise topographic analysis of brainstem lesions according to their level and side. Special emphasis is placed on the vestibular roll plane syndromes of ocular tilt reaction, lateropulsion in Wallenberg's syndrome, thalamic and cortical astasia and their association with roll plane tilt of perceived vertical. Recovery is based on a functionally significant central compensation of a vestibular tone imbalance, the mechanism of which is largely unknown. Physical therapy may facilitate this central compensation, but this has not yet been proven in prospective studies.
偏航、横滚和俯仰，提出了一种中枢性前庭综合征的临床分类。特定平面的综合征由眼球运动、姿势和感知体征来确定。偏航平面体征包括水平眼震、指物偏向、旋转性和向侧方倾倒、感知的正前方向左或向右偏移。横滚平面体征包括扭转性眼震、斜偏、眼球扭转、头部、身体倾斜以及感知垂直方向的顺时针或逆时针倾斜。俯仰平面体征包括上跳/下跳性眼震、向前/向后倾斜和跌倒、感知地平线的偏移。如此定义的前庭综合征能够根据脑干病变的部位和侧别进行精确的定位分析。特别强调了眼倾斜反应的前庭横滚平面综合征、延髓背外侧综合征中的向侧方推挤、丘脑和皮质性站立不能及其与感知垂直方向横滚平面倾斜的关联。恢复基于前庭张力失衡的具有功能意义的中枢性代偿，其机制在很大程度上尚不清楚。物理治疗可能有助于这种中枢性代偿，但在前瞻性研究中尚未得到证实。
