Liao Lih-Jen, Young Yi-Ho
Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Laryngoscope. 2004 Jul;114(7):1305-9. doi: 10.1097/00005537-200407000-00031.
OBJECTIVES/HYPOTHESIS: Because the sacculocollic reflex is a descending pathway passing through the territory of basilar artery, the aim of the study was to investigate whether hypoperfusion affects this pathway by applying vestibular evoked myogenic potential (VEMP) testing in patients with basilar artery migraine.
A prospective study from May 2000 to April 2002.
Twenty patients were diagnosed as having basilar artery migraine according to the criteria of the International Headache Society and literature. Eight were male and 12 were female patients, and their ages ranged from 9 to 48 years (mean age, 40 y). Each patient underwent a battery of audio-vestibular tests.
Electronystagmography disclosed abnormal eye tracking test in six patients (30%), and there were abnormal optokinetic nystagmus test results in nine patients (45%). Caloric test revealed canal paresis in seven patients, directional preponderance in four patients, and normal responses in nine patients (45%). Vestibular evoked myogenic potential testing disclosed absent vestibular evoked myogenic potentials in seven patients and delayed vestibular evoked myogenic potentials in two patients, with one patient showing absent vestibular evoked myogenic potentials on one side and delayed vestibular evoked myogenic potentials on the other side. The remaining 10 patients (50%) had bilateral normal vestibular evoked myogenic potentials. Five patients had preserved both caloric and VEMP test responses, six patients displayed absent caloric and VEMP test responses, and the remaining nine patients had either abnormal caloric test responses or abnormal vestibular evoked myogenic potentials, exhibiting a nonsignificant relationship between caloric test responses and vestibular evoked myogenic potentials. Relief of headache and vertigo was achieved after 3 months of medication. Ten asymptomatic patients with either absent or delayed vestibular evoked myogenic potentials before treatment underwent follow-up VEMP test, and nine patients (90%) displayed normal vestibular evoked myogenic potentials bilaterally.
Vestibular evoked myogenic potential testing evaluates the sacculocollic reflex, which descends through the lower brainstem. Some patients with basilar artery migraine have absent or delayed vestibular evoked myogenic potentials, presumably because the descending pathway from the saccule through the brainstem to cranial nerve XI is interrupted, which is attributed to hypoperfusion in the territory of the basilar artery. After 3 months of medication, recovery of normal vestibular evoked myogenic potentials in an asymptomatic patient indicates reversible ischemia in the territory of the basilar artery.
目的/假设：由于球囊脊髓反射是一条通过基底动脉区域的下行通路，本研究的目的是通过对基底动脉型偏头痛患者进行前庭诱发肌源性电位（VEMP）测试，来调查灌注不足是否会影响该通路。
2000年5月至2002年4月的一项前瞻性研究。
根据国际头痛协会的标准和文献，20例患者被诊断为基底动脉型偏头痛。男性8例，女性12例，年龄9至48岁（平均年龄40岁）。每位患者都接受了一系列听-前庭测试。
眼震电图显示6例患者（30%）的眼跟踪测试异常，9例患者（45%）的视动性眼震测试结果异常。冷热试验显示7例患者半规管轻瘫，4例患者方向优势，9例患者（45%）反应正常。前庭诱发肌源性电位测试显示7例患者前庭诱发肌源性电位缺失，2例患者前庭诱发肌源性电位延迟，1例患者一侧前庭诱发肌源性电位缺失，另一侧前庭诱发肌源性电位延迟。其余10例患者（50%）双侧前庭诱发肌源性电位正常。5例患者冷热试验和VEMP测试反应均保留，6例患者冷热试验和VEMP测试反应均缺失，其余9例患者冷热试验反应或前庭诱发肌源性电位异常，冷热试验反应与前庭诱发肌源性电位之间无显著相关性。用药3个月后头痛和眩晕缓解。对10例治疗前前庭诱发肌源性电位缺失或延迟的无症状患者进行了VEMP测试随访，9例患者（90%）双侧前庭诱发肌源性电位正常。
前庭诱发肌源性电位测试评估通过脑桥下部下行的球囊脊髓反射。一些基底动脉型偏头痛患者前庭诱发肌源性电位缺失或延迟，推测是因为从球囊通过脑干到第XI对脑神经的下行通路中断，这归因于基底动脉区域的灌注不足。用药3个月后，无症状患者前庭诱发肌源性电位恢复正常表明基底动脉区域存在可逆性缺血。
