von Brevern Michael, Zeise Daniel, Neuhauser Hannelore, Clarke Andrew H, Lempert Thomas
Neurologische Klinik, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
Brain. 2005 Feb;128(Pt 2):365-74. doi: 10.1093/brain/awh351. Epub 2004 Dec 15.
Migrainous vertigo (MV) is an increasingly recognized cause of episodic vertigo. However, the pathophysiology of MV is still a matter of speculation and it is not known to what extent the dysfunction is located in the central or peripheral vestibular system. The aim of this prospective study was to describe the clinical spectrum of acute MV and to clarify which structures of the vestibular system are involved. Testing of 20 patients with acute MV included neuro-otological examination, recording of spontaneous and positional nystagmus with 3D video-oculography, and audiometry. Pathological nystagmus was observed in 70% of patients during acute MV: six had isolated spontaneous nystagmus, five had isolated positional nystagmus and three had a combination of the two. Only a few patients showed additional ocular motor deficits. Imbalance was observed in all patients except one. Hearing was not affected in any patient during the attack. The findings during acute MV point to central-vestibular dysfunction in 10 patients (50%) and to peripheral vestibular dysfunction in three patients (15%). In the remaining seven patients (35%) the site of involvement could not be determined with certainty. MV should be considered in the differential diagnosis of vertigo with spontaneous and positional nystagmus and can present both as a central and a peripheral vestibular disorder.
偏头痛性眩晕（MV）是发作性眩晕越来越常见的病因。然而，MV的病理生理学仍存在推测，尚不清楚功能障碍在中枢或外周前庭系统中的累及程度。这项前瞻性研究的目的是描述急性MV的临床谱，并阐明前庭系统的哪些结构受累。对20例急性MV患者的检查包括神经耳科学检查、用三维视频眼震图记录自发性和位置性眼震，以及听力测定。70%的急性MV患者观察到病理性眼震：6例有孤立的自发性眼震，5例有孤立的位置性眼震，3例两者兼有。只有少数患者有额外的眼球运动缺陷。除1例患者外，所有患者均观察到失衡。发作期间所有患者听力均未受影响。急性MV期间的发现表明，10例患者（50%）存在中枢前庭功能障碍，3例患者（15%）存在外周前庭功能障碍。其余7例患者（35%）受累部位无法确定。在伴有自发性和位置性眼震的眩晕鉴别诊断中应考虑MV，其可表现为中枢性和外周性前庭疾病。
