Bertholon Pierre, Tringali Stephane, Faye Mamadou B, Antoine Jean Christophe, Martin Christian
Department of Otorhinolaryngology-Head and Neck Surgery, Bellevue Hospital, Saint-Etienne, France.
Ann Otol Rhinol Laryngol. 2006 Aug;115(8):587-94. doi: 10.1177/000348940611500804.
The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus.
Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness.
One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV.
A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.
本研究旨在调查出现位置性眼球震颤患者的各种诊断情况。
对490例主要因眩晕和/或步态不稳前来就诊的连续患者，在后半规管平面（PC；Dix-Hallpike手法）和水平半规管平面（HC；患者仰卧位向两侧翻滚）系统地进行位置试验。
100例患者（20%）出现位置性眼球震颤。其中83例患者的眼球震颤起源于外周，包括80例良性阵发性位置性眩晕（BPPV）患者。在BPPV患者中，后半规管受累61例，水平半规管受累18例（地向性水平眼球震颤11例，背地性7例；4例患者地向性与背地性相互转换），后半规管和水平半规管均受累1例。12例患者有中枢性位置性眼球震颤的证据，包括7例患有各种神经系统疾病的患者在Dix-Hallpike手法检查时出现位置性下跳性眼球震颤，以及2例分别患有小脑缺血和明确偏头痛性眩晕的患者在水平半规管试验时出现背地性水平眼球震颤。另有5例患者无法确定位置性眼球震颤的外周或中枢起源，包括1例可能为偏头痛性眩晕患者和1例可能为前半规管BPPV患者。
后半规管BPPV背景下的旋转性上跳性眼球震颤、水平半规管BPPV引起的水平眼球震颤（无论是地向性还是背地性）以及与各种中枢性疾病相关的位置性下跳性眼球震颤是位置性眼球震颤最常见的3种类型。地向性水平位置性眼球震颤，以及肯定的地向性与背地性相互转换的水平位置性眼球震颤提示水平半规管BPPV。相反，不发生变化（从背地性到地向性）的背地性水平位置性眼球震颤可能提示中枢性病变。
