De Stefano Alessandro, Kulamarva Gautham, Dispenza Francesco
ENT Institute, Department of Surgical, Clinical and Experimental Sciences, G.d'Annunzio University of Chieti and Pescara, Italy.
Auris Nasus Larynx. 2012 Aug;39(4):378-82. doi: 10.1016/j.anl.2011.07.008. Epub 2011 Aug 30.
An insidious percentage of paroxysmal positional vertigo appears to be intractable with canalith repositioning maneuver and also is not self-limiting. This type of positional vertigo is sustained by the action of intracranial tumors that mimics the clinical aspects of benign paroxysmal positional vertigo.Aim of this study is to clarify the features of these forms of positional vertigo, which we indicate as malignant paroxysmal positional vertigo.
We retrospectively reviewed the clinical records of all the patients who presented with vertigo spells and were managed at our tertiary care referral centre over a three years period. Two hundred and eleven patients with diagnosis of positional paroxysmal vertigo were included in the final study.
Seven patients were affected by intracranial tumors causing a positional vertigo and were classified as malignant paroxysmal positional vertigo patients after radiological and histological diagnosis. These patients were affected by an internal auditory canal mass alone or with extension in the cerebello pontine angle that mimicked a benign positional vertigo.
We can conclude that the clinician should keep in mind the differentiation between benign positional vertigo and malignant positional vertigo. When the patients with positional vertigo presents a strange behaviour of symptoms, nystagmus or response to the canalith repositioning maneuver a radiological investigation must be undertaken in every doubtful case.
隐匿比例的阵发性位置性眩晕似乎难以通过耳石复位手法治疗，且不会自行缓解。这种类型的位置性眩晕由颅内肿瘤的作用所致，其模仿了良性阵发性位置性眩晕的临床症状。本研究的目的是阐明这些形式的位置性眩晕的特征，我们将其称为恶性阵发性位置性眩晕。
我们回顾性分析了在三年期间于我们的三级医疗转诊中心接受治疗的所有眩晕发作患者的临床记录。最终研究纳入了211例诊断为位置性阵发性眩晕的患者。
7例患者受颅内肿瘤影响导致位置性眩晕，经影像学和组织学诊断后被归类为恶性阵发性位置性眩晕患者。这些患者单独受内耳道肿物影响，或肿物延伸至小脑脑桥角，表现类似良性位置性眩晕。
我们可以得出结论，临床医生应牢记良性位置性眩晕和恶性位置性眩晕的鉴别。当位置性眩晕患者出现症状的奇怪表现、眼球震颤或对耳石复位手法的反应时，在每一个可疑病例中都必须进行影像学检查。
