Lechner Corinna, Taylor Rachael L, Todd Chris, Macdougall Hamish, Yavor Robbie, Halmagyi G Michael, Welgampola Miriam S
Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
J Neurol. 2014 May;261(5):1009-17. doi: 10.1007/s00415-013-7223-5. Epub 2014 Mar 28.
Direction changing horizontal positional nystagmus can be observed in a variety of central and peripheral vestibular disorders. We tested sixty subjects with horizontal positional nystagmus and vertigo on the Epley Omniax(®) rotator. Monocular video recordings were performed with the right or left ear down, in the supine and prone positions. Nystagmus slow-phase velocity (SPV) was plotted as a function of time. Thirty-one subjects diagnosed with horizontal canalolithiasis had paroxysmal horizontal geotropic nystagmus with the affected ear down (onset 0.8 ± 1 s, range 0-4.9 s, duration 11.7-47.9 s, peak SPV 79 ± 67°/s). The SPV peaked at 5-20 s and declined to 0 by 60 s; at 40 s from onset, the average SPV was 1.8 % of the peak. Nine subjects diagnosed with cupulolithiasis had persistent apogeotropic horizontal nystagmus (onset 0.7 ± 1.4 s, range 0-4.3 s). Peak SPV was 54.2 ± 31.8°/s and 26.6 ± 12.2°/s with unaffected and affected ears down, respectively. At 40 s, the average SPV had decayed to only 81 % (unaffected ear down) and 65 % (affected ear down) of the peak. Twenty subjects were diagnosed with disorders other than benign positional vertigo (BPV) [vestibular migraine (VM), Ménière's Disease, vestibular schwannoma, unilateral or bilateral peripheral vestibular loss]. Subjects with VM (n = 13) had persistent geotropic or apogeotropic horizontal nystagmus. On average, at 40 s from nystagmus onset, the SPV was 61 % of the peak. Two patients with Ménière's Disease had persistent apogeotropic horizontal nystagmus; the peak SPV at 40 s ranged between 28.6 and 49.5 % of the peak. Symptomatic horizontal positional nystagmus can be observed in canalolithiasis, cupulolithiasis and diverse central and peripheral vestibulopathies; its temporal and intensity profile could be helpful in the separation of these entities.
变向性水平位置性眼球震颤可见于多种中枢性和周围性前庭疾病。我们在Epley Omniax（®）旋转仪上对60例有水平位置性眼球震颤和眩晕的受试者进行了测试。在仰卧位和俯卧位时，分别将右耳或左耳向下，进行单眼视频记录。将眼球震颤慢相速度（SPV）绘制成时间的函数。31例被诊断为水平半规管耳石症的受试者，患耳向下时出现阵发性水平地向性眼球震颤（起始时间0.8±1秒，范围0 - 4.9秒，持续时间11.7 - 47.9秒，最大SPV 79±67°/秒）。SPV在5 - 20秒时达到峰值，60秒时降至0；从起始开始40秒时，平均SPV为峰值的1.8%。9例被诊断为壶腹嵴顶耳石症的受试者出现持续性背地性水平眼球震颤（起始时间0.7±1.4秒，范围0 - 4.3秒）。患耳向下和未患耳向下时，最大SPV分别为54.2±31.8°/秒和26.6±12.2°/秒。在40秒时，平均SPV分别衰减至峰值的81%（未患耳向下）和65%（患耳向下）。20例被诊断为除良性阵发性位置性眩晕（BPV）以外的疾病（前庭性偏头痛（VM）、梅尼埃病、前庭神经鞘瘤、单侧或双侧周围性前庭功能减退）。VM患者（n = 13）出现持续性地向性或背地性水平眼球震颤。平均而言，从眼球震颤起始开始40秒时，SPV为峰值的61%。2例梅尼埃病患者出现持续性背地性水平眼球震颤；40秒时的最大SPV为峰值的28.6%至49.5%。在耳石症、壶腹嵴顶耳石症以及各种中枢性和周围性前庭病变中均可观察到有症状的水平位置性眼球震颤；其时间和强度特征可能有助于区分这些疾病。
