Zhao Fei, Zhuang Jianhua, Xie Xuewei, Jin Zhe, Chen Ying, Zhao Zhongxin
Department of Neurology, Changzheng Hospital, Second Military Medical University; Dizziness Diagnosis and Treatment Centre, Second Military Medical University, Shanghai 200003, China.
Department of Neurology, Changzheng Hospital, Second Military Medical University; Dizziness Diagnosis and Treatment Centre, Second Military Medical University, Shanghai 200003, China. Email:
Zhonghua Nei Ke Za Zhi. 2014 Oct;53(10):764-7.
To explore the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) with bilateral positive Dix-Hallpike test.
This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012. Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis.
Among all the patients, 55 (11.2%) of them presented with bilateral nystagmus by the provocative test. According to the type of nystagmus provoked by Dix-Hallpike maneuver, the 55 patients can be divided into the following four categories. (1) Bilateral geotropic (n = 16) and apogeotropic nystagmus (n = 5): all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver. (2) Bilateral predominant down-beating nystagmus (n = 2): patients in this group were diagnosed with anterior canal BPPV, and got recovered after Kim maneuver. (3) Bilateral torsional up-beating geotropic nystagmus (n = 20): after a lying-down test, 6 of the patients manifested as vertical up-beating nystagmus and 14 patients remained torsional up-beating nystagmus. The former were diagnosed with bilateral posterior canal BPPV, and were cured after bilateral PRM therapy, and the latter were diagnosed with horizontal canal BPPV, who were cured after Barbecue maneuver. (4) Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side (n = 12). The down-beating nystagmus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver. These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy.
It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test. The diagnoses should be made by the types of nystagmus provoked step by step before maneuver therapy.
探讨双侧Dix-Hallpike试验阳性的良性阵发性位置性眩晕（BPPV）的诊断与治疗。
这是一项基于2012年1月至2012年12月在长征医院眩晕门诊确诊的BPPV患者临床资料的回顾性研究。本分析共纳入490例由Dix-Hallpike手法诱发眩晕和眼球震颤的患者。
在所有患者中，55例（11.2%）在激发试验中出现双侧眼球震颤。根据Dix-Hallpike手法诱发的眼球震颤类型，这55例患者可分为以下四类。（1）双侧地向性（n = 16）和背地性眼球震颤（n = 5）：所有这些患者均被诊断为水平半规管BPPV，在仰卧位摇头运动和烧烤手法后眩晕消失。（2）双侧以向下跳动为主的眼球震颤（n = 2）：该组患者被诊断为前半规管BPPV，经Kim手法后恢复。（3）双侧扭转向上跳动地向性眼球震颤（n = 20）：卧位试验后，6例患者表现为垂直向上跳动性眼球震颤，14例患者仍为扭转向上跳动性眼球震颤。前者被诊断为双侧后半规管BPPV，经双侧PRM治疗后治愈，后者被诊断为水平半规管BPPV，经烧烤手法后治愈。（4）一侧为扭转向上跳动地向性眼球震颤，另一侧为向下跳动性眼球震颤（n = 12）。在第二次Dix-Hallpike手法前，患者先以头向下30度坐位半小时，另一侧的向下跳动性眼球震颤消失。这些患者被诊断为单侧后半规管BPPV，经PRM治疗后治愈。
Dix-Hallpike试验诱发双侧眼球震颤的眩晕患者较为常见。在手法治疗前，应根据逐步诱发的眼球震颤类型进行诊断。
