Angeli Simon I, Snapp Hillary, Velandia Sandra, Morgenstein Kari
Department of Otolaryngology, University of Miami Miller School of Medicine , Miami, FL , USA.
Acta Otolaryngol. 2015 Apr;135(4):335-41. doi: 10.3109/00016489.2014.985798. Epub 2015 Mar 5.
Although combined utricular and canal paresis has been described previously, this is the first report of canal hyperactivity associated with utricular hypofunction. Unsteadiness and swaying were the most common symptoms, and patients with shorter duration of symptoms also had positional vertigo. We propose that this syndrome is a variant of utricular dysfunction and should be considered in the differential diagnosis of peripheral vestibular disorders.
To describe a syndrome of instability associated with utricular dysfunction and hyperactive caloric responses.
The study comprised 11 consecutive patients exhibiting abnormalities of the eccentric subjective visual vertical test (e-SVV) and high responses during the caloric test of the videonystagmography (VNG). We carried out a review of symptoms, physical examination, and vestibular tests.
There was no gender predilection or obvious etiology. The patients' main complaint included instability with linear symptoms (i.e., tilting, rocking, and swaying), with positional vertigo as a secondary symptom. Oculomotor testing, visual fixation index, and brain MRI were normal, excluding a central nervous system disorder. VNG was essentially normal except for hyperactive responses during the caloric testing in all patients. Abnormal e-SVV was found in 10 patients unilaterally and bilaterally in 1 patient. Abnormal oVEMP was found in seven of seven patients, further supporting a utricular site of lesion.
尽管此前已有关于联合性椭圆囊和半规管轻瘫的描述，但这是首例与椭圆囊功能减退相关的半规管功能亢进的报告。不稳感和摇摆是最常见的症状，症状持续时间较短的患者也有位置性眩晕。我们认为这种综合征是椭圆囊功能障碍的一种变体，在周围性前庭疾病的鉴别诊断中应予以考虑。
描述一种与椭圆囊功能障碍及热试验反应亢进相关的不稳综合征。
该研究纳入了11例连续的患者，这些患者在偏心主观视觉垂直试验（e-SVV）中表现异常，且在视频眼震图（VNG）的热试验中反应强烈。我们对症状、体格检查和前庭测试进行了回顾。
无性别倾向，也无明显病因。患者的主要主诉包括伴有线性症状（如倾斜、摇晃和摆动）的不稳感，位置性眩晕为次要症状。动眼神经测试、视觉固定指数和脑部磁共振成像均正常，排除了中枢神经系统疾病。除所有患者在热试验期间反应亢进外，VNG基本正常。10例患者e-SVV单侧异常，1例双侧异常。7例患者中有7例oVEMP异常，进一步支持了椭圆囊病变部位。
