Cui Xiangning, Feng Yong, Mei Lingyun, He Chufeng, Lu Xiaojing, Zhang Hua, Chen Hongsheng
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Jan;29(1):27-30.
To analyze and summarize nystagmus of patients with posterior canal benign paroxysmal positional vertigo (BPPV) in positioning test,and to improve the diagnosis and treatment of posterior canal BPPV (PSC-BPPV).
The present study was conducted on 175 patients who had unilateral BPPV of the posterior semicircular canal (PSC). Their positional nystagmus recorded by videnonystagmography in Dix-Hallpike test,roll test and roll over test were analyzed to summarize the characteristics of nystagmus on nystagmograph of PSC-BP-PV.
Of the 175 patients, lesion was located in the left PSC in 69 (39.4%) patients,the right PSC in 106 (60. 6%)patients. The nystagmus of patients with PSC-canalithiasis showed upward on the vertical phase of nystagmograph and orientated the different side on horizontal phase in the head hangging position. The horizontal phase pointed to the contralateral side in 47(26. 9%) patients, the ipsilateral contralateral side in 100(57. 1%) patients,no significant reverse ingredients in 28(16.0%) patients. When these patients returned to sit,139(79.4%) patients showed down beating positioning nystagmus, whereas 36 (20. 6%) patients with no nystagmus only had a short vertigo or dizziness. The horizontal phase of the 139 patients pointed to the contralateral side in 40(22. 9%) patients,the ipsilateral contralateral side in 68(38. 9%) patients,no significant reverse ingredients in 31(17. 7%) patients. In roll test,12 patients of the right PSC-BPPV presented an up-beating rotatory nystagmus when the head turned to right,and 5 patients of the left PSC-BPPV presented a down-beating rotatory nystagmus when the head turned to left. When the patients changed body from the left lateral position to the right lateral position in the roll over test, 74(42. 3%) patientsshowed vertical positioning nystagmus. In 30 patients who presented an up-beating nystagmus, there were 25(83. 3%) patientscame from the right PSC-BPPV. In 44 patients who presented a down-beating nystagmus, there were 36(81. 8%) patientscame from the left PSC-BPPV. The direction of the vertical nystagmus was highly correlated with the judgment about the side of the PSC-BPPV in roll over test (P<0. 01).
The patient with PSC-canalithiasis showed an uncertain direction in torsional nystagmus in Dix-Hallpike test,the diagnosis was mainly concern with the vertical nystagmus. When we found a rotatory nystagmus with much more up-beating nystagmus in roll test, it might be PSC-BPPV. We also can use the roll over test to diagnose the location of the otolith in which side of the PSC-BPPV.
分析和总结后半规管良性阵发性位置性眩晕（BPPV）患者在定位试验中的眼震情况，以提高后半规管BPPV（PSC - BPPV）的诊断和治疗水平。
对175例单侧后半规管（PSC）BPPV患者进行研究。分析其在Dix - Hallpike试验、摇头试验和翻滚试验中通过视频眼震图记录的位置性眼震，总结PSC - BP - PV眼震图上眼震的特点。
175例患者中，病变位于左侧PSC 69例（39.4%），右侧PSC 106例（60.6%）。PSC管结石症患者在头悬垂位时眼震图垂直相向上，水平相向不同侧。水平相指向对侧47例（26.9%），指向同侧对侧100例（57.1%），无明显反向成分28例（16.0%）。当这些患者恢复坐位时，139例（79.4%）患者出现向下跳动性定位眼震，而36例（20.6%）无眼震的患者仅出现短暂眩晕或头晕。139例患者水平相指向对侧40例（22.9%），指向同侧对侧68例（38.9%），无明显反向成分31例（17.7%）。在摇头试验中，右侧PSC - BPPV患者12例头转向右侧时出现向上跳动性旋转性眼震，左侧PSC - BPPV患者5例头转向左侧时出现向下跳动性旋转性眼震。在翻滚试验中，患者从左侧卧位变为右侧卧位时，74例（42.3%）患者出现垂直定位眼震。在30例出现向上跳动性眼震的患者中，25例（83.3%）来自右侧PSC - BPPV。在44例出现向下跳动性眼震的患者中，36例（81.8%）来自左侧PSC - BPPV。翻滚试验中垂直眼震方向与PSC - BPPV侧别判断高度相关（P<0.01）。
PSC管结石症患者在Dix - Hallpike试验中扭转性眼震方向不定，诊断主要关注垂直眼震。当在摇头试验中发现旋转性眼震且向上跳动性眼震较多时，可能为PSC - BPPV。还可利用翻滚试验诊断PSC - BPPV耳石所在侧别。
