Emiliano De Schutter Duilio, Pérez Fernández Nicolás
Department of Neurology, Universidad Nacional de Cuyo, Mendoza, Argentina.
Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain.
Case Rep Otolaryngol. 2017;2017:3628402. doi: 10.1155/2017/3628402. Epub 2017 Dec 4.
In 2013, a 70-year-old male was admitted with an acute episode of vertigo, nausea, and vomiting with duration of one day. The patient's background included prehypertension, vitiligo, left ventricular hypertrophy, and Sjögren's syndrome. He denied any previous episode of vertigo or migraine manifestations. Neither hearing loss nor tinnitus or otorrhea was detected at the time of evaluation. No neurological symptoms were found. There was a left-beating spontaneous nystagmus Grade 3. The patient could stand still and walk on his own with some help without falling. Day 1 vHIT showed a significant reduction in VOR gain and refixation saccades after head impulses were delivered in the planes of the right anterior and horizontal semicircular canals. MRI showed no significant findings. He was treated with steroids. A vHIT performed 14 days later showed recovery of gains and no refixation saccades. In 2015, the patient had a new episode of acute vertigo. The clinical examination was similar, and the vHIT revealed a new drop of right superior and lateral canal gains. Cervical and ocular VEMPs were performed, and no significant asymmetry was detected. Serum PCR for herpes viruses resulted negative. Contrast MRI was performed without relevant brain findings.
2013年，一名70岁男性因急性眩晕、恶心和呕吐发作一天入院。患者既往有高血压前期、白癜风、左心室肥厚和干燥综合征。他否认既往有眩晕发作或偏头痛表现。评估时未发现听力损失、耳鸣或耳漏。未发现神经症状。有3级向左跳动的自发性眼球震颤。患者在一些帮助下能够自行站立和行走而不摔倒。第1天的视频头脉冲试验（vHIT）显示，在右前半规管和水平半规管平面施加头部脉冲后，视动性眼震（VOR）增益和重新注视扫视显著降低。磁共振成像（MRI）未发现明显异常。他接受了类固醇治疗。14天后进行的vHIT显示增益恢复且无重新注视扫视。2015年，患者出现新的急性眩晕发作。临床检查结果相似，vHIT显示右上半规管和外半规管增益再次下降。进行了颈肌和眼肌前庭诱发肌源性电位（VEMP）检查，未发现明显不对称。疱疹病毒血清聚合酶链反应（PCR）结果为阴性。增强MRI检查未发现脑部相关异常。
