Otoneurology Centre.
Physiotherapy, Vennesla, Norway.
Otol Neurotol. 2019 Jan;40(1):96-102. doi: 10.1097/MAO.0000000000002020.
BACKGROUND: In patients with chronic benign paroxysmal positional vertigo (BPPV), i.e., chronic vestibular multicanalicular canalithiasis (CVMCC), abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal (SCC) ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication. OBJECTIVE: To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whiplash associated disorders (WAD). STUDY DESIGN: Retrospective consecutive observational cohort study. SETTING: Ambulatory at a private Otoneurology Centre. PATIENTS: One hundred sixty-three patients with CVMCC and a history of trauma. INTERVENTION: Based on the symptoms (structured symptom questionnaire), the patients are post hoc sub grouped according to the criteria of the different diagnoses. MAIN OUTCOME MEASURE: Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses. RESULTS: 98% of all patients with CVMCC fulfill the Barany Society criteria of a probable vestibular migraine; 17% fulfill the International Classification of Headache Disorders defined vestibular migraine criteria; 63% fulfill the Fukuda criteria of ME/CFS; 100% of the patients with WAD suffer from CVMCC. CONCLUSION: This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patient's dominant symptom.
背景:在慢性良性阵发性位置性眩晕(BPPV)患者中,即慢性前庭多管管石症(CVMCC),患病的迷路通过健康的前庭核复合体向其终末器官传递异常信号。前庭-丘脑-皮质反射正如前庭性偏头痛中所提出的那样,只是这些反射中的一种。在一组被诊断为 CVMCC 的患者中,针对每个半规管(SCC)的耳石复位操改善了 90%的疼痛和其他症状。提高对 CVMCC 的认识可能会减轻痛苦和持续用药。
目的:评估 CVMCC 是否可能是前庭性偏头痛、肌痛性脑脊髓炎/慢性疲劳综合征(ME/CFS)和挥鞭样损伤相关疾病(WAD)症状的触发因素。
研究设计:回顾性连续观察队列研究。
设置:在私人耳神经科中心进行门诊治疗。
患者:163 例患有 CVMCC 且有创伤史的患者。
干预措施:根据症状(结构化症状问卷),患者随后根据不同诊断的标准进行亚组分组。
主要观察指标:符合不同诊断标准的 CVMCC 患者的频率。
结果:所有 CVMCC 患者中有 98%符合前庭性偏头痛的可能 Barany 协会标准;17%符合国际头痛疾病分类定义的前庭性偏头痛标准;63%符合 Fukuda 定义的 ME/CFS 标准;100%的 WAD 患者患有 CVMCC。
结论:这项调查支持了 CVMCC 可能是前庭性偏头痛、ME/CFS 和 WAD 症状触发因素的假设。患者实际接受的诊断通常与患者的主导症状相符。
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