用定量前庭测试将后循环卒中与前庭神经炎分开。
Separating posterior-circulation stroke from vestibular neuritis with quantitative vestibular testing.
机构信息
Department of Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
出版信息
Clin Neurophysiol. 2020 Aug;131(8):2047-2055. doi: 10.1016/j.clinph.2020.04.173. Epub 2020 Jun 8.
OBJECTIVE
To separate vestibular neuritis (VN) from posteriorcirculation stroke (PCS) using quantitative tests of canal and otolith function.
METHODS
Video Head-Impulse tests (vHIT) were used to assess all three semicircular canal pairs; vestibulo-ocular reflex (VOR) gain and saccade metrics were examined. Cervical and ocular-Vestibular-Evoked Myogenic Potentials (c- and oVEMP) and Subjective Visual Horizontal (SVH) were used to assess otolith function.
RESULTS
For controls (n = 40), PCS (n = 22), and VN (n = 22), mean horizontal-canal VOR-gains were 0.96 ± 0.1, 0.85 ± 0.3 and 0.40 ± 0.2, refixation-saccade prevalence was 71.9 ± 41, 90.7 ± 57, 209.2 ± 62 per 100 impulses and cumulative-saccade amplitudes were 0.9 ± 0.4°, 2.4 ± 2.2°, 8.0 ± 3.5°. Abnormality-rates for cVEMP, oVEMP and SVH were 38%, 9%, 72% for PCS, and 43%, 50%, 91% for VN. A gain ≤0.68, refixation-saccade prevalence of ≥135% and cumulative-saccade amplitudes ≥5.3° separated VN from PCS with sensitivities of 95.5%, 95.5%, and 81.8%, and specificities of 68.2%, 86.4% and 95.5%. VOR-gain and saccade prevalence when combined, separated VN from PCS with a sensitivity and specificity of 90.9%. Abnormal oVEMP asymmetry-ratios were of low sensitivity (50%) but high specificity (90.9%) for separating VN from PCS.
CONCLUSION
vHIT provided the best separation of VN from PCS. VOR-gain, refixation-saccade prevalence and amplitude were effective discriminators of VN from PCS.
SIGNIFICANCE
vHIT and oVEMP could assist early identification of the aetiology of Acute Vestibular Syndrome in the Emergency Room.
目的
使用半规管和耳石器功能的定量测试将前庭神经炎 (VN) 与后循环卒中 (PCS) 区分开来。
方法
使用视频头脉冲测试 (vHIT) 评估所有三个半规管对；检查前庭眼反射 (VOR) 增益和扫视度量。颈性和眼性前庭肌源性电位 (c- 和 oVEMP) 和主观水平 (SVH) 用于评估耳石功能。
结果
对于对照组 (n=40)、PCS (n=22) 和 VN (n=22)，水平半规管 VOR 增益的平均值分别为 0.96±0.1、0.85±0.3 和 0.40±0.2，重新固定扫视的患病率分别为每 100 次脉冲 71.9±41、90.7±57 和 209.2±62，累积扫视幅度分别为 0.9±0.4°、2.4±2.2° 和 8.0±3.5°。cVEMP、oVEMP 和 SVH 的异常率分别为 38%、9% 和 72%，用于 PCS，以及 43%、50% 和 91%，用于 VN。增益≤0.68、重新固定扫视患病率≥135%和累积扫视幅度≥5.3°可将 VN 与 PCS 区分开来，其敏感性分别为 95.5%、95.5% 和 81.8%，特异性分别为 68.2%、86.4% 和 95.5%。当结合 VOR 增益和扫视患病率时，VN 与 PCS 的敏感性和特异性为 90.9%。异常的 oVEMP 不对称比对于将 VN 与 PCS 区分开来具有较低的敏感性 (50%)，但特异性较高 (90.9%)。
结论
vHIT 可最好地区分 VN 与 PCS。VOR 增益、重新固定扫视患病率和幅度是区分 VN 与 PCS 的有效指标。
意义
vHIT 和 oVEMP 可协助急诊室急性前庭综合征病因的早期识别。
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