单侧外周性前庭功能障碍患者的前庭映射。
Vestibular mapping in patients with unilateral peripheral-vestibular deficits.
机构信息
From the Cantonal Hospital Baden (A.A.T.); Faculty of Medicine (A.A.T., C.J.B., K.P.W.), University of Zurich; Departments of Neurology (A.A.T., C.J.B., E.B., K.P.W.), Ophthalmology (C.J.B., K.P.W.), and Otorhinolaryngology (C.J.B.), University Hospital Zurich; and Clinical Neuroscience Center (A.A.T., C.J.B., K.P.W.), Zurich, Switzerland.
出版信息
Neurology. 2020 Dec 1;95(22):e2988-e3001. doi: 10.1212/WNL.0000000000010812. Epub 2020 Sep 10.
OBJECTIVE
To test the hypothesis that patterns of semicircular canal (SCC) and otolith impairment in unilateral vestibular loss depend on the underlying disorders, we analyzed peripheral-vestibular function of all 5 vestibular sensors.
METHODS
For this retrospective case series, we screened the hospital video-head-impulse test database (n = 4,983) for patients with unilaterally impaired SCC function who also received ocular vestibular-evoked myogenic potentials and cervical vestibular-evoked myogenic potentials (n = 302). Frequency of impairment of vestibular end organs (horizontal/anterior/posterior SCC, utriculus/sacculus) was analyzed with hierarchical cluster analysis and correlated with the underlying etiology.
RESULTS
Acute vestibular neuropathy (AVN) (37.4%, 113 of 302), vestibular schwannoma (18.2%, 55 of 302), and acute cochleovestibular neuropathy (6.6%, 20 of 302) were most frequent. Horizontal SCC impairment (87.4%, 264 of 302) was more frequent ( < 0.001) than posterior (47.4%, 143 of 302) and anterior (37.8%, 114 of 302) SCC impairment. Utricular damage (58%, 175 of 302) was noted more often ( = 0.003) than saccular impairment (32%, 98 of 302). On average, 2.6 (95% confidence interval 2.48-2.78) vestibular sensors were deficient, with higher numbers ( ≤ 0.017) for acute cochleovestibular neuropathy and vestibular schwannoma than for AVN, Menière disease, and episodic vestibular syndrome. In hierarchical cluster analysis, early mergers (posterior SCC/sacculus; anterior SCC/utriculus) pointed to closer pathophysiologic association of these sensors, whereas the late merger of the horizontal canal indicated a more distinct state.
CONCLUSIONS
While the extent and pattern of vestibular impairment critically depended on the underlying disorder, more limited damage in AVN and Menière disease was noted, emphasizing the individual range of loss of function and the value of vestibular mapping. Likely, both the anatomic properties of the different vestibular end organs and their vulnerability to external factors contribute to the relative sparing of the vertical canals and the sacculus.
目的
为了验证这样一个假说，即单侧前庭功能丧失的半规管（SCC）和耳石损伤模式取决于潜在的疾病，我们分析了所有 5 个前庭传感器的外周前庭功能。
方法
在这项回顾性病例系列研究中，我们从医院视频头脉冲测试数据库（n=4983）中筛选出单侧 SCC 功能受损且同时接受眼性前庭诱发肌源性电位和颈性前庭诱发肌源性电位检查的患者（n=302）。采用层次聚类分析对前庭终器（水平/前/后 SCC、椭圆囊/球囊）损伤的频率进行分析，并与潜在病因相关联。
结果
急性前庭神经病（AVN）（37.4%，302 例中的 113 例）、前庭神经鞘瘤（18.2%，302 例中的 55 例）和急性耳蜗前庭神经病（6.6%，302 例中的 20 例）最为常见。水平 SCC 损伤（87.4%，302 例中的 264 例）比后部（47.4%，302 例中的 143 例）和前部（37.8%，302 例中的 114 例）SCC 损伤更常见（<0.001）。椭圆囊损伤（58%，302 例中的 175 例）比球囊损伤（32%，302 例中的 98 例）更常见（=0.003）。平均有 2.6（95%置信区间 2.48-2.78）个前庭传感器存在缺陷，急性耳蜗前庭神经病和前庭神经鞘瘤的数量更高（≤0.017），而急性前庭神经病、梅尼埃病和发作性前庭综合征则较少。在层次聚类分析中，后部 SCC/球囊和前部 SCC/椭圆囊的早期融合表明这些传感器之间存在更密切的病理生理学关联，而水平管的晚期融合则表明存在更明显的状态。
结论
虽然前庭损伤的程度和模式主要取决于潜在疾病，但在 AVN 和梅尼埃病中观察到的损伤程度较小，这强调了功能丧失的个体范围和前庭映射的价值。可能是不同前庭终器的解剖特性及其对外界因素的易感性导致了垂直管和球囊的相对保留。
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