Rosengren Sally M, Young Allison S, Taylor Rachael L, Welgampola Miriam S
Central Clinical School, Faculty of Medicine and Health, University of Sydney.
Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia.
Curr Opin Neurol. 2022 Feb 1;35(1):64-74. doi: 10.1097/WCO.0000000000001023.
To most neurologists, assessing the patient with vertigo is an unpleasant and worrisome task. A structured history and focused examination can be complemented by carefully selected laboratory tests, to reach an early and accurate diagnosis. We provide evidence-based recommendations for vestibular test selection.
The video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (VEMP) and home-video nystagmography are four modern, noninvasive methods of assessing vestibular function, which are equally applicable in the hospital and office-practice. Collectively, they enable assessment of all five vestibular end-organs. The prevalence and patterns of test abnormalities are distinct for each vestibular disorder. We summarize typical abnormalities encountered in four common vestibular syndromes.
In the context of acute vestibular syndrome, an abnormal vHIT with low gain and large amplitude refixation saccades and an asymmetric oVEMP separates innocuous vestibular neuritis from stroke. In episodic spontaneous vertigo, high-velocity ictal nystagmus and asymmetric cVEMP help separate Ménière's disease from vestibular migraine. In chronic imbalance, all three tests help detect unilateral or bilateral vestibular loss as the root cause. Recurrent positional vertigo requires no laboratory test and can be diagnosed and treated at the bedside, guided by video nystagmography.
对大多数神经科医生而言，评估眩晕患者是一项令人不快且令人担忧的任务。结构化病史和重点检查可辅以精心挑选的实验室检查，以实现早期准确诊断。我们为前庭检查的选择提供基于证据的建议。
视频头脉冲试验（vHIT）、颈性和眼性前庭诱发肌源性电位（VEMP）以及家庭视频眼震图是四种评估前庭功能的现代非侵入性方法，在医院和门诊实践中同样适用。它们共同能够评估所有五个前庭终器。每种前庭疾病的检查异常发生率和模式各不相同。我们总结了四种常见前庭综合征中遇到的典型异常情况。
在急性前庭综合征的情况下，vHIT出现增益降低和大幅度重新注视扫视异常以及眼性VEMP不对称，可将无害的前庭神经炎与中风区分开来。在发作性自发性眩晕中，高速发作性眼震和颈性VEMP不对称有助于将梅尼埃病与前庭性偏头痛区分开来。在慢性平衡失调中，这三项检查都有助于检测出单侧或双侧前庭功能丧失作为根本原因。复发性位置性眩晕无需实验室检查，可在视频眼震图的指导下在床边进行诊断和治疗。
