Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Kumo-ro 20, Beomo-ri, Mulgum-eup, Yangsan, Gyeongnam, 50612, South Korea.
Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea.
J Neurol. 2022 Sep;269(9):4742-4752. doi: 10.1007/s00415-022-11105-y. Epub 2022 Apr 8.
This study aimed to determine the incidence, pattern, and etiology of dissociated vestibulo-ocular reflex (VOR) function according to the stimulus frequency in dizzy patients. We retrospectively evaluated the results of bithermal caloric tests and video-head impulse tests (vHITs) in 1022 patients with dizziness or vertigo between July 2016 and April 2021. Patients were classified into concordant group (normal or abnormal results on both tests) and discordant group (dissociated results between two tests). Of 1022 patients, discordant group had 159 (16%), comprising abnormal horizontal vHITs with normal caloric responses (n = 36, 23%) and abnormal caloric tests with normal horizontal vHITs (n = 123, 77%). The former group showed similar frequency of peripheral (44%) and central (42%) causes, and more common involvement of bilateral horizontal semicircular canals in central than peripheral causes (86.7 vs 37.5%, p = 0.005). The most common peripheral causes were Meniere's disease and chronic vestibular neuritis, while central causes were variable, but mainly affecting the cerebellum. In the latter group, peripheral causes were common (67%), with the main etiologies being Meniere's disease and vestibular neuritis, whereas central causes were found in only 5%. The degree of canal paresis did not differ significantly between patients with central and peripheral causes. Discordant VOR function according to the stimulus frequency was not uncommon in dizzy patients. Specific patterns of VOR dissociation according to the disease etiologies may offer insight into underlying pathophysiology.
本研究旨在根据刺激频率确定头晕患者分离性前庭眼反射（VOR）功能的发生率、模式和病因。我们回顾性评估了 2016 年 7 月至 2021 年 4 月间 1022 例头晕或眩晕患者的冷热双侧温度试验（BCT）和视频头脉冲试验（vHIT）结果。患者分为一致组（两项检查结果均正常或异常）和不一致组（两项检查结果不一致）。在 1022 例患者中，不一致组有 159 例（16%），包括水平性 vHIT 异常而冷热试验正常（n=36，23%）和冷热试验异常而水平性 vHIT 正常（n=123，77%）。前者组显示外周性（44%）和中枢性（42%）病因的频率相似，且中枢性病因更常见双侧水平半规管受累（86.7%比 37.5%，p=0.005）。最常见的外周性病因是梅尼埃病和慢性前庭神经炎，而中枢性病因多种多样，但主要影响小脑。在后一组中，外周性病因常见（67%），主要病因是梅尼埃病和前庭神经炎，而中枢性病因仅占 5%。中枢性和外周性病因患者的半规管轻瘫程度无显著差异。根据刺激频率出现不一致的 VOR 功能在头晕患者中并不少见。根据病因学的不同，VOR 分离的特定模式可能有助于了解潜在的病理生理学。
