Lee Sun-Uk, Park Euyhyun, Kim Hyo-Jung, Choi Jeong-Yoon, Kim Ji-Soo
Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Neurol Clin Pract. 2024 Apr;14(2):e200235. doi: 10.1212/CPJ.0000000000200235. Epub 2024 Jan 10.
The diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the evolution of vestibular function and their underlying physiology during and between the attacks of MD and thus aims to help identify this common disorder with many faces according to the phase.
During the attacks, the direction of spontaneous nystagmus changes over time, beating initially toward the affected ear (irritative nystagmus), then toward the healthy ear (paretic nystagmus), and finally back toward the affected ear again (recovery nystagmus). Apart from these direction changes, atypical forms of spontaneous nystagmus, such as downbeat, discordant horizontal-torsional, and aperiodic alternating nystagmus, can be observed. Head impulse tests (HITs) are mostly normal during the irritative/recovery phases, but positive in more than half of patients during the paretic phase. By contrast, caloric tests are usually abnormal irrespective of the phases, although paradoxical caloric hyper-responsiveness can be observed in 18% of patients during the irritative/recovery phases. Thus, dissociation in the findings of caloric tests-HITs can be observed during and between the attacks. Horizontal head shaking tends to augment spontaneous nystagmus during each phase, while skull vibration mostly induces nystagmus beating toward the healthy ear irrespective of the phases. During the attacks, ocular vestibular-evoked myogenic potentials (VEMPs) may be enhanced, whereas cervical VEMPs are usually decreased during stimulation of the involved ear.
Recognizing these evolutions of vestibular findings during and between the attacks of MD would provide insights into its pathophysiology and aid in treatments and diagnosis.
梅尼埃病（MD）的诊断基于眩晕特征和听力学评估结果。本综述聚焦于MD发作期间及发作间期前庭功能演变的最新研究发现及其潜在生理机制，旨在根据疾病阶段帮助识别这一具有多种表现的常见疾病。
发作期间，自发性眼震的方向随时间变化，最初朝向患耳（刺激性眼震），然后朝向健耳（麻痹性眼震），最后再次朝向患耳（恢复性眼震）。除了这些方向变化外，还可观察到非典型形式的自发性眼震，如下跳性、不协调的水平扭转性和无规律交替性眼震。在刺激性/恢复性阶段，摇头试验（HITs）大多正常，但在麻痹性阶段超过半数患者呈阳性。相比之下，冷热试验通常在各阶段均异常，尽管在18%的患者中，刺激性/恢复性阶段可观察到矛盾性冷热反应亢进。因此，在发作期间及发作间期，冷热试验和摇头试验结果可出现分离。水平摇头在各阶段往往会增强自发性眼震，而颅骨振动大多会诱发眼震朝向健耳，且与阶段无关。发作期间，眼性前庭诱发肌源性电位（VEMPs）可能增强，而刺激患侧耳时，颈性VEMPs通常降低。
认识到MD发作期间及发作间期前庭检查结果的这些演变，将有助于深入了解其病理生理学，并辅助治疗和诊断。
