Deng Qiaomei, Zhang Xueqing, Wen Chao, Huang Xiaobang, Chen Taisheng, Wang Wei
Zhejiang Chinese Medical University，Hangzhou，310053，China.
Department of Otorhinolaryngology Head and Neck Surgery，Tianjin First Central Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Dec;38(12):1122-1126;1133. doi: 10.13201/j.issn.2096-7993.2024.12.006.
Exploring the performance characteristics of spontaneous nystagmus（SN） in video-head impulse test（vHIT） and its possible effects on saccade. Vestibular function tests such as vHIT and SN were conducted in 48 patients with acute unilateral vestibulopathy（AUVP）. The saccade characteristics of vHIT in patients without SN and those with SN were analyzed, as well as the expression characteristics of SN in vHIT. Among the 48 AUVP patients, there were 34 cases with SN, including 31 cases with saccade on the healthy side, 11 cases with both the same and opposite directions of eye movement, 19 with the opposite only, 1 with same direction only, and 3 cases without saccade. There were 14 patients without SN, of whom 10 showed saccade on the healthy side, including 4 with both eye movements in the same and opposite direction, 2 in the opposite direction only, 4 in the same direction only, and 4 without saccade. There is a correlation between reverse saccade on the healthy side and the presence of SN in patients. SN in vHIT can appear opposite to the direction of eye movement on the healthy side, while on the affected side it can appear the same as the direction of eye movement and may cause more discrete overt saccade. 32 patients in the acute phase（≤2 w）, 29 patients with SN, SN intensity of（6.7 ± 3.2） °/s, and 3 patients without SN. 16 cases in non acute phase（>2 w）, 5 cases with SN, SN intensity of（3.7 ± 2.1） °/s, and 11 cases without SN. In the acute phase there were 30 cases of saccade on the healthy side, 10 cases with both the same and opposite direction of eye movement, 18 cases with only the opposite direction, 2 cases with only the same direction and 2 cases without saccade. There is a correlation between the duration of the disease and the occurrence of reverse saccade on the healthy side. The intensity cut off point of SN for reverse saccade is 2.1 °/s in the healthy lateral semicircular canal vHIT. Compensatory saccades and SN waves with similar waveforms are mostly present in vHIT in AUVP patients. SN wave is in the opposite direction of the normal side and eye movement wave, and the affected side and dominant saccade direction are in the same direction and mixed together, which can affect the dispersion and amplitude of overt saccade in vHIT. Accurate identification of SN in vHIT of AUVP patients is not only the key factor to identify compensatory saccade, but also can provide help for the diagnosis and compensatory assessment of AUVP.
探索视频头脉冲试验（vHIT）中自发性眼震（SN）的表现特征及其对扫视的可能影响。对48例急性单侧前庭病变（AUVP）患者进行了vHIT和SN等前庭功能测试。分析了无SN患者和有SN患者vHIT的扫视特征，以及vHIT中SN的表现特征。48例AUVP患者中，有34例出现SN，其中健侧有扫视的31例，眼球运动方向相同和相反的11例，仅相反方向的19例，仅相同方向的1例，无扫视的3例。无SN的患者有14例，其中健侧出现扫视的10例，眼球运动方向相同和相反的4例，仅相反方向的2例，仅相同方向的4例，无扫视的4例。患者健侧反向扫视与SN的存在之间存在相关性。vHIT中的SN可出现在健侧眼球运动方向的相反方向，而在患侧可与眼球运动方向相同，并可能导致更离散的明显扫视。急性期（≤2周）患者32例，有SN的29例，SN强度为（6.7±3.2）°/s，无SN的3例。非急性期（>2周）患者16例，有SN的5例，SN强度为（3.7±2.1）°/s，无SN的11例。急性期健侧有扫视的30例，眼球运动方向相同和相反的10例，仅相反方向的18例，仅相同方向的2例，无扫视的2例。病程与健侧反向扫视的发生之间存在相关性。在健侧水平半规管vHIT中，SN导致反向扫视的强度截断点为2.1°/s。AUVP患者的vHIT中大多存在波形相似的代偿性扫视和SN波。SN波与正常侧和眼球运动波方向相反，患侧与优势扫视方向相同且混合在一起，可影响vHIT中明显扫视的离散度和幅度。准确识别AUVP患者vHIT中的SN不仅是识别代偿性扫视的关键因素，也可为AUVP的诊断和代偿评估提供帮助。
