Dumas G, Charachon R, Ghozali S
Clinique ORL, CHU de Grenoble.
Ann Otolaryngol Chir Cervicofac. 1994;111(6):301-13.
51 cases of benign paroxysmal vertigo have been investigated in 3 years. The findings put in evidence: the particular frequency of this pathology (18% of BPPV in a vestibulometry consultation), its opportunist character and the possible association with other more severe pathologies (meningiomas, multiple sclerosis, cerebellar venous angioma, vascular cerebral infarction) or more benign pathologies (labyrinth malformation, middle fossa atrophia). Sémont liberatory maneuver revealed to be much efficient (50% of patients free of disease after a single repositioning manoeuvre). Only 3 cases remaining unchanged after 2 years and intractable were proposed for surgery. We mention 7% of bilateral forms and 5% of alternating recurrent forms (sometimes on the right and sometimes on the left side). The recurrence is noted in 50% of BPPV followed at least during one year. We describe a particular topographic form concerning probably a cupulolithiasis of the external canal. 53% of cases beneficiated of CT-scan or of magnetic resonance imaging. The frequency and the possibility of pathological associations with BPPV bring to a particular vigilance for the diagnosis and to a particular care in the affirmation of the benignity in the case of long lasting vertigo (superior to 6 months), or when the nystagmus duration in Hallpike position is superior to 60 seconds.
在3年时间里对51例良性阵发性眩晕患者进行了调查。研究结果表明:这种病症具有特殊的发病率(在前庭功能检查门诊中占良性阵发性位置性眩晕的18%),其具有伺机性特点,并且可能与其他更严重的病症(如脑膜瘤、多发性硬化症、小脑静脉血管瘤、脑血管梗死)或更良性的病症(如迷路畸形、中颅窝萎缩)相关。Semont解脱手法显示非常有效(单次复位操作后50%的患者症状消失)。仅3例患者在2年后病情未改善且难以治疗,因此建议进行手术。我们提到双侧形式占7%,交替复发性形式占5%(有时在右侧,有时在左侧)。在至少随访一年的良性阵发性位置性眩晕患者中,50%出现复发。我们描述了一种特殊的地形学形式,可能与外耳道耳石症有关。53%的病例接受了CT扫描或磁共振成像检查。良性阵发性位置性眩晕的发病频率以及与其他病症相关的可能性,使得在诊断时需要格外警惕,对于持续眩晕(超过6个月)或在Hallpike位眼震持续时间超过60秒的病例,在确定其为良性时需要格外谨慎。