McClure J A, Parnes L S
Department of Otolaryngology, University of Western Ontario, London, Canada.
Baillieres Clin Neurol. 1994 Nov;3(3):537-45.
Benign positional vertigo is a common clinical entity encountered in any dizzy clinic. It is easily diagnosed on the basis of historical information and a positive Dix-Hallpike position test. The available evidence suggests that this condition is due to involvement of the posterior semicircular canal. The pathophysiology of this condition can be explained theoretically on the basis of free-floating particles within the endolymph of the posterior semicircular canal that move under the influence of gravity with certain provocative positional changes. Based on this theoretical model, a variety of particle-repositioning manoeuvres have been developed that attempt to relocate the loose particles from the posterior semicircular canal to the utricular sac. If the particles are kept in the utricular sac for a period of 48 h by maintaining the patient in an upright position, the clinical symptoms are relieved in a high proportion of patients. If the manoeuvre is unsuccessful on a first attempt, or if the benign positional vertigo recurs at a later date, the condition can usually be relieved by a second manoeuvre. Bilateral benign positional vertigo can be treated by performing a manoeuvre on one side followed by a manoeuvre on the other side at a later date. On occasion, posterior canal benign positional vertigo is converted to horizontal canal benign positional vertigo, but this subsides readily within the 48-h post-manoeuvre period.
良性阵发性位置性眩晕是任何眩晕门诊中常见的临床病症。根据病史信息和阳性的 Dix-Hallpike 位置试验很容易诊断。现有证据表明，这种病症是由于后半规管受累所致。这种病症的病理生理学理论上可以基于后半规管内淋巴液中的自由漂浮颗粒来解释，这些颗粒在重力影响下随着某些诱发位置变化而移动。基于这一理论模型，已经开发出了多种颗粒复位手法，试图将松散的颗粒从后半规管重新定位到椭圆囊。如果通过让患者保持直立姿势将颗粒在椭圆囊中保持 48 小时，很大一部分患者的临床症状会得到缓解。如果首次手法操作不成功，或者良性阵发性位置性眩晕在之后复发，通常可以通过第二次手法操作来缓解病情。双侧良性阵发性位置性眩晕可以先对一侧进行手法操作，之后再对另一侧进行手法操作来治疗。偶尔，后半规管良性阵发性位置性眩晕会转变为水平半规管良性阵发性位置性眩晕，但这种情况在手法操作后的 48 小时内会很快消退。
