轻嵴帽患者的临床特征分析

摘要

目的 对诊断为轻嵴帽患者的临床特征进行分析.方法 随访2016年7月—2017年8月于眩晕门诊位置性试验表现为持续水平向地变向性位置性眼震患者18例,调查病史,应用视频眼震和基于Supine Roll试验进一步检查位置性眼震特征,和眼震消失平面.全部患者均给予Barbecue耳石复位治疗,评价治疗后即时及1个月后的疗效.结果 原发14例,继发或伴发4例,包括突发性聋4例,同时伴偏头痛病史4例(22.2%),2例为孕妇.所有患者仰卧位及侧卧位均分别诱发持续水平性方向固定及向地性变向性眼震,并出现眼震消失平面且位于患侧.直立头位出现自发性眼震仅2例(1.1%).16例试行Barbecue方法复位1周,无痊愈病例,仅18.8%改善,无效达81.2%.后改为观察不再干预,1月后评估痊愈75%病例,改善及无效各12.5%.结论 持续性向地性变向性位置性眼震患者眼震表现基本符合轻嵴帽假说,确切发生机制未明,可依据零平面检测对轻嵴帽患者进行侧别判定,零平面侧为患侧.行复位无效,具有自愈性.%Objectives To report clinical characteristics of patients diagnosed with light cupula.Methods Eigh-teen patients who demonstrated persistent horizontal geotropic direction-changing positional nystagmus (DCPN) by Roll test at our vertigo clinic were enrolled from July 2016 to August 2017.In addition to medical history,videonystag-moscopy (VNG) and Supine Roll test were used to further determine characteristics of positional nystagmus and the plane in which nystagmus disappeared.All patients were treated with the Barbecue roll maneuver,and efficacy was eval-uated immediately and 1 months after treatment.Results Fourteen of the cases were determined to have primary light cupula,while the rest 4 cases had either secondary or concomitant light cupula.Concurrent sudden deafness was present in 4 cases,history of migraine in 4 cases(22.2%)and pregnancy in 2 cases.In all patients,persistent horizontally fixed directional nystagmus and geotropic direction-changing nystagmus were induced in the supine and lateral positions,re-spectively,with the nystagmus disappearance plane being on the affected side.Spontaneous nystagmus was seen in the upright position in only 2 cases (1.1%).Despite Barbecue maneuvers for a week in 16 cases,none showed complete symptom resolution with an improvement rate of merely 18.8% and non-response rate of 81.2%.Treatment was suspend-ed and patients were re-evaluated after a month and showed a complete symptom resolution rate of 75%,an improve-ment rate of 12.5% and a no change rate of 12.5%.Conclusions The clinical characteristics in this group of patients with persistent geotropic direction-changing positional nystagmus are basically consistent to presence of light cupula by theory.The exact pathogenic mechanism is unknown.The affected side can be determined according to the neutral point test in patients with light cupula.Repositioning maneuvers appear to be ineffective,but the condition seems to show a tendency of self-healing.