后循环梗死患者的眼动及前庭功能评价

摘要

目的：评价眼动及前庭功能检查对后循环梗死（posterior circulation Infarction，PCI）患者的诊断价值。方法纳入22例PCI患者，收集其临床基线资料，包括性别、年龄、首发症状、高血压、糖尿病、吸烟、饮酒史及入院体征等相关指标。患者均行眼动检查：包括凝视试验（gaze test，GT）、扫视试验（saccade test，ST）、平滑跟踪试验（smooth pursuit test，SPT）、视动眼震检查（optokinetic nystagmus test，OPK）；前庭功能检查：包括自发眼震（spontaneous nystagmus，SN）、摇头试验（head shaking test， HST）、固视抑制检查，上述检查均应用眼震视图仪（videonystagmograph，VNG）进行记录。结果共纳入22例PCI患者，首发症状：15例（68.2%）为头晕/眩晕，7例（31.8%）为肢体无力麻木。眼动检查提示：异常19例（86.4%），其中GT异常4例（18.2%），ST异常11例（50.0%），SPT异常15例（68.2%），OPK异常12例（54.5%）。前庭功能检查提示：22例完成SN检查，其中SN阳性8例（36.4%），包括小脑梗死4例，脑桥梗死3例，左侧延髓背外侧、双侧小脑半球及蚓部梗死1例；17例完成HST检查，其中HST阳性6例（35.3%），包括小脑梗死2例，脑桥梗死2例，小脑及脑桥梗死1例，右侧小脑及延髓上段梗死1例；19例完成固视抑制检查，其中固视抑制失败8例（42.1%），包括双侧小脑梗死1例，脑桥梗死4例，左侧延髓梗死1例，右侧小脑及延髓上段梗死1例，左侧延髓背外侧、双侧小脑半球及蚓部梗死1例。以头晕/眩晕为首发症状的患者与以肢体无力、麻木为首发症状的患者相比，眼动及固视抑制检查阳性率高（P分别为0.023和0.045）。结论小脑、延髓梗死的患者常以头晕/眩晕起病；眼动检查有助于筛查PCI患者；小脑梗死患者的病灶侧别常与自发、摇头眼震的水平成分一致；脑桥梗死患者HST后可诱发下跳眼震；脑桥、延髓梗死患者常固视抑制失败。%Objective To evaluate the role of eye movement and vestibular function examination in the diagnosis of posterior circulation infarction patients, and provide evidence for clinical diagnosis. Methods A total of 22 patients of posterior circulation infarction were included in this study, clinical information of the involved patients were collected, including gender, age, initial symptom, hypertension, diabetes, smoking and drinking history, and admission signs. All patients were detected with eye movement examinations (including gaze test, saccade test, smooth pursuit test and optokinetic nystagmus test) and vestibular function examinations (including spontaneous nystagmus, head shaking test and ifxation suppression test). The above examinations were recorded using the videonystagmograph. Results Among 22 patients of posterior circulation infarction, initial symptoms were dizziness/vertigo in 15 cases and limb weakness and numbness in 7 cases. Eye movement examinations showed the abnormality in 19 cases, in which 4 cases by gazes test, 11 cases by saccade test, 15 cases by smooth pursuit test and 12 cases by optokinetic nystagmu test. Vestibular functiondetection showed that, 22 patients completed the spontaneous nystagmus examination, in which 8 cases were positive (4 cases of cerebellar infarction, 3 cases of pontine infarction, and 1 case of Wallenberg syndrome on the left side and cerebellar hemisphere and vermis infarction on the right side); 17 patients completed the head shaking test, in which 6 cases were positive (2 cases of cerebellum infarction, 2 cases of pontine infarction, 1 case of cerebellar and pontine infarction, and 1 case of Wallenberg syndrome); 19 patients completed the ifxation suppression test, in which 8 cases failed in the test (1 case of bilateral cerebellar and pontine infarction, 4 cases of pontine infarction, 2 cases of Wallenberg syndrome, and 1 case of Wallenberg syndrome on the left side and cerebellar hemisphere and vermis infarction on the right side). Conclusion The cerebellar and medulla oblongata infarction patients often appear dizziness/vertigo as initial symptoms; eye movement detection is helpful for screening posterior circulation infarction; the lesioned hemisphere in patients with cerebellar infarction is consistent with the horizontal component of the spontaneous nystagmus and head shaking; after head shaking test, patients with pontine infarction induced downbeat nystagmus; pontine and medullary infarction patients often fail in the ifxation suppression test.