眩晕患者床旁检查

摘要/Abstract

摘要：

眩晕的临床表现复杂，涉及多学科知识，眩晕的定位是眩晕诊断的首要问题。伴有明显的耳科或神经系统体征的眩晕患者较易诊断，但仅表现为孤立性眩晕的患者的诊断却极具有挑战性。近年来，随着研究的深入，除了最为重要的神经系统、耳科查体外，基于前庭耳石通路及眼动通路的眼位、眼震、眼动、头动及姿势步态等的床旁检查，亦极大地丰富了眩晕患者的定位诊断学。这些床旁检查方法的规范应用，将有助于医师及时地进行定位诊断，识别中枢还是外周性眩晕。基于此，本文对眩晕床旁检查方法及其相关临床意义做一简要综述。

文章导读： 本文系统介绍了有助于眩晕定位诊断的临床检查操作及方法，并对其原理和意义进行了分析。

关键词: 眩晕; 床旁检查; 前庭功能; 眼震; 眼动

Abstract:

Vertigo, which involves multidisciplinary knowledge, can manifest complicated and varied forms. The key of the diagnosis of vertigo is to distinguish central vertigo from peripheral vertigo. Patients accompanied with obvious otology or neurological signs are easy to diagnose, but the diagnosis of patients with isolated vertigo is challenging. In recent years, in addition to the most important examination of otological and the nervous system, with the developing of the research, bedside evaluation of vertigo patients includes eye position, nystagmus, oculomotor, head movements, posture and gait, which is based on vestibular otolith pathway and oculomotor pathway, greatly enriches the topical diagnostic of vertigo. Standardization of the bedside evaluation of vertigo will further help us identify the central or peripheral vertigo. This article will review the method and clinical significance of the bedside evaluation of vertigo patients.

Key words: Vertigo; Bedside evaluation; Vestibular function; Nystagmus; Oculomotor

桑文文，洪渊，杨旭. 眩晕患者床旁检查[J]. 中国卒中杂志, 2015, 10(05): 414-422.

SANG Wen-Wen, HONG Yuan, YANG Xu. Bedside Evaluation of Vertigo Patients[J]. Chinese Journal of Stroke, 2015, 10(05): 414-422.

参考文献

1 Huh YE, Kim JS. Bedside evaluation of dizzy patients[J]. J Clin Neurol, 2013, 9:203-213.

2 Osiro S, Zurada A, Gielecki J, et al. A review of subclavian steal syndrome with clinical correlation[J]. Med Sci Monit, 2012, 18:RA57-RA63.

3 Bradley JG, Davis KA. Orthostatic hypotension[J]. Am Fam Physician, 2003, 68:2393-2400.

4 Newman-Toker DE, Camargo CA. 'Cardiogenic vertigo'-true vertigo as the presenting manifestation of primary cardiac disease[J]. Nat Clin Pract Neurol, 2006, 2:167-172.

5 Toupet M, Ferrary E, Grayeli AB. Visual analog scale to assess vertigo and dizziness after repositioning maneuvers for benign paroxysmal positional vertigo[J]. J Vestib Res, 2011, 21:235-241.

6 Dannenbaum E, Paquet N, Chilingaryan G, et al. Clinical evaluation of dynamic visual acuity in subjects with unilateral vestibular hypofunction[J]. Otol Neurotol, 2009, 30:368-372.

7 Ko MW, Dalmau J, Galetta SL. Neuro-ophthalmologic manifestations of paraneoplastic syndromes[J]. J Neuro-Ophthalmol, 2008, 28:58-68.

8 Brodsky MC, Donahue SP, Vaphiades M, et al. Skew deviation revisited[J]. Surv Ophthalmol, 2006, 51:105-128.

9 Curthoys IS, Dai MJ, Halmagyi GM. Human ocular torsional position before and after unilateral vestibular neurectomy[J]. Exp Brain Res, 1991, 85:218-225.

10 Halmagyi GM, Gresty MA, Gibson WPR. Ocular tilt reaction with peripheral vestibular lesion[J]. Ann Neurol, 1979, 6:80-83.

11 Brandt T, Dieterich M. Vestibular syndromes in the roll plane:topographic diagnosis from brainstem to cortex[J]. Ann Neurol, 1994, 36:337-347.

12 Baier B, Bense S, Dieterich M. Are signs of ocular tilt reaction in patients with cerebellar lesions mediated by the dentate nucleus?[J]. Brain, 2008, 131:1445-1454.

13 Dieterich M, Brandt T. Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs[J]. Ann Neurol, 1993, 33:292-299.

14 Dieterich M, Brandt T. Brain activation studies on visual-vestibular and ocular motor interaction[J]. Curr Opin Neurol, 2000, 13:13-18.

15 Kattah JC, Pula J, Newman-Toker DE. Ocular lateropulsion as a central oculomotor sign in acute vestibular syndrome is not posturally dependent[J]. Ann N Y Acad Sci, 2011, 1233:249-255.

16 Serra A, Leigh RJ. Diagnostic value of nystagmus:spontaneous and induced ocular oscillations[J]. J Neurol Neurosurg Psychiatry, 2002, 73:615-618.

17 Baloh RW. Vestibular neuritis[J]. N Engl J Med, 2003, 348:1027-1032.

18 Robinson DA, Zee DS, Hain T C, et al. Alexander's law:Its behavior and origin in the human vestibulo-ocular reflex[J]. Ann Neurol, 1984, 16:714-722.

19 Hotson JR, Baloh RW. Acute vestibular syndrome[J]. N Engl J Med, 1998, 339:680-685.

20 Zee DS. Ophthalmoscopy in examination of patients with vestibular disorders[J]. Ann Neurol, 1978, 3:373-374.

21 Glasauer S, Hoshi M, Kempermann U, et al. Three-dimensional eye position and slow phase velocity in humans with downbeat nystagmus[J]. J Neurophysiol, 2003, 89:338-354.

22 Harbison JW. The neurology of eye movements[J]. Arch Neurol, 2000, 57:1375.

23 Zapala DA. Down-beating nystagmus in anterior canal benign paroxysmal positional vertigo[J]. J Am Acade Audiol, 2008, 19:257-266.

24 Brantberg K, Bergenius J. Treatment of anterior benign paroxysmal positional vertigo by canal plugging:a case report[J]. Acta Otolaryngol, 2002, 122:28-30.

25 Marti S, Straumann D, Glasauer S. The origin of downbeat nystagmus:An asymmetry in the distribution of on-directions of vertical gaze-velocity Purkinje cells[J]. Ann N Y Acad Sci, 2005, 1039:548-553.

26 Strupp M, Kremmyda O, Adamczyk C, et al. Central ocular motor disorders, including gaze palsy and nystagmus[J]. J Neurol, 2014, 261:542-558.

27 Walker MF, Zee DS. Beside vestibular examination[J]. Otolaryngol Clin North Am, 2000, 33:495-506.

28 Gaymard B, Pierrot-Deseilligny C. Neurology of saccades and smooth pursuit[J]. Curr Opin Neurol, 1999, 12:13-19.

29 Cnyrim CD, Newman-Toker D, Karch C, et al. Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”[J]. J Neurol Neurosurg Psychiatry, 2008, 79:458-460.

30 Salsano E, Umeh C, Rufa A, et al. Vertical supranuclear gaze palsy in Niemann-Pick type C disease[J]. Neurol Sci, 2012, 33:1225-1232.

31 Weber KP, Aw ST, Todd M J, et al. Head impulse test in unilateral vestibular loss:Vestibulo-ocular reflex and catch-up saccades[J]. Neurology, 2008, 70:454-463.

32 Newman-Toker DE, Kattah JC, Alvernia JE, et al. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis[J]. Neurology, 2008, 70:2378-2385.

33 Jeong SH, Kim JS, Baek IC, et al. Perverted head impulse test in cerebellar ataxia[J]. The Cerebellum, 2013, 12:773-775.

34 Chen L, Lee W, Chambers B R, et al. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit[J]. J Neurol, 2011, 258:855-861.

35 Hain TC, Spindler J. Head-shaking nystagmus//The vestibulo-ocular reflex and vertigo[M]. New York:Raven, 1993:217-217.

36 Angeli SI, Velandia S, Snapp H. Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy[J]. Am J Otolaryngol, 2011, 32:522-527.

37 Huh YE, Kim JS. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction:imaging correlations[J]. Brain, 2011, 134:3662-3671.

38 王武庆, 孙琴, 陈良. 闭目踏步试验对单侧外周前庭损伤的定侧价值[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45:946-948.

39 李婧, 陈忠云, 徐志伟, 等. 良性阵发性位置性眩晕[J]. 神经损伤与功能重建, 2013, 8:293-295.

40 Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging[J]. Stroke, 2009, 40:3504-3510.

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