双侧后半规管良性阵发性位置性眩晕的诊治思路

发布时间：2018-09-01 11:18

【摘要】：目的探讨双侧后半规管良性阵发性位置眩晕(BPPV)的诊治思路。方法回顾性分析2012年1月至12月我院神经内科眩晕专病门诊诊治的、双侧Dix-Hallpike诱发试验均出现扭转、向上、向地性眼震患者的临床资料,总结其诊治思路。结果 20例BPPV患者在Dix-Hallpike诱发试验时双侧均出现扭转、向上、向地性眼震发作,进一步行平躺试验和低头试验,其中6例患者平躺试验时出现垂直向上眼震发作而低头试验无眼震发作,判断为双侧后半规管BPPV,给予两侧颗粒手法复位后患者眩晕症状缓解;其余14例患者在平躺试验和低头试验时仍表现为扭转、向上性眼震发作,但此时二者眼震的扭转方向相反,判断为眼震带扭转、向上成分的单侧水平半规管BPPV,给予一侧Barbecue手法复位后患者眩晕症状消失。结论对Dix-Hallpike诱发试验双侧出现扭转、向上、向地性眼震发作的患者,不应贸然诊断为双侧后半规管BPPV,应排除眼震出现扭转、向上成分的单侧水平半规管BPPV。
[Abstract]:Objective to investigate the diagnosis and treatment of bilateral posterior semicircular canal benign paroxysmal positional vertigo (BPPV). Methods from January to December 2012, the clinical data of patients with vertigo in our hospital from January to December 2012 were analyzed retrospectively. The clinical data of patients with bilateral Dix-Hallpike evoked test were analyzed, and the diagnosis and treatment ideas were summarized. Results Twist, upward and ground nystagmus were observed on both sides of 20 patients with BPPV in Dix-Hallpike induced test. There were 6 patients with vertical upward nystagmus and no nystagmus in the bowing test. The results showed that the symptoms of vertigo were alleviated after bilateral posterior semicircular canal BPPV, was given bilateral granule manual reduction. The other 14 patients still showed torsion and upward nystagmus in lying down test and bow down test, but the torsion direction of the two nystagmus was opposite, which was judged to be nystagmus zone torsion. Vertigo symptoms disappeared after unilateral horizontal semicircular canal BPPV, with upward component was treated with unilateral Barbecue manual reduction. Conclusion for the patients with bilateral torsion, upward or land-based nystagmus in Dix-Hallpike induction test, the diagnosis of bilateral posterior semicircular canal BPPV, should not be hastily diagnosed, and the unilateral horizontal semicircular canal BPPV. with upward component should be excluded from nystagmus torsion.
【作者单位】：第二军医大学长征医院神经内科;
【分类号】：R764

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