前庭性偏头痛患者的前庭功能分析
|
摘要
目的探讨前庭性偏头痛(vestibular migraine,VM)患者的前庭功能特点。方法对43例确诊为VM的患者(VM组)及30例健康志愿者(对照组)分别进行纯音测听、声导抗、冷热水试验(caloric test)、眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)、颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)和视频头脉冲试验(video head impulse test,vHIT),比较分析两组结果。结果VM组患者中纯音测听、冷热水试验、oVEMP及vHIT中的水平增益、代偿性扫视异常例数分别为10例(23.3%)、14例(32.6%)、18例(41.9%)、14例(32.6%)、13例(30.2%),显著高于对照组[分别为0例(0%)、3例(10.0%)、5例(16.7%)、1例(3.3%)、0例(0%)](P<0.05),而声导抗、cVEMP及vHIT中的水平不对称性比异常例数分别为3例(7.0%)、10例(23.3%)、3例(7.0%),与对照组[分别为0例(0%)、7例(23.3%)、2例(6.7%)]差异无统计学意义(P>0.05)。43例VM患者中,oVEMP振幅比(amplitude ratio,AR)及耳间不对称比(interaural asymmetric ratio,IAR)的异常率最高,分别为41.9%及34.9%。结论 VM患者存在一定程度的前庭功能损害,纯音测听、冷热水试验、oVEMP及vHIT中的水平增益、代偿性扫视结果有助于VM患者的诊断及与其他前庭性疾病的鉴别。
Objective To evaluate the vestibular function changes in VM patients.Methods Totally 43 patients diagnosed as VM and 30 healthy volunteers were evaluated by pure tone audiometry,acoustic impedance,caloric test,ocular vestibular evoked myogenic potential(oVEMP),cervical vestibular evoked myogenic potential(cVEMP)and video head impulse test(vHIT).Results The rates of abnormalaudiometry,caloric test,oVEMP,gain in horizontal semicircular canal and saccades of vHIT in theVM group 10 of abnormal(23.3%)、14 of abnormal(32.6%)、18 of abnormal(41.9%)、14 of abnormal(32.6%)、13 of abnormal(30.2%)respectively were significantly higher than those in control subjects(0 of abnormal、3 of abnormal(10.0%)、5 of abnormal(16.7%)、1 of abnormal(3.3%)、0 of abnormal,respectively(P<0.05).The rates of abnormaltympanometry,cVEMP,asymmetry in horizontal semicircular canal of vHIT in theVM group(3 of abnormal(7.0%)、10 of abnormal(23.3%)、3 of abnormal(7.0%))has no significantdifference between that in control subjects(0 of abnormal、7 of abnormal(23.3%)、2 of abnormal(6.7%))(P>0.05).In the 43 patients with VM,the abnormal rates of the amplitude(AR,41.9%)and interaural asymmetry ratio(IAR)in oVEMP were the highest,respectively.Conclusion Vestibular dysfunction may be common among vestibular migraine patients.The tests such as pure tone audiometry,caloric test,oVEMP and vHIT in the horizontal gain may help to diagnose VM and distinguish other vestibular diseases.
Objective To evaluate the vestibular function changes in VM patients.Methods Totally 43 patients diagnosed as VM and 30 healthy volunteers were evaluated by pure tone audiometry,acoustic impedance,caloric test,ocular vestibular evoked myogenic potential(oVEMP),cervical vestibular evoked myogenic potential(cVEMP)and video head impulse test(vHIT).Results The rates of abnormalaudiometry,caloric test,oVEMP,gain in horizontal semicircular canal and saccades of vHIT in theVM group 10 of abnormal(23.3%)、14 of abnormal(32.6%)、18 of abnormal(41.9%)、14 of abnormal(32.6%)、13 of abnormal(30.2%)respectively were significantly higher than those in control subjects(0 of abnormal、3 of abnormal(10.0%)、5 of abnormal(16.7%)、1 of abnormal(3.3%)、0 of abnormal,respectively(P<0.05).The rates of abnormaltympanometry,cVEMP,asymmetry in horizontal semicircular canal of vHIT in theVM group(3 of abnormal(7.0%)、10 of abnormal(23.3%)、3 of abnormal(7.0%))has no significantdifference between that in control subjects(0 of abnormal、7 of abnormal(23.3%)、2 of abnormal(6.7%))(P>0.05).In the 43 patients with VM,the abnormal rates of the amplitude(AR,41.9%)and interaural asymmetry ratio(IAR)in oVEMP were the highest,respectively.Conclusion Vestibular dysfunction may be common among vestibular migraine patients.The tests such as pure tone audiometry,caloric test,oVEMP and vHIT in the horizontal gain may help to diagnose VM and distinguish other vestibular diseases.
引文
1蒋子栋.关注前庭性偏头痛[J].中华医学杂志,2016,96:321.
2 Von Brevern M,Arnold G,Lempert T.Migrainousvertigo[J].Schmerz,2004,18:411.
3 Jensen R,Stovner LJ.Epidemiology and comorbidity of headache[J].Lancet Neurol,2008,7:354.
4 Neuhauser H,Leopold M,von Brevern M,et al.Theinterrelations of migraine,vertigo,and migrainous vertigo[J].Neurology,2001,56:436.
5 Lempert T,Olesen J,Furman J,et al.Vestibular migraine:diagnostic criteria[J].J Vestib Res,2012,22:167.
6 Headache Classification Committee of the International Headache Society(IHS).The international classification of headache disorders,3rd edition(beta version)[J].Cephalalgia,2013,33:629.
7 Yollu U,Uluduz DU,Yilmaz M,et al.Vestibular migraine screening in a migraine-diagnosed patientpopulation,and assessment of vestibulocochlear function[J].Clin Otolaryngol,2017,42:25.
8 于澜,赵苗苗,李清溪,等.EMG修正对颈部及眼部前庭诱发肌源性电位的影响[J].中华耳科学杂志,2017,15:147.
9 周娜,吴子明,张素珍,等.不同刺激模式前庭诱发肌源性电位的反应特性[J].中华耳鼻咽喉科杂志,2004,39:483.
10 Murofushi T,Matsuzaki M,Wu CH.Short tone burstevokedmyogenic potentials on the sternocleidomastoid muscle:arethese potentials also of vestibular origin[J]?Arch Otolaryngol Head Neck Surg,1999,125:660.
11 Weber KP,Aw ST,Todd MJ,et al.Head impulse test in unilateral vestibular loss:vestibulo-ocular reflex and catchup saccades[J].Neurology,2008,70:454.
12 Cass SP,Furman JM,Ankerstjerne K,et al.Migrainerelatedvestibulopathy[J].Ann Otol Rhinol Laryngol,1997,106:182.
13 Johnson GD.Medical management of migraine-relateddizziness and vertigo[J].Laryngoscope,1998,108:1.
14 Cass SI,Ankerstjerne JKP,Yetiser SP,et al.Migrainerelated vestibulopathy[J].Ann Oto lRhinol Laryngol,1997,106:182.
15 Park JH,Viirre E.Vestibular migraine may be an important cause ofdizziness/vertigo in perimenopausal period[J].Med Hypotheses,2010,75:409.
16 Lopez-Escamez JA,Carey J,Chung WH,et al.Diagnostic criteria for Menière's disease[J].J Vestib Res,2015,25:1.
17 蒋子栋.前庭性偏头痛相关问题再探讨[J].中华耳科学杂志,2016,14:486.
18 Arts HA,Kileny PK,Telian SA.Diagnostic testing for endolymphatic hydrops[J].Otolaryngol Clin North Am,1997,30:987.
19 王正敏.梅尼埃病概述[J].中国眼耳鼻喉科杂志,2013,13:134.
20 Battista RA.Audiometric findings of patients with migraine-associated dizziness[J].Otol Neurotol,2004,25:987.
21 Lecrux C,Hamel E.The neurovascular unit in brain function and disease[J].Acta Physiol(Oxf),2011,203:47.
22 Minor LB,Goldberg JM.Infiuence of static head position on the horizontal nystagmus evoked by caloric,rotational and optokinetic stimulation in the squirrel monkey[J].Exp Brain Res,1990,82:1.
23 Kang WS,Lee SH,Yang CJ,et al.Vestibular function tests for vestibular migraine:clinical implication of video head impulse and caloric tests[J].Frontiers in Neurology,2016,7:166.
24 吴子明,张素珍,刘兴健,等.儿童梅尼埃病与老年梅尼埃病的临床比较研究[J].中华耳科学杂志,2011,9:136.
25 Killer HE,Forrer A,Flammer J.Retinal vasospasm duringan attack of migraine[J].Retina,2003,23:253.
26 Curthoys IS,Iwasaki S,ChiharaY,et al.The ocular vestibularevoked myogenic potential to air-conducted sound:probablesuperior vestibular nerve origin[J].Clin Neurophysiol,2011,122:611.
27 Inoue A,Egami N,Fujimoto C,et al.Vestibular evoked myogenic potentials in vestibular migraine:do they help differentiating from Meni re's disease[J]?Annals of Otology,Rhinology&Laryngology,2016,10:1177.
28 张青,许信达,牛晓蓉,等.年龄因素对气导声刺激诱发的眼肌和颈肌前庭诱发肌源性电位的影响[J].中华耳鼻咽喉头颈外科杂志,2014,49:897.
29 Zaleski A,Bogle J,Starling A,et al.Vestibular evoked myogenicpotentials in patients with vestibular migraine[J].Otol Neurotol,2015,36:295.
30 Allena M,Magis D,De Pasqua V,et al.The vestibulo-collic reflex is abnormal in magraine[J].Cephalalgia,2007,27:1150.
31 Furman JM,Marcus DA,Balaban CD.Vestibularmigraine:clinical aspects and pathophysiology[J].Lancet Neurot,2013,12:706.
32 谢溯江,郑颖鹃,张琳.中枢血管性急性前庭综合征研究进展[J].中华临床医师杂志,2013,10:10251.
33 林颖,高林溪,韩丽萍,等.视频头脉冲检查在评价外周前庭病变中的作用[J].中华耳鼻咽喉头颈外科杂志,2015,50:724.
2 Von Brevern M,Arnold G,Lempert T.Migrainousvertigo[J].Schmerz,2004,18:411.
3 Jensen R,Stovner LJ.Epidemiology and comorbidity of headache[J].Lancet Neurol,2008,7:354.
4 Neuhauser H,Leopold M,von Brevern M,et al.Theinterrelations of migraine,vertigo,and migrainous vertigo[J].Neurology,2001,56:436.
5 Lempert T,Olesen J,Furman J,et al.Vestibular migraine:diagnostic criteria[J].J Vestib Res,2012,22:167.
6 Headache Classification Committee of the International Headache Society(IHS).The international classification of headache disorders,3rd edition(beta version)[J].Cephalalgia,2013,33:629.
7 Yollu U,Uluduz DU,Yilmaz M,et al.Vestibular migraine screening in a migraine-diagnosed patientpopulation,and assessment of vestibulocochlear function[J].Clin Otolaryngol,2017,42:25.
8 于澜,赵苗苗,李清溪,等.EMG修正对颈部及眼部前庭诱发肌源性电位的影响[J].中华耳科学杂志,2017,15:147.
9 周娜,吴子明,张素珍,等.不同刺激模式前庭诱发肌源性电位的反应特性[J].中华耳鼻咽喉科杂志,2004,39:483.
10 Murofushi T,Matsuzaki M,Wu CH.Short tone burstevokedmyogenic potentials on the sternocleidomastoid muscle:arethese potentials also of vestibular origin[J]?Arch Otolaryngol Head Neck Surg,1999,125:660.
11 Weber KP,Aw ST,Todd MJ,et al.Head impulse test in unilateral vestibular loss:vestibulo-ocular reflex and catchup saccades[J].Neurology,2008,70:454.
12 Cass SP,Furman JM,Ankerstjerne K,et al.Migrainerelatedvestibulopathy[J].Ann Otol Rhinol Laryngol,1997,106:182.
13 Johnson GD.Medical management of migraine-relateddizziness and vertigo[J].Laryngoscope,1998,108:1.
14 Cass SI,Ankerstjerne JKP,Yetiser SP,et al.Migrainerelated vestibulopathy[J].Ann Oto lRhinol Laryngol,1997,106:182.
15 Park JH,Viirre E.Vestibular migraine may be an important cause ofdizziness/vertigo in perimenopausal period[J].Med Hypotheses,2010,75:409.
16 Lopez-Escamez JA,Carey J,Chung WH,et al.Diagnostic criteria for Menière's disease[J].J Vestib Res,2015,25:1.
17 蒋子栋.前庭性偏头痛相关问题再探讨[J].中华耳科学杂志,2016,14:486.
18 Arts HA,Kileny PK,Telian SA.Diagnostic testing for endolymphatic hydrops[J].Otolaryngol Clin North Am,1997,30:987.
19 王正敏.梅尼埃病概述[J].中国眼耳鼻喉科杂志,2013,13:134.
20 Battista RA.Audiometric findings of patients with migraine-associated dizziness[J].Otol Neurotol,2004,25:987.
21 Lecrux C,Hamel E.The neurovascular unit in brain function and disease[J].Acta Physiol(Oxf),2011,203:47.
22 Minor LB,Goldberg JM.Infiuence of static head position on the horizontal nystagmus evoked by caloric,rotational and optokinetic stimulation in the squirrel monkey[J].Exp Brain Res,1990,82:1.
23 Kang WS,Lee SH,Yang CJ,et al.Vestibular function tests for vestibular migraine:clinical implication of video head impulse and caloric tests[J].Frontiers in Neurology,2016,7:166.
24 吴子明,张素珍,刘兴健,等.儿童梅尼埃病与老年梅尼埃病的临床比较研究[J].中华耳科学杂志,2011,9:136.
25 Killer HE,Forrer A,Flammer J.Retinal vasospasm duringan attack of migraine[J].Retina,2003,23:253.
26 Curthoys IS,Iwasaki S,ChiharaY,et al.The ocular vestibularevoked myogenic potential to air-conducted sound:probablesuperior vestibular nerve origin[J].Clin Neurophysiol,2011,122:611.
27 Inoue A,Egami N,Fujimoto C,et al.Vestibular evoked myogenic potentials in vestibular migraine:do they help differentiating from Meni re's disease[J]?Annals of Otology,Rhinology&Laryngology,2016,10:1177.
28 张青,许信达,牛晓蓉,等.年龄因素对气导声刺激诱发的眼肌和颈肌前庭诱发肌源性电位的影响[J].中华耳鼻咽喉头颈外科杂志,2014,49:897.
29 Zaleski A,Bogle J,Starling A,et al.Vestibular evoked myogenicpotentials in patients with vestibular migraine[J].Otol Neurotol,2015,36:295.
30 Allena M,Magis D,De Pasqua V,et al.The vestibulo-collic reflex is abnormal in magraine[J].Cephalalgia,2007,27:1150.
31 Furman JM,Marcus DA,Balaban CD.Vestibularmigraine:clinical aspects and pathophysiology[J].Lancet Neurot,2013,12:706.
32 谢溯江,郑颖鹃,张琳.中枢血管性急性前庭综合征研究进展[J].中华临床医师杂志,2013,10:10251.
33 林颖,高林溪,韩丽萍,等.视频头脉冲检查在评价外周前庭病变中的作用[J].中华耳鼻咽喉头颈外科杂志,2015,50:724.