169例急性前庭性眩晕的临床研究  

Differential diagnosis of acute vestibulopathy

作　　者：吴子明[1] 李新民[2] 张庆泉[2] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科眩晕治疗中心,北京100853 [2]烟台毓璜顶医院耳鼻咽喉科,烟台264000

出　　处：《中国听力语言康复科学杂志》2007年第2期14-17,共4页Chinese Scientific Journal of Hearing and Speech Rehabilitation

摘　　要：目的了解各种急性前庭病(眩晕)的发病情况,重点鉴别急性单发性眩晕中的椎基底动脉供血不足导致的眩晕和偏头痛性眩晕。方法回顾分析169例各种急性前庭病(眩晕)的发病率,重点分析神经耳科学检查在急性单发性眩晕中因椎基底动脉供血不足导致的眩晕和偏头痛性眩晕的鉴别诊断中的作用。结果各种急性前庭病的发病率依次为:梅尼埃病、椎基底动脉供血不足、良性阵发性位置性眩晕、偏头痛伴眩晕、前庭神经炎、突聋伴眩晕和迟发性膜迷路积水、外淋巴漏。椎基底动脉供血不足导致的眩晕和偏头痛性眩晕在病史、神经耳科学检查方面有诸多不同。结论在临床上,椎基底动脉供血不足与偏头痛相关的急性前庭病的鉴别诊断可能是鉴别的重点。鉴别的方法目前主要依靠详细的病史、神经耳科学检查、易患因素的特点以及其它必要的辅助检查。椎基底动脉供血不足更多出现在中年以上,一般都有心-脑血管方面的异常;而偏头痛性眩晕的发病平均年龄明显早于前者,均有一项或几项下列现象:偏头痛家族史,运动敏感,声、光敏感。Objective To observe the incidence of variety of acute vestibulopathy （vertigo） and the emphasis was put on the differential diagnosis of vertebral basilar insufficiency （VBI） and migrainous vertigo （MV）. Methods To analyze the significance of medical history, otoneurological assessment in the differentiation of VBI and MV. Results The incidence of acute vestibulopathy were ranked as meniere＇s disease,VBI, benign paroxysmal positional vertigo（BPPV）,MV, vestibular neuritis, delayed endolymphatic hydrops （EDH）,sudden deafness with vertigo and perilymphatic fistula（PLF） respectively. VBI and MV were different in some aspects,such as medical history and otoneurological assessment. Conclusion Clinically, the differentiation between VBI and MV is a crucial point for effective treatment, depending on detailed medical history, otoneurological examination and exploration of other factors. The patients with VBI all have one of following abnormality as hyper- or hypotention, diabetes, hyperlipids or vertebrobasillar artery disorders; and those with MV are much likely to have migrainous family history, motion sensitivity, photo-or phonophobia.

关 键 词：急性前庭病:鉴别诊断 椎基底动脉供血不足 偏头痛性眩晕 

分 类 号：R764[医药卫生—耳鼻咽喉科]