Dix-Hallpike诱发试验双侧阳性的良性阵发性位置性眩晕患者的诊治  

Management of bilateral benign paroxysmal positional vertigo with Dix-Hallpike test

作　　者：赵菲[1] 庄建华[1] 谢雪微[1] 靳哲[1] 陈瑛[1] 赵忠新[1] 

机构地区：[1]第二军医大学长征医院神经内科第二军医大学眩晕诊治中心,上海200003

出　　处：《中华内科杂志》2014年第10期764-767,共4页Chinese Journal of Internal Medicine

摘　　要：目的 探讨Dix-Hallpike诱发试验双侧阳性的良性阵发性位置性眩晕（BPPV）患者的诊治.方法 回顾性分析2012年1-12月第二军医大学长征医院神经内科眩晕专病门诊的BPPV患者的临床资料.结果 Dix-Hallpike诱发试验出现眩晕与眼震发作共490例,其中双侧阳性55例,占11.2％,按诱发出的眼震类型将其进一步分为4类：（1）双侧水平向地性眼震16例,双侧水平离地性眼震5例,判断为水平半规管BPPV,给予平躺左右摇头训练及Barbecue复位后症状缓解;（2）双侧向下为主的眼震2例,判断为前半规管BPPV,给予Kim复位后症状消失;（3）双侧扭转、向上、向地性眼震,进一步行平躺试验,6例表现为垂直向上性眼震,判断为双后半规管BPPV,给予双侧PRM复位后症状缓解;14例仍为扭转、向上性眼震,结合平卧侧头诱发试验判断为水平半规管BPPV,给予Barbecue复位;（4）一侧为扭转、向上、向地性眼震,对侧为向下性眼震12例,坐位头前倾30°,半小时后再行Dix-Hallpike诱发试验均表现为该侧扭转、向上、向地性眼震,而对侧向下性眼震消失,判断为该侧后半规管BPPV,给予PRM复位后症状消失.结论 Dix-Hallpike诱发试验双侧阳性并不少见,临床应该根据诱发出的眼震类型进一步分类,逐步判断出受累的半规管并给予相应的手法复位.Objective To explore the diagnosis and treatment of benign paroxysmal positional vertigo （BPPV） with bilateral positive Dix-Hallpike test.Methods This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012.Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis.Results Among all the patients,55 （11.2%） of them presented with bilateral nystagmus by the provocative test.According to the type of nystagmus provoked by DixHallpike maneuver,the 55 patients can be divided into the following four categories.（1） Bilateral geotropic （n =16） and apogeotropic nystagmus （n =5）：all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver.（2） Bilateral predominant down-beating nystagmus （n =2）：patients in this group were diagnosed with anterior canal BPPV,and got recovered after Kim maneuver.（3） Bilateral torsional up-beating geotropic nystagmus （n =20）：after a lying-down test,6 of the patients manifested as vertical up-beating nystagmus and 14 patientsremained torsional up-beating nystagmus.The formerwere diagnosed with bilateral posterior canal BPPV,and were cured after bilateral PRM therapy,and the latter were diagnosed with horizontal canal BPPV,who were cured after Barbecue maneuver.（4） Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side （n =12）.The down-beating nystagrnus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver.These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy.Conclusions It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test.The diagnoses should be made by the types of nystagmus provo

关 键 词：眩晕 良性阵发性位置性眩晕 Dix-Hallpike诱发试验 双侧 平躺试验 

分 类 号：R741[医药卫生—神经病学与精神病学]