10例前庭阵发症的临床特点及误诊分析  

Clinical Characteristics in 10 Patients with Misdiagnosed Vestibular Paroxysmia

作　　者：庞颖 邹祺缘 陈宏 代佳秋 李佳[1] 陈子琦 胡国华[1] 曾继红[1] 康厚墉[1] PANG Ying;ZOU Qiyuan;CHEN Hong;DAI Jiaqiu;LI Jia;CHEN Ziqi;HU Guohua;ZENG Jihong;KANG Houyong(Department of Otorhinolaryngology,First Affiliated Hospital of Chongqing Medical Universit)

机构地区：[1]重庆医科大学附属第一医院耳鼻咽喉科,重庆400016

出　　处：《中华耳科学杂志》2018年第3期280-284,共5页Chinese Journal of Otology

基　　金：重庆市科委集成示范计划资助项目;编号:cstc2015jcsf 10012-04~~

摘　　要：目的分析前庭阵发症(Vestibular Paroxysmia,VP)的临床特征、误诊原因。方法收集重庆医科大学附属第一医院10例最终确诊为VP或可疑VP的住院患者。其中,入院时1例初诊为前庭阵发症、9例误诊,出院时6例确诊为VP、4例为可疑VP。回顾性分析上述患者的诊治经过、病史与检查特征。结果 VP的诊断较为困难,主要依靠其临床特点、听力学相关检查、前庭功能以及典型的影像学表现来诊断。VP主要表现为发作性眩晕,持续时间小于1分钟,前庭功能检查可发现前庭功能减退,部分患者可伴随听力下降,ABR检查结果可提示异常,内听道MRI通常可发现血管压迫神经(Neurovascular Compression,NVC)现象,抗癫痫药物治疗对大部分VP患者有较好疗效。结论 VP是一种较易误诊的疾病,因临床表现缺乏特异性,应注意与梅尼埃病、良性阵发性位置性眩晕、前庭性偏头痛、突发性耳聋伴眩晕等其他类型的眩晕疾病相鉴别。临床医生应加强对该病的认识,提高前庭阵发症的诊治率。Objective To report clinical features and causes of misdiagnosed Vestibular Paroxysmia （VP）. Meth-ods Ten patients with eventual diagnosis of VP or probable VP at the First Affiliated Hospital of Chongqing Medical University were included. Among them, only 1 was initially diagnosed with VP and the rest were misdiagnosed. Six of the 10 patients were diagnosed with VP and 4 with probable VP at discharge. Their diagnoses and treatment, medical his-tory and physical examination findings were reviewed. Results VP diagnosis is difficult and depends mainly on clinical manifestations, audiology and vestibular test results, as well as characteristic imaging features. Clinical features of VP include episodic vertigo attack with a duration of less than 1 minute, hypofunction on vestibular tests, hearing loss,ab-normal ABR results, and signs of neurovascular compression （NVC） in the internal auditory canal on MRI. Antiepileptic drugs are effective for VP. Conclusion VP can be easily misdiagnosed due to lack of specific clinical manifestations, Care should be taken to distinguish VP from other types of vertigo diseases, such as Meniere＇s disease, BPPV, vestibular migraine and sudden deafness with vertigo. Clinicians should increase their understanding of VP in order to improve its diagnosis and treatment.

关 键 词：前庭阵发症 听觉脑干反应(ABR) 前庭诱发肌源性电位(VEMP) 前庭功能 内听道MRI 抗癫痫药物 

分 类 号：R764[医药卫生—耳鼻咽喉科]