瞬目反射、视频头脉冲试验和前庭肌源性诱发电位在眩晕疾病中的临床应用  

Clinical application of blink reflex,video head impulse test,and vestibular myogenic evoked potentials in dizzy diseases

作　　者：李岩 辛红 王佳佳 LI Yan;XIN Hong;WANG Jiajia(Department of Neurology,Binzhou People’s Hospital,Binzhou 256600,China)

机构地区：[1]滨州市人民医院神经内科,山东滨州256600

出　　处：《中风与神经疾病杂志》2025年第2期155-158,共4页Journal of Apoplexy and Nervous Diseases

基　　金：滨州市人民医院院级课题(XJ2022009104)。

摘　　要：目的探究瞬目反射(BR)、视频头脉冲试验(vHIT)、前庭肌源性诱发电位(VEMP)三种电生理检测方法在眩晕疾病中的应用价值。方法回顾性分析诊断为后循环缺血性孤立性眩晕(37例),急性前庭神经炎(43例)的共80例眩晕患者的瞬目反射(BR)、视频头脉冲试验(vHIT)、前庭肌源性诱发电位(VEMP)各项电生理结果,及分析后循环缺血性孤立性眩晕患者的影像学表现。结果后循环缺血性孤立性眩晕组BR阳性率75.6%,vHIT阳性率0%,VEMP阳性率32.4%;急性前庭神经炎组BR阳性率18.6%,vHIT阳性率88.4%,VEMP阳性率55.8%。结论(1)BR在后循环缺血性孤立性眩晕中有较高的阳性率;(2)vHIT在诊断急性前庭神经炎上具有良好的敏感性及特异性;(3)VEMP可以发现前庭周围性眩晕;(4)后循环缺血性孤立性眩晕患者从梗死病变部位分析,小脑梗死比例最高,其次为脑干梗死。三种电生理技术联合应用可将后循环缺血性孤立性眩晕及急性前庭神经炎鉴别开来,对后循环缺血性孤立性眩晕的早期鉴别诊断及治疗有指导意义。Objective To investigate the clinical application value of blink reflex(BR),video head impulse test(vHIT),and vestibular evoked myogenic potentials(VEMP)in vertigo diseases.Methods A retrospective analysis was performed for the electrophysiological results of BR,vHIT,and VEMP in 80 patients with vertigo diseases,among whom there were 37 patients with posterior circulation ischemic isolated vertigo and 43 patients with acute vestibular neuritis,and the imaging findings of patients with posterior circulation ischemic isolated vertigo were also analyzed.Results For the post circulation ischemic isolated vertigo group,the positive rates of BR,vHIT,and VEMP were 75.6%,0%,and 32.4%,respectively,and for the acute vestibular neuritis group,the positive rates of BR,vHIT,and VEMP were 18.6%,88.4%,and 55.8%,respectively.Conclusion There is a relatively high positive rate of BR in posterior circulation ischemic isolated vertigo,and vHIT has good sensitivity and specificity in the diagnosis of acute vestibular neuritis,while VEMP can identify peripheral vestibular vertigo.As for the location of infarct lesions in the patients with posterior circulation ischemic isolated vertigo,the patients with cerebellar infarction account for the highest proportion,followed by those with brainstem infarction.The combined use of these three electrophysiological techniques can differentiate posterior circulation ischemic isolated vertigo from acute vestibular neuritis,thereby guiding the early differential diagnosis and treatment of posterior circulation ischemic isolated vertigo.

关 键 词：瞬目反射(BR) 视频头脉冲试验 前庭肌源性诱发电位 后循环缺血性孤立性眩晕 急性前庭神经炎 

分 类 号：R441.2[医药卫生—诊断学] R741.04[医药卫生—临床医学]