Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus
Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus
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DOI：
10.1136/jnnp.2009.199208
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发表时间：
2011-01-01
影响因子：
11
通讯作者：
Straumann, Dominik
中科院分区：
文献类型：
--
作者：
Bueki, Bela;Simon, Laszlo;Straumann, Dominik
背景目前，良性阵发性定位性眩晕（BPPV）的明确诊断需要检测由Dix-Hallpike（垂直半规管）或仰卧滚动（水平半规管）动作引起的定位性或位置性眼球震颤，这表明受影响的半规管或圆顶结石。然而，有些患者尽管有BPPV的典型症状，但没有记录到位置性眼球震颤，这被称为“主观BPPV”（sBPPV）。这些患者通常抱怨短暂的眩晕发作期间和之后坐起来，有时异常retropulsion的trunk.Aim在这项研究中，作者的目的是确定这些患者是否真的表现出异常的仰卧起坐躯干振荡时，测量姿势描记。在200例眩晕或头晕患者中，43%的sBPPV伴坐位眩晕发作，20%为经典BPPV。方法对20例sBPPV伴坐位眩晕患者进行姿势图记录。基于他们的发现，作者提出了一种新型的BPPV，即所谓的2型BPPV（BPPV的典型主诉，Dix-Hallpike体位无眼球震颤，但坐位时短暂眩晕），这可能是后管短臂内慢性小管结石的结果。此外，作者认为2型BPPV可能与sBPPV相同或构成其主要亚组，经常发生在眩晕患者中。对于治疗，作者建议从Dix-Hallpike体位重复仰卧起坐，以将后半规管的短臂从泪小管结石中解放出来。
Background Presently, the unambiguous diagnosis of benign paroxysmal positioning vertigo (BPPV) requires the detection of positioning or positional nystagmus provoked by Dix-Hallpike (for vertical semicircular canals) or supine roll (for horizontal semicircular canals) manoeuvres, which indicates canalo- or cupolithiasis of affected semicircular canals. There are patients, however, in whom-despite typical complaints of BPPV-no positional nystagmus can be documented; this is called 'subjective BPPV' (sBPPV). These patients usually complain of short vertigo spells during and after sitting up, sometimes with abnormal retropulsion of the trunk.Aim In this study, the authors aimed to ascertain whether these patients in fact demonstrate abnormal sitting-up trunk oscillations when measured by posturography. Of 200 unselected patients with vertigo or dizziness, 43% had sBPPV with vertigo spells while sitting up, and 20% classical BPPV.Methods Posturographic recordings were performed in 20 patients with sBPPV and sitting-up vertigo.Results and discussion Seven of the 20 patients had trunk oscillations during the act of sitting up and for a short time immediately afterwards. Based on their findings, the authors propose a new type of BPPV, the so-called Type 2 BPPV (typical complaints of BPPV, no nystagmus in Dix-Hallpike positions but short vertigo spell while sitting up), which may be the result of chronic canalolithiasis within the short arm of a posterior canal. Furthermore, the authors suggest that Type 2 BPPV, which could be identical to sBPPV or constitute a major subgroup of it, occurs frequently among patients with vertigo. For therapy, the authors recommend repetitive sit-ups from the Dix-Hallpike positions to liberate the short arm of the posterior canal from canaloliths.